Correlation of lung parenchymal MR signal intensity with pulmonary function tests and quantitative computed tomography (CT) evaluation: a pilot study

PURPOSE: To evaluate the effect of ventilatory impairment on MR signal intensity of the lung parenchyma. MATERIALS AND METHODS: Subjects were five normal volunteers (age = 30 +/- 7.9 years, mean +/- SD) and 19 male patients with chronic obstructive lung disease (COPD) (mean age = 70.4 +/- 6.5 years). Coronal MR images were obtained over entire lung fields at full inspiration and full expiration with cardiac triggering on a 1.5T system. Changes in the mean lung intensity between the two respiratory states were normalized by each intercept of the linear regression lines of the signal changes, and the slope of the relationship was calculated. Computed tomography (CT) images were also obtained in COPD patients at full inspiration using a multidetector row CT scanner. Attenuation values less than -950 Hounsfield units (HU) (RA-950) represented the percentage of relative lung area on the CT. RESULTS: The mean slope of COPD patients (0.365 +/- 0.074) was less steep than that of the normal subjects (0.570 +/- 0.124, P < 0.001). In COPD patients, the slope correlated significantly with forced expiratory volume in one second (FEV1, r = 0.508, P = 0.026), but not with RA-950. CONCLUSION: In COPD patients, lung signal change measured by MRI correlates with airflow obstruction, but not with volume of the emphysema measured by lung CT.     

Measurement of MR signal and T2* in lung to characterize a tight skin mouse model of emphysema using single-point imaging

PURPOSE: To evaluate whether MRI signal and T2* measurements of lung tissue acquired at ultrashort detection times (tds) can detect emphysematous changes in lungs. MATERIALS AND METHODS: MR signal intensity of in vivo mouse lungs was measured at 4.7 T at tds of 0.2 and 0.4 msec using single-point imaging (SPI). T2* was calculated from the measurements obtained at the two tds. Two groups of 8- and 30-week-old Tight Skin (TS) and aged-matched CB57BL/6 mice were examined. The TS mice spontaneously developed emphysema-like alveolar enlargement. In vivo micro-computed tomography (microCT) scanning and histology were used as reference methods. RESULTS: MR signal and T2* were significantly lower in the lungs of TS mice than in controls. There were no significant differences between the different age groups. MR signal in lung parenchyma correlated linearly (P < 0.0001, r = 0.89) with microCT mass density, and T2* correlated linearly (P < 0.0001, r = -0.91) with the alveoli size (mean linear intercept [MLI]). CONCLUSION: The MR signal intensity and T2* measured at short tds can be used as imaging biomarkers to characterize parenchyma density and alveolar size, respectively.     

基于肺部血流MRI信号在心动周期内变化的灌注成像技术研究

目的探讨血流变化对肺部MRI信号的影响，并研究1种新的MR肺血流灌注成像方法。方法对健康志愿者15例，采用相位对比电影MRI技术测量大肺动脉血流速度和流量在心动周期内的变化；并选用单次激发半傅立叶变换超快速自旋回波序列观察肺实质MR信号的相应改变，评价其相关性；根据不同心动期相肺实质MR信号的差异进行图像减影。结果肺实质．MRI信号表现为心脏收缩期降低，舒张期升高。大肺动脉的瞬时速度、瞬时流量与其呈负相关(r=-0．878、-0．770，P=0，002、0．015)。经肺部MRI信号差异最大的舒张末期和收缩中期的MRI减影可获得肺灌注像。结论肺实质MRI信号的改变与肺血流模式和速度有关。该技术是1种简便易行的非对比剂性的MR肺灌注评价新方法。     

