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Oxygen-Enhanced MR Ventilation Imaging of the Lung

Preliminary Clinical Experience in 25 Subjects

Yoshiharu Ohno1, Hiroto Hatabu2, Daisuke Takenaka1, Shuji Adachi1, Marc Van Cauteren3 and Kazuro Sugimura1

1 Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
2 Department of Radiology, Pulmonary Functional Imaging Research, University of Pennsylvania Medical Center, 3600 Market St., Ste. 370, Philadelphia, PA 19104-2649.
3 Philips Medical Systems Corporation, Philips Bldg. 2-13-37, Kohnan, Minato-ku, Tokyo 108-8507, Japan.



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  		Fig. 1. —30-year-old healthy male volunteer. Relative enhancement map obtained after oxygen inhalation shows homogeneous (yellow) and high oxygen enhancement (red). Maximum mean relative enhancement ratio was 45.1% SI (percentage increase of signal intensity).

 


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  		Fig. 2A. —45-year-old man with lung cancer without pulmonary emphysema. Oxygen-enhanced MR ventilation source image by HASTE (TE, 16; interecho spacing, 4 msec; inversion time, 720 msec) shows tumor in left upper lobe.

 


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  		Fig. 2B. —45-year-old man with lung cancer without pulmonary emphysema. Relative enhancement map obtained after oxygen inhalation shows little enhancement of tumor (arrow). Area of decreased oxygen enhancement (arrowheads) was also observed in lung parenchyma adjacent to mass. Maximum mean relative enhancement ratio by oxygen inhalation was 22.1%SI (percentage increase of signal intensity).

 


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  		Fig. 2C. —45-year-old man with lung cancer without pulmonary emphysema. 81mKr ventilation scintigraphy shows defect in left upper lobe and was matched with relative enhancement map (B).

 


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  		Fig. 3A. —65-year-old man with lung cancer without pulmonary emphysema. Oxygen-enhanced MR ventilation source image by HASTE (TE, 16; interecho spacing, 4 msec; inversion time, 720 msec) shows atelectasis in right middle and lower lung field.

 


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  		Fig. 3B. —65-year-old man with lung cancer without pulmonary emphysema. Relative enhancement map obtained after oxygen inhalation shows little enhancement of atelectatic lung and tumor. Area of decreased oxygen-enhancement in lateral peripheral portion of anterior segment of right upper lobe was also observed. This may be due to restricted physical motion. Maximum mean relative enhancement ratio by oxygen inhalation was 26.1%SI (percentage increase of signal intensity).

 


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  		Fig. 3C. —65-year-old man with lung cancer without pulmonary emphysema. 81mKr ventilation scintigraphy shows defect in right middle and lower lung fields and was matched with relative enhancement map (B).

 


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  		Fig. 4A. —81-year-old woman with lung cancer and pulmonary emphysema. Oxygen-enhanced MR ventilation source image by HASTE (TE, 16; interecho spacing, 4 msec; inversion time, 720 msec) shows tumor in right upper lobe.

 


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  		Fig. 4B. —81-year-old woman with lung cancer and pulmonary emphysema. Relative enhancement map obtained after oxygen inhalation shows little enhancement of tumor. Area with decreased oxygen enhancement (arrows) is much larger than accurate tumor itself. Relative enhancement map by oxygen inhalation indicates area of impaired regional ventilation possibly due to invasion of maximal tumor to surrounding tissue, disturbed perfusion by tumor in surrounding lung parenchyma, or scar. Maximum mean relative enhancement ratio by oxygen inhalation was 11.3%SI (percentage increase of signal intensity).

 


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  		Fig. 4C. —81-year-old woman with lung cancer and pulmonary emphysema. 81mKr ventilation scintigraphy shows defect in right upper lobe and was matched with relative enhancement map (B).

 


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  		Fig. 5. —Graph shows mean relative enhancement time course curve in healthy volunteers ({blacksquare}), in lung cancer patients without pulmonary emphysema ({diamondsuit}), and in lung cancer patients with pulmonary emphysema ([UNK]). Maximum mean relative enhancement ratios in lung cancer patients (without emphysema, 18.4 ± 1.3 %SI [percentage increase of signal intensity]; with emphysema, 15.5 ± 3.3 %SI) are significantly less than those of healthy volunteers (31.8 ± 2.7 %SI) (p < 0.001). Mean slopes of relative enhancement of lung cancer patients (without emphysema, 0.50 ± 0.02 %SI/sec; with emphysema, 0.05 ± 0.02 %SI/sec) are significantly less than those of healthy volunteers (0.69 ± 0.06 %SI/sec) (p < 0.001). Mean slope of relative enhancement of lung cancer patients with pulmonary emphysema is significantly less than that of lung cancer patients without emphysema (p < 0.001).

 


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  		Fig. 6. —Graph shows strong correlation between mean slope of relative enhancement and forced expiratory volume in 1 sec (FEV1) (percentage predicted) (y = 0.12x - 0.38, r = 0.86, r2 = 0.74, p < 0.0001). %SI/sec = percentage increase of signal intensity per second.

 


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  		Fig. 7. —Graph shows excellent correlation between maximum mean relative enhancement ratio and diffusing lung capacity (DLco) (percentage predicted) (y = 0.55x - 15.3, r = 0.90, r2 = 0.81, p < 0.0001). %SI = percentage increase of signal intensity.

 


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  		Fig. 8. —Graph shows good correlation between maximum mean relative enhancement ratio and high-resolution CT (HRCT) emphysema score (y = -1.8x + 19.9, r = 0.62, r2 = 0.38, p = 0.007). %SI = percentage increase of signal intensity.

 


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  		Fig. 9. —Graph shows strong correlation between maximum mean relative enhancement ratio and mean distribution ratio (y = 1.2x - 1.8, r = 0.88, r2 = 0.77, p = 0.004). %SI = percentage increase of signal intensity.

 

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