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. 2016 Mar;137(3):789-96.e7.
doi: 10.1016/j.jaci.2015.08.045. Epub 2015 Oct 29.

Clinical correlates of lung ventilation defects in asthmatic children

Talissa A Altes  1 , John P Mugler 3rd  2 , Kai Ruppert  3 , Nicholas J Tustison  4 , Joanne Gersbach  4 , Sylvia Szentpetery  5 , Craig H Meyer  2 , Eduard E de Lange  4 , W Gerald Teague  6
Affiliations

Clinical correlates of lung ventilation defects in asthmatic children

Talissa A Altes et al. J Allergy Clin Immunol. 2016 Mar.

Abstract

Background: Lung ventilation defects identified by using hyperpolarized 3-helium gas ((3)He) lung magnetic resonance imaging (MRI) are prevalent in asthmatic patients, but the clinical importance of ventilation defects is poorly understood.

Objectives: We sought to correlate the lung defect volume quantified by using (3)He MRI with clinical features in children with mild and severe asthma.

Methods: Thirty-one children with asthma (median age, 10 years; age range, 3-17 years) underwent detailed characterization and (3)He lung MRI. Quantification of the (3)He signal defined ventilation defect and hypoventilated, ventilated, and well-ventilated volumes.

Results: The ventilation defect to total lung volume fraction ranged from 0.1% to 11.6%. Children with ventilation defect percentages in the upper tercile were more likely to have severe asthma than children in the lower terciles (P = .005). The ventilation defect percentage correlated (P < .05 for all) positively with the inhaled corticosteroid dose, total number of controller medications, and total blood eosinophil counts and negatively with the Asthma Control Test score, FEV1 (percent predicted), FEV1/forced vital capacity ratio (percent predicted), and forced expiratory flow rate from 25% to 75% of expired volume (percent predicted).

Conclusion: The lung defect volume percentage measured by using (3)He MRI correlates with several clinical features of asthma, including severity, symptom score, medication requirement, airway physiology, and atopic markers.

Keywords: (3)He magnetic resonance imaging; Hyperpolarized; childhood asthma; severe asthma; ventilation defects; ventilation heterogeneity.

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Figures

Figure 1.
Figure 1.
Hyperpolarized 3He lung MRI in a 4 year old with severe asthma. This gray scale image illustrates the spectrum of signal intensities attained in a small child with the free breathing acquisition protocol. Note that with the first inhalation of hyperpolarized 3He, a large focal ventilation defect is visible in the right middle and right lower lobes (A.). With subsequent inhalations the defect persists, and there is delayed filling of a region in the left upper lobe (B.). The region with delayed filling eventually fills (C.) and during the washout phase (D.) demonstrates relatively “bright” signal intensity consistent with trapped 3He gas.
Figure 2.
Figure 2.
Coronal hyperpolarized 3He lung MRI slices in two children with asthma. The gray scale images are shown above the corresponding labeled images which have undergone automated analysis of the 3He signal intensity. The ventilation defect volume is labeled black on the gray scale images and red on the automated images, the hypoventilated volume is gray on the gray scale images and green on the automated images, the ventilated volume is white on the gray scale images and blue on the automated images, and the well-ventilated volume is bright white on the gray scale images and yellow on the automated images. Subject 12 has mild to moderate asthma and normal lung function. The gray scale images show primarily white to bright white regions and the automated images show mostly yellow regions. This subject had a relatively low defect volume to total lung volume ratio of 0.3% Subject 36 by contrast has severe asthma, with significant airflow obstruction at baseline. The MRI shows visible contrasts in both the gray scale and automated images. Note the relative abundance of red and green regions on the automated images compared to subject 12. This subject had a relatively high defect volume to total lung volume ratio of 8.6%.
Figure 3.
Figure 3.
Bar plot of 4 ventilation volume compartments as measured by automated analysis of the inhaled 3He MRI signal and stratified by the tercile distribution of the FEV1/FVC ratio % predicted in 31 children with asthma. The volume compartments are expressed as the median values of the volume compartments expressed as % of the total lung volume. Children with FEV1 /FVC % in the lower tercile (< 66% predicted) had significantly higher ventilation defect, hypoventilated, and ventilated volume ratios, but lower well-ventilated to total lung volume ratios versus children with FEV1/FVC % in the middle and upper terciles (p < 0.05 for all comparisons).
Figure 4.
Figure 4.
Scatter plots showing the correlation between the ventilation defect volume ratio with selected variables in children with asthma. There was a strong inverse correlation between ventilation defect volume ratio and the FEV1/FVC % (A.) and the FEF25–75 % predicted (B.) The ventilation defect volume ratio also correlated significantly with other clinical markers including the percentage of blood eosinophils (C) and the asthma control test (D).
See this image and copyright information in PMC

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