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Asthma

  • David G. Mummy
  • Wei Zha
  • Ronald L. Sorkness
  • Sean B. FainEmail author
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

Asthma is a disease with significant clinical impact and growing incidence, particularly in children. It is characterized by a complex interplay of environmental and genetic factors that affect airway structure and function, leading to recurrent and spatially heterogeneous airway obstruction. Conventional methods for evaluating lung function using spirometry and plethysmography are neither capable of assessing regional obstruction nor the regional dynamics of airway obstruction. MRI methods that exploit gas contrast agents have emerged as an attractive approach for evaluating heterogeneity and mechanisms of airway obstruction in the asthmatic lung without requiring ionizing radiation. Specific gas agents that show promise include hyperpolarized gases, oxygen enhancement, and fluorinated gases. Hyperpolarized (HP) helium-3 (3He) and xenon-129 (129Xe) MRI techniques in particular have enabled visualization of the airspaces of the lungs, including the large airways and lung parenchyma, during breath-held and dynamic respiratory maneuvers. This method has been applied to study disease progression, response to therapy, and asthma phenotypes. Diffusion-weighted MRI may be used to measure the dimensions of small airways and alveolar microstructure, allowing for the determination of structural changes associated with disease progression. Ultrashort echo time (UTE) MRI, an emerging technique, allows for rapid 3D acquisition of lung images at a resolution approaching that of CT. Patterns of poor ventilation observed on HP MRI identify regions of obstruction that may reflect underlying structural changes in the airway such as remodeling or chronic inflammation. HP MRI has also been used in conjunction with CT to perform image-guided sampling of airways leading to areas of poor ventilation in the lung, enabling the development of biomarkers of disease. These multimodality comparisons between CT and HP MRI may help evaluate regional structure-function relationships to assess causal mechanisms of disease and response to therapy and potentially to develop new disease phenotypes associated with clinical outcomes and healthcare utilization.

Keywords

Polarized gas Fast MRI Airway obstruction Ventilation Asthma Asthma phenotypes 

Glossary of Acronyms

%DLCO

Percent predicted diffusing capacity of the lung for carbon monoxide

ACOS

Asthma-COPD overlap syndrome

ADC

Apparent diffusion coefficient

BAL

Bronchoalveolar lavage

BT

Bronchial thermoplasty

CF

Cystic fibrosis

COPD

Chronic obstructive pulmonary disease

DWI

Diffusion-weighted imaging

FEV1

Forced expiratory volume in 1 s

FID

Free induction decay

FLASH

Fast low-angle shot

FRC

Functional residual capacity

FSE

Fast spin echo

FVC

Forced vital capacity

GRE

Gradient-recalled echo

HP

Hyperpolarized

IOS

Impulse oscillometry

IPF

Idiopathic pulmonary fibrosis

MDCT

Multi-detector computed tomography

OE

Oxygen enhanced

OTF

Oxygen transfer function

PET

Positron emission tomography

PFT

Pulmonary function test

PSE

Percent signal enhancement

qCT

Quantitative CT

RF

Radio frequency

RV

Residual volume

SEOP

Spin-exchange optical pumping

SNR

Signal-to-noise ratio

SPECT

Single-photon emission computed tomography

SSFSE

Single shot fast spin echo

SV

Specific Ventilation

TLC

Total lung capacity

UTE

Ultrashort echo time

V/Q

Ventilation/perfusion

VDP

Ventilation defect percent

Xrms

Chi root-mean-square acinar dimension

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • David G. Mummy
    • 1
  • Wei Zha
    • 2
  • Ronald L. Sorkness
    • 3
  • Sean B. Fain
    • 4
    • 5
    Email author
  1. 1.Department of Biomedical EngineeringUniversity of WisconsinMadisonUSA
  2. 2.Department of Medical PhysicsUniversity of WisconsinMadisonUSA
  3. 3.School of Pharmacy and Morris Institute for Respiratory ResearchUniversity of WisconsinMadisonUSA
  4. 4.Departments of Medical Physics, Radiology, and Biomedical EngineeringUniversity of WisconsinMadisonUSA
  5. 5.2488 Wisconsin Institutes for Medical Research (WIMR)University of WisconsinMadisonUSA

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