129Xe and Free-Breathing 1H Ventilation MRI in Patients With Cystic Fibrosis: A Dual-Center Study

Helen Marshall; Andreas Voskrebenzev; Laurie J. Smith; Alberto M. Biancardi; Agilo L. Kern; Guilhem J. Collier; Piotr A. Wielopolski; Pierluigi Ciet; Harm A.W.M. Tiddens; Jens Vogel-Claussen; Jim M. Wild

doi:10.1002/jmri.28470

¹²⁹Xe and Free-Breathing ¹H Ventilation MRI in Patients With Cystic Fibrosis: A Dual-Center Study

Helen Marshall^*, Andreas Voskrebenzev, Laurie J. Smith, Alberto M. Biancardi, Agilo L. Kern, Guilhem J. Collier, Piotr A. Wielopolski, Pierluigi Ciet, Harm A.W.M. Tiddens, Jens Vogel-Claussen, Jim M. Wild

^*Corresponding author for this work

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Abstract

Background: Free-breathing ¹H ventilation MRI shows promise but only single-center validation has yet been performed against methods which directly image lung ventilation in patients with cystic fibrosis (CF). Purpose: To investigate the relationship between ¹²⁹Xe and ¹H ventilation images using data acquired at two centers. Study type: Sequence comparison. Population: Center 1; 24 patients with CF (12 female) aged 9–47 years. Center 2; 7 patients with CF (6 female) aged 13–18 years, and 6 healthy controls (6 female) aged 21–31 years. Data were acquired in different patients at each center. Field Strength/Sequence: 1.5 T, 3D steady-state free precession and 2D spoiled gradient echo. Assessment: Subjects were scanned with ¹²⁹Xe ventilation and ¹H free-breathing MRI and performed pulmonary function tests. Ventilation defect percent (VDP) was calculated using linear binning and images were visually assessed by H.M., L.J.S., and G.J.C. (10, 5, and 8 years' experience). Statistical Tests: Correlations and linear regression analyses were performed between ¹²⁹Xe VDP, ¹H VDP, FEV₁, and LCI. Bland–Altman analysis of ¹²⁹Xe VDP and ¹H VDP was carried out. Differences in metrics were assessed using one-way ANOVA or Kruskal–Wallis tests. Results: ¹²⁹Xe VDP and ¹H VDP correlated strongly with; each other (r = 0.84), FEV₁ z-score (¹²⁹Xe VDP r = −0.83, ¹H VDP r = −0.80), and LCI (¹²⁹Xe VDP r = 0.91, ¹H VDP r = 0.82). Bland–Altman analysis of ¹²⁹Xe VDP and ¹H VDP from both centers had a bias of 0.07% and limits of agreement of −16.1% and 16.2%. Linear regression relationships of VDP with FEV₁ were not significantly different between ¹²⁹Xe and ¹H VDP (P = 0.08), while ¹²⁹Xe VDP had a stronger relationship with LCI than ¹H VDP. Data Conclusion: ¹H ventilation MRI shows large-scale agreement with ¹²⁹Xe ventilation MRI in CF patients with established lung disease but may be less sensitive to subtle ventilation changes in patients with early-stage lung disease. Evidence Level: 2. Technical Efficacy: Stage 2.

Original language	English
Pages (from-to)	1908-1921
Number of pages	14
Journal	Journal of Magnetic Resonance Imaging
Volume	57
Issue number	6
Early online date	11 Oct 2022
DOIs	https://doi.org/10.1002/jmri.28470
Publication status	Published - Jun 2023

Bibliographical note

Funding Information:
Thanks to Dave Capener and Jody Bray for patient scanning, and Leanne Armstrong for study visit co-ordination at center 1. Thanks to Melanie Pfeifer and Frank Schröder for outstanding technical assistance in performing the MRI examinations at center 2. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health.

Publisher Copyright:
© 2022 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.

