Characterization of acinar airspace involvement in asthmatic patients by using inert gas washout and hyperpolarized 3helium magnetic resonance

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:137

Article

Gonem, Sherif¹  Hardy, Steven²  Buhl, Niels²  Hartley, Ruth¹  Soares, Marcia¹  Kay, Richard³  Costanza, Rino⁴  Gustafsson, Per⁵  Brightling, Christopher E.¹  Owers-Bradley, John²  Siddiqui, Salman¹ 

[1] Univ Leicester, Inst Lung Hlth, Dept Infect Immun & Inflammat, Leicester LE1 7RH, Leics, England

[2] Univ Nottingham, Dept Phys & Astron, Nottingham NG7 2RD, England

[3] Novartis Pharmaceut, Basel, Switzerland

[4] Chiesi UK, Cheadle, England

[5] Cent Hosp Skovde, Dept Paediat, Skovde, Sweden

关键词: Asthma;    small airways;    acinus;    physiology;   

DOI  :  10.1016/j.jaci.2015.06.027

来源: Elsevier

【 摘 要 】

Background: The multiple-breath inert gas washout parameter acinar ventilation heterogeneity (Sacin) is thought to be a marker of acinar airway involvement but has not been validated by using quantitative imaging techniques in asthmatic patients. Objective: We aimed to use hyperpolarized (3)Hediffusion magnetic resonance at multiple diffusion timescales and quantitative computed tomographic (CT) densitometry to determine the nature of acinar airway involvement in asthmatic patients. Methods: Thirty-seven patients with asthma and 17 age-matched healthy control subjects underwent spirometry, body plethysmography, multiple-breath inert gas washout (with the tracer gas sulfur hexafluoride), and hyperpolarized He-3 diffusion magnetic resonance. A subset of asthmatic patients (n = 27) underwent quantitative CT densitometry. Results: Ninety-four percent (16/17) of patients with an increased S-acin had Global Initiative for Asthma treatment step 4 to 5 asthma, and 13 of 17 had refractory disease. The apparent diffusion coefficient (ADC) of He-3 at 1 second was significantly higher in patients with S-acin-high asthma compared with that in healthy control subjects (0.024 vs 0.017, P<.05). Sacin correlated strongly with ADCs at 1 second (R = 0.65, P<.001) but weakly with ADCs at 13 ms (R = 0.38, P<.05). ADCs at both 13 ms and 1 second correlated strongly with the mean lung density expiratory/inspiratory ratio, a CT marker of expiratory air trapping (R = 0.77, P<.0001 for ADCs at 13 ms; R = 0.72, P<.001 for ADCs at 1 second). Conclusion: Sacin is associated with alterations in long-range diffusion within the acinar airways and gas trapping. The precise anatomic nature and mechanistic role in patients with severe asthma requires further evaluation.

【 授权许可】

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