Luis A. Torres, Kristine E. Lee, Gregory P. Barton, Andrew D. Hahn,Nathan Sandbo, Mark L. Schiebler, Sean B. Fain
European Respiratory Journal 2022; DOI: 10.1183/13993003.02058-2021
Objectives The objective of this work was to apply quantitative and semi-quantitative dynamic contrast enhanced MRI (DCE-MRI) methods to evaluate lung perfusion in idiopathic pulmonary fibrosis (IPF).
Materials and Methods In this prospective trial 41 subjects, including healthy control (control) and IPF subjects, were studied using DCE-MRI at baseline. IPF subjects were then followed for 1 year, progressive IPF (IPFprog) were distinguished from stable IPF (IPFstable) subjects based on a decline in percent predicted FVC (FVC%p) or DLCO (DLCO%p) measured during followup visits. 35/41 subjects were retained for final baseline analysis at (control: N=15; IPFstable: N=14; IPFprog: N=6). Seven measures and their coefficients of variation (CV) were derived using temporally resolved DCE-MRI. Two sets of global and regional comparisons were made: control versus IPF groups, and control versus IPFstable versus IPFprog groups, using linear regression analysis. Each measure was compared to FVC%p, DLCO%p, and the lung clearance index (LCI%p) using a Spearman rank correlation.
Results DCE-MRI identified regional perfusion differences between control and IPF subjects using first moment transit time (FMTT), contrast uptake slope (SLOPE), and pulmonary blood flow (PBF) (p≤0.05), while global averages did not. FMTT was shorter for IPFprog compared to both IPFstable (p=0.004) and control groups (p=0.023). Correlations were observed between PBF CV and DLCO%p (rs=−0.48, p=0.022) and %LCI (rs=+0.47, p=0.015). Significant group differences were detected in age (p<0.001), DLCO%p (p<0.001), FVC%p (p=0.001), and LCI%p (p=0.007).
Conclusions Global analysis obscures regional changes in pulmonary hemodynamics in IPF using DCE-MRI in IPF. Decreased FMTT may be a candidate marker for IPF progression.
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Conflict of interest: Dr. Schiebler reports grant funding from the National Heart, Lung, and Blood Institute (NHLBI SARPIII - RFA-HL-11-018 and SARP IV 4P01HL088594-09, R01 HL080414) and ownership of Elucida Oncology Inc., Elucida Medical Inc., Healthmyne Inc., Stemina Biomarker Discovery Inc., and X-Vax, Inc.
Conflict of interest: Dr. Fain reports grant funding from NHLBI (NHLBI R01HL126771, NHLBI RO1 HL146689), GE Healthcare, American Lung Association, as well as compensation from Caladarius Biosciences, Polarean PLC, and Sanofi/Regeneron. All other authors have nothing to disclose.
Conflict of interest: Dr. Torres has nothing to disclose.
Conflict of interest: Dr. Lee has nothing to disclose.
Conflict of interest: Dr. Barton has nothing to disclose.
Conflict of interest: Dr. Hahn has nothing to disclose.
Conflict of interest: Dr. Sandbo has nothing to disclose.