David Mummy¹, Erika Coleman², Ziyi Wang³, Elianna Bier³, Junlan Lu⁴, Bastiaan Driehuys^1,3,4, and Yuh-Chin Huang^2
1Radiology, Duke University, Durham, NC, United States, ²Medicine, Duke University, Durham, NC, United States, ³Biomedical Engineering, Duke University, Durham, NC, United States, ⁴Medical Physics, Duke University, Durham, NC, United States

Hyperpolarized ¹²⁹Xe MRI images acquired pre/post-bronchodilator treatment in COPD (N=17) provide a new means of evaluating gas evaluating gas exchange in regions of new, existing, and lost ventilation. Here we demonstrate via longitudinal image registration that, despite improvements in FEV1 and regional ventilation following treatment, no changes in region-based measures of ¹²⁹Xe barrier or RBC signal were observed. This suggests the presence of persistent vascular abnormalities in COPD that are not addressed by bronchodilation.

Mary A. Neal¹, Benjamin J. Pippard^1,2, Ian Forrest³, Rod A. Lawson⁴, Holly F. Fisher⁵, John N. S. Matthews⁵, Kieren G. Hollingsworth^1,2, A. John Simpson¹, Jim M. Wild⁶, and Peter E. Thelwall^1,2
1Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom, ²Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom, ³Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom, ⁴Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom, ⁵Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom, ⁶POLARIS, Department of IICD, University of Sheffield, Sheffield, United Kingdom

¹⁹F-MRI of inhaled perfluoropropane can be used for assessment of pulmonary ventilation. Static breath hold ¹⁹F-MR images were acquired pre- and post-bronchodilator following inhalation of a perfluoropropane/oxygen gas mixture in patients with asthma and patients with chronic obstructive pulmonary disease (COPD). Percentage ventilated lung volume (%VV) was calculated from each of the ¹⁹F-MR images. %VV was significantly reduced in both patient groups, and between pre- and post-bronchodilator acquisitions in the asthmatic patient group. A strong positive correlation between %VV and spirometric indices was revealed. Gas inhalations were well tolerated by all participants, with no adverse events.

Andrew D Hahn¹, Katie J Carey^1,2, Nathan D Sandbo³, Jeff Kammermann¹, Robert V Cadman³, David G Mummy⁴, Mark L Schiebler^1,2, Amy Malik³, and Sean B Fain^1,2,5
1Medical Physics, University of Wisconsin - Madison, Madison, WI, United States, ²Radiology, University of Wisconsin - Madison, Madison, WI, United States, ³Medicine, University of Wisconsin - Madison, Madison, WI, United States, ⁴Radiology, Duke University, Durham, NC, United States, ⁵Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, United States

Predicting outcomes and monitoring longitudinal treatment response in IPF is unreliable using currently available clinical biomarkers.  We investigate associations between hyperpolarized ¹²⁹Xe MRI biomarkers of ventilation and gas exchange and treatment with anti-fibrotic medication in IPF patients over a 1-year period.  Anti-fibrotic treatment was associated with improved ventilation and gas exchange, relative to no anti-fibrotic treatment, after 1 year.  Within-patient improvements in gas exchange were significantly larger in patients treated with anti-fibrotic medications.  No longitudinal associations were found between anti-fibrotic treatment and spirometry, suggesting the imaging biomarkers may be more useful for monitoring anti-fibrotic treatment response in IPF.

Hooman Hamedani¹, Stephen Kadlecek¹, Faraz Amzajerdian¹, Ryan Baron¹, Kai Ruppert¹, Ian Duncan¹, Luis Loza¹, Tahmina Achekzai¹, Maurizio Cereda¹, and Rahim R. Rizi^2
1University of Pennsylvania, Philadelphia, PA, United States, ²Radiology, University of Pennsylvania, Philadelphia, PA, United States

Here, we present an approach for comprehensively assessing the lung’s response to an intervention. Using our multi-breath approach during tidal breathing, we evaluated whether after a Treatment with Zephyr Endobronchial Valves, ventilation is successfully redistributed to the healthier lung, and whether this shift in ventilation can effectively improve gas exchange in non-targeted lobes. We showed gas exchange was more than doubled in the upper left lobe, exceeding the modest ventilation increase observed after occlusion of the LL lobe, likely indicating dramatically improved Q. Notably, right lung function was also improved, perhaps due to normalized breathing mechanics. 

Filip Klimeš^1,2, Andreas Voskrebenzev^1,2, Lea Behrendt^1,2, Marcel Gutberlet^1,2, Gesa Helen Pöhler^1,2, Till Frederik Kaireit^1,2, Cristian Crisosto^1,2, Frank Wacker^1,2, and Jens Vogel-Claussen^1,2
1Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany, ²Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Centre for Lung Research (DZL), Hannover, Germany

Correction of lung motion is a mandatory step for the voxel-wise signal analysis of Fourier Decomposion (FD) based methods, such as phase-resolved functional lung (PREFUL) MRI. Usually, all images are registered towards one fixed image in intermediate lung position. In this work, a group oriented registration approach with three different target images (expiration, middle, inspiration) was tested and the influence on functional parameters derived by PREFUL was evaluated in 41 study participants. While small significant differences were observed, high absolute agreement of all functional ventilation and perfusion parameters was found indenpedent on the chosen target volume.

