ISMRM 23rd Annual Meeting & Exhibition • 30 May - 05 June 2015 • Toronto, Ontario, Canada

Combined Educational & Scientific Session

Quantitative Biomarkers of Chest Disease: the Role of MRI in a Multimodality Practice


ORGANIZERS: Lorenzo Mannelli, M.D., Ph.D., Ivan Pedrosa, M.D., Scott B. Reeder, M.D., Ph.D. & Edwin J.R. van Beek, M.D., Ph.D., M.Ed., FRCR

Thursday 4 June 2015

This two hour course will showcase MRI methodologies and compare them with the currently used methods towards diagnosis of COPD, lung cancer and pulmonary vascular disease. The MRI techniques will demonstrate the value of standard non-contrast methods, the introduction of Gadolinium for perfusion and angiography and the use of inhaled contrast agents, including hyperpolarized noble gases, towards enabling clinicians both a choice and to optimize the morphological and functional information that MRI may have to offer over the standard approaches using CT and PET-CT imaging.

Target Audience
This course is aimed at radiologists, imaging scientists and MR technologists who wish to review the state-of-art MRI methods for diagnosis of thoracic disorders, and to learn about the potential use of these methods in conjunction with other imaging modalities.

Educational Objectives
As a result of attending this course, participants should be able to:
• Distinguish the various modalities used for clinical lung disease management;
• Convey the role of MRI within the diagnostic tools available;
• Illustrate novel applications of MRI for diagnosis of thoracic disease.

Moderators: Mitchell S. Albert, Ph.D., Jim M. Wild, Ph.D.
16:00   Introduction
16:03   Imaging of Chronic Obstructive Pulmonary Disease (COPD): MRI vs. CT
Grace Parraga, Ph.D.
16:18 0977.   
Tobacco smoke exposure reduces lung T1 in COPD patients
Daniel F Alamidi1, Alexandra R Morgan2,3, Penny L Hubbard Cristinacce3, Lars H Nordenmark4, Paul D Hockings4,5, Kerstin M Lagerstrand1, Simon S Young6, Josephine H Naish3, John C Waterton3,6, Lars E Olsson7, and Geoff J.M Parker2,3
1Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden, 2Bioxydyn Ltd, Manchester, United Kingdom, 3Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom, 4AstraZeneca R&D, Mölndal, Sweden, 5Chalmers University of Technology, MedTech West, Gothenburg, Sweden,6AstraZeneca R&D, Alderley Park, United Kingdom, 7Department of Medical Physics, Lund University, Lund, Sweden

Cigarette smoking is the primary cause of COPD. MRI may improve disease characterization with new lung function assessments where often T1 measurements are included. We investigated whether tobacco smoke exposure affects lung T1 in COPD patients. Free breathing T1 measurements were performed in 23 COPD smokers and 11 healthy age-matched non-smokers. A strong correlation between smoke exposure and T1 was observed, that may be due to smoking-induced lung pathology or the presence of impurities in the lung. Consequently, the smoking history of a patient is an essential factor when T1 is used as a readout in studies of lung diseases.

16:30 0978.   Quantitative Evaluation of Emphysema in COPD Patients via CT and UTE MR Image Analysis
David J. Roach1,2, Yannick Crémillieux3, Suraj Serai4, Robert Thomen1,5, Sadia Benzaquen6, and Jason C. Woods1,2
1Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States, 2Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States, 3Centre de Résonance Magnétique des Systèmes Biologiques, Université de Bordeaux, Bordeaux, France, 4Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States, 5Physics, Washington University in St. Louis, St. Louis, Missouri, United States, 6University of Cincinnati College of Medicine, Cincinnati, Ohio, United States

We investigated whether lung ultrashort echo-time (UTE) MRI could generate quantitative imaging biomarkers for patients diagnosed with chronic obstructive pulmonary disease (COPD). COPD patients and control subjects were imaged via UTE MRI; these images were compared to chest CTs, both qualitatively and quantitatively. UTE MRI signal intensity was lower in the COPD group (p<0.001) and emphysema index (EI) was higher (p<0.006). EI of MRI correlated well with EI calculated via CT (R2=0.82). This study demonstrates that UTE MRI can be employed to quantify tissue destruction in emphysema patients, and can potentially assess COPD extent and severity.

