Hyperpolarised gas MR lung imaging – Breaks through to clinical practice

Abstract

Introduction: It is 18 years since the first hyperpolarised gas MRI of the lungs of healthy volunteers were demonstrated (Lancet. 1996 May 11;347(9011):1297-9.). In this time research has demonstrated the exquisite sensitivity of the method to changes in lung structure and function not attainable with other modalities. However, clinical uptake has been hampered by patents, regulatory issues, availability of 3He and access to the technology. Objective: Here we report the first clinical diagnostic images worldwide following regulatory approval for manufacture of the gases for routine clinical lung MRI in the UK. Methods: lung ventilation MRI were acquired from a 14y female runner referred with non-CF bronchiectasis who despite normal PFTs had decreased exercise capacity, despite CPET being normal. Following the scans the patient was treated with IV antibiotics and reassessed at 2 weeks. Results: FEV1, LCI and lung volumes all showed no significant sign of improvement whilst the MRI showed qualitative and quantitative improved regional lung ventilation Conclusions: The results indicate the clinical efficacy of the treatment and more importantly the improved sensitivity of the imaging over PFTs as a more sensitive diagnostic and prognostic outcome marker. With improvements in gas polarisation and MRI technology routine clinical lung imaging with the cheaper gas 129Xe is now possible and large scale evaluation in clinical workup is now underway.