Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Strasse 65, 88397, Biberach an der Riß, Germany.
Eur Radiol. 2022 Mar;32(3):1879-1890. doi: 10.1007/s00330-021-08229-6. Epub 2021 Sep 22.
Pulmonary perfusion abnormalities are prevalent in patients with chronic obstructive pulmonary disease (COPD), are potentially reversible, and may be associated with emphysema development. Therefore, we aimed to evaluate the clinical meaningfulness of perfusion defects in percent (QDP) using DCE-MRI.
We investigated a subset of baseline DCE-MRIs, paired inspiratory/expiratory CTs, and pulmonary function testing (PFT) of 83 subjects (age = 65.7 ± 9.0 years, patients-at-risk, and all GOLD groups) from one center of the "COSYCONET" COPD cohort. QDP was computed from DCE-MRI using an in-house developed quantification pipeline, including four different approaches: Otsu's method, k-means clustering, texture analysis, and 80 percentile threshold. QDP was compared with visual MRI perfusion scoring, CT parametric response mapping (PRM) indices of emphysema (PRM) and functional small airway disease (PRM), and FEV1/FVC from PFT.
All QDP approaches showed high correlations with the MRI perfusion score (r = 0.67 to 0.72, p < 0.001), with the highest association based on Otsu's method (r = 0.72, p < 0.001). QDP correlated significantly with all PRM indices (p < 0.001), with the strongest correlations with PRM (r = 0.70 to 0.75, p < 0.001). QDP was distinctly higher than PRM (mean difference = 35.85 to 40.40) and PRM (mean difference = 15.12 to 19.68), but in close agreement when combining both PRM indices (mean difference = 1.47 to 6.03) for all QDP approaches. QDP correlated moderately with FEV1/FVC (r = - 0.54 to - 0.41, p < 0.001).
QDP is associated with established markers of disease severity and the extent corresponds to the CT-derived combined extent of PRM and PRM. We propose to use QDP based on Otsu's method for future clinical studies in COPD.
• QDP quantified from DCE-MRI is associated with visual MRI perfusion score, CT PRM indices, and PFT. • The extent of QDP from DCE-MRI corresponds to the combined extent of PRM and PRM from CT. • Assessing pulmonary perfusion abnormalities using DCE-MRI with QDP improved the correlations with CT PRM indices and PFT compared to the quantification of pulmonary blood flow and volume.
慢性阻塞性肺疾病（COPD）患者中普遍存在肺灌注异常，这些异常可能是可逆的，并且可能与肺气肿的发展有关。因此，我们旨在使用 DCE-MRI 评估灌注缺陷百分比（QDP）的临床意义。
我们对来自“COSYCONET”COPD 队列一个中心的 83 名患者（年龄=65.7±9.0 岁、高危患者和所有 GOLD 组）的基线 DCE-MRI、吸气/呼气 CT 配对和肺功能测试（PFT）进行了研究。使用内部开发的定量分析管道从 DCE-MRI 计算 QDP，包括四种不同的方法：Otsu 方法、k-均值聚类、纹理分析和 80%阈值。QDP 与 MRI 灌注评分、CT 参数量化反应映射（PRM）肺气肿（PRM）和功能性小气道疾病（PRM）指数以及 PFT 中的 FEV1/FVC 进行了比较。
所有 QDP 方法均与 MRI 灌注评分高度相关（r=0.67 至 0.72，p<0.001），其中基于 Otsu 方法的相关性最高（r=0.72，p<0.001）。QDP 与所有 PRM 指数均显著相关（p<0.001），与 PRM 相关性最强（r=0.70 至 0.75，p<0.001）。QDP 明显高于 PRM（平均差异=35.85 至 40.40）和 PRM（平均差异=15.12 至 19.68），但当结合两种 PRM 指数时，QDP 差异非常小（平均差异=1.47 至 6.03）。QDP 与 FEV1/FVC 中度相关（r=-0.54 至-0.41，p<0.001）。
QDP 与疾病严重程度的既定标志物相关，其程度与 CT 衍生的 PRM 和 PRM 的综合程度相对应。我们建议在 COPD 的未来临床研究中使用基于 Otsu 方法的 QDP。
从 DCE-MRI 定量的 QDP 与 MRI 灌注评分、CT PRM 指数和 PFT 相关。
DCE-MRI 中 QDP 的程度与 CT 上的 PRM 和 PRM 综合程度相对应。
与量化肺血流和容积相比，使用 DCE-MRI 评估灌注异常并用 QDP 评估可提高与 CT PRM 指数和 PFT 的相关性。
