超极化129氙磁共振成像定量评估轻至中度哮喘患者的区域通气差异：半自动通气缺陷百分比计算与肺功能测试的前瞻性比较
Hyperpolarized 129Xenon Magnetic Resonance Imaging to Quantify Regional Ventilation Differences in Mild to Moderate Asthma: A Prospective Comparison Between Semiautomated Ventilation Defect Percentage Calculation and Pulmonary Function Tests.
作者信息
Ebner Lukas, He Mu, Virgincar Rohan S, Heacock Timothy, Kaushik Suryanarayanan S, Freemann Matthew S, McAdams H Page, Kraft Monica, Driehuys Bastiaan
机构信息
From the *Department of Radiology, and †Center for In Vivo Microscopy, Duke University Medical Center; ‡Department of Electrical and Computer Engineering, Duke University; §Department of Pulmonary and Critical Care Medicine, Duke University Medical Center; ∥Department of Biomedical Engineering, and ¶Medical Physics Graduate Program, Duke University, Durham, NC.
出版信息
Invest Radiol. 2017 Feb;52(2):120-127. doi: 10.1097/RLI.0000000000000322.
OBJECTIVES
The aim of this study was to investigate ventilation in mild to moderate asthmatic patients and age-matched controls using hyperpolarized (HP) Xenon magnetic resonance imaging (MRI) and correlate findings with pulmonary function tests (PFTs).
MATERIALS AND METHODS
This single-center, Health Insurance Portability and Accountability Act-compliant prospective study was approved by our institutional review board. Thirty subjects (10 young asthmatic patients, 26 ± 6 years; 3 males, 7 females; 10 older asthmatic patients, 64 ± 6 years; 3 males, 7 females; 10 healthy controls) were enrolled. After repeated PFTs 1 week apart, the subjects underwent 2 MRI scans within 10 minutes, inhaling 1-L volumes containing 0.5 to 1 L of Xe. Xe ventilation signal was quantified by linear binning, from which the ventilation defect percentage (VDP) was derived. Differences in VDP among subgroups and variability with age were evaluated using 1-tailed t tests. Correlation of VDP with PFTs was tested using Pearson correlation coefficient. Reproducibility of VDP was assessed using Bland-Altman plots, linear regression (R), intraclass correlation coefficient, and concordance correlation coefficient.
RESULTS
Ventilation defect percentage was significantly higher in young asthmatic patients versus young healthy subjects (8.4% ± 3.2% vs 5.6% ± 1.7%, P = 0.031), but not in older asthmatic patients versus age-matched controls (16.8% ± 10.3% vs 11.6% ± 6.6%, P = 0.13). Ventilation defect percentage was found to increase significantly with age (healthy, P = 0.05; asthmatic patients, P = 0.033). Ventilation defect percentage was highly reproducible (R = 0.976; intraclass correlation coefficient, 0.977; concordance correlation coefficient, 0.976) and significantly correlated with FEV1% (r = -0.42, P = 0.025), FEF25%-75% (r = -0.45, P = 0.019), FEV1/FVC (r = -0.71, P < 0.0001), FeNO (r = 0.69, P < 0.0001), and RV/TLC (r = 0.51, P = 0.0067). Bland-Altman analysis showed a bias for VDP of -0.88 ± 1.52 (FEV1%, -0.33 ± 7.18).
CONCLUSIONS
Xenon MRI is able to depict airway obstructions in mild to moderate asthma and significantly correlates with PFTs.
目的
本研究旨在使用超极化（HP）氙磁共振成像（MRI）研究轻度至中度哮喘患者及年龄匹配的对照者的通气情况，并将结果与肺功能测试（PFT）相关联。
材料与方法
本单中心、符合《健康保险流通与责任法案》的前瞻性研究经我们机构审查委员会批准。招募了30名受试者（10名年轻哮喘患者，26±6岁；3名男性，7名女性；10名老年哮喘患者，64±6岁；3名男性，7名女性；10名健康对照者）。在相隔1周进行重复PFT后，受试者在10分钟内接受2次MRI扫描，吸入含0.5至1L氙的1L气体。通过线性分箱对氙通气信号进行量化，由此得出通气缺陷百分比（VDP）。使用单尾t检验评估亚组间VDP的差异以及与年龄的变异性。使用Pearson相关系数检验VDP与PFT的相关性。使用Bland-Altman图、线性回归（R）、组内相关系数和一致性相关系数评估VDP的可重复性。
结果
年轻哮喘患者的通气缺陷百分比显著高于年轻健康受试者（8.4%±3.2%对5.6%±1.7%，P = 0.031），但老年哮喘患者与年龄匹配的对照者相比则无显著差异（16.8%±10.3%对11.6%±6.6%，P = 0.13）。发现通气缺陷百分比随年龄显著增加（健康者，P = 0.05；哮喘患者，P = 0.033）。通气缺陷百分比具有高度可重复性（R = 0.976；组内相关系数，0.977；一致性相关系数，0.976），并与FEV1%（r = -0.42，P = 0.025）、FEF25%-75%（r = -0.45，P = 0.019）、FEV1/FVC（r = -0.71，P < 0.0001）、FeNO（r = 0.69，P < 0.0001）和RV/TLC（r = 0.51，P = 0.0067）显著相关。Bland-Altman分析显示VDP的偏差为-0.88±1.52（FEV1%，-0.33±7.18）。
结论
氙MRI能够描绘轻度至中度哮喘中的气道阻塞情况，并与PFT显著相关。
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