Benlala Ilyes, Dournes Gaël, Girodet Pierre-Olivier, Laurent François, Ben Hassen Wadie, Baldacci Fabien, De Senneville Baudouin Denis, Berger Patrick
University Bordeaux, INSERM, CRCTB, U 1045, Bordeaux, France.
CHU de Bordeaux, Service d'imagerie Cardiaque et Thoracique, CIC-P 1401, Service d'Explorations Fonctionnelles Respiratoires, Bordeaux, France.
Insights Imaging. 2025 Mar 25;16(1):71. doi: 10.1186/s13244-025-01939-1.
Severe asthma patients are prone to severe exacerbations with a need of hospital admission increasing the economic burden on healthcare systems. T2w lung MRI was found to be useful in the assessment of bronchial inflammation. The main goal of this study is to compare quantitative MRI T2 signal bronchial intensity between patients with severe and non-severe asthma.
This is an ancillary study of a prospective single-center study (NCT03089346). We assessed the mean T2 intensity MRI signal of the bronchial wall area (BrWall_T2-MIS) in 15 severe and 15 age and sex-matched non-severe asthmatic patients. They also have had pulmonary function tests (PFTs), fractional exhaled nitric oxide (FeNO) and blood eosinophils count (Eos). Comparisons between the two groups were performed using Student's t-test. Correlations were assessed using Pearson coefficients. Reproducibility was assessed using intraclass correlation coefficient and Bland-Altman analysis.
BrWall_T2-MIS was higher in severe than in non-severe asthma patients (74 ± 12 vs 49 ± 14; respectively p < 0.001). BrWall_T2-MIS showed a moderate inverse correlation with PFTs in the whole cohort (r = -0.54, r = -0.44 for FEV1(%pred) and FEV1/FVC respectively, p ≤ 0.01) and in the severe asthma group (r = -0.53, r = -0.44 for FEV1(%pred) and FEV1/FVC respectively, p ≤ 0.01). Eos was moderately correlated with BrWall_T2-MIS in severe asthma group (r = 0.52, p = 0.047). Reproducibility was almost perfect with ICC = 0.99 and mean difference in Bland-Altman analysis of -0.15 [95% CI = -0.48-0.16].
Quantification of bronchial wall T2w signal intensity appears to be able to differentiate severe from non-severe asthma and correlates with obstructive PFTs' parameters and inflammatory markers in severe asthma.
The development of non-ionizing imaging biomarkers could play an essential role in the management of patients with severe asthma in the current era of biological therapies.
Severe asthma exhibits severe exacerbations with a high burden on healthcare systems. T2w bronchial wall signal intensity is related to inflammatory biomarker in severe asthma. T2w MRI may represent a non-invasive tool to follow up severe asthma patients.
重度哮喘患者容易发生严重急性加重，需要住院治疗，这增加了医疗系统的经济负担。已发现T2加权肺部MRI在评估支气管炎症方面有用。本研究的主要目的是比较重度哮喘患者与非重度哮喘患者之间MRI T2信号支气管强度的定量情况。
这是一项前瞻性单中心研究（NCT03089346）的辅助研究。我们评估了15例重度哮喘患者和15例年龄及性别匹配的非重度哮喘患者支气管壁区域的平均T2强度MRI信号（BrWall_T2-MIS）。他们还进行了肺功能测试（PFT）、呼出一氧化氮分数（FeNO）和血液嗜酸性粒细胞计数（Eos）。两组之间的比较采用Student t检验。相关性采用Pearson系数进行评估。再现性采用组内相关系数和Bland-Altman分析进行评估。
重度哮喘患者的BrWall_T2-MIS高于非重度哮喘患者（分别为74±12和49±14；p<0.001）。在整个队列中，BrWall_T2-MIS与PFT呈中度负相关（FEV1（%预计值）和FEV1/FVC的r分别为-0.54和-0.44，p≤0.01），在重度哮喘组中也是如此（FEV1（%预计值）和FEV1/FVC的r分别为-0.53和-0.44，p≤0.01）。在重度哮喘组中，Eos与BrWall_T2-MIS呈中度相关（r=0.52，p=0.047）。再现性几乎完美，ICC=0.99，Bland-Altman分析中的平均差异为-0.15 [95%CI=-0.48-0.16]。
支气管壁T2加权信号强度的定量似乎能够区分重度哮喘与非重度哮喘，并与重度哮喘中阻塞性PFT参数和炎症标志物相关。
在当前生物治疗时代，非电离成像生物标志物的开发可能在重度哮喘患者的管理中发挥重要作用。
重度哮喘表现出严重急性加重，给医疗系统带来沉重负担。T2加权支气管壁信号强度与重度哮喘中的炎症生物标志物相关。T2加权MRI可能是一种随访重度哮喘患者的非侵入性工具。
