PT - JOURNAL ARTICLE AU - Grace T. Mussell AU - Helen Marshall AU - Laurie J. Smith AU - Alberto M. Biancardi AU - Paul J.C. Hughes AU - David J. Capener AU - Jody Bray AU - Andrew J. Swift AU - Smitha Rajaram AU - Alison M. Condliffe AU - Guilhem J. Collier AU - Chris S. Johns AU - Nick D. Weatherley AU - Jim M. Wild AU - Ian Sabroe TI - Xenon ventilation MRI in difficult asthma: initial experience in a clinical setting AID - 10.1183/23120541.00785-2020 DP - 2021 Jul 01 TA - ERJ Open Research PG - 00785-2020 VI - 7 IP - 3 4099 - http://openres.ersjournals.com/content/7/3/00785-2020.short 4100 - http://openres.ersjournals.com/content/7/3/00785-2020.full SO - erjor2021 Jul 01; 7 AB - Background Hyperpolarised gas magnetic resonance imaging (MRI) can be used to assess ventilation patterns. Previous studies have shown the image-derived metric of ventilation defect per cent (VDP) to correlate with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and FEV1 in asthma.Objectives The aim of this study was 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 subgroup 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, Asthma Control Questionnaire 7 (ACQ7) and blood eosinophil count. Images were reviewed by a multidisciplinary team.Results VDP and VHI correlated with FEV1, FEV1/FVC and forced expiratory flow between 25% and 75% of FVC 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.This article demonstrates the feasibility of using 129Xe MRI in clinical practice. Discordance between symptoms, spirometry and MRI can support the use of further treatment or suggest coexisting breathing control issues or laryngeal disorders. https://bit.ly/3ky4oXP