Background Pulmonary function tests are central to diagnosis and monitoring of respiratory diseases but do not provide information on regional lung function heterogeneity. Fluorine 19 (19F) MRI of inhaled perfluoropropane permits quantitative and spatially localized assessment of pulmonary ventilation properties without tracer gas hyperpolarization. Purpose To assess regional lung ventilation properties using 19F MRI of inhaled perfluoropropane in participants with asthma, participants with chronic obstructive pulmonary disease (COPD), and healthy participants, including quantitative evaluation of bronchodilator response in participants with respiratory disease. Materials and Methods This prospective, dual-center study included participants with asthma or COPD from July 2019 to September 2022 and healthy participants from May 2018 to June 2019. Participants underwent conventional spirometry, proton MRI, and 19F MRI following inhalation of a 79% perfluoropropane and 21% oxygen gas mixture. Three-dimensional 19F MRI scans were acquired during a single breath hold. For participants with asthma or COPD, spirometric and MRI measurements were repeated following administration of nebulized salbutamol. Ventilation defect percentage (VDP) was calculated from perfluoropropane distribution. Linear mixed-effects models were used to assess differences in VDP between participant groups and before and after bronchodilator administration. Results Thirty-five participants with asthma (mean age, 50 years ± 18 [SD]; 21 male participants), 21 participants with COPD (mean age, 69 years ± 6; 14 male participants), and 38 healthy participants (mean age, 41 years ± 11; 20 male participants) were evaluated. 19F MRI-derived VDP was elevated in participants with COPD (geometric mean, 27.2%) and participants with asthma (geometric mean, 8.3%) compared with healthy participants (geometric mean, 1.8%; geometric mean ratio, 15.2 [95% CI: 11.1, 20.6] for COPD and 4.6 [95% CI: 3.2, 6.6] for asthma; P < .001 for both). After bronchodilator administration, VDP was reduced by 33% in participants with asthma (from 8.3% to 5.6%) and 14% in participants with COPD (from 27.2% to 23.3%; P < .001 for both). Conclusion 19F MRI of inhaled perfluoropropane was sensitive to changes in regional ventilation properties associated with lung disease and enabled quantification of changes following bronchodilator therapy. Published under a CC BY-NC-ND 4.0 license. Supplemental material is available for this article. See also the editorial by Unger in this issue.

中文翻译：

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使用 19F MRI 评估哮喘和慢性阻塞性肺病的肺通气和支气管扩张剂反应。


背景 肺功能检查是诊断和监测呼吸系统疾病的核心，但不提供有关区域肺功能异质性的信息。吸入全氟丙烷的氟 19 （19F） MRI 可对肺通气特性进行定量和空间定位评估，而不会出现示踪气体超极化。目的 使用吸入全氟丙烷的 19F MRI 评估哮喘参与者、慢性阻塞性肺病 （COPD） 参与者和健康参与者的局部肺通气特性，包括定量评估呼吸系统疾病参与者的支气管扩张剂反应。材料和方法 这项前瞻性、双中心研究包括 2019 年 7 月至 2022 年 9 月的哮喘或 COPD 参与者以及 2018 年 5 月至 2019 年 6 月的健康参与者。参与者在吸入 79% 全氟丙烷和 19% 氧气混合物后接受了常规肺活量测定、质子 MRI 和 21F MRI。在单次屏气期间获得三维 19F MRI 扫描。对于患有哮喘或 COPD 的参与者，在雾化吸入沙丁胺醇给药后重复进行肺活量和 MRI 测量。通气缺陷百分比 （VDP） 是根据全氟丙烷分布计算的。线性混合效应模型用于评估参与者组之间以及支气管扩张剂给药前后 VDP 的差异。结果 评估了 35 名哮喘参与者 （平均年龄 50 岁 ± 18 [SD];21 名男性参与者）、21 名 COPD 参与者 （平均年龄 69 岁± 6 岁;14 名男性参与者）和 38 名健康参与者 （平均年龄 41 岁± 11 岁;20 名男性参与者）。COPD 参与者的 19F MRI 衍生的 VDP 升高（几何平均值，27.2%）和哮喘参与者（几何平均值，8.3%）与健康参与者（几何平均值，1.8%;几何平均值，COPD 为 15.2 [95% CI： 11.1， 20.6] 和哮喘为 4.6 [95% CI： 3.2， 6.6];两者均为 P < .001）。支气管扩张剂给药后，哮喘参与者的 VDP 降低了 33%（从 8.3% 降至 5.6%），COPD 参与者的 VDP 降低了 14%（从 27.2% 降至 23.3%;两者均为 P < .001）。结论 吸入全氟丙烷的 19F MRI 对与肺部疾病相关的区域通气特性的变化很敏感，并能够量化支气管扩张剂治疗后的变化。在 CC BY-NC-ND 4.0 许可下发布。本文提供了补充材料。另请参见 Unger 在本期的社论。