用非对比潮气呼吸 1H 磁共振成像评估严重哮喘患者的特殊通气情况

IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Radiology. Cardiothoracic imaging Pub Date : 2023-12-01 DOI:10.1148/ryct.230054
Dante P I Capaldi, Norman B Konyer, Melanie Kjarsgaard, Anna Dvorkin-Gheva, Ronald J Dandurand, Parameswaran Nair, Sarah Svenningsen
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Participants with severe asthma underwent all assessments before and after BD therapy, and type 2 airway inflammatory biomarkers were determined (blood eosinophil count, sputum eosinophil percentage, sputum eosinophil-free granules, and fraction of exhaled nitric oxide) to generate a cumulative type 2 biomarker score. Specific ventilation was derived from tidal breathing <sup>1</sup>H MRI and its response to BD therapy, and relationships with biomarkers of type 2 airway inflammation and airway dysfunction were evaluated. Results Mean MRI specific ventilation improved with BD inhalation (from 0.07 ± 0.04 to 0.11 ± 0.04, <i>P</i> < .001). Post-BD MRI specific ventilation (<i>P</i> = .046) and post-BD change in MRI specific ventilation (<i>P</i> = .006) were greater in participants with asthma with type 2 low biomarkers compared with participants with type 2 high biomarkers of airway inflammation. 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引用次数: 0

摘要

目的 确定质子 (1H) MRI 衍生的特异性通气量是否对支气管扩张剂 (BD) 治疗有反应,以及是否与重症哮喘患者 2 型气道炎症和气道功能障碍的临床生物标记物相关。材料与方法 在这项前瞻性研究中,2018 年至 2021 年间招募的 27 名重症哮喘参与者(平均年龄为 52 岁 ± 9 [SD];17 名女性,10 名男性)和 7 名健康对照者(平均年龄为 47 岁 ± 16;5 名女性,2 名男性)接受了当天的肺活量测定、呼吸振荡测定和潮气式呼吸 1H 磁共振成像。患有严重哮喘的参与者在 BD 治疗前后接受了所有评估,并测定了 2 型气道炎症生物标志物(血液嗜酸性粒细胞计数、痰中嗜酸性粒细胞百分比、痰中无嗜酸性粒细胞颗粒和呼出一氧化氮分数),以生成 2 型生物标志物累积得分。通过潮气呼吸 1H 磁共振成像得出特定通气量及其对 BD 治疗的反应,并评估其与 2 型气道炎症和气道功能障碍生物标记物之间的关系。结果 吸入 BD 后,平均 MRI 比通气量有所改善(从 0.07 ± 0.04 到 0.11 ± 0.04,P < .001)。与气道炎症生物标记物含量高的 2 型哮喘患者相比,生物标记物含量低的 2 型哮喘患者在 BD 后的磁共振特定通气量(P = .046)和磁共振特定通气量在 BD 后的变化(P = .006)更大。磁共振成像特定通气量在 BD 后的变化与 1 秒内用力呼气量的变化(r = 0.40,P = .04)、5 赫兹阻力(r = -0.50,P = .01)、19 赫兹阻力(r = -0.42,P = .01)、反应面积(r = -0.54,P < .01)和 5 赫兹反应(r = 0.48,P = .01)相关。结论 通过潮气呼吸 1H 磁共振成像评估的特定通气量对 BD 治疗有反应,并且与重症哮喘患者气道疾病的临床生物标志物相关。关键词MRI、重症哮喘、通气、2 型炎症 本文有补充材料。RSNA, 2023 另请参阅本期 Moore 和 Chandarana 的评论。
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Specific Ventilation in Severe Asthma Evaluated with Noncontrast Tidal Breathing 1H MRI.

Purpose To determine if proton (1H) MRI-derived specific ventilation is responsive to bronchodilator (BD) therapy and associated with clinical biomarkers of type 2 airway inflammation and airways dysfunction in severe asthma. Materials and Methods In this prospective study, 27 participants with severe asthma (mean age, 52 years ± 9 [SD]; 17 female, 10 male) and seven healthy controls (mean age, 47 years ± 16; five female, two male), recruited between 2018 and 2021, underwent same-day spirometry, respiratory oscillometry, and tidal breathing 1H MRI. Participants with severe asthma underwent all assessments before and after BD therapy, and type 2 airway inflammatory biomarkers were determined (blood eosinophil count, sputum eosinophil percentage, sputum eosinophil-free granules, and fraction of exhaled nitric oxide) to generate a cumulative type 2 biomarker score. Specific ventilation was derived from tidal breathing 1H MRI and its response to BD therapy, and relationships with biomarkers of type 2 airway inflammation and airway dysfunction were evaluated. Results Mean MRI specific ventilation improved with BD inhalation (from 0.07 ± 0.04 to 0.11 ± 0.04, P < .001). Post-BD MRI specific ventilation (P = .046) and post-BD change in MRI specific ventilation (P = .006) were greater in participants with asthma with type 2 low biomarkers compared with participants with type 2 high biomarkers of airway inflammation. Post-BD change in MRI specific ventilation was correlated with change in forced expiratory volume in 1 second (r = 0.40, P = .04), resistance at 5 Hz (r = -0.50, P = .01), resistance at 19 Hz (r = -0.42, P = .01), reactance area (r = -0.54, P < .01), and reactance at 5 Hz (r = 0.48, P = .01). Conclusion Specific ventilation evaluated with tidal breathing 1H MRI was responsive to BD therapy and was associated with clinical biomarkers of airways disease in participants with severe asthma. Keywords: MRI, Severe Asthma, Ventilation, Type 2 Inflammation Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Moore and Chandarana in this issue.

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