Quantitative and qualitative evaluations of fetal lung with MR imaging

PURPOSE: To measure both volume and signal intensity of the fetal lung at magnetic resonance (MR) imaging and to evaluate the clinical use of this method to predict fetal pulmonary hypoplasia. MATERIALS AND METHODS: A total of 87 fetuses evaluated with MR imaging at 24-39 weeks of gestation were classified into a control group with good respiratory outcome (group A, n = 58) or a poor outcome group with severe respiratory disturbance after birth (group B, n = 29). Planimetric measurement of total lung volume and calculation of the ratio of lung signal intensity to spinal fluid signal intensity (L/SF) were performed on MR images by using region-of-interest analysis. Regression analysis, analysis of covariance, analysis of variance, and receiver operating characteristic (ROC) analysis were performed. RESULTS: The best fit for group A lung volume was represented by the regression line V = (2.41 x G) - 37.6 (r = 0.537, P <.001), in which V is lung volume and G is gestational weeks; that for group B, by V = (0.97 x G) - 14.0 (r = 0.378, P <.05). Results of analysis of covariance with gestational weeks used as a covariate showed a significant difference in lung volume between the two groups (P <.001). Mean +/- SEM for L/SF ratio was 0.817 +/- 0.013 and 0.598 +/- 0.019 in groups A and B, respectively (P <.001). For prediction of postnatal respiratory outcome, the area under the ROC curve for lung volume and L/SF ratio combined was 0.990, significantly higher than that for lung volume alone (P <.05). CONCLUSION: Simultaneous measurement of fetal lung volume and signal intensity on MR images is a promising method for predicting fetal pulmonary hypoplasia.     

Pediatric musculoskeletal tumors: use of dynamic, contrast-enhanced MR imaging to monitor response to chemotherapy.

The ability of dynamic, gadolinium-enhanced magnetic resonance (MR) imaging to allow prediction of histologic responses to initial chemotherapy was evaluated in 20 patients with osteosarcoma (n = 12), Ewing sarcoma (n = 4), rhabdomyosarcoma (n = 3), or synovial sarcoma (n = 1). Tumor signal intensity was measured on fast low-angle shot (FLASH) gradient-echo images obtained at 15-second intervals before and 3 or more minutes after manual intravenous injection of gadopentetate dimeglumine. Signal intensity was plotted against time, and slopes were calculated for the percentage increase in signal intensity per minute. Slopes and changes in maximum tumor size during and after chemotherapy were correlated with histologic evaluations of tumor response. Eleven of the 20 tumors met histologic criteria for response. Histologic response was moderately correlated with slopes obtained during chemotherapy (rs [Spearman rank correlation] = .53, P = .02) but not with changes in tumor size (rs = .02, P = .94). Tumor slopes obtained after chemotherapy were highly correlated with histologic findings (rs = .65, P = .007); the correlation with changes in tumor size increased but remained nonsignificant (rs = .41, P = .11).     

Assessment of lung development using hyperpolarized helium-3 diffusion MR imaging

PURPOSE: To determine whether hyperpolarized helium-3 (HHe) diffusion MR can detect the expected enlargement of alveoli that occurs with lung growth during childhood. MATERIALS AND METHODS: A total of 29 normal subjects aged four to 30 years underwent HHe diffusion MR imaging with the b-value pair 0, 1.6 second/cm(2). A second acquisition during a separate breathhold was performed using the b-value pair 0, 4 second/cm(2) to evaluate the dependence on b-value. The mean apparent diffusion coefficient (ADC) and lung volume for each acquisition and each subject was determined. RESULTS: Subjects as young as four years of age were able to cooperate with the imaging procedure. The mean ADC increased with increasing subject age (r = 0.8; P < 0.001), with a 55% increase in mean ADC from the youngest to oldest subject. Lung volumes measured on MR were highly repeatable for the two HHe MR acquisitions (r = 0.980, P < 0.001). The mean ADC values measured with the two different b-value pairs were highly correlated (r = 0.975; P < 0.001), but the higher b-value pair resulted in slightly lower mean ADCs (P < 0.001). CONCLUSION: HHe diffusion MR appears to detect the expected increase in alveolar size during childhood, and thus HHe MR may be a noninvasive method to assess development of the lung microstructure.     

