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Hyperpolarised ³He MRI versus HRCT in COPD and normal volunteers: PHIL trial

¹ Academic Dept of Radiology, University of Sheffield, Sheffield, UK. ² Dept of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. ³ Dept of Radiology, ⁸ Institute of Physics, Johannes Gutenberg University, ⁷ Max Planck Institute for Polymer Research, Mainz, ⁵ Dept of Radiology, Clinic for Thoracic Diseases, ⁹ Dept of Diagnostic and Interventional Radiology, University Hospital Heidelburg, Heidelberg, and ⁶ Clinical Epidemiology and Health Economy Unit, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany. ⁴ Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark.

CORRESPONDENCE: E. J. R. van Beek, Professor of Radiology, Carver College of Medicine, C-751 GH, 200 Hawkins Drive, Iowa City, IA 52242-1077, USA. E-mail: edwin-vanbeek{at}uiowa.edu

Keywords: Apparent diffusion coefficient, chronic obstructive lung disease, emphysema, high-resolution computed tomography, hyperpolarised helium-3 magnetic resonance imaging

Received: September 9, 2008
Accepted June 11, 2009

The aim of the present study was to apply hyperpolarised (HP) ³He magnetic resonance imaging (MRI) to identify patients with chronic obstructive pulmonary disease (COPD) and ₁-antitrypsin deficiency (₁-ATD) from healthy volunteers and compare HP ³He MRI findings with high-resolution computed tomography (HRCT) in a multicentre study. Quantitative measurements of HP ³He MRI (apparent diffusion coefficient (ADC)) and HRCT (mean lung density (MLD)) were correlated with pulmonary function tests.

A prospective three centre study enrolled 122 subjects with COPD (either acquired or genetic) and age-matched never-smokers. All diagnostic studies were completed in 94 subjects (52 with COPD; 13 with ₁-ATD; 29 healthy subjects; 63 males; and 31 females; median age 62 yrs). The consensus assessment of radiologists, blinded for other test results, estimated nonventilated lung volume (HP ³He MRI) and percentage diseased lung (HRCT). Quantitative evaluation of all data for each centre consisted of ADC (HP ³He MRI) and MLD measurements (HRCT), and correlation with forced expiratory volume in 1 s (FEV₁)/forced vital capacity (FVC) indicating airway obstruction, and the diffusing capacity of the lung for carbon monoxide (D_L,CO) indicating alveolar destruction.

Using lung function tests as a reference, regional analysis of HP ³He MRI and HRCT correctly categorised normal volunteers in 100% and 97%, COPD in 42% and 69% and ₁-ATD in 69% and 85% of cases, respectively. Direct comparison of HP ³He MRI and CT revealed 23% of subjects with moderate/severe structural abnormalities had only mild ventilation defects. In comparison with lung function tests, ADC was more effective in separating COPD patients from healthy subjects than MLD (p<0.001 versus 0.038). ADC measurements showed better correlation with D_L,CO than MLD (r = 0.59 versus 0.29).

Hyperpolarised ³He MRI correctly categorised patients with COPD and normal volunteers. It offers additional functional information, without the use of ionising radiation whereas HRCT gives better morphological information. We showed the feasibility of a multicentre study using different magnetic resonance systems.