RT Journal Article
SR Electronic
T1 Xenon ventilation MRI in difficult asthma; initial experience in a clinical setting
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00785-2020
DO 10.1183/23120541.00785-2020
A1 Grace T. Mussell
A1 Helen Marshall
A1 Laurie J. Smith
A1 Alberto M. Biancardi
A1 Paul J.C. Hughes
A1 David J. Capener
A1 Jody Bray
A1 Andrew J. Swift
A1 Smitha Rajaram
A1 Alison M. Condliffe
A1 Guilhem J. Collier
A1 Chris S. Johns
A1 Nick D. Weatherley
A1 Jim M. Wild
A1 Ian Sabroe
YR 2021
UL http://openres.ersjournals.com/content/early/2021/07/15/23120541.00785-2020.abstract
AB Background Hyperpolarised gas MRI can be used to assess ventilation patterns. Previous studies have shown the image derived metric of ventilation defect percent (VDP) to correlate with FEV1/FVC and FEV1 in asthma.Objectives To explore the utility of hyperpolarised xenon-129 (129Xe) ventilation MRI in clinical care and examine its relationship with spirometry and other clinical metrics in people seen in a severe asthma service.Methods 26 people referred from a severe asthma clinic for MRI scanning were assessed by contemporaneous 129Xe MRI and spirometry. A sub-group of 18 patients also underwent reversibility testing with spirometry and MRI. Quantitative MRI measures of ventilation were calculated; VDP and the ventilation heterogeneity index (VHI), and compared to spirometry, ACQ7 and blood eosinophil count. Images were reviewed by a multidisciplinary team.Results VDP and VHI correlated with FEV1, FEV1/FVC and FEF25–75% but not with ACQ7 or blood eosinophil count. Discordance of MRI imaging and symptoms and/or pulmonary function tests also occurred, prompting diagnostic re-evaluation in some cases.Conclusion Hyperpolarised gas MRI provides a complementary method of assessment in people with difficult to manage asthma in a clinical setting. When used as a tool supporting clinical care in a severe asthma service, occurrences of discordance between symptoms, spirometry and MRI scanning indicate how MRI scanning may add to a management pathway.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Grace Mussell reports no conflicts of interest.Conflict of interest: Dr. Marshall reports grants from Astra Zeneca, personal fees from Astra Zeneca, outside the submitted work.Conflict of interest: Laurie Smith reports no conflicts of interest.Conflict of interest: Dr Biancardi reports no conflicts of interest.Conflict of interest: Dr Hughes reports no conflicts of interest.Conflict of interest: Dr. Capener has nothing to disclose.Conflict of interest: Dr. Bray has nothing to disclose.Conflict of interest: Dr Swift reports no conflicts of interest.Conflict of interest: Dr Rajaram reports no conflicts of interest.Conflict of interest: Professor Condliffe reports no conflicts of interest.Conflict of interest: Dr Collier reports no conflicts of interest.Conflict of interest: Dr Johns reports no conflicts of interest.Conflict of interest: Dr Weatherley reports no conflicts of interest.Conflict of interest: Professor Wild reports grants from Astra Zeneca, personal fees from Astra Zeneca, outside the submitted work.Conflict of interest: Dr. Sabroe reports grants and personal fees from Astra Zeneca, grants from GSK, grants from Astra Zeneca, outside the submitted work.