Background

Measurement of regional lung ventilation with hyperpolarized ¹²⁹Xe magnetic resonance imaging (¹²⁹Xe MRI) in pediatric asthma is poised to advance our understanding of disease mechanisms and pathophysiology in a disorder with diverse clinical phenotypes. ¹²⁹Xe MRI has not been investigated in a pediatric asthma cohort.

Objective

We hypothesized that ¹²⁹Xe MRI is feasible and can demonstrate ventilation defects that relate to and predict clinical severity in a pediatric asthma cohort.

Methods

Thirty-seven children (13 with severe asthma, 8 with mild/moderate asthma, 16 age-matched healthy controls) aged 6 to 17 years old were imaged with ¹²⁹Xe MRI. Ventilation defect percentage (VDP) and image reader score were calculated and compared with clinical measures at baseline and at follow-up.

Results

Children with asthma had higher VDP (P = .002) and number of defects per image slice (defects/slice) (P = .0001) than children without asthma. Children with clinically severe asthma had significantly higher VDP and number of defects/slice than healthy controls. Children with asthma who had a higher number of defects/slice had a higher rate of health care utilization (r = 0.48; P = .03) and oral corticosteroid use (r = 0.43; P = .05) at baseline. Receiver-operating characteristic analysis demonstrated that the VDP and number of defects/slice were predictive of increased health care utilization, asthma, and severe asthma. VDP correlated with FEV₁ (r = −0.35; P = .04) and FEV₁/forced vital capacity ratio (r = −0.41; P = .01).

Conclusions

¹²⁹Xe MRI correlates with asthma severity, health care utilization, and oral corticosteroid use. Because delineation of clinical severity is often difficult in children, ¹²⁹Xe MRI may be an important biomarker for severity, with potential to identify children at higher risk for exacerbations and improve outcomes.

中文翻译：

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129Xe MRI 作为小儿哮喘临床疾病严重程度的衡量标准

背景

^{使用超极化129} Xe 磁共振成像 ( ¹²⁹ Xe MRI) 测量小儿哮喘的局部肺通气量有望促进我们对具有多种临床表型的疾病的疾病机制和病理生理学的理解。¹²⁹ Xe MRI 尚未在儿科哮喘队列中进行过研究。

客观的

我们假设¹²⁹ Xe MRI 是可行的，并且可以证明与儿科哮喘队列的临床严重程度相关并预测其临床严重程度的通气缺陷。

方法

年龄在 6 至 17 岁之间的 37 名儿童（13 名患有严重哮喘，8 名患有轻度/中度哮喘，16 名年龄匹配的健康对照）接受了 129 Xe MRI^成像。计算通气缺陷百分比 (VDP) 和图像阅读器评分，并与基线和随访时的临床测量值进行比较。

结果

与没有哮喘的儿童相比，患有哮喘的儿童具有更高的 VDP ( P  = .002) 和每个图像切片的缺陷数（缺陷/切片） ( P  = .0001)。患有临床严重哮喘的儿童的 VDP 和缺陷/切片数明显高于健康对照。具有较高缺陷/切片数的哮喘儿童 在基线时具有较高的医疗保健利用率 ( r  = 0.48；P  = .03) 和口服皮质类固醇的使用率 ( r  = 0.43；P = .05)。接受者操作特征分析表明，VDP 和缺陷/切片数量可预测医疗保健利用率、哮喘和严重哮喘的增加。VDP 与 FEV ₁ (r  = −0.35；P  = .04) 和 FEV ₁ / 用力肺活量比率 ( r  = −0.41; P  = .01)。

结论

¹²⁹ Xe MRI 与哮喘严重程度、医疗保健利用率和口服皮质类固醇的使用相关。由于描绘儿童的临床严重程度通常很困难，因此¹²⁹ Xe MRI 可能是严重程度的重要生物标志物，有可能识别出急性加重风险较高的儿童并改善结果。