title: Abnormalities in hyperpolarized (129)Xe magnetic resonance imaging and spectroscopy in two patients with pulmonary vascular disease.
abstract: The diagnosis of pulmonary vascular disease (PVD) is usually based on hemodynamic and/or clinical criteria. Noninvasive imaging of the heart and proximal vasculature can also provide useful information. An alternate approach to such criteria in the diagnosis of PVD is to image the vascular abnormalities in the lungs themselves. Hyperpolarized (HP) (129)Xe magnetic resonance imaging (MRI) is a novel technique for assessing abnormalities in ventilation and gas exchange in the lungs. We applied this technique to two patients for whom there was clinical suspicion of PVD. Two patients who had significant hypoxemia and dyspnea with no significant abnormalities on computed tomography imaging or ventilation-perfusion scan and only mild or borderline pulmonary arterial hypertension at catheterization were evaluated. They underwent HP (129)Xe imaging and subsequently had tissue diagnosis obtained from lung pathology. In both patients, HP (129)Xe imaging demonstrated normal ventilation but markedly decreased gas transfer to red blood cells with focal defects on imaging, a pattern distinct from those previously described for idiopathic pulmonary fibrosis or obstructive lung disease. Pathology on both patients later demonstrated severe PVD. These findings suggest that HP (129)Xe MRI may be useful in the diagnosis of PVD and monitoring response to therapy. Further studies are required to determine its sensitivity and specificity in these settings.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA.
authors.forename: Talal
authors.initials: T
authors.lastname: Dahhan
authors.affiliation: Center for In Vivo Microscopy, Biomedical Engineering, Duke University, Durham, North Carolina, USA.
authors.forename: Shiv S
authors.initials: SS
authors.lastname: Kaushik
authors.affiliation: Center for In Vivo Microscopy, Biomedical Engineering, Duke University, Durham, North Carolina, USA; Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA.
authors.forename: Mu
authors.initials: M
authors.lastname: He
authors.affiliation: Department of Radiology, Duke University, Durham, North Carolina, USA.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Mammarappallil
authors.affiliation: Division of Pulmonary and Critical Care, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Victor F
authors.initials: VF
authors.lastname: Tapson
authors.affiliation: Department of Radiology, Duke University, Durham, North Carolina, USA.
authors.forename: Holman P
authors.initials: HP
authors.lastname: McAdams
authors.affiliation: Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Sporn
authors.affiliation: Center for In Vivo Microscopy, Biomedical Engineering, Duke University, Durham, North Carolina, USA; Department of Radiology, Duke University, Durham, North Carolina, USA.
authors.forename: Bastiaan
authors.initials: B
authors.lastname: Driehuys
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA.
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Rajagopal
keywords: magnetic resonance imaging; pulmonary hypertension; pulmonary vascular disease; xenon