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Updated: May 8, 2025
Multi-modal Pulmonary Imaging: Using Complementary Information from CT and Hyperpolarized 129Xe MRI to Evaluate Lung Structure-Function
Published on: April 12, 2024
Comparative analysis of thoracic structure and function using CT and dynamic MRI in pediatric thoracic insufficiency
Sara Hassani1, Yubing Tong1, Nima Broomand Lomer1
1Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Insights
Neuromuscular disease significantly impacts respiratory mechanics in pediatric Thoracic Insufficiency Syndrome (TIS). Skeletal muscle volume and diaphragm interaction are key to understanding TIS respiratory function.
Area of Science:
- Pediatric Pulmonology
- Thoracic Imaging
- Respiratory Mechanics
Background:
- Thoracic Insufficiency Syndrome (TIS) affects respiration and lung growth in children.
- The relationship between thoracic structure and respiratory function in pediatric TIS, with or without neuromuscular disease (NMD), is not well understood.
Purpose of the Study:
- To evaluate the interrelationships between thoracic structure and regional respiratory function in pediatric TIS patients.
- Utilize dynamic MRI (dMRI) and CT imaging to assess these connections.
Main Methods:
- Analyzed dMRI and CT scans of 25 pediatric TIS patients (8 with NMD, 17 without).
- Quantified intercostal muscle (ICM) and skeletal muscle (SM) volumes, lung volumes, and chest wall/diaphragm excursion volumes.
- Compared symmetry ratios and assessed correlations between structural and functional parameters.
Main Results:
- TIS patients with NMD had larger lung and muscle volumes, but similar tidal and excursion volumes compared to those without NMD.
- Diaphragmatic asymmetry was more pronounced than chest wall asymmetry, especially in TIS-NMD patients.
- Thoracic SM volume showed a stronger correlation with tidal volume than ICM volume.
Conclusions:
- Distinct structural-functional relationships exist in pediatric TIS patients with and without NMD.
- Neuromuscular disease significantly alters respiratory mechanics in TIS.
- Emphasizes the critical role of skeletal muscle and diaphragm interaction in TIS.
Purpose:
Thoracic insufficiency syndrome (TIS) impairs normal respiration and lung growth. In pediatric patients with or without neuromuscular disease (NMD), the relationship between thoracic structure and regional respiratory function remains understudied. We aimed to evaluate these interrelationships using dynamic magnetic resonance imaging (dMRI) and computed tomography (CT).
Methods:
This study included 25 pediatric TIS patients: 8 with NMD and 17 without NMD. Thoracic dMRI and CT images were analyzed to quantify intercostal muscle (ICM) volume, skeletal muscle (SM) volume, lung volumes at end-inspiration and end-expiration, chest wall excursion volume, and diaphragm excursion volume. Right-to-left volumetric symmetry ratios were compared using unpaired t-testing, and correlations between structural and functional parameters were assessed using Pearson correlation analysis.
Results:
Lung and muscle volumes were generally larger in the TIS-NMD compared to TIS non-NMD, reflecting age-related differences, although lung tidal volumes and diaphragmatic and chest wall excursion volumes were generally similar. The degree of asymmetry reflected by diaphragmatic respiratory function symmetry ratios exceeded that of chest wall symmetry ratios in both groups, with greater disparity in TIS-NMD (3.6 vs 1.8 in TIS-NMD compared to 2.8 vs 2.5 in TIS non-NMD). Correlation between thoracic SM volume and tidal volume was stronger than the correlation between ICM volume and tidal volume in both groups. TIS-NMD patients demonstrated unique compensatory dynamics, including a negative correlation between SM volume and diaphragmatic excursion volume.
Conclusion:
Distinct interrelationships exist between thoracic structure and function in TIS patients with and without NMD. These findings suggest that NMD significantly influences respiratory mechanics, emphasizing the role of SM and diaphragm interaction.
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