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Hyperpolarised gas MRI ready for clinical use

Presented By
Dr Sarah Svenningsen, McMaster University, Canada
ERS 2022

Hyperpolarised gas MRI showed to be a promising prognostic biomarker for patients with asthma and COPD. In addition, it is useful for monitoring disease and guiding localised therapy. The approval for clinical use has been established in the UK and is pending in the USA.

“Hyperpolarised gas MRI directly measures static ventilation, capturing information from the whole lung,” explained Dr Sarah Svenningsen (McMaster University, Canada) at the start of her presentation [1]. The ventilation defect percent (VDP) is the relevant outcome of this method. Dr Svenningsen emphasised that hyperpolarised gas MRI showed that ventilation defects in patients with asthma and COPD are regionally heterogeneous and patient-specific [2,3]. Moreover, this method has demonstrated to be sensitive to disease-specific pathologic changes, such as smooth muscle dysfunction, mucus plugs, and cells in lumen in patients with asthma [4,5], or emphysema in patients with COPD [6]. “Thus, hyperpolarised gas MRI can deliver high-resolution, visually appealing images, sensitive to disease pathology in asthma and/or COPD,” summarised Dr Svenningsen.

Predict clinical outcomes

“How can we use this tool in the clinical management of patients with asthma and COPD?” asked Dr Svenningsen. Predicting clinical outcomes is one of the applications of hyperpolarised gas MRI. In patients with mild-to-moderate COPD, baseline MRI VDP was predictive of the longitudinal change in the St. George’s Respiratory Questionnaire (SGRQ) and of annual forced expiratory volume in 1 second (FEV1) change [7]. Another study showed that MRI VDP was the only measure to predict exacerbations requiring hospitalisation in patients with mild-to-moderate COPD [8]. Similarly, VDP was a significant predictor of 2-year exacerbation rate in patients with severe asthma [9]. “In summary, VDP measured with hyperpolarised gas MRI is a promising prognostic biomarker for patients with asthma and COPD,” concluded Dr Svenningsen.

Monitoring disease and guiding localised therapy

In a similar fashion, MRI VDP has demonstrated to be a sensitive measure of treatment response in asthma and COPD populations and may be more sensitive than the gold-standard spirometry measurements of airflow obstruction [10,11]. This technique may also be used to guide localised therapies in asthma and COPD. For example, a study demonstrated that bronchial thermoplasty treatment guided by hyperpolarised gas MRI achieved the same clinical outcomes as the standard bronchial thermoplasty sessions without guidance, resulting in a reduced procedure time, decreased costs, and fewer adverse events [12].

“Next to these useful applications, regulatory approval for the clinical use of hyperpolarised gas MRI has been established in the UK and is pending in the USA. Also, initial clinical experiences of this highly sensitive, safe, objective, and non-invasive measure are being collected at this moment,” concluded Dr Svenningsen.

  1. Svenningsen S. Hyperpolarised gas MRI to guide patient management in severe asthma and COPD. Session 344, Abstract 2979, ERS Congress 2022, 4-6 September
  2. Svenningsen S, et al. Thorax. 2014;69(1):63–71.
  3. Kirby M, et al. Radiology. 2012;265(2):600–610.
  4. Nilsen K, et al. J Appl Physiol. 2021;130(3):781–791.
  5. Svenningsen S, et al. Am J Respir Crit Care Med. 2018;197(7):876–884.
  6. Capaldi DPI, et al. Radiology. 2016;279(2):597–608.
  7. Kirby M, et al. Thorax. 2017;72(5):475–477.
  8. Kirby M, et al. Radiology. 2014;273(3):887–896.
  9. Mummy D, et al. JACI. 2020;146(4):831–839.
  10. Svenningsen S, et al. Chest. 2020;158(4):1350–1360.
  11. Singh D, et al. Respir Res. 2022 Feb 10;23(1):26.
  12. Svenningsen S, et al. ERJ Open Res. 2021;7(3):00268–2021.

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