Konietzke Marilisa, Triphan Simon M F, Eichinger Monika, Bossert Sebastian, Heller Hartmut, Wege Sabine, Eberhardt Ralf, Puderbach Michael U, Kauczor Hans-Ulrich, Heußel Gudula, Heußel Claus P, Risse Frank, Wielpütz Mark O
Boehringer Ingelheim Pharma GmbH and Co. KG, Biberach an der Riß, Germany.
Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany.
Front Med (Lausanne). 2022 Oct 24;9:1022981. doi: 10.3389/fmed.2022.1022981. eCollection 2022.
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows the assessment of pulmonary perfusion, which may play a key role in the development of muco-obstructive lung disease. One problem with quantifying pulmonary perfusion is the high variability of metrics. Quantifying the extent of abnormalities using unsupervised clustering algorithms in residue function maps leads to intrinsic normalization and could reduce variability.
We investigated the reproducibility of perfusion defects in percent (QDP) in clinically stable patients with cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD).
15 CF (29.3 ± 9.3y, FEV1%predicted = 66.6 ± 15.8%) and 20 COPD (66.5 ± 8.9y, FEV1%predicted = 42.0 ± 13.3%) patients underwent DCE-MRI twice 1 month apart. QDP, pulmonary blood flow (PBF), and pulmonary blood volume (PBV) were computed from residue function maps using an in-house quantification pipeline. A previously validated MRI perfusion score was visually assessed by an expert reader.
Overall, mean QDP, PBF, and PBV did not change within 1 month, except for QDP in COPD ( < 0.05). We observed smaller limits of agreement (± 1.96 ) related to the median for QDP (CF: ± 38%, COPD: ± 37%) compared to PBF (CF: ± 89%, COPD: ± 55%) and PBV (CF: ± 55%, COPD: ± 51%). QDP correlated moderately with the MRI perfusion score in CF ( = 0.46, < 0.05) and COPD ( = 0.66, < 0.001). PBF and PBV correlated poorly with the MRI perfusion score in CF ( =-0.29, = 0.132 and =-0.35, = 0.067, respectively) and moderately in COPD ( =-0.57 and =-0.57, < 0.001, respectively).
In patients with muco-obstructive lung diseases, QDP was more robust and showed a higher correlation with the MRI perfusion score compared to the traditionally used perfusion metrics PBF and PBV.
动态对比增强磁共振成像（DCE-MRI）可用于评估肺灌注，这可能在黏液阻塞性肺疾病的发展中起关键作用。量化肺灌注的一个问题是指标的高度变异性。使用残差函数图中的无监督聚类算法量化异常程度可实现内在归一化，并可降低变异性。
我们研究了囊性纤维化（CF）和慢性阻塞性肺疾病（COPD）临床稳定患者中灌注缺损百分比（QDP）的可重复性。
15例CF患者（29.3±9.3岁，预测FEV1%=66.6±15.8%）和20例COPD患者（66.5±8.9岁，预测FEV1%=42.0±13.3%）相隔1个月接受两次DCE-MRI检查。使用内部量化流程从残差函数图中计算QDP、肺血流量（PBF）和肺血容量（PBV）。由一位专业阅片者对先前验证的MRI灌注评分进行视觉评估。
总体而言，除COPD患者的QDP外（<0.05），平均QDP、PBF和PBV在1个月内未发生变化。与PBF（CF：±89%，COPD：±55%）和PBV（CF：±55%，COPD：±51%）相比，我们观察到QDP（CF：±38%，COPD：±37%）与中位数相关的一致性界限更小（±1.96）。QDP与CF患者（=0.46，<0.05）和COPD患者（=0.66，<0.001）的MRI灌注评分中度相关。CF患者中PBF和PBV与MRI灌注评分相关性较差（分别为=-0.29，=0.132和=-0.35，=0.067），而在COPD患者中相关性为中度（分别为=-0.57和=-0.57，<0.001）。
在黏液阻塞性肺疾病患者中，与传统使用的灌注指标PBF和PBV相比，QDP更稳健，且与MRI灌注评分的相关性更高。
