Pulmonary functional MRI: Detecting the structure–function pathologies that drive asthma symptoms and quality of life

Harkiran K. Kooner; Marrissa J. McIntosh; Vedanth Desaigoudar; Jonathan H. Rayment; Rachel L. Eddy; Bastiaan Driehuys; Grace Parraga

doi:10.1111/resp.14197

journal article Jan 10, 2022

Pulmonary functional MRI: Detecting the structure–function pathologies that drive asthma symptoms and quality of life

Harkiran K. Kooner Marrissa J. McIntosh Vedanth Desaigoudar Jonathan H. Rayment Rachel L. Eddy Bastiaan Driehuys Grace Parraga

Respirology Vol. 27 No. 2 pp. 114-133 · Wiley

View at Publisher Save 10.1111/resp.14197

Abstract

AbstractPulmonary functional MRI (PfMRI) using inhaled hyperpolarized, radiation‐free gases (such as 3He and 129Xe) provides a way to directly visualize inhaled gas distribution and ventilation defects (or ventilation heterogeneity) in real time with high spatial (~mm3) resolution. Both gases enable quantitative measurement of terminal airway morphology, while 129Xe uniquely enables imaging the transfer of inhaled gas across the alveolar–capillary tissue barrier to the red blood cells. In patients with asthma, PfMRI abnormalities have been shown to reflect airway smooth muscle dysfunction, airway inflammation and remodelling, luminal occlusions and airway pruning. The method is rapid (8–15 s), cost‐effective (~$300/scan) and very well tolerated in patients, even in those who are very young or very ill, because unlike computed tomography (CT), positron emission tomography and single‐photon emission CT, there is no ionizing radiation and the examination takes only a few seconds. However, PfMRI is not without limitations, which include the requirement of complex image analysis, specialized equipment and additional training and quality control. We provide an overview of the three main applications of hyperpolarized noble gas MRI in asthma research including: (1) inhaled gas distribution or ventilation imaging, (2) alveolar microstructure and finally (3) gas transfer into the alveolar–capillary tissue space and from the tissue barrier into red blood cells in the pulmonary microvasculature. We highlight the evidence that supports a deeper understanding of the mechanisms of asthma worsening over time and the pathologies responsible for symptoms and disease control. We conclude with a summary of approaches that have the potential for integration into clinical workflows and that may be used to guide personalized treatment planning.

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References

Details

Published: Jan 10, 2022
Vol/Issue: 27(2)
Pages: 114-133
License: View

Authors

H

Harkiran K. Kooner

Robarts Research Institute, Western University London Ontario Canada; Department of Medical Biophysics Western University London Ontario Canada

M

Marrissa J. McIntosh

Robarts Research Institute, Western University London Ontario Canada; Department of Medical Biophysics Western University London Ontario Canada

V

Vedanth Desaigoudar

Robarts Research Institute, Western University London Ontario Canada; Department of Medical Biophysics Western University London Ontario Canada

J

Jonathan H. Rayment

Department of Pediatrics University of British Columbia Vancouver British Columbia Canada

R

Rachel L. Eddy

Centre of Heart Lung Innovation, Division of Respiratory Medicine, Department of Medicine University of British Columbia Vancouver British Columbia Canada

B

Bastiaan Driehuys

Center for In Vivo Microscopy Duke University Medical Centre Durham North Carolina USA

G

Grace Parraga

Robarts Research Institute, Western University London Ontario Canada; Department of Medical Biophysics Western University London Ontario Canada; Division of Respirology, Department of Medicine Western University London Ontario Canada; School of Biomedical Engineering Western University London Ontario Canada

Funding

National Heart, Lung, and Blood Institute Award: R01HL105643

Natural Sciences and Engineering Research Council of Canada

Canadian Institutes of Health Research

Cystic Fibrosis Foundation

Cystic Fibrosis Canada

Michael Smith Foundation for Health Research

Cite This Article

Harkiran K. Kooner, Marrissa J. McIntosh, Vedanth Desaigoudar, et al. (2022). Pulmonary functional MRI: Detecting the structure–function pathologies that drive asthma symptoms and quality of life. Respirology, 27(2), 114-133. https://doi.org/10.1111/resp.14197

Pulmonary functional MRI: Detecting the structure–function pathologies that drive asthma symptoms and quality of life

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