Journal
THORAX
Volume 76, Issue 2, Pages 144-151Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/thoraxjnl-2019-214375
Keywords
interstitial fibrosis; idiopathic pulmonary fibrosis; imaging; CT MRI etc
Categories
Funding
- National Institute of Health Research [NIHR-RP-R3-12-027]
- Medical Research Council [MR/M008894/1]
- GlaxoSmithKline [BIDS3000032592]
- National Institutes of Health Research (NIHR) [NIHR-RP-R3-12-027] Funding Source: National Institutes of Health Research (NIHR)
- MRC [MR/M008894/1] Funding Source: UKRI
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The study found correlations between DCE-MRI first pass perfusion and existing physiological gas exchange metrics in IPF patients, suggesting that capillary perfusion deficit may contribute to gas exchange limitation. The FWHMmean metric showed a significant increase over a 6-month period and may serve as a quantitative biomarker for pulmonary vascular disease progression in IPF.
Introduction Idiopathic pulmonary fibrosis (IPF) is a fatal disease of lung scarring. Many patients later develop raised pulmonary vascular pressures, sometimes disproportionate to the interstitial disease. Previous therapeutic approaches that have targeted pulmonary vascular changes have not demonstrated clinical efficacy, and quantitative assessment of regional pulmonary vascular involvement using perfusion imaging may provide a biomarker for further therapeutic insights. Methods We studied 23 participants with IPF, using dynamic contrast-enhanced MRI (DCE-MRI) and pulmonary function tests, including forced vital capacity (FVC), transfer factor (TLCO) and coefficient (K-CO) of the lungs for carbon monoxide. DCE-MRI parametric maps were generated including the full width at half maximum (FWHM) of the bolus transit time through the lungs. Key metrics used were mean (FWHMmean) and heterogeneity (FWHMIQR). Nineteen participants returned at 6 months for repeat assessment. Results Spearman correlation coefficients were identified between TLCO and FWHMIQR (r=-0.46; p=0.026), K-CO and FWHMmean (r=-0.42; p=0.047) and K-CO and FWHMIQR (r=-0.51; p=0.013) at baseline. No statistically significant correlations were seen between FVC and DCE-MRI metrics. Follow-up at 6 months demonstrated statistically significant decline in FVC (p=0.040) and K-CO (p=0.014), with an increase in FWHMmean (p=0.040), but no significant changes in TLCO (p=0.090) nor FWHMIQR (p=0.821). Conclusions DCE-MRI first pass perfusion demonstrates correlations with existing physiological gas exchange metrics, suggesting that capillary perfusion deficit (as well as impaired interstitial diffusion) may contribute to gas exchange limitation in IPF. FWHMmean showed a significant increase over a 6-month period and has potential as a quantitative biomarker of pulmonary vascular disease progression in IPF.
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