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129Xe and Free-Breathing 1H Ventilation MRI in Patients With Cystic FibrosisFinal published version, 1.78 MBLicence: CC BY

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Marshall, H., Voskrebenzev, A., Smith, L. J., Biancardi, A. M., Kern, A. L., Collier, G. J., Wielopolski, P. A., Ciet, P., Tiddens, H. A. W. M., Vogel-Claussen, J., & Wild, J. M. (2023). ¹²⁹Xe and Free-Breathing ¹H Ventilation MRI in Patients With Cystic Fibrosis: A Dual-Center Study. Journal of Magnetic Resonance Imaging, 57(6), 1908-1921. https://doi.org/10.1002/jmri.28470

@article{506979b474ee45a3b2597cc0e7e5a1d8,

title = "129Xe and Free-Breathing 1H Ventilation MRI in Patients With Cystic Fibrosis: A Dual-Center Study",

abstract = "Background: Free-breathing 1H ventilation MRI shows promise but only single-center validation has yet been performed against methods which directly image lung ventilation in patients with cystic fibrosis (CF). Purpose: To investigate the relationship between 129Xe and 1H ventilation images using data acquired at two centers. Study type: Sequence comparison. Population: Center 1; 24 patients with CF (12 female) aged 9–47 years. Center 2; 7 patients with CF (6 female) aged 13–18 years, and 6 healthy controls (6 female) aged 21–31 years. Data were acquired in different patients at each center. Field Strength/Sequence: 1.5 T, 3D steady-state free precession and 2D spoiled gradient echo. Assessment: Subjects were scanned with 129Xe ventilation and 1H free-breathing MRI and performed pulmonary function tests. Ventilation defect percent (VDP) was calculated using linear binning and images were visually assessed by H.M., L.J.S., and G.J.C. (10, 5, and 8 years' experience). Statistical Tests: Correlations and linear regression analyses were performed between 129Xe VDP, 1H VDP, FEV1, and LCI. Bland–Altman analysis of 129Xe VDP and 1H VDP was carried out. Differences in metrics were assessed using one-way ANOVA or Kruskal–Wallis tests. Results: 129Xe VDP and 1H VDP correlated strongly with; each other (r = 0.84), FEV1 z-score (129Xe VDP r = −0.83, 1H VDP r = −0.80), and LCI (129Xe VDP r = 0.91, 1H VDP r = 0.82). Bland–Altman analysis of 129Xe VDP and 1H VDP from both centers had a bias of 0.07% and limits of agreement of −16.1% and 16.2%. Linear regression relationships of VDP with FEV1 were not significantly different between 129Xe and 1H VDP (P = 0.08), while 129Xe VDP had a stronger relationship with LCI than 1H VDP. Data Conclusion: 1H ventilation MRI shows large-scale agreement with 129Xe ventilation MRI in CF patients with established lung disease but may be less sensitive to subtle ventilation changes in patients with early-stage lung disease. Evidence Level: 2. Technical Efficacy: Stage 2.",

author = "Helen Marshall and Andreas Voskrebenzev and Smith, {Laurie J.} and Biancardi, {Alberto M.} and Kern, {Agilo L.} and Collier, {Guilhem J.} and Wielopolski, {Piotr A.} and Pierluigi Ciet and Tiddens, {Harm A.W.M.} and Jens Vogel-Claussen and Wild, {Jim M.}",

note = "Funding Information: Thanks to Dave Capener and Jody Bray for patient scanning, and Leanne Armstrong for study visit co-ordination at center 1. Thanks to Melanie Pfeifer and Frank Schr{\"o}der for outstanding technical assistance in performing the MRI examinations at center 2. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health. Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.",

year = "2023",

month = jun,

doi = "10.1002/jmri.28470",

language = "English",

volume = "57",

pages = "1908--1921",

journal = "Journal of Magnetic Resonance Imaging",

issn = "1053-1807",

publisher = "John Wiley & Sons Inc.",

number = "6",

}

TY - JOUR

T1 - 129Xe and Free-Breathing 1H Ventilation MRI in Patients With Cystic Fibrosis

T2 - A Dual-Center Study

AU - Marshall, Helen

AU - Voskrebenzev, Andreas

AU - Smith, Laurie J.

AU - Biancardi, Alberto M.

AU - Kern, Agilo L.

AU - Collier, Guilhem J.

AU - Wielopolski, Piotr A.

AU - Ciet, Pierluigi

AU - Tiddens, Harm A.W.M.

AU - Vogel-Claussen, Jens

AU - Wild, Jim M.

N1 - Funding Information: Thanks to Dave Capener and Jody Bray for patient scanning, and Leanne Armstrong for study visit co-ordination at center 1. Thanks to Melanie Pfeifer and Frank Schröder for outstanding technical assistance in performing the MRI examinations at center 2. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health. Publisher Copyright: © 2022 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.

