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INVEST RADIO:使用MRI评估肺淋巴管肌瘤病患者的肺部结构和区域功能

2022-07-19 shaosai MedSci原创

淋巴管肌瘤病的特点是肺部平滑肌样细胞的增生,导致含气囊肿、复发性气胸和呼吸困难。随着疾病的发展,肺实质的破坏导致1秒内强制呼气量(FEV1)的下降和一氧化碳扩散能力(DLCO)的降低。

淋巴管瘤病(LAM)是一种罕见的肺部囊性疾病,绝经前妇女中较为常见。淋巴管瘤病的特点是肺部平滑肌样细胞的增生,导致含气囊肿、复发性气胸和呼吸困难。随着疾病的发展,肺实质的破坏导致1秒内强制呼气量(FEV1)的下降和一氧化碳扩散能力(DLCO)的降低。FEV1已被用作治疗性临床试验的主要终点,FEV1和DLCO的下降率是治疗决策的重要指标。

现阶段临床上通常使用胸部X线和CT成像评估LAM的肺部情况其中CT图像中得出的肺部囊肿百分比("囊肿评分")是联邦食品和药物管理局批准的量化疾病程度的成像标志物。相反,与CT相比,磁共振成像(MRI)往往对肺部解剖结构的成像分辨率较低,但可提供区域肺功能信息。磁共振成像技术包括超极化气体成像、氧增强成像和基于傅里叶分解的方法,已被用于评估区域通气和灌注以确定一些肺部疾病的功能缺陷。

近日,发表在INVEST RADIO杂志的一项研究评估了一种新型的0.55T MRI系统在LAM患者中进行成像和功能评估的应用,并比较了MRI测量值与整体PFTs之间的关系。

本研究在一个低场(0.55T)MRI系统上对65名LAM患者进行了肺部成像。T2加权成像用于评估肺部形态,并得出囊肿评分,即囊肿占据肺实质的百分比。使用氧增强MRI评估区域肺功能,采用屏气式超短回波时间成像和吸入100%氧气作为T1缩短的MR造影剂。吸入氧气后的信号增强百分比和表示功能缺陷的低氧增强的肺部百分比的测量与2天内进行的全球肺功能测试测量相关联。 

本研究能够使用T2加权MRI对该患者群体的囊肿异常进行成像,并计算出囊肿评分,与CT扫描测量结果密切相关(R = 0.86,P < 0.0001)。氧增强图显示了LAM患者肺功能的区域缺陷。在个别患者中观察到囊肿之间氧强化的异质性。低增强区域的百分比与FEV1(R = -0.37,P = 0.007)、FEV1/FVC(R = -0.33,P = 0.02)和囊肿评分(R = 0.40,P = 0.02)显示出明显的相关性。常氧和高氧之间测量的动脉血ΔT1,作为血液中溶解氧的代用指标,与DLCO相关(R = -0.28,P = 0.03)。 

 
图 氧增强功能肺部MRI产生的百分比信号增强图。色标代表吸入100%氧气后肺部组织内的信号增强百分比(PSE)。根据FEV1、DLCO和CT图像,分为中度(A)和重度(B)。增强的区域变化表明了局部功能障碍

本研究应用定制的高性能0.55T MRI系统对LAM患者进行了T2加权的肺部形态成像和氧增强的肺部功能成像,区域氧增强图可显示LAM患者群体的功能受损,其与PFT测量相关。

 

原文出处:

Ipshita Bhattacharya,Rajiv Ramasawmy,Ahsan Javed,et al.Assessment of Lung Structure and Regional Function Using 0.55 T MRI in Patients With Lymphangioleiomyomatosis.DOI:10.1097/RLI.0000000000000832

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    2022-08-31 一叶知秋
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    2022-07-20 amyloid

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