Laura Saunders¹, Paul J. C. Hughes¹, Dave Capener¹, David G Kiely^1,2, Jim M Wild¹, and Andy J Swift^1
1Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom, ²Sheffield Pulmonary Vascular Disease Unit, Sheffield, United Kingdom

Identifying the cause of lung perfusion defects is vital for chronic thromboembolic pulmonary hypertension (CTEPH) or chronic thromboembolic disease (CTED) diagnosis. 30 patients with suspected CTEPH underwent Look-Locker M0 and T₁ mapping, 16/30 were diagnosed with CTEPH or CTED. Co-registered peak perfusion maps were used to identify perfusion defects. T₁ was significantly lower in perfusion defects in all patients. Patients with CTEPH or CTED had significantly lower M0 in non-perfused lung, whereas control patients did not have significantly differences between perfused and non-perfused lung. Lung M0 maps may allow differentiation of perfusion defects in patients with CTEPH/CTED from other patients.

Corin Willers¹, Lukas Maager¹, Bettina S. Frauchiger¹, Kathryn Ramsey¹, Grzegorz Bauman^2,3, Orso Pusterla^2,3, Oliver Bieri^2,3, and Philipp Latzin^1
1Division of Pediatric Respiratory Medicine, Department of Pediatrics,, Inselspital, Bern University Hospital, University of Bern, Switzerland, Bern, Switzerland, ²Division of Radiological Physics, Department of Radiology, University of Basel Hospital Basel, Basel, Switzerland, Basel, Switzerland, ³Department of Biomedical Engineering, University of Basel, Basel, Switzerland, Basel, Switzerland

Matrix Pencil MRI in cystic fibrosis is a sensitive and promising technique to monitor progression of lung disease, and is especially well-suited for children. In this work, we investigate the agreement between changes in functional lung MRI and in lung function tests during a 1-year follow-up period. We demonstrate the benefit of imaging to interpret changes in lung function correctly.

Ahsan Javed¹, Rajiv Ramasawmy¹, Joel Moss², Waqas Majeed³, Pan Su³, Thomas Benkert⁴, Himanshu Bhat³, and Adrienne E Campbell-Washburn^5
1Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States, ²Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States, ³Siemens Medical Solutions USA Inc., Malvern, PA, United States, ⁴Siemens Healthcare GmbH, Erlangen, Germany, ⁵Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD, United States

Low signal in the lung parenchyma, and reduced signal-to-noise at 0.55T makes high resolution lung imaging challenging. SNR can be improved by using longer spiral readouts. However, these readouts are susceptible to artifacts from trajectory errors, and blurring from concomitant fields which are amplified at lower field strengths. Here we present an optimized self-gated, ultra-short echo time, stack-of-spirals acquisition which leverages inline corrections for trajectory imperfections, measurement drift, and concomitant fields to enable robust high resolution lung imaging on low field scanners. We also demonstrate the improvement in image quality in patients with lung nodules and Lymphangioleiomyomatosis (LAM).

Darren Hsu¹, Fei Tan², Michael Lustig³, and Peder E. Z. Larson^4
1Department of Computer Science, University of California, Berkeley, Berkeley, CA, United States, ²Department of Bioengineering, University of California, Berkeley - University of California, San Francisco, San Francisco, CA, United States, ³Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, United States, ⁴Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States

The visualization of respiratory inhalation-exhalation cycles are applied to pulmonary MR images. Using 3D UTE phase resolved MR Images, respiratory phases were reconstructed from free breathing images. Applying signal intensity based methods, biomarker metrics such as time to signal intensity peak (TTP) or full width at half maximum (FWHM) intensity are extracted from the image. The resulting visualizations depict localized respiratory function to help clinicians understand the rate and velocity at which lung tissue expands from full inspiration to full expiration.

Yoshiharu Ohno^1,2,3, Masao Yui⁴, Takeshi Yoshikawa^3,5, Yoshimori Kassai⁴, Kaori Yamamoto⁴, Kazuhiro Murayama², and Hiroshi Toyama^1
1Radiology, Fujita Health University School of Medicine, Toyoake, Japan, ²Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan, ³Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan, ⁴Canon Medical Systems Corporation, Otawara, Japan, ⁵Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan

No major reports have been reported the comparison of capability for differentiating recurrence from non-recurrence groups in candidates for surgical resection due to lung cancer among CEST imaging, DWI and PET/CT.  We hypothesized that CEST imaging, which was determined as APT-weighted (APTw) imaging at 3.5 ppm, had equal or better potential for prediction of postoperative recurrence prediction in postoperative lung cancer patients, when compared with DWI and FDG-PET/CT.  The purpose of this study was to compare the prediction capability of among single- and multi-parametric approaches by APTw imaging, DWI, and FDG-PET/CT in NSCLC patients.