Synopsis
Accurately
characterizing the chemical shifts of 129Xe in the lung, enables
probing pulmonary gas exchange at the micron scale interface between the
alveoli and capillary beds. Doing so requires decomposing the dissolved phase 129Xe
spectrum. Whereas previous work identified only two dissolved-phase 129Xe
resonances associated with blood and barrier tissues, we now employ improved
non-linear fitting techniques to decompose complex FIDs into three resonances. This
enables us to report updated ratios of 129Xe uptake in blood and
barrier resonances, many of which differ significantly between control and IPF
groups. Purpose
For
patients with idiopathic pulmonary fibrosis, the introduction of new therapies
has created an urgent need for better metrics that can help both diagnose the
disease and quantify progression or therapy response. This need is well
addressed by the chemical shifts and solubility of
129Xe in tissues,
which have enabled sensitive and direct spectroscopic assessment of lung
function
1. Previous work in this arena had recognized only 2
dissolved-phase
129Xe resonances associated with barrier tissues and
blood. Here we employ improved non-linear curve fitting methods to accurately
decompose the complex
129Xe FIDs into 3 stable dissolved-phase
resonances
2 in both healthy and IPF subjects. Moreover, we use a
more robust gas-phase reference
3 to report on frequency shifts and
linewidth changes in IPF. By accurately characterizing these spectral
differences between healthy and IPF subjects, we can develop quantitative tools
that better stage disease progression, assess therapy response earlier, and
perhaps even stratify subclasses of IPF to improve outcomes.
Methods
129Xe spectra were acquired from 7 healthy normal
(age 38±16.9 years) and 8 IPF subjects (age 65.1±4.9 years) during a 15 second
breathold using a 1.5T GE 15M4 EXCITE MRI scanner (GE Healthcare, Waukesha WI)
and a Quadrature
129Xe vest coil (Clinical MR Solutions, Brookfield,
WI). Approximately 200 mL of isotopically enriched
129Xe (85%) was
hyperpolarized to ~20% via spin-exchange optical pumping (Model 9800, Polarean,
Inc., Durham, NC), then combined with 800 mL of N
2. After inhaling
the 1 L mixture, 200 FIDs were acquired with the following scan parameters: 512
samples/FID, TE/TR = 0.875/20 ms, BW = 8.06 kHz, 1200 μs 3-lobe sinc pulse, flip
angle ≈ ~18°. The first 100 frames were discarded to eliminate
contamination from magnetization that originated downstream of the capillary
beds. The remaining 100 frames were averaged and then decomposed into a series
of exponentially decaying FIDs using the trust-region-reflect algorithm to minimize
the complex least-squares residual error
4.
Resonant frequencies were aligned relative to the alveolar gas-phase resonance,
which occurs at -2.9 ppm after correcting for the Xe-O
2 , Xe -Xe, and
bulk magnetic susceptibility shifts
5,6,7.
Results
Figure
1 illustrates several of the primary differences in
129Xe spectra
from healthy subjects and patients with IPF. These include readily apparent
differences in amplitudes, frequencies, and linewidths of the RBC and 2 barrier
peaks. Figure 2 shows that the RBC:barrier continues to be significantly
reduced in IPF as found with previous 2-peak fits
1. However,
RBC:barrier in healthy subjects is found to be 0.44±0.23 with the 3-peak fit
versus 0.55±0.13 with 2-dissolved phase peaks. Figure 3 summarizes the results
of two-sample unpaired T-tests of all fit parameters. In IPF patients, the RBC
frequency shifts negatively relative to healthy subjects. However, now
decomposing the 2 barrier peaks reveals that they also are shifted to lower
frequency in IPF. Moreover, in IPF the linewidths of both barrier peaks were found
to be dramatically narrower than in healthy volunteers. Finally, phasing the
spectra relative to the RBC resonances demonstrated that barrier 1 experiences a
statistically different starting phase between IPF and healthy subjects.
Discussion
The
reduction in RBC:Barrier among IPF subjects agrees with previous work. However,
fitting 2 barrier peaks has reduced the mean RBC:Barrier ratio in healthy
subjects. This is reasonable considering that in pure blood consisting of 40%
RBC and 60% plasma, the maximum RBC:barrier would be 0.67, even before
considering additional barrier components from tissue matrix needed to support
the lung. The negative shift of the RBC compartment in IPF is consistent with
decreased oxygenation relative to healthy subjects
8. However, the
negative shifts of the two barrier peaks are new compared to previous human
studies
1. This difference is likely a consequence of our improved spectral
fitting, which also accounts for different phases of the 2 barrier peaks. Both
barrier peaks exhibit strikingly narrower linewidths, suggestive of decreased exchange
that could result from interstitial thickening physically separating these two
compartments. In summary, fitting of the complex
129Xe gas exchange spectra
to include 3 dissolved-phase resonances reveals numerous spectral parameters
that are significantly altered in IPF and may help in both diagnosing and
staging this disease.
Acknowledgements
R01HL126771, R01HL105643, P41 EB015897, Gilead SciencesReferences
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