非对比性潮气呼吸 H MRI 评估严重哮喘的特定通气。
Specific Ventilation in Severe Asthma Evaluated with Noncontrast Tidal Breathing H MRI.
机构信息
From the Department of Radiation Oncology, Division of Physics, University of California San Francisco, San Francisco, Calif (D.P.I.C.); Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health (M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital, Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, Canada (R.J.D.).
出版信息
Radiol Cardiothorac Imaging. 2023 Dec;5(6):e230054. doi: 10.1148/ryct.230054.
Purpose To determine if proton (H) MRI-derived specific ventilation is responsive to bronchodilator (BD) therapy and associated with clinical biomarkers of type 2 airway inflammation and airways dysfunction in severe asthma. Materials and Methods In this prospective study, 27 participants with severe asthma (mean age, 52 years ± 9 [SD]; 17 female, 10 male) and seven healthy controls (mean age, 47 years ± 16; five female, two male), recruited between 2018 and 2021, underwent same-day spirometry, respiratory oscillometry, and tidal breathing H MRI. Participants with severe asthma underwent all assessments before and after BD therapy, and type 2 airway inflammatory biomarkers were determined (blood eosinophil count, sputum eosinophil percentage, sputum eosinophil-free granules, and fraction of exhaled nitric oxide) to generate a cumulative type 2 biomarker score. Specific ventilation was derived from tidal breathing H MRI and its response to BD therapy, and relationships with biomarkers of type 2 airway inflammation and airway dysfunction were evaluated. Results Mean MRI specific ventilation improved with BD inhalation (from 0.07 ± 0.04 to 0.11 ± 0.04, < .001). Post-BD MRI specific ventilation ( = .046) and post-BD change in MRI specific ventilation ( = .006) were greater in participants with asthma with type 2 low biomarkers compared with participants with type 2 high biomarkers of airway inflammation. Post-BD change in MRI specific ventilation was correlated with change in forced expiratory volume in 1 second ( = 0.40, = .04), resistance at 5 Hz ( = -0.50, = .01), resistance at 19 Hz ( = -0.42, = .01), reactance area ( = -0.54, < .01), and reactance at 5 Hz ( = 0.48, = .01). Conclusion Specific ventilation evaluated with tidal breathing H MRI was responsive to BD therapy and was associated with clinical biomarkers of airways disease in participants with severe asthma. MRI, Severe Asthma, Ventilation, Type 2 Inflammation © RSNA, 2023 See also the commentary by Moore and Chandarana in this issue.
目的
确定质子（H）MRI 衍生的比通气是否对支气管扩张剂（BD）治疗有反应，并与 2 型气道炎症和严重哮喘气道功能障碍的临床生物标志物相关。
材料与方法
在这项前瞻性研究中，招募了 2018 年至 2021 年间的 27 名严重哮喘患者（平均年龄，52 岁±9[标准差]；17 名女性，10 名男性）和 7 名健康对照者（平均年龄，47 岁±16；5 名女性，2 名男性），所有参与者均在同一天接受了肺量测定、呼吸震荡测量和潮式呼吸 H MRI 检查。严重哮喘患者在 BD 治疗前后均接受了所有评估，并确定了 2 型气道炎症生物标志物（血嗜酸性粒细胞计数、痰嗜酸性粒细胞百分比、痰嗜酸性粒细胞无颗粒和呼出一氧化氮分数）以生成累积的 2 型生物标志物评分。比通气由潮式呼吸 H MRI 衍生而来，并评估其对 BD 治疗的反应，以及与 2 型气道炎症和气道功能障碍生物标志物的关系。
结果
BD 吸入后 MRI 比通气均值改善（从 0.07±0.04 增至 0.11±0.04，<.001）。与气道炎症 2 型高生物标志物的哮喘患者相比，2 型低生物标志物的哮喘患者的 BD 后 MRI 比通气（ =.046）和 BD 后 MRI 比通气的变化（ =.006）更大。BD 后 MRI 比通气的变化与 1 秒用力呼气量（ = 0.40， =.04）、5 Hz 阻力（ = -0.50， =.01）、19 Hz 阻力（ = -0.42， =.01）、电抗面积（ = -0.54， <.01）和 5 Hz 电抗（ = 0.48， =.01）的变化相关。
结论
使用潮式呼吸 H MRI 评估的比通气对 BD 治疗有反应，并与严重哮喘患者的气道疾病临床生物标志物相关。
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