MR assessment of fetal lung development using lung volumes and signal intensities

The purpose of this study was to evaluate the monitoring and diagnostic potential of MRI in fetal lung development and disease using lung volume and signal intensity changes through gestation. Thirty-five healthy fetuses (22–42 weeks) were examined on a 1.5- T MR system using sagittal T2w single-shot fast spin-echo imaging (TR indefinite, TE 90 ms, slice thickness/gap 3–5/0 mm, FOV 26–40 cm, NEX 0.5). Fetal body and lung were segmented manually and volumes calculated. Signal intensities (SI) of fetal lung and three reference values were measured on the section best displaying the lung. Regions of interests were defined by including the maximal organ area possible. The following SI ratios were generated: lung/liver, lung/amniotic fluid, lung/muscle, liver/fluid and liver/muscle. Volumes and ratios were correlated with gestational age. Data from seven fetuses with pulmonary pathology were compared with these normative values. Absolute lung volume varied from 12.3 to 143.5 cm³ in correlation with gestational age (P<0.001); lung volume relative to total body volume ranged from 1.6 to 5.0%, decreasing with gestational age (P=0.001). All SI ratios measured were unrelated to gestational age. Diagnoses in the seven abnormal fetuses were hydrothorax (n=2), congenital cystic adenomatoid malformation (n=2), diaphragmatic hernia (n=2) and pulmonary sequestration (n=1); their absolute and relative lung volumes were below normal (P<0.001). The SI ratios did not differ significantly from those in the normal population. Normative MR fetal lung volumes may have important clinical applications in confirming and quantifying intrauterine pulmonary hypoplasia and in complementing ultrasound in the planning of fetal and post-natal surgery. No clinical relevance was found for fetal lung SI values.     

Ultrashort echo time (UTE) MRI of the lung: Assessment of tissue density in the lung parenchyma

Nonuniform disruption of lung architecture is usually assessed by CT, which carries potential radiation risk. Here we report our use of a three‐dimensional ultrashort echo time MR method to image the lungs of normal mice at different positive end‐expiratory pressures in a 3‐T clinical MR system. The ultrashort echo time sequence in conjunction with a projection acquisition of the free induction decay could reduce the echo time to 100 μsec and provide a more inherent MR signal intensity from the lung parenchyma, which is usually invisible due to its short T*₂ in conventional MRI methods. The signal intensity and T*₂ was reduced as the positive end‐expiratory pressure became higher. Further, these parameters were highly correlated to the changes in lung volume (% lung expansion). The results indicated that the MR signal acquired at ultrashort echo time in the lung parenchyma represents interstitial tissue density including blood. The capability of acquiring sufficient MR signal would have implications for the direct assessment of parenchymal architecture in the lung. Therefore, ultrashort echo time imaging may have the potential to assist detection of early and localized pathological destruction of lung tissue architecture observed in various pulmonary disorders such as emphysema without incurring the risks of radiation exposure. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Gravity-dependent signal gradients on MR images of the lung in supine and prone positions: a comparison with isogravitational signal variability

PURPOSE: To investigate the tendency of proton MR signal intensity (SI) gradients to be steeper in the supine than in the prone body position, and to quantify the relation between gravity-related and isogravitational changes of SI on proton MR images of the lung. MATERIALS AND METHODS: In eight healthy volunteers, MR images were obtained in the supine and prone positions using a multiple inversion recovery turbo spin-echo (TSE) sequence. The variation in SI along the gravity-dependent direction and within isogravitational planes was measured on a pixel-by-pixel basis. Ratios of slopes were calculated for comparisons among volunteers. Comparisons of ratios were made using Fisher's exact test. Isogravitational variability was compared with the mean SI, the signal-to-noise ratio (SNR), and the image noise. RESULTS: The average ratios of slopes showed that the overall SI gradient was steeper in the supine than the prone position, with a substantial difference in the supine/prone ratios between inspiration (1.21) and expiration (1.72). In both the supine and prone positions, gravity-dependent gradients were steeper in expiration than in inspiration (P = 0.001). The SI variability along the gravitational direction was larger than the isogravitational variability. The isogravitational variability in turn was larger than the image noise but smaller than the mean SI of the MR images. CONCLUSION: Gravity-dependent gradients in proton MR SI are steeper in the supine than in the prone position. The magnitudes of these gradients were larger than the isogravitational signal variability, showing that MRI is sensitive to gravitationally induced effects.     