16:42   Imaging of Lung Cancer: MRI vs. PET-CT
Edwin J. van Beek, M.D., Ph.D.
16:57 0979.   Diffusion-Weighted MRI (DWI) with Fast Advanced Spin-Echo Sequence: Comparison of N-Stage Assessment with DWI with Echo-Planar Imaging and FDG-PET/CT in Non-Small Cell Lung Cancer Patients - permission withheld
Yoshiharu Ohno1,2, Shinichiro Seki3, Hisanobu Koyama3, Takeshi Yoshikawa1,2, Sumiaki Matsumoto1,2, Yoshiko Ueno3, Katsusuke Kyotani4, Yoshimori Kassai5, Masao Yui5, Hitoshi Yamagata5, and Kazuro Sugimura3
1Advanced Biomedical Imaging Research, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan, 2Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan, 3Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan, 4Center for Radiology and Radiation Oncology, Kobe University Hospital, KObe, Hyogo, Japan, 5Toshiba Medical Systems Corporation, Tochigi, Japan

Clinicians are frequently asked to evaluate the accurate N-stage because it is essential for choosing the appropriate surgical treatment for NSCLC patients. We hypothesized that diagnostic performance for N-stage assessment on DWI with FASE sequence had higher than that on DWI with EPI sequence and FDG-PET/CT in NSCLC patients. The purpose of this study was directly compare the capability for N-stage assessment of DWI using an FASE sequence (FASE-DWI) with that of DWI using the EPI sequence (EPI-DWI) and PET/CT in NSCLC patients.

17:09 0980.   Detection of Pulmonary Nodules by Ultra-short TE Sequences in Oncology Patients using a PET/MR System
Nicholas Scott Burris1, Peder Larson1, Kevin M Johnson2, Michael D Hope3, Spencer Behr3, and Thomas A Hope3
1Radiology, University of California San Francisco, San Francisco, CA, United States, 2University of Wisconsin–Madison, WI, United States, 3University of California San Francisco, CA, United States

Using an investigational 3T PET/MR system, 3D ultra-short TE (UTE) and zero TE sequences (ZTE) were used to evaluate pulmonary nodules in 5 oncology patients undergoing clinical PET/CT, with CT considered the gold-standard. UTE was highly sensitive for nodules ≥8mm (95%) and moderately sensitive for smaller nodules between 4-6mm in size (71%). ZTE was less sensitive for >8mm (51%) and nodules 4-6mm (42%). PET-avid nodules were detected at higher rates by both sequences. Preliminary results of UTE for pulmonary nodule detection are promising, and UTE may offer an alterative approach to PET/MR evaluation of oncology patients in the future.

17:21   Imaging of Pulmonary Vascular Disease: MRI vs. CT
Jim M. Wild, Ph.D.
17:36 0981.   Pulmonary Perfusion Phase Imaging using Self-gated Fourier Decomposition MRI
Daniel Stäb1,2, Simon Veldhoen2, Andre Fischer2, Stefan Weick3,4, Andreas Max Weng2, Clemens Wirth2, Thorsten A Bley2, and Herbert Köstler2
1The Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia, 2Institute of Radiology, University of Würzburg, Würzburg, Bavaria, Germany, 3Department of Radiation Oncology, University of Würzburg, Würzburg, Bavaria, Germany, 4Department of Experimental Physics 5, University of Würzburg, Würzburg, Bavaria, Germany

Fourier Decomposition MRI facilitates the reconstruction of perfusion weighted images from a time series of morphologic lung images. We demonstrate that perfusion-weighted data obtained by SENCEFUL, a Fourier Decomposition based method employing respiratory and cardiac self-navigation for the calculation of the image series, carries also information about the phase of the pulmonary perfusion. Pulmonary perfusion phase maps can be calculated which may contain diagnostically valuable information and might be helpful for refining the diagnostic information given by the perfusion maps. Examples of one volunteer and one patient with cystic fibrosis are given.

17:48 0982.   MR Imaging, targeting and characterization of pulmonary fibrosis using intra-tracheal administration of Gadolinium based nanoparticles
Nawal Tassali1, Andrea Bianchi1, François Lux2, Gerard Raffard1, Stephane Sanchez1, Olivier Tillement2, and Yannick Cremillieux1
1Centre de Resonance Magnetique des Systemes Biologiques, CNRS UMR 5536, Universite de Bordeaux, Bordeaux, France, 2Institut Lumière Matière, CNRS UMR 5306, Universite Claude Bernard, Domaine Scientifique de la Doua, Villeurbane, France

Pulmonary fibrosis is a lethal disease and models are critical to develop diagnostic approaches. We investigated here whether MRI combined with gadolinium-based nanoparticles can help visualize and characterize lung fibrosis in mice. Gd-based contrast agent was intra-tracheally administered in bleomycin-treated and in healthy mice and UTE-MRI images were acquired. Signal enhancement (SE), contrast-to-noise ratio (CNR), and pharmacokinetics of the nanoparticles in mice lungs were quantified. A SE of 120%, a twofold increase of CNR and a longer elimination time constant of the nanoparticles were obtained in bleomycin-treated mice. These findings demonstrate new imaging protocols for detecting and characterizing fibrotic tissues.

18:00   Adjournment & Meet the Teachers