patient preparation and subject training for hyperpolarized xenon mri

Beoordeling van de longfunctie met hypergepolariseerde Xenon-129 MRI

Hyperpolarized Xenon-129 (HXe) magnetic resonance imaging (MRI)1 is a technique that offers unique insights into lung structure, function, and gas exchange processes. By dramatically amplifying the magnetization of Xenon gas through spin-exchange optical pumping, HXe MRI achieves an order-of-magnitude improvement in signal-to-noise ratio compared to thermally polarized Xenon MRI2,3,4,5,6. This hyperpolarization enables the direct visualization and quantification of Xenon gas uptake into lung tissue and blood, which would otherwise be undetectable with conventional thermally polarized MRI7.
Chemical shift saturation recovery (CSSR) MR spectroscopy8,9,10,11,12,13 has proven to be one of the most valuable HXe MRI techniques. CSSR involves selectively saturating the magnetization of Xenon dissolved in lung tissue and blood using frequency-specific radiofrequency (RF) pulses. The subsequent recovery of the dissolved-phase (DP) signal as it exchanges with fresh hyperpolarized Xenon gas in the airspaces on a timescale of ms offers important functional information about the lung parenchyma.
Since its development in the early 2000s, the techniques behind CSSR spectroscopy have been progressively refined14,15,16,17,18,19,20,21,22,23. Further, advances in modeling Xenon uptake curves have enabled the extraction of specific physiological parameters, such as alveolar wall thickness and pulmonary transit times10,24,25,26. Studies have shown CSSR&#39;s sensitivity to subtle changes in lung microstructure and gas exchange efficiency in the form of pulmonary abnormalities found in clinically healthy smokers27, as well as in a range of lung diseases, including chronic obstructive pulmonary disease (COPD)18,27,28, fibrosis29, and radiation-induced lung injury30,31. CSSR spectroscopy has also been demonstrated to be sensitive to detect oscillations in the DP signal corresponding to pulsatile blood flow during the cardiac cycle32.
While significant progress has been made, practical challenges remain in implementing CSSR spectroscopy on clinical MRI systems. Scan times requiring single-dose breath holds approaching 10 s may be too long for pediatric subjects33,34 or patients with severe lung disease35,36. Additionally, the technique is susceptible to measurement biases if acquisition parameters such as the order of the saturation delay times or the efficacy of the dissolved-phase saturation are not properly optimized21. To address these limitations and make CSSR more accessible to the broader research community, clear, step-by-step protocols for both conventional breath hold and free-breathing acquisitions, currently under development, are needed.
The objective of this paper is to present a detailed methodology for performing optimized CSSR MR spectroscopy using HXe gas. The protocol will cover polarization and delivery of the Xenon gas, RF pulse calibration, sequence parameter selection, subject preparation, data acquisition, and key steps in data analysis. Examples of experimental results will be provided. It is hoped that this comprehensive guide will serve as a foundation for CSSR implementations across sites and help realize the full potential of this technique for quantifying lung microstructural changes in a range of pulmonary diseases.

Auteur in de schijnwerpers: onderzoek naar longziekten bevorderen met vrij ademende hypergepolariseerde Xenon-129 MRI

Kwantitatieve meting van longstructuur en -functie verkregen uit hypergepolariseerde xenonspectroscopie

Our research focuses on using hyperpolarizing on 129 MRI technology to assess pulmonary function and to investigate lung diseases. The main objective is to see how this imaging technique can lead to better detection, understanding, and tracking of different lung conditions. Most hyperpolarized lung MR imaging is performed during a breath hold.We believe that pulmonary function quantified under such an artificial condition, may not fully reflect gas exchange during regular respiration, and we are testing new free breathing measurements that do not require any breath hold. Current challenges include the optimization of the CSSR acquisition technique for consistency and accuracy in the face of physiological variation and patient compliance. Severely ill or pediatric patients struggle with maintaining lengthy breath holds.The CSSR heart technique appears particularly sensitive to changes in alveolar septal wall thickness. As we and others in the field of demonstrated, alveolar wall thickening can indicate the presence of interstitial edema, inflammation, or pulmonary fibrosis. All metrics derived from CSSR spectroscopy acquisitions are currently based on the temporal dynamics of the signal amplitudes.In the future though, we hope to include changes in peak shape and center frequency in the analysis to obtain a more complete picture of the ongoing gas exchange processes.

Voorbereiding van de patiënt en training van proefpersonen voor hypergepolariseerde xenon-MRI

Stel om te beginnen het fysiologische monitoringsysteem in om ademhalingscurves en real-time gasanalyse tijdens beeldvorming vast te leggen. Sluit de MRI-kamerhoofdtelefoon aan en test deze met het audiosignaal dat de proefpersoon begeleidt met behulp van een audio-opname voor in- en uitademen. Pas de afspeelsnelheid van de audiotrack aan. Adem in.Gebaseerd op de normale ademhalingsfrequentie van elke proefpersoon. Adem in.Adem uit. Bereid vervolgens het scannerbed voor met een schone hoofdsteun, beensteunkussen en deken. Plaats de losgemaakte spiraal van het Xenon 129-borstvest op de tafel van de MRI-scanner en steek de connectorstekker van de spoel erin.Voor een onderzoek naar vrije ademhaling laat u de proefpersoon kennismaken met de inadem-uitademingsspraakopname voor gesynchroniseerde ademhaling tijdens beeldvorming. Leid de proefpersoon naar de MRI-kamer en plaats hem op het scannerbed, liggend op de open spoel van het xenonvest. Zodra het onderwerp is gepositioneerd, maakt u de klittenbandsluitingen vast zodat de vestspoel gesloten is, maar de borst van de proefpersoon niet vernauwt.Voor een onderzoek naar vrije ademhaling plaatst u een gezichtsmasker met een pneumatak over het gezicht van de patiënt. Trek de bandjes aan zodat het masker goed over de neus en mond past zonder te strak te zitten. Verwijder na het passen het masker en leg het opzij voor later, waarbij u de banden achter het hoofd van het onderwerp laat.Plaats vervolgens twee pulsoximeters op beide wijsvingers om de hartslag en de zuurstofverzadiging in het bloed tijdens het onderzoek continu te controleren. Plaats een MRI-compatibele hoofdtelefoon over de oren van de proefpersoon. Verplaats de MRI-scannertafel in de magneetboring zodat de longen van de proefpersoon zich in het midden van het gezichtsveld bevinden.

Research

JoVE Journal

Medicine

Patient Preparation and Subject Training for Hyperpolarized Xenon MRI

Quantitative Measure of Lung Structure and Function Obtained from Hyperpolarized Xenon Spectroscopy

Hyperpolarized Xenon-129 (HXe) magnetic resonance imaging (MRI) provides tools for obtaining 2- or 3-dimensional maps of lung ventilation patterns, gas ...

Polarizing Xenon-129 for Hyperpolarized Xenon Spectroscopy

Polariserend xenon-129 voor hypergepolariseerde xenonspectroscopie

Performing Hyperpolarized Xenon-129 Inhalation for Chemical Shift Saturation Recovery (CSSR) Measurement

Hypergepolariseerde xenon-129-inhalatie uitvoeren voor meting van chemische verschuivingsverzadigingsherstel (CSSR)