Background
Methods
Clinical respiratory imaging research techniques in Cystic Fibrosis
Global lung function assessment
X-Ray based methods
Chest X-Ray (CXR)
High Resolution Computed Tomography (HRCT)
Magnetic Resonance Imaging (MRI)
Novel respiratory imaging research applications
Hyperpolarized gas MRI in Cystic Fibrosis patients
Hyperpolarized helium-3 MRI
Hyperpolarized xenon-129 MRI
Non-contrast enhanced MRI in Cystic Fibrosis
Phase-contrast X-ray imaging in Cystic Fibrosis
Current critical gaps in our understanding
Method | Technique | Role | Advantages | Disadvantages | Ref |
---|---|---|---|---|---|
CT | HRCT |
• Lung anatomy/morphology assessment
• Disease progression evaluation
• Treatment response evaluation |
+ quick
+ easy to apply
+ well established in clinical practice
+ high spatial resolution |
- ionizing radiation method
- lack of pulmonary function assessment | |
CT | CV-HRCT |
• Lung anatomy/morphology assessment in infants
• Disease progression evaluation
• Treatment response evaluation |
+ assess lung changes in infants
+ high spatial resolution |
- ionizing radiation method
- lack of pulmonary function assessment | |
MRI | IV CE-MRI |
• Assessment of pulmonary vascular bed perfusion
• Lung structure evaluation |
+ Radiation free method
+ pulmonary function assessment (perfusion) |
- not applicable for all patients (metal parts in body, pacemaker etc.)
- low spatial resolution due to low proton density of lungs
- GD contrast can cause allergies | |
MRI |
3He MRI |
• Assessment of ventilation and diffusion functional imaging
• Disease progression evaluation
• Treatment response evaluation |
+ radiation free method
+ sensitive track early progression of the disease, early treatment response
+ quantitative information about function (ventilation defect, apparent diffusion coefficient) |
- not applicable for all patients (metal parts in body, pacemaker etc.)
- low spatial resolution due to low proton density of lungs
- currently not applicable to infants due to complicated protocol | |
MRI |
129Xe MRI |
• Assessment of ventilation, diffusion and perfusion possible during one imaging protocol
• Disease progression evaluation
• Treatment response evaluation |
+ radiation free method
+ sensitive- track early progression of the disease, early treatment response
+ in-vivo observation of gas dissolution into barrier and RBCs
+ quantitative information about function (ventilation defect, apparent diffusion coefficient, gas-transfer defect) |
- not applicable for all patients (metal parts in body, pacemaker etc.)
- low spatial resolution due to low proton density of lungs
- up to date not applicable to infants due to complicated protocol
- potentially hazardous due to Xe anaesthetic properties | |
MRI | Non CE-MRI: ASL |
• Assessment of perfusion
• Disease progression evaluation |
+ radiation free method
+ pulmonary function assessment (perfusion)
+ quantitative information (perfusion heterogeneity) |
- not applicable for all patients (metal parts in body, pacemaker etc.)
- low spatial resolution due to low proton density of lungs | |
MRI | Non CE-MRI: FD MRI |
• Assessment of ventilation and perfusion
• Disease progression evaluation |
+ radiation free method
+ pulmonary function assessment (perfusion and ventilation)
+ quantitative information (perfusion homogeneity
+ results comparable to single photon emission CT and CE-MRI but without exogenous contrast |
- not applicable for all patients (metal parts in body, pacemaker etc.)
- low spatial resolution due to low proton density of lungs | |
MRI | Non CE-MRI: nT1 |
• Assessment of perfusion
• Disease progression evaluation |
+ radiation free method
+ pulmonary function assessment (perfusion and ventilation)
+ quantitative information (dissolution phase homogeneity) |
- not applicable for all patients (metal parts in body, pacemaker etc.)
- low spatial resolution due to low proton density of lungs | |
MRI | Non CE-MRI: DWI |
• Assessment of diffusion changes to localize mucus plugs |
+ radiation free method
+ diffusion changes- localization of areas with elevated diffusion called hotspots |
- not applicable for all patients (metal parts in body, pacemaker etc.)
- low spatial resolution due to low proton density of lungs | [65] |
Synchrotron based X-Ray | Phase contrast x-ray imaging |
• Assessment of structural and functional changes in a microscale |
+ very high spatial and temporal resolution of images
+ cimaging function and morphology in microscale |
- ionizing radiation method- not applicable for humans |