pre-scan preparation and coaching of subject for 129xe mri of lung ventilation

폐 기능을 연구하기 위한 과분극 129Xe MRI를 위한 표준화된 워크플로우

Hyperpolarized 129Xe MRI is an exciting tool for non-invasive, spatially-resolved characterization and quantification of specific aspects of pulmonary function1,2,3. Acquisition and reconstruction approaches similar to those used in anatomical proton MRI yield images of inhaled 129Xe in the lungs, permitting visualization of non-ventilated lung regions and region-resolved quantification of ventilation distribution4,5,6,7,8. More advanced pulse sequence and analysis techniques yield further complementary information, including quantification of gas-exchange efficacy between alveoli and pulmonary capillaries via spectroscopic MRI9,10,11,12,13 and characterization of alveolar microstructure integrity via diffusion-weighted MRI14,15,16.
Inhaled 129Xe has been proven safe and tolerable in adult and pediatric subjects, including those with pulmonary disease17,18. Measurements of lung function derived from 129Xe MRI have shown sensitivity to structural and functional alterations in many pulmonary disease contexts, including chronic obstructive pulmonary disease6,10,19, cystic fibrosis20,21,22, idiopathic pulmonary fibrosis23,24,25, and asthma7,10,26. Given the high safety and tolerability of 129Xe MRI, the lack of ionizing radiation in MRI compared with other common imaging approaches, and the high reproducibility of 129Xe MRI results27,28, 129Xe MRI holds significant promise, in particular for precise serial monitoring of individuals receiving a time course of therapy for chronic pulmonary disease.
The safety and clinical promise of 129Xe MRI have led to its FDA approval in December 2022 for lung ventilation imaging in persons aged 12 years and older29. Given this, it is anticipated that the number of research and clinical sites capable of performing 129Xe MRI (currently ~20 worldwide) will increase significantly over the coming years. As 129Xe MRI spreads to new institutions, it is important that robust methodological resources exist to allow sites to build out clinically relevant 129Xe MRI techniques quickly and to perform scans and generate results that are closely comparable with those of existing sites.
In this work, we will outline the current best practices for human hyperpolarized 129Xe MRI of lung ventilation, as agreed upon by member institutions of the 129Xe MRI Clinical Trials Consortium (Xe MRI CTC) and summarized in a recent position paper30. Topics will include the preparation of tailored pulse sequences ideal for a complete 129Xe MRI workflow, preparation, and administration of hyperpolarized 129Xe gas, an optimized workflow for human 129Xe MRI sessions, and best practices for monitoring subject safety and comfort during MRI sessions.

저자 스포트라이트: 129Xe MRI를 사용한 폐 영상 발전을 위한 표준화 및 모범 사례

폐 환기의 과분극 129Xe 자기 공명 이미지 획득

Our research seeks to establish Xenon MRI as a clinical tool for characterizing lung function. Xenon MRI allows us to directly visualize ventilation defects in patients with obstructive lung diseases like COPD, asthma, and cystic fibrosis. It offers information that can't be obtained from standard MRI and pulmonary function test.Xenon MRI was recently approved by the FDA for clinical evaluation of lung ventilation. This represents a culmination of a huge amount of effort by the people in our field and it's an exciting opportunity to show how Xenon MRI can improve patient care and outcomes in pulmonary disease. Xenon MRI is still a relatively new family of techniques, and standardization is still an ongoing process.This protocol distills the existing standards for Xenon ventilation MRI into a form that we hope will be useful to research in clinical sites who are trying to perform these scans for the first time. Common clinical readouts of lung function, like pulmonary function tests, only give a single number for the entire lung with no spatial information included. Xenon MRI can make regional assessments of several aspects of lung health and function, which we believe will be very useful in the clinic.Only a few institutions are currently performing Xenon MRI, but we expect there will be many more sites soon considering the recent FDA approval. We hope that this Xenon ventilation MRI protocol will serve as a blueprint for new sites and help em to ramp up their Xenon MRI operations more quickly.

폐 환기의 129Xe MRI를 위한 피험자의 사전 스캔 준비 및 코칭

시작하려면 피험자가 스캐너 밖에서 연습할 수 있도록 공기가 들어 있는 하나 이상의 테들라 백을 준비합니다. 실제 연구 중에 백에서 흡입할 크세논 및 완충 가스의 총 부피와 일치하는 공기량을 사용하십시오. 숨참기 스캔 중에 피험자가 착용할 코 클립을 준비하고 숨을 참기 시작하기 전에 코 클립을 피사체의 코에 맞춥니다.피험자를 코칭하기 위해 각 시도에 대해 하나의 공기 충전 백을 사용하십시오. 가방을 만들기 전에 피험자에게 정기적으로 여러 번 숨을 들이쉬고 내쉬도록 요청하십시오. 시술 도중, 피험자의 흉부를 관찰하여 지시 사항을 제대로 이행하고 있는지 확인한다.다음으로, 테들라 백에 부착된 튜브를 피험자의 입에 넣습니다. 피험자가 숨을 들이쉴 수 있도록 가방을 잡고 밸브를 엽니다. 피험자에게 숨을 들이쉬라고 한 다음, 피험자에게 숨을 참으라고 요청하십시오.연습할 때 일반적인 크세논 129 스캔이 경과하는 데 필요한 대략적인 시간인 10-15초까지 기다립니다. 그런 다음 피험자에게 이 시점에서 숨을 내쉬고 숨을 쉬도록 요청하십시오. 피험자에게 심호흡을 여러 번 하고 내쉬도록 지도하여 폐에서 크세논 129를 더 빨리 제거하고 정상 산소 포화도 수준으로 더 빨리 복귀하도록 한다.피험자가 지시를 안정적으로 수행할 수 있는지 확인하고 연습 실행 중에 그렇게 할 수 없는 피험자를 제외하는 것을 고려하십시오.

Research

JoVE Journal

Medicine

Pre-Scan Preparation and Coaching of Subject for 129Xe MRI of Lung Ventilation

Acquiring Hyperpolarized 129Xe Magnetic Resonance Images of Lung Ventilation

Hyperpolarized 129Xe MRI comprises a unique array of structural and functional lung imaging techniques. Technique standardization across sites is ...

연구

의학

Preparation of MRI Scanner Room and Subject Positioning for 129Xe MRI of Lung Ventilation

폐 환기의 129Xe MRI를 위한 MRI 스캐너 룸 및 피험자 위치 지정 준비

Performing 129Xe MRI Scan of Lung Ventilation to Assess Pulmonary Function

폐 기능을 평가하기 위해 폐 환기의 129Xe MRI 스캔 수행