ISMRM 24th Annual Meeting & Exhibition • 07-13 May 2016 • Singapore

Combined Educational & Scientific Session: Quantitative Biomarkers of Chest Disease: Role of MRI in a Multimodality Practice?

Skill Level: Intermediate

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

Thursday 12 May 2016

This two hour course will demonstrate the application of MRI methodologies against the other modalities currently used for the diagnosis of COPD, lung cancer and pulmonary vascular disease. The MRI presentations will highlight both non-contrast and contrast-enhanced methods to obtain morphologic, functional and angiographic information, towards enabling clinicians both a choice and to optimise the information that MRI may have to offer over the standard approaches using CT and PET 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 metods in conjunction with other imaging modalities.

Educational Objectives
Upon completion of 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; and
  • Illustrate novel applications of MRI for diagnosis of thoracic disease.

Moderators: Tally Altes, Jim Wild
Chronic Obstructive Pulmonary Disease: What Does MRI Offer Compared to CT? - Permission Withheld
Yoshiharu Ohno1,2
1Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan, 2Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan
This lecture covers 1) state of the art pulmonary MR techniques for morphological and functional assessment, 2) its clinical applications in COPD and 3) future direction of pulmonary functional MR imaging.  We believe that the findings of further basic studies as well as clinical applications of this new technique will validate the real significance of pulmonary MRI for the future of COPD assessment and its usefulness for diagnostic radiology and pulmonary medicine.

Comparison of 3He and 129Xe MRI for Evaluation of Lung Microstructure and Ventilation in Healthy Volunteers and COPD Patients at 1.5 T
Neil James Stewart1, Ho-Fung Chan1, Guilhem Jean Collier1, Felix Clemens Horn1, Graham Norquay1, Juan Parra-Robles1, Denise Yates2, Paul Collini3, Rod Lawson4, Helen Marshall1, and Jim Michael Wild1
1Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom, 2Novartis Institutes for Biomedical Research, Cambridge, MA, United States, 3Academic Unit of Immunology and Infectious Diseases, University of Sheffield, Sheffield, United Kingdom, 4Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
3He and 129Xe ventilation and diffusion-weighted MR images were acquired at 1.5T in healthy volunteers and, at multiple time-points, in COPD patients in order to compare the functional sensitivity and assess the repeatability of MR-derived measures of ventilated volume (VV%) and apparent diffusion coefficient (ADC) from each of the two gases. ADC values from both nuclei exhibited excellent agreement and significant correlations with pulmonary function tests (PFTs) (p<0.001), whilst VV% values were less comparable. ADC and VV% metrics derived from both nuclei were also shown to be repeatable, with coefficient of variation values similar to those of PFTs.

Discrimination of COPD Patients, Healthy Smokers and Age-matched Normals with Hyperpolarized Xenon-129 MR Spectroscopy
Kai Ruppert1,2, Kun Qing2, Talissa A. Altes2,3, and John P. Mugler III2
1Cincinnati Children's Hospital, Cincinnati, OH, United States, 2University of Virginia, Charlottesville, VA, United States, 3University of Missouri, Columbia, MO, United States
Chemical Shift Saturation Recovery (CSSR) MR Spectroscopy permits the in-vivo measurement of the alveolar septal wall thickness (SWT) by quantifying the uptake of hyperpolarized xenon-129 by lung parenchyma on a millisecond timescale. In this study we correlated the SWT with apparent diffusion coefficient (ADC) measurements in patients with chronic-obstructive pulmonary disease (COPD), healthy smokers and age-matched normals. While the ADC measurements and conventional pulmonary function tests could detect statistically significant differences between the COPD and non-COPD subjects, only CSSR spectroscopy could, in addition, discriminate healthy smokers from the age-matched normals.

Imaging Lung Cancer: MRI, PET or Both?
Nina F Schwenzer1
1Dept. of Radiology, University Hospital Tübingen
Whereas CT is mainly used for local staging, PET/CT offers additional information about tumor metabolism and distant metastases. Although MRI is still limited in the detection of small lung nodules it offers additional functional information about diffusion and perfusion of tumor masses. In the framework of personalized medicine imaging has evolved from localizing disease towards prognostic and predictive biomarkers as well as treatment response. Hybrid modalities (PET/CT and PET/MRI) have the potential to offer a broad variety of parameters (i.e. textural parameters and multiparametric information) which can be used for further analyses such as radiomics or radiogenomics.

