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Novel translational pulmonary MRI in paediatrics: a review of the past 10 years
Alexander M Matheson1, Matthew M Willmering1,2, Gael Dournes3
1Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Magnetic resonance imaging (MRI) offers a safe, radiation-free method for pediatric lung imaging. Pulmonary MRI advances reveal disease mechanisms and treatment responses in children with various respiratory conditions.
Area of Science:
- Pediatric Pulmonology
- Medical Imaging
- Radiology
Background:
- Pediatric respiratory diseases present unique challenges due to developmental factors and patient compliance.
- Differentiating disease effects from normal lung growth is crucial for understanding pediatric lung conditions.
- Magnetic resonance imaging (MRI) provides detailed lung imaging without ionizing radiation, making it suitable for children.
Purpose of the Study:
- To review advancements in pulmonary MRI over the past decade.
- To illustrate how these MRI discoveries are being applied in clinical settings for pediatric lung diseases.
- To highlight MRI's role in understanding disease mechanisms and treatment responses in pediatric respiratory conditions.
Main Methods:
- Utilizing standard proton (1H) MRI and hyperpolarized 129Xe gas MRI for lung structure and function assessment.
- Employing rapid scan acquisition techniques, with some scans completed in as little as four seconds.
- Applying dynamic structural imaging to analyze lung motion, airway collapse, ventilation, and perfusion.
Main Results:
- Structural MRI can identify airway abnormalities, consolidation, mucus plugging, and bronchiectasis.
- Dynamic MRI provides insights into lung mechanics and physiological function.
- Pulmonary MRI has been applied to diverse pediatric lung diseases including asthma, cystic fibrosis, and interstitial lung diseases.
Conclusions:
- Pulmonary MRI is a valuable, radiation-free tool for pediatric respiratory care.
- Advances in MRI techniques offer a comprehensive understanding of pediatric lung diseases.
- These developments are increasingly translating into clinical applications for improved patient outcomes.
Abstract:
Paediatric respirology presents distinctive challenges relative to adult care: patients have difficulties performing pulmonary function tests, more frequently have trouble complying, have distinct pathophysiology relative to adults and have diseases that occur alongside normal or abnormal lung development. Understanding and disentangling the effects of disease and growth are important to identifying the pathophysiology that drives paediatric disease and affects the quality of life of this vulnerable group. Magnetic resonance imaging (MRI) can provide detailed images of lung structure and function using either standard 1H (proton) MRI or hyperpolarised 129Xe (xenon) gas MRI. Radiation exposure in this vulnerable group is problematic, but MRI is ionising radiation-free and safe to perform in children and neonates. Exam acquisition speed has improved with some scans taking as little as 4 s. Structural imaging using 1H MRI can assess the airways and locate consolidation, mucus plugging and bronchiectasis. Dynamic structural imaging can extract information about lung motion and airway collapse, and can even be used to extract ventilation and perfusion information. In the past decade, pulmonary MRI has been examined in a wide variety of diseases, including asthma, bronchopulmonary dysplasia, bronchiolitis obliterans, childhood interstitial lung diseases, cystic fibrosis and multiple rare lung diseases. This multitechnique approach using MRI provides a holistic view that elucidates underlying disease mechanisms and connects them to patient outcomes and treatment response. This review will examine developments in pulmonary MRI over the past decade, with the aim of illustrating recent advances in research and how these discoveries are beginning to be applied to clinical settings.