Prediction of postoperative pulmonary function using perfusion magnetic resonance imaging of the lung

PURPOSE: To assess semiquantitatively the regional distribution of lung perfusion using magnetic resonance (MR) perfusion imaging.MATERIALS AND METHODS: Subjects were 20 consecutive patients with bronchogenic carcinoma, who underwent MR imaging (MRI) and radionuclide (RN) perfusion scans for preoperative evaluation. Three-dimensional (3D) images of whole lungs were obtained before and 7 seconds after bolus injection of contrast material (5 ml of Gd-DTPA). Subtraction images were constructed from these dynamic images. Lung areas enhanced with the contrast material were measured and multiplied by changes in signal intensity, summed for the whole lung, and the right-to-left lung ratios were calculated. The predicted postoperative forced expiratory volume in 1 second (FEV1) was estimated using MR and RN perfusion ratios.RESULTS: The correlation between perfusion ratios derived from the MR and RN studies was excellent (r = 0.92). Sixteen of 20 patients underwent surgery, and 12 patients had postoperative pulmonary function tests. The predicted FEV1 derived from the MR perfusion ratio correlated well with the postoperative FEV1 in the 12 patients (r = 0.68).CONCLUSION: Perfusion MRI is suitable for semiquantitative evaluation of regional pulmonary perfusion.     

MR elastography of human lung parenchyma: technical development, theoretical modeling and in vivo validation

Purpose:

To develop a novel MR‐based method for visualizing the elastic properties of human lung parenchyma in vivo and to evaluate the ability of this method to resolve differences in parenchymal stiffness at different respiration states in healthy volunteers.

Materials and Methods:

A spin‐echo MR Elastography (MRE) pulse sequence was developed to provide both high shear wave motion sensitivity and short TE for improved visualization of lung parenchyma. The improved motion sensitivity of this approach was modeled and tested with phantom experiments. In vivo testing was then performed on 10 healthy volunteers at the respiratory states of residual volume (RV) and total lung capacity (TLC).

Results:

Shear wave propagation was visualized within the lungs of all volunteers and was processed to provide parenchymal shear stiffness maps for all 10 subjects. Density corrected stiffness values at TLC (1.83 ± 0.22 kPa) were higher than those at the RV (1.14 ± 0.14 kPa) with the difference being statistically significant (P < 0.0001).

Conclusion:

¹H‐based MR elastography can noninvasively measure the shear stiffness of human lung parenchyma in vivo and can quantitate the change in shear stiffness due to respiration. The values obtained were consistent with previously reported in vitro assessments of cadaver lungs. Further work is required to increase the flexibility of the current acquisition and to investigate the clinical potential of lung MRE. J. Magn. Reson. Imaging 2011;33:1351–1361. © 2011 Wiley‐Liss, Inc.     

