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Thoracic Quantitative Dynamic MRI to Understand Developmental Changes in Normal Ventilatory Dynamics
Yubing Tong1, Jayaram K Udupa1, Joseph M McDonough2
1Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, PA.
Insights
Quantitative dynamic MRI reveals significant asymmetry in children's thoracic ventilatory components, with right-sided structures being larger. These dynamics change with age, highlighting the need for normative data in pediatric respiratory research.
Area of Science:
- Pediatric respiratory physiology
- Medical imaging analysis
- Thoracic biomechanics
Background:
- Normative quantitative measures of regional thoracic ventilatory dynamics are crucial for understanding pediatric thoracic growth and function.
- Existing databases lack comprehensive data on these dynamic measures in children.
Purpose of the Study:
- To quantify changes in ventilatory pump dynamics during childhood using thoracic quantitative dynamic MRI (QdMRI).
- To establish normative data for regional thoracic ventilatory function in children.
Main Methods:
- 51 dynamic MRI scans were analyzed to derive volumetric parameters for lungs, hemidiaphragms, and hemichest walls during tidal breathing.
- Volume-based symmetry and functional coefficients were calculated to compare left and right sides and component contributions.
- Statistical analyses compared volume components across four age-based groups.
Main Results:
- Significant asymmetry was observed, with right thoracic components being larger than left (e.g., lung tidal volume ratio 1.56).
- Lung volumes and hemichest wall tidal volumes increased substantially with age across the studied pediatric groups.
- Diaphragm excursion and chest wall contributions to tidal volume showed age-related changes.
Conclusions:
- Normal pediatric thoracic ventilatory components exhibit significant asymmetry and change with age.
- Chest wall and diaphragm contributions to ventilation vary dynamically and with growth.
- Thoracic QdMRI provides quantitative data essential for characterizing regional thoracic function and growth related to ventilation.
Background:
A database of normative quantitative measures of regional thoracic ventilatory dynamics, which is essential to understanding better thoracic growth and function in children, does not exist.
Research Question:
How to quantify changes in the components of ventilatory pump dynamics during childhood via thoracic quantitative dynamic MRI (QdMRI)?
Study Design And Methods:
Volumetric parameters were derived via 51 dynamic MRI scans for left and right lungs, hemidiaphragms, and hemichest walls during tidal breathing. Volume-based symmetry and functional coefficients were defined to compare left and right sides and to compare contributions of the hemidiaphragms and hemichest walls with tidal volumes (TVs). Statistical analyses were performed to compare volume components among four age-based groups.
Results:
Right thoracic components were significantly larger than left thoracic components, with average ratios of 1.56 (95% CI, 1.41-1.70) for lung TV, 1.81 (95% CI, 1.60-2.03) for hemidiaphragm excursion TV, and 1.34 (95% CI, 1.21-1.47) for hemichest wall excursion TV. Right and left lung volumes at end-expiration showed, respectively, a 44% and 48% increase from group 2 (8 ≤ age < 10) to group 3 (10 ≤ age < 12). These numbers from group 3 to group 4 (12 ≤ age ≤ 14) were 24% and 28%, respectively. Right and left hemichest wall TVs exhibited, respectively, 48% and 45% increases from group 3 to group 4.
Interpretation:
Normal right and left ventilatory volume components have considerable asymmetry in morphologic features and dynamics and change with age. Chest wall and diaphragm contributions vary in a likewise manner. Thoracic QdMRI can provide quantitative data to characterize the regional function and growth of the thorax as it relates to ventilation.
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