patient preparation and subject training for hyperpolarized xenon mri

Évaluation de la fonction pulmonaire à l’aide de l’IRM hyperpolarisée au xénon-129

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.

Pleins feux sur l’auteur : Faire progresser la recherche sur les maladies pulmonaires grâce à l’IRM hyperpolarisée au xénon-129 en respiration libre

Mesure quantitative de la structure et de la fonction pulmonaires obtenue à partir de la spectroscopie de xénon hyperpolarisé

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.

Préparation du patient et formation du sujet pour l’IRM au xénon hyperpolarisé

Pour commencer, mettez en place le système de surveillance physiologique pour enregistrer les courbes respiratoires et l’analyse des gaz en temps réel pendant l’imagerie. Connectez et testez le casque d’IRM avec le signal audio qui guide le sujet à l’aide d’un enregistrement audio inspiré-expiré. Ajustez la vitesse de lecture de la piste audio. Inspirez.Expirez.Basé sur la fréquence respiratoire normale de chaque sujet. Ensuite, préparez le lit du scanner avec un appui-tête propre, un coussin de soutien pour les jambes et une couverture. Placez la bobine de poitrine Xenon 129 non fixée sur la table de l’appareil d’IRM et insérez la fiche de connexion de la bobine.Pour une étude de respiration libre, présentez au sujet l’enregistrement de la voix inspirer-expirer pour une respiration synchronisée pendant l’imagerie. Conduisez le sujet dans la salle d’IRM et placez-le sur le lit du scanner, allongé sur la bobine ouverte du gilet au xénon. Une fois le sujet positionné, attachez les sangles velcro de manière à ce que la bobine du gilet soit fermée, mais ne resserre pas la poitrine du sujet.Pour une étude de respiration libre, placez un masque facial avec un pneumatac sur le visage du patient. Serrez les sangles pour que le masque s’adapte parfaitement au nez et à la bouche sans être trop serré. Après l’ajustement, retirez le masque et mettez-le de côté pour plus tard, en laissant les sangles derrière la tête du sujet.Placez ensuite deux oxymètres de pouls sur les deux index pour surveiller en permanence la fréquence cardiaque et la saturation en oxygène du sang pendant l’étude. Placez des écouteurs compatibles avec l’IRM sur les oreilles du sujet. Déplacez la table du scanner IRM dans l’alésage de l’aimant de sorte que les poumons du sujet soient positionnés au centre du champ de vision.

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 ...

Recherche

Médecine

Polarizing Xenon-129 for Hyperpolarized Xenon Spectroscopy

Xénon-129 polarisant pour la spectroscopie de xénon hyperpolarisé

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

Inhalation de xénon-129 hyperpolarisé pour la mesure de la récupération de la saturation par décalage chimique (CSSR)