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Characterization and Detection of Physiologic Lung Changes Before and After Placement of Bronchial Valves Using Hyperpolarized Helium-3 MR Imaging

Posted Aug 31, 2011 Updated Apr 10, 2023
By Jaime Mata PhD , Talissa Altes MD , Jonathon Truwit MD , Peter Sylvester BS , Eduard de Lange MD , Yun Shim MD , Ajeet Vinayak MD , James Brookeman PhD , John Mugler PhD
7 min read

Rationale and Objectives

The aim of this study was to determine the efficacy of hyperpolarized 3 He (HHe) ventilation and apparent diffusion coefficient (ADC) HHe magnetic resonance imaging (MRI) in detecting changes in lung function and microstructure in emphysematous lung after bronchial valve (BV) placement.

Materials and Methods

One patient diagnosed with emphysema had nine BVs placed in upper lobe bronchi. Imaging was performed before and 6 months after BV placement. Coronal HHe ventilation MRI was used to assess volume changes in the ventilated portions of the lung. Coronal ADC HHe MRI, acquired with b value pairs of 0 and 1.6 s/cm 2 during a second 10-second breath-hold, was used to compute ADC values.

Results

HHe ventilation MRI revealed decreased ventilation in the treated segments of the upper lobes after BV placement. Increased ventilation in the lower lobes and two untreated segments of the left upper lobes were also observed, with an upward shift of the major fissure of the right lung. Whole-lung mean ADC decreased by 6.3% from baseline, from 0.48 ± 0.196 to 0.45 ± 0.176 cm 2 /s (toward healthier values) following BV placement.

Conclusions

HHe ventilation MRI detected an increase in whole-lung volume and an interlobar fissure shift indicative of increased ventilation of lower relative to upper lobes. Reduced ADC values suggest increased ventilation to healthy lower lobes at the expense of more diseased, expanded alveolar spaces in the upper lobes distal to BV placement. These results suggest that this ionizing radiation–free method of examining the lungs may offer functional and structural information useful in BV intervention planning.

Chronic obstructive pulmonary disease (COPD) is a disease state characterized by chronic airflow limitation due to chronic bronchitis and emphysema, a condition marked by the progressive destruction of the alveolar walls and subsequent enlargement of the airspace. Although the upper lobes are usually the first affected, there is considerable variability in the location and degree of emphysema. Emphysematous changes lead to a decrease in lung ventilation as air becomes entrapped within afflicted lung regions and are the cause of dyspnea, exercise impairment, and a reduced quality of life . In 2005, emphysema was deemed primarily responsible for the deaths of >14,000 Americans , and it is estimated that >2 million people in the United States alone are currently affected by this disease . Lung volume reduction surgery with surgical removal of the nonfunctioning, hyperinflated areas has been shown to be effective in patients whose emphysema predominantly involved the upper lobes; however, the procedure is highly invasive and is associated with high morbidity (20%–30%) and mortality (7.6%) rates within 90 days after surgery .

New, less invasive bronchoscopic approaches to treat COPD have been tested in the past decade and are currently under investigation . These new procedures involve a variety of different devices (eg, bronchial blockers, bronchial sealants, one-way bronchial valves [BVs]), but their basic concept is the reduction of ventilation to the areas with the most severe emphysema, which, if atelectasis occurs, is conceptually similar to the volume loss created by lung volume reduction surgery but with a much less invasive procedure. The IBV Valve (Spiration, Inc, Redmond, WA), which is currently undergoing phase III clinical trials in the United States, is one such device for the minimally invasive treatment of patients with severe emphysema. This small one-way BV can be placed during a single bronchoscopic procedure in selected bronchi. The BV can induce atelectasis , but investigations using quantitative computed tomography have shown that the most common mechanism associated with significant improvement in quality of life was a redirection of airflow to nontreated regions of the lung . Currently, multiple valves are placed bilaterally in upper lobe bronchi in patients with upper lobe–predominant emphysema . Although the upper lobes are commonly the first area to be affected, there is considerable variability in the location and degree of emphysema. The development of a clinical imaging modality that can generate high-resolution, three-dimensional functional maps of the lung without the use of ionizing radiation could provide a more targeted approach to valve placement, which could improve effectiveness.

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Materials and methods

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Figure 1, Frontal chest x-ray of a patient who received nine bronchial valves, five in the right lung and four in the left lung (arrows). (Right) Magnification of the area within the dotted line on the left, showing the region of valve placement.

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Results

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Figure 2, Hyperpolarized 3 He ventilation magnetic resonance images for nine contiguous coronal slices covering the entire lung from baseline (a–i) and 6 months after bronchial valve placement (j–r) . Solid and dashed white arrows indicate areas of increased and decreased ventilation, respectively. Gray arrows emphasize the upward shift of the right major fissure following treatment.

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Figure 3, Apparent diffusion coefficient (ADC) hyperpolarized 3 He maps for seven contiguous coronal slices covering the entire lung from baseline (a–g) and 6 months after bronchial valve (BV) placement (h–n) . ADC values (mean ± standard deviation) are given for each slice. Decreased and increased mean ADC values are displayed in red and green, respectively. At baseline, the anterior region of the upper lobes had markedly elevated ADC (red arrows), while in posttreatment images, these targeted regions showed no ventilation. The posterior region of the left upper lobe improved in ventilation following BV placement, but the ADC was noticeably elevated (green arrows). The posterior region of the right lower lobe expanded following treatment and displayed relatively normal ADC values (green arrows).

Figure 4, Whole-lung histogram overlay displaying the spread of apparent diffusion coefficient (ADC) values for baseline (dark gray) and 6 months after intervention (light gray). The tighter distribution around the median after bronchial valve placement indicated less diseased ventilated lung.

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Discussion

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Conclusions

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Academic Radiology, Volume 18, Issue 9
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