A comparison between free-breathing radial VIBE in 3T MR and endoscopic ultrasound for preoperative T staging of potentially resectable esophageal cancer with histopathological correlation
Jinrong Qu1,2, Hui Liu3, Zhaoqi Wang2, Ihab R Kamel4, Kiefer Berthold5, Robert Grimm5,6, Jianjun Qin7, and Hailiang Li1
1Radiology, Henan Cancer Hospital, Zhengzhou, China, People's Republic of, 2Radiology, the affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China, People's Republic of, 3MR Collaboration, Siemens Healthcare, Shanghai, China, People's Republic of, 4Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States, 5MR Pre-development, Siemens Healthcare, Erlangen, Germany, 6Erlangen, Germany, 7Thoracic surgery, Henan Cancer Hospital, Zhengzhou, China, People's Republic of
Contrast-enhanced free-breathing r-VIBE is superior to EUS in T staging of potentially resectable EC, not only for T1 and T2, but also for T3 and T4.

Evaluating tumor biology of lung adenocarcinoma: multimodality-multiparametric approach - Permission Withheld
Ho Yun Lee1, Seong-Yoon Yun Ryu1, Ji Yun Jeong2, Kyung Soo Lee1, and Young Mog Shim3
1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of, 2Pathology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea, Republic of, 3Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of
Our purpose is to investigate tumor biology of lung adenocarcinoma such as tumor cellularity, characteristics of invasion, histologic subtype, and tumor differentiation using multimodality and multiparametric imaging approach.

SUVmax was significantly greater in the solid subtype and poorly differentiated tumor when compared to other subtypes or differentiations. f tended to increase as tumor differentiation changed more poorly, whereas D and D * showed a trend of decrease in poorly differentiated tumors. Tumor size, the size of the solid portion within the tumor, and ADC showed significant correlation with extent of tumor invasion. SUVmax showed significant correlation with tumor cellularity.

Imaging of Pulmonary Vascular Disease: Can MRI Replace CT?
Mark Schiebler1
MRI methods have become increasingly relied upon by pulmonary medicine and cardiovascular medicine to help diagnose pulmonary hypertension and monitor the effects of therapy on the right ventricle. Recently selected sites have begun using MRA for the primary diagnosis of pulmonary embolism. This symposium will discuss the highlights and difficulties in the use of MRI for the diagnosis and follow up of pulmonary vascular diseases.

Quantification of lung parenchyma perfusion in small animal imaging with Flow-sensitive Alternating Inversion Recovery (FAIR) 2D UTE
Marta Tibiletti1, Andrea Bianchi2, Detlef Stiller2, and Volker Rasche1,3
1Core Facility Small Animal MRI, Ulm University, Ulm, Germany, 2Target Discovery Research, In-vivo imaging laboratory, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany, 3Department of Internal Medicine II, Ulm University, Ulm, Germany
Functional information of the lung is of great importance for staging and monitoring lung disease. In this context, perfusion is conventionally addressed by systemic injection of contrast agent (CA) with subsequent quantitatively monitoring of the wash-in of the CA, or more frequently qualitatively assessment of the lung intensity pattern during the CA steady-state phase. Especially in small animal imaging, quantification of the respective perfusion dynamics is difficult due to the rather coarse temporal resolution achievable. In this work, the application of the non-invasive FAIR technique is combined with a 2D UTE readout thus enabling non-invasive quantification of lung perfusion.

Comparison of Pulmonary Magnetic Resonance Angiography (MRA) and free-breathing Ultra short time to echo (UTE) for the comprehensive evaluation of the vascular and non-vascular anatomy of the chest
Julie A Bauml1, Mark L Schiebler1, Christopher J Francois1, Kevin M Johnson2, and Scott K Nagle1,2,3
1Radiology, University of Wisconsin Madison, Madison, WI, United States, 2Medical Physics, University of Wisconsin Madison, Madison, WI, United States, 3Pediatrics, University of Wisconsin Madison, Madison, WI, United States
MR imaging of the chest is challenging due to the low proton density, the short T2* of the lungs and cardiorespiratory motion. Many patients suspected of pulmonary embolism are short of breath, which can limit the utility of breath-held techniques. Free-breathing ultrashort echo time (UTE) approaches (TE < 0.10 ms) help to overcome some of these difficulties. In this prospective pilot clinical study, we demonstrate that UTE provides better overall depiction of chest structures when compared to MRA. We conclude that UTE is complementary to MRA of the chest in the analysis of both vascular and non-vascular thoracic structures.

Adjournment & Meet the Teachers

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