The effect of lung volume on nodule size on CT

RATIONALE AND OBJECTIVES: We sought to determine how measures of nodule diameter and volume on computed tomography (CT) vary with changes in inspiratory level. MATERIALS AND METHODS: CT scans were performed with inspiration suspended at total lung capacity (TLC) and then at residual volume (RV) in 41 subjects, in whom 75 indeterminate lung nodules were detected. A fully automated contouring program was used to segment the lungs; followed by segmentation of all nodules and the corresponding lobe using semiautomated contouring in both TLC and RV scans. The percent changes in lung and lobar volumes between TLC and RV were correlated with percent changes in nodule diameters and volumes. RESULTS: Both nodule diameter and volume varied nonuniformly from TLC to RV-some nodules decreased in size, while others increased. There was a 16.8% mean change in absolute volume across all nodules. Stratified by size, the mean value of the absolute percent volume changes for nodules > or =5 mm and <5 mm were not significantly different (P = .26). Stratified by maximum attenuation, the mean value of the absolute percent volume changes between the TLC and RV series for noncalcified (17.7%, SD = 13.1) and completely calcified nodules (8.6% SD = 5.7) were significantly different (P < .05). CONCLUSION: Significant differences in nodule size were measured between TLC and RV scans. This has important implications for standardizing acquisition protocols in any setting where size and, more important, size change are being used for purposes of lung cancer staging, nodule characterization, or treatment response assessment.     

Dynamic computed tomography of the neonatal lung: volume calculations and validation in an animal model

PURPOSE: The purpose of this study was to evaluate and validate dynamic volume calculation by respiratory-gated multislice computed tomography (CT) in small neonatal animals. MATERIALS AND METHODS: Six mechanically ventilated newborn piglets were imaged in a multislice CT with 0.5-mm slice thickness (4:16 pitch, 0.5-second rotation time, 120 kV). The respirator was connected to the CT unit for recording the respiratory signal. Simultaneously, tidal volume was measured by the respirator and functional residual capacity (FRC) using a multiple-breath washin-washout technique (MBW) with heptafluoropropane (HFP) as tracer gas. Complete volume datasets were reconstructed throughout the respiratory cycle in increments of 10% using retrospective half-scan gating. All animals were scanned in 3 different ventilator settings. Dynamic lung volumes (tidal volumes) were calculated by means of segmentation of the lung parenchyma during the respiratory cycle using work-in-progress software. RESULTS: The mean (+/-standard deviation) FRC determined by CT was 24.7+/-8.6 mL versus 24.8+/-7.3 mL for the MBW technique. There was no statistically significant difference (P=0.555). Pearson's correlation coefficient showed a strong correlation between the data obtained with CT and that obtained with the MBW technique (r=0.886). After exclusion of one outlier, tidal volumes showed a similar correlation (r=0.837) without significant differences in the mean values (CT: 8.9+/-2.4 mL and respirator: 8.7+/-2.4 mL, P=0.566). CONCLUSION: Dynamic multislice CT with respiratory gating allows for calculation of lung volumes and may be useful for future CT applications in human neonatal lung imaging.     

Effect of the rate of gadolinium injection on magnetic resonance pulmonary perfusion imaging.

PURPOSE: To determine whether the injection rate of contrast agent affects the dynamics of enhancement of the pulmonary parenchyma on magnetic resonance (MR) pulmonary perfusion imaging. MATERIALS AND METHODS: Fifteen healthy volunteers underwent enhanced MR pulmonary perfusion imaging to evaluate the effects of different injection rates. Injection rates were 1, 3, or 5 mL/second. Regions of interest (ROIs) were chosen in the lung and aorta to analyze the change in signal intensity over time. RESULTS: As the injection rate increased, the peak enhancement occurred significantly earlier (P = 0.0012), but the peak enhancement signal-to-noise ratio (SNR) value was not affected (P = 0.25). With the 3- and 5-mL/second injection rates, images of both the pulmonary circulation and systemic circulation were obtained separately. However, with 1 mL/second, higher enhancement of the aorta was overlapped with peak enhancement of the lung tissue. CONCLUSION: The injection rate affects the enhancement profiles of the pulmonary parenchyma.     

Ultra‐short echo time (UTE) MR imaging of the lung: Comparison between normal and emphysematous lungs in mutant mice

Purpose:

To investigate the utility of ultra‐short echo time (UTE) sequence as pulmonary MRI to detect non‐uniform disruption of lung architecture that is typical of emphysema.

