Magnetic Resonance Imaging of Lung Perfusion

Author:

Triphan Simon M.F.123ORCID,Bauman Grzegorz45,Konietzke Philip123,Konietzke Marilisa126,Wielpütz Mark O.123ORCID,

Affiliation:

1. Diagnostic and Interventional Radiology University Hospital Heidelberg Heidelberg Germany

2. Translational Lung Research Center Heidelberg (TLRC) German Center for Lung Research (DZL) Heidelberg Germany

3. Department of Diagnostic and Interventional Radiology with Nuclear Medicine Thoraxklinik at University Hospital Heidelberg Heidelberg Germany

4. Division of Radiological Physics, Department of Radiology University Hospital of Basel Basel Switzerland

5. Department of Biomedical Engineering University of Basel Allschwil Switzerland

6. Boehringer Ingelheim Pharma GmbH & Co. KG Biberach an der Riß Germany

Abstract

“Lung perfusion” in the context of imaging conventionally refers to the delivery of blood to the pulmonary capillary bed through the pulmonary arteries originating from the right ventricle required for oxygenation. The most important physiological mechanism in the context of imaging is the so‐called hypoxic pulmonary vasoconstriction (HPV, also known as “Euler‐Liljestrand‐Reflex”), which couples lung perfusion to lung ventilation. In obstructive airway diseases such as asthma, chronic‐obstructive pulmonary disease (COPD), cystic fibrosis (CF), and asthma, HPV downregulates pulmonary perfusion in order to redistribute blood flow to functional lung areas in order to conserve optimal oxygenation. Imaging of lung perfusion can be seen as a reflection of lung ventilation in obstructive airway diseases. Other conditions that primarily affect lung perfusion are pulmonary vascular diseases, pulmonary hypertension, or (chronic) pulmonary embolism, which also lead to inhomogeneity in pulmonary capillary blood distribution. Several magnetic resonance imaging (MRI) techniques either dependent on exogenous contrast materials, exploiting periodical lung signal variations with cardiac action, or relying on intrinsic lung voxel attributes have been demonstrated to visualize lung perfusion. Additional post‐processing may add temporal information and provide quantitative information related to blood flow. The most widely used and robust technique, dynamic‐contrast enhanced MRI, is available in clinical routine assessment of COPD, CF, and pulmonary vascular disease. Non‐contrast techniques are important research tools currently requiring clinical validation and cross‐correlation in the absence of a viable standard of reference. First data on many of these techniques in the context of observational studies assessing therapy effects have just become available.Level of Evidence5Technical EfficacyStage 5

Funder

Bundesministerium für Bildung und Forschung

Publisher

Wiley

Subject

Radiology, Nuclear Medicine and imaging

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