Department of Interventional and Diagnostic Radiology, Hannover Medical School, Hannover, Germany; Integrated Research and Treatment Center Transplantation (IfB-Tx), Hannover, Germany.
Department of Interventional and Diagnostic Radiology, Hannover Medical School, Hannover, Germany; Integrated Research and Treatment Center Transplantation (IfB-Tx), Hannover, Germany.
Acad Radiol. 2019 Feb;26(2):170-178. doi: 10.1016/j.acra.2018.05.006. Epub 2018 Jun 19.
To evaluate the feasibility of multiparametric magnetic resonance imaging (MRI) of the lungs to detect impaired organ function in a porcine model of ischemic injury within an ex-vivo lung perfusion system (EVLP) prior to transplantation.
Twelve pigs were anesthetized, and left lungs were clamped to induce warm ischemia for 3 hours. Right lungs remained perfused as controls. Lungs were removed and installed in an EVLP for 12 hours. Lungs in the EVLP were imaged repeatedly using computed tomography, proton MRI (H-MRI) and fluorine MRI (F-MRI). Dynamic contrast-enhanced derived parenchymal blood volume, oxygen washout times, and F washout times were calculated. P was measured for ischemic and normal lungs, wet/dry ratio was determined, histologic samples were assessed, and cytokines in the lung tissue were analyzed. Statistical analysis was performed using nonparametric testing.
Eleven pigs were included in the final analysis. Ischemic lungs showed significantly higher wet/dry ratios (p = 0.024), as well as IL-8 tissue levels (p = 0.0098). Histologic assessment as well as morphologic scoring of computed tomography and H-MRI did not reveal significant differences between ischemic and control lungs. F washout (p = 0.966) and parenchymal blood flow (p = 0.32) were not significantly different. Oxygen washout was significantly prolonged in ischemic lungs compared to normal control lungs at the beginning (p = 0.018) and further prolonged at the end of the EVLP run (p = 0.005).
Multiparametric pulmonary MRI is feasible in lung allografts within an EVLP system. Oxygen-enhanced imaging seems to be a promising marker for ischemic injury, enabling detection of affected lung segments prior to transplantation.
在体外肺灌注系统（EVLP）中，评估多参数磁共振成像（MRI）检测缺血性损伤猪离体肺模型中器官功能障碍的可行性。
12 只猪被麻醉，左肺夹闭以诱导 3 小时热缺血。右肺保持灌注作为对照。肺被取出并安装在 EVLP 中 12 小时。在 EVLP 中，使用计算机断层扫描、质子 MRI（H-MRI）和氟 MRI（F-MRI）对肺部进行反复成像。计算了动态对比增强衍生的实质血容量、氧洗脱时间和 F 洗脱时间。测量了缺血和正常肺的 P 值，确定了湿/干比，评估了组织学样本，并分析了肺组织中的细胞因子。使用非参数检验进行统计分析。
最终有 11 只猪被纳入分析。缺血肺的湿/干比显著升高（p = 0.024），IL-8 组织水平也显著升高（p = 0.0098）。组织学评估以及 CT 和 H-MRI 的形态评分未显示缺血肺与对照肺之间存在显著差异。F 洗脱（p = 0.966）和实质血流（p = 0.32）无显著差异。与正常对照肺相比，缺血肺的氧洗脱在 EVLP 运行开始时显著延长（p = 0.018），在运行结束时进一步延长（p = 0.005）。
在 EVLP 系统中，多参数肺 MRI 对肺移植物是可行的。氧增强成像似乎是一种有前途的缺血性损伤标志物，能够在移植前检测到受影响的肺段。
