1H and 129Xe MRI to detect functional and structural lung disease in sub-clinical cystic fibrosis

Abstract

MRI offers distinct advantages over CT for early disease detection in CF, being radiation free and capable of measuring both function and structure. Hyperpolarised gas ventilation MRI is highly sensitive to early lung disease and 1H MRI sequences generate high-resolution images for detection of structural disease. Here, we report the ability of different MRI sequences to detect CF-related lung abnormalities. 14 children and adults with CF and normal FEV1 and 5 healthy children (HC) were assessed. All subjects performed 129Xe ventilation and 1H anatomical MRI (sequences = 3D SPGR, acquired during breath-hold at total lung capacity (TLC) and residual volume (RV) and UTE, acquired during free-breathing). Subjects also performed lung clearance index (LCI) and spirometry. 129Xe MRI was segmented to calculate the ventilation defect percentage (VDP). 129Xe and 1H MRI were reviewed by an experienced chest radiologist, using a binary method for the presence or absence of common CF pathophysiology. All subjects had a normal FEV1. All HC had normal LCI, and normal 129Xe and 1H MRI. In contrast, 43% of CF subjects had an abnormal LCI. All CF subjects had visible 129Xe ventilation defects; VDP was significantly higher than controls (p In CF patients with normal FEV1, functional and anatomical abnormalities can be assessed and detected at the same visit using both free-breathing and breath-hold MRI sequences, highlighting the potential of MRI in the routine imaging of CF lung disease.