PY - 2023/6

Y1 - 2023/6

N2 - Background: Free-breathing 1H ventilation MRI shows promise but only single-center validation has yet been performed against methods which directly image lung ventilation in patients with cystic fibrosis (CF). Purpose: To investigate the relationship between 129Xe and 1H ventilation images using data acquired at two centers. Study type: Sequence comparison. Population: Center 1; 24 patients with CF (12 female) aged 9–47 years. Center 2; 7 patients with CF (6 female) aged 13–18 years, and 6 healthy controls (6 female) aged 21–31 years. Data were acquired in different patients at each center. Field Strength/Sequence: 1.5 T, 3D steady-state free precession and 2D spoiled gradient echo. Assessment: Subjects were scanned with 129Xe ventilation and 1H free-breathing MRI and performed pulmonary function tests. Ventilation defect percent (VDP) was calculated using linear binning and images were visually assessed by H.M., L.J.S., and G.J.C. (10, 5, and 8 years' experience). Statistical Tests: Correlations and linear regression analyses were performed between 129Xe VDP, 1H VDP, FEV1, and LCI. Bland–Altman analysis of 129Xe VDP and 1H VDP was carried out. Differences in metrics were assessed using one-way ANOVA or Kruskal–Wallis tests. Results: 129Xe VDP and 1H VDP correlated strongly with; each other (r = 0.84), FEV1 z-score (129Xe VDP r = −0.83, 1H VDP r = −0.80), and LCI (129Xe VDP r = 0.91, 1H VDP r = 0.82). Bland–Altman analysis of 129Xe VDP and 1H VDP from both centers had a bias of 0.07% and limits of agreement of −16.1% and 16.2%. Linear regression relationships of VDP with FEV1 were not significantly different between 129Xe and 1H VDP (P = 0.08), while 129Xe VDP had a stronger relationship with LCI than 1H VDP. Data Conclusion: 1H ventilation MRI shows large-scale agreement with 129Xe ventilation MRI in CF patients with established lung disease but may be less sensitive to subtle ventilation changes in patients with early-stage lung disease. Evidence Level: 2. Technical Efficacy: Stage 2.

AB - Background: Free-breathing 1H ventilation MRI shows promise but only single-center validation has yet been performed against methods which directly image lung ventilation in patients with cystic fibrosis (CF). Purpose: To investigate the relationship between 129Xe and 1H ventilation images using data acquired at two centers. Study type: Sequence comparison. Population: Center 1; 24 patients with CF (12 female) aged 9–47 years. Center 2; 7 patients with CF (6 female) aged 13–18 years, and 6 healthy controls (6 female) aged 21–31 years. Data were acquired in different patients at each center. Field Strength/Sequence: 1.5 T, 3D steady-state free precession and 2D spoiled gradient echo. Assessment: Subjects were scanned with 129Xe ventilation and 1H free-breathing MRI and performed pulmonary function tests. Ventilation defect percent (VDP) was calculated using linear binning and images were visually assessed by H.M., L.J.S., and G.J.C. (10, 5, and 8 years' experience). Statistical Tests: Correlations and linear regression analyses were performed between 129Xe VDP, 1H VDP, FEV1, and LCI. Bland–Altman analysis of 129Xe VDP and 1H VDP was carried out. Differences in metrics were assessed using one-way ANOVA or Kruskal–Wallis tests. Results: 129Xe VDP and 1H VDP correlated strongly with; each other (r = 0.84), FEV1 z-score (129Xe VDP r = −0.83, 1H VDP r = −0.80), and LCI (129Xe VDP r = 0.91, 1H VDP r = 0.82). Bland–Altman analysis of 129Xe VDP and 1H VDP from both centers had a bias of 0.07% and limits of agreement of −16.1% and 16.2%. Linear regression relationships of VDP with FEV1 were not significantly different between 129Xe and 1H VDP (P = 0.08), while 129Xe VDP had a stronger relationship with LCI than 1H VDP. Data Conclusion: 1H ventilation MRI shows large-scale agreement with 129Xe ventilation MRI in CF patients with established lung disease but may be less sensitive to subtle ventilation changes in patients with early-stage lung disease. Evidence Level: 2. Technical Efficacy: Stage 2.

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¹²⁹Xe and Free-Breathing ¹H Ventilation MRI in Patients With Cystic Fibrosis: A Dual-Center Study

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