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 . 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 . “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 . Another study showed that MRI VDP was the only measure to predict exacerbations requiring hospitalisation in patients with mild-to-moderate COPD . Similarly, VDP was a significant predictor of 2-year exacerbation rate in patients with severe asthma . “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 .
“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.
- Svenningsen S. Hyperpolarised gas MRI to guide patient management in severe asthma and COPD. Session 344, Abstract 2979, ERS Congress 2022, 4-6 September
- Svenningsen S, et al. Thorax. 2014;69(1):63–71.
- Kirby M, et al. Radiology. 2012;265(2):600–610.
- Nilsen K, et al. J Appl Physiol. 2021;130(3):781–791.
- Svenningsen S, et al. Am J Respir Crit Care Med. 2018;197(7):876–884.
- Capaldi DPI, et al. Radiology. 2016;279(2):597–608.
- Kirby M, et al. Thorax. 2017;72(5):475–477.
- Kirby M, et al. Radiology. 2014;273(3):887–896.
- Mummy D, et al. JACI. 2020;146(4):831–839.
- Svenningsen S, et al. Chest. 2020;158(4):1350–1360.
- Singh D, et al. Respir Res. 2022 Feb 10;23(1):26.
- Svenningsen S, et al. ERJ Open Res. 2021;7(3):00268–2021.
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Table of Contents: ERS 2022
Letter from the Editor
ERS 2022 Highlights Podcast
COVID-19: What Is New?
Does vilobelimab reduce mortality in severe COVID-19?
Awake proning not positive in COVID-19
Favipiravir may help patients over 60 years with COVID-19 to recover
Brensocatib fails in severe COVID-19
Inhaled agent under investigation for COVID-19
Accurate voice-based COVID-19 diagnostic test in development
Novel scoring tool for post-COVID syndrome aids clinicians and researchers
COPD: Therapies and Innovations
Icenticaftor achieves results on top of triple inhalation therapy in COPD
STARR2: A new approach for treating COPD exacerbations
COPD medication not effective in symptomatic smokers with preserved spirometry
Do digital tools improve physical activity in COPD?
Hyperpolarised gas MRI ready for clinical use
All About Asthma
Tezepelumab in asthma: mucus plugging down, lung function up
Digital asthma intervention improves health and reduces costs
Digitally enhanced therapy lowers treatment burden and costs in severe asthma
Mepolizumab beneficial for patients with severe eosinophilic asthma
Progress in Paediatrics
Antibiotics cause increased risk of wheezing in severe RSV bronchiolitis
Inhaled corticosteroids useful in preterms with decreased lung function
Fish oil or vitamin D during pregnancy can prevent croup
Encouraging results of nintedanib in children with fibrosing ILD
Focus on Interventional Pulmonology
Head-to-head: lung volume reduction surgery vs endobronchial valves
Durable effect of endobronchial valves in severe emphysema
Cone beam CT-guided ENB improves detection of pulmonary nodules
Confirmatory mediastinoscopy not needed in resectable NSCLC
Sleep and Breathing Disorders
In the spotlight: Cancer trends in obstructive sleep apnoea
Impact of CPAP on cardiac endpoints in OSA
Sustained hypoxaemia predicts unprovoked VTE in OSA
CPAP therapy in the prevention of cardiovascular risk in patients with OSA
Other Remarkable Research
Excellent results for high-flow nasal cannula oxygen therapy in acute respiratory failure
Antifibrotic therapy may slow down FVC decline in RAILD
Intravenous N-acetylcysteine performs well in hospitalised patients
Men and women respond differently to diesel exhaust
New trends in cystic lung diseases
COVID-19 far more deadly than seasonal flu, large study confirms
Early pulmonary rehabilitation post-COVID-19 aids recovery
Gastroesophageal reflux, IPF and lessons learned