Evaluation of asthma with hyperpolarized helium-3 MRI - Correlation with clinical severity and spirometry

Background: Accurate characterization of asthma severity is difficult due to the variability of symptoms. Hyperpolarized helium-3 MRI ((HHeMR)-He-3) is a new technique in which the airspaces are visualized, depicting regions with airflow obstruction as ventilation defects. The objective of this study was to compare the extent of (HHeMR)-He-3 ventilation defects with measures of asthma severity and spirometry. Methods: Patients with a physician diagnosis of asthma and normal control subjects underwent (HHeMR)-He-3. For each person, the number and size of ventilation defects were scored and the average number of ventilation defects per slice (VDS) was calculated. The correlations of the imaging findings with measures of asthma severity and spirometry were determined. Results: There were 58 patients with asthma (mild-intermittent, n = 13; mild-persistent, n = 13; moderate-persistent, n = 20; and severe-persistent, n = 12) and 18 control subjects. Mean +/- SE VDS for asthmatics was significantly greater than for control subjects (0.99 +/- 0.15 vs; 0.26 +/- 0.22, p = 0.004). Among asthmatics, VDS was significantly higher for the group with moderate-persistent and severe-persistent disease than for the group with mild-intermittent and mild-persistent disease (1.37 +/- 0.24 vs 0.53 +/- 0.12, p < 0.001). VDS correlated significantly with FEV1/FVC (r = -0.51, p = 0.002), forced expiratory flow between 25% and 75% from the beginning of FVC (FEF25-75%) percentage of predicted for height, sex, and race (%predicted) [r = -0.50, p = 0.001], and FEV1 %predicted (r = -0.40, p = 0.002), but not with FVC %predicted (r = -0.26, p = 0.057) and peak expiratory flow %predicted (r = -0.16, p = 0.231). Many asthmatics had an elevated VDS, but their spirometric indexes, except FEF25%-75%, were normal. Most ventilation defects were < 3 cm in size for all asthmatics. In the group of patients with moderate-to-severe persistant asthma, there were more defects >= 3 cm than in the group with mild-intermittent and mild-persistent disease (p = 0.021). Conclusions: Regional changes of airflow obstruction in asthmatics depicted by (HHeMR)-He-3 correlate with measures of asthma severity and spirometry.