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MR imaging of pulmonary lung nodules during one lung flooding: first morphological evaluation using an ex vivo human lung model

Abstract

Objectives

Magnetic resonance imaging in pulmonary oncology is limited because of unfavourable physical and physiological conditions in ventilated lung. Previous work showed operability of One Lung Flooding using saline in vivo in MR units, and that valuable conditions for ultrasound and thermal-based interventions exist. Therefore, this study investigates the morphological details of human lung during Lung Flooding to evaluate its further value focusing on MR-guided interventions.

Materials and methods

MR imaging was performed on 20 human lung lobes containing lung cancer and metastases. Lobes were intraoperatively flooded with saline and imaged using T1w Gradient Echo and T2 Spin Echo sequences at 1.5 T. Additionally, six patients received pre-operative MRI.

Results

During lung flooding, all lung tumours and metastases were visualized and clearly demarked from the surrounding lung parenchyma. The tumour mass appeared hyperintense in T1w and hypointense in T2w MR imaging. Intra-pulmonary bronchial structures were well differentiated in T2w and calcification in T1w MR sequences.

Conclusion

Superior conditions with new features of lung MRI were found during lung flooding with an unrestricted visualization of malignant nodules and clear demarcation of intra-pulmonary structures. This could lead to new applications of MR-based pulmonary interventions such as laser or focused ultrasound-based thermal ablations.

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Abbreviations

ADC:

Adeno carcinoma

BAC:

Bronco alveolar carcinoma

CNR:

Contrast-to-noise ratio

CRC:

Colorectal carcinoma

CT:

Computer tomography

FA:

Flip angle

FIO2 :

Fraction inspired oxygen

FUS:

Focused ultrasound surgery

GRE:

Gradient echo

HASTE:

Half-Fourier acquisition single-shot turbo spin echo sequence

HIFU:

High-intensity focused ultrasound

IDC:

Invasive mammary ductal carcinoma

LC:

Lung cancer

LCC:

Large-cell carcinoid

LUL:

Left upper lobe

LLL:

Left lower lobe

LMTS:

Lung metastasis

MIP:

Maximum intensity projection

MRI:

Magnet resonance imaging

NSCLC:

Non-small cell lung cancer

OLF:

One lung flooding

PET:

Positron emission tomography

PDC:

Pancreatic ductal carcinoma

PTFE:

Polytetrafluoroethylene

PFC:

PerFluoroCarbonate liquid

RCC:

Renal cell carcinoma

PP:

Polypropylene

RML:

Right middle lobe

RUL:

Right upper lobe

RLL:

Right lower lobe

ROI:

Region of interest

SAR:

Specific absorption rate

SQC:

Squamous carcinoma

TE:

Echo time

TR:

Repetition time

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Author information

FW and TGL developed the study design and conception. TGL performed clinical selection of cases and performed surgical resection. FW performed ex vivo lung preparation. Acquisition of MR data and statistics were performed by JB and FW. FW, JB, and TGL were drafting the manuscript.

Correspondence to Frank Wolfram.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests, neither financial nor non-financial. This research was supported by the FUS Foundation, Charlottesville, VA, USA (FUS325) and the SRH Waldklinikum Gera, Germany.

Ethic approval

All surgical procedures were performed at the clinic for thoracic and vascular surgery of the SRH Wald-Klinikum Gera, Germany. The use of human tissue for this study was approved by the ethics committee of the Medical Association of Thuringia (TLLV) and patients were informed prior to surgery. This article does not contain any studies with animals performed by any of the authors.

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Appendix

Appendix

$$ {\text{\% Contrast}} = { }\frac{{I_{{\text{T}}} - I_{{\text{L}}} }}{{I_{{\text{L}}} }}{ }100. $$
(1)

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Wolfram, F., Böttcher, J. & Lesser, T.G. MR imaging of pulmonary lung nodules during one lung flooding: first morphological evaluation using an ex vivo human lung model. Magn Reson Mater Phy (2020). https://doi.org/10.1007/s10334-020-00826-8

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Keywords

  • MRI
  • One lung flooding
  • Lung imaging
  • Lung cancer
  • MR intervention
  • HIFU