Materials and Methods:

MRI of the lungs was conducted with a three‐dimensional UTE sequence in transgenic mice with severe emphysema and their wild‐type littermates in a 3 Tesla clinical MR system. Measurements of the signal intensity (SI) and transverse relaxation time (T2*) of the lung parenchyma were performed with various echo times (TEs) ranging from 100 μs to 2 ms.

Results:

Much higher SI of the lung parenchyma was observed at an UTE of 100 μs compared with longer TEs. The emphysematous lungs had reduced SIs and T2* than the controls, in particular at end‐expiratory phase. The results suggested that both SI and T2* in lung parenchyma measured with the method represent fractional volume of lung tissue.

Conclusion:

The UTE imaging provided MR signal from the lung parenchyma. Moreover, the UTE sequence was sensitive to emphysematous changes and may provide a direct assessment of lung parenchyma. UTE imaging has the potential to assist detection of localized pathological destruction of lung tissue architecture in emphysema. J. Magn. Reson. Imaging 2010;32:326–333. © 2010 Wiley‐Liss, Inc.     

Running-induced changes in lung function are not altered by acute moderate hypoxia

The purpose of this study was to describe the acute changes in pulmonary function and volumes induced by running in a simulated normobaric hypoxic environment. Eleven men (X- = 26 years, 78 kg) ran 5 miles (run time approximately equal to 40 min) under normoxic (N) and hypoxic (H) conditions. A PO2 Aerobic Exerciser was used to approximate an altitude of 2286 m (PIO2 = 113 mm Hg). Impedance cardiography was used to measure cardiac output and segmental transthoracic impedance (Zo) was used to identify thoracic fluid shifts. Similar reductions in vital capacity (7%) and increases in residual volume (10%) occurred after the N and H runs with no change in total lung capacity. Flow rates breathing air or He/O2, closing volume, and closing capacity did not change. The DLCO breathhold maneuver caused a significant fall in pulmonary blood flow after running but diffusing capacity appeared to be unaffected. No changes occurred in Zo at the apex, middle, or base of the lung after either run. The hypoxic pulmonary pressor response failed to modify the pulmonary changes observed after equivalent normoxic exercise. The lung volume changes subsequent to either run were due to expiratory limitation. Previous speculation of an exercise-induced interstitial edema could not be confirmed.     

Non-invasive quantification of pancreatic exocrine function using secretin-stimulated MRCP

Our objective was to quantify water volume using magnetic resonance cholangiopancreatography (MRCP) sequences and apply this to secretin-stimulated studies with the aim of quantifying pancreatic exocrine function. A commercially available single-shot MRCP sequence was used in conjunction with a body phased-array coil and a 1.5-T MR system. Signal intensity was measured in samples of water, pancreatic, duodenal juice, and secretin-stimulated pancreatic juice. A water phantom was made and MR calculated volumes compared with known water volumes within the phantom. Changes in small intestinal volume in response to secretin were measured in a group of 11 patients with no evidence of pancreatic disease. Changes in water volume were plotted over time. The pancreatic duct diameter before and after secretin was noted and filling defects were sought. All patients also underwent an axial breath-hold T1-weighted gradient-echo sequence and the pancreatic parenchyma was evaluated for size and signal intensity. There was no difference in the signal intensity of the different juice samples. There was excellent correlation between known and calculated MRCP volumes (χ²=0.99). All patients demonstrated normal duct morphology on MRCP and normal pancreatic parenchyma on T1-weighted imaging. The mean flow rate in the patient population was 8.1±2.5 ml/s over a median of 7 min (range 5–9 min). The MRCP sequence can be used to measure water volume. Sequential MRCP measurements following secretin permitted calculation of volume change and flow rate. This should prove useful as an indicator of pancreatic exocrine function. Electronic Publication     

High-resolution three-dimensional magnetic resonance imaging of mouse lung in situ

OBJECTIVES: This study establishes a method for high-resolution isotropic magnetic resonance (MR) imaging of mouse lungs using tracheal liquid-instillation to remove MR susceptibility artifacts. METHODS: C57BL/6J mice were instilled sequentially with perfluorocarbon and phosphate-buffered saline to an airway pressure of 10, 20, or 30 cm H2O. Imaging was performed in a 7T MR scanner using a 2.5-cm Quadrature volume coil and a 3-dimensional (3D) FLASH imaging sequence. RESULTS: Liquid-instillation removed magnetic susceptibility artifacts and allowed lung structure to be viewed at an isotropic resolution of 78-90 microm. Instilled liquid and modeled lung volumes were well correlated (R = 0.92; P < 0.05) and differed by a constant tissue volume (220 +/- 92 microL). 3D image renderings allowed differences in structural dimensions (volumes and areas) to be accurately measured at each inflation pressure. CONCLUSION: These data demonstrate the efficacy of pulmonary liquid instillation for in situ high-resolution MR imaging of mouse lungs for accurate measurement of pulmonary airway, parenchymal, and vascular structures.     

Assessment of lung perfusion impairment in patients with pulmonary artery-occlusive and chronic obstructive pulmonary diseases with noncontrast electrocardiogram-gated fast-spin-echo perfusion MR imaging

PURPOSE: To evaluate the ability of noncontrast electrocardiogram (ECG)-gated fast-spin-echo (FSE) perfusion MR images for defining regional lung perfusion impairment, as compared with technetium (Tc)-99m macroaggregated albumin (MAA) single-photon emission computed tomography (SPECT) images. MATERIALS AND METHODS: After acquisition of ECG-gated multiphase FSE MR images during cardiac cycles at selected lung levels in nine healthy volunteers, 11 patients with pulmonary artery-occlusive diseases, and 15 patients with chronic obstructive pulmonary diseases (COPD), the subtracted perfusion-weighted (PW) MR images were obtained from the two-phase images of the minimum lung signal intensity (SI) during systole and the maximum SI during diastole, and were compared with SPECT images. RESULTS: ECG-gated PW images showed uniform but posture-dependent perfusion gradient in normal lungs and visualized the various sizes of perfusion defects in affected lungs. These defect sites were nearly consistent with those on SPECT images, with a significant correlation for the affected-to-unaffected perfusion contrast (r = 0.753; P < 0.0001). These MR images revealed that the pulmonary arterial blood flow in the affected areas of COPD was relatively preserved as compared with pulmonary artery-occlusive diseases, and also showed significant decrease in blood flow, even in the areas with homogeneous perfusion on SPECT images in patients with focal pulmonary emphysema. CONCLUSION: This noninvasive MR technique allows qualitative and quantitative assessment of lung perfusion, and may better characterize regional perfusion impairment in pulmonary artery-occlusive diseases and COPD.     

Demonstration of gravity-dependent lung perfusion with contrast-enhanced magnetic resonance imaging

Imaging of lung perfusion using contrast-enhanced dynamic magnetic resonance (MR) was performed in both the supine and prone positions in six volunteers. Regions of interest (ROIs) were chosen in the dependent and non-dependent portions of the right lung. The percentage increase in signal intensity (SI) and the mean slope were calculated. In the supine position, the dorsal ROI had a greater increase in SI (236.0% vs. 156.9%, P < 0.05) and a faster rise in the slope of enhancement (55.1%/sec vs. 30.1%/sec, P < 0.05) than the ventral ROI. After changing to the prone position, higher peak enhancement (234.3% vs. 177.4%, P < 0.05) and faster slopes (59.6%/sec vs. 35.3%/sec, P < 0.05) shifted to the anterior ROI. We conclude that dynamic contrast-enhanced MR imaging is sensitive to demonstrate gravitationally dependent differences in lung perfusion.