title: Noncystic Fibrosis Bronchiectasis: Regional Abnormalities and Response to Airway Clearance Therapy Using Pulmonary Functional Magnetic Resonance Imaging.
abstract: Evidence-based treatment and management for patients with bronchiectasis remain challenging. There is a need for regional disease measurements as focal distribution of disease is common. Our objective was to evaluate the ability of magnetic resonance imaging (MRI) to detect regional ventilation impairment and response to airway clearance therapy (ACT) in patients with noncystic fibrosis (CF) bronchiectasis, providing a new way to objectively and regionally evaluate response to therapy.
  
  
  
  Fifteen participants with non-CF bronchiectasis and 15 age-matched healthy volunteers provided written informed consent to an ethics board-approved Health Insurance Portability and Accountability Act-compliant protocol and underwent spirometry, plethysmography, computed tomography (CT), and hyperpolarized3He MRI. Bronchiectasis patients also completed a Six-Minute Walk Test, the St. George's Respiratory questionnaire, and Patient Evaluation Questionnaire (PEQ), and returned for a follow-up visit after 3 weeks of daily oscillatory positive expiratory pressure use. CT evidence of bronchiectasis was qualitatively reported by lobe, and MRI ventilation defect percent (VDP) was measured for the entire lung and individual lobes.
  
  
  
  CT evidence of bronchiectasis and abnormal VDP (14 ± 7%) was observed for all bronchiectasis patients and no healthy volunteers. There was CT evidence of bronchiectasis in all lobes for 3 patients and in 3 ± 1 lobes (range = 1-4) for 12 patients. VDP in lobes with CT evidence of bronchiectasis (19 ± 12%) was significantly higher than in lobes without CT evidence of bronchiectasis (8 ± 5%, P = .001). For patients, VDP in lung lobes with (P < .0001) and without CT evidence of bronchiectasis (P = .006) was higher than in healthy volunteers (3 ± 1%). For all patients, mean PEQ-ease-bringing-up-sputum (P = .048) and PEQ-patient-global-assessment (P = .01) were significantly improved post-oscillatory positive expiratory pressure. An improvement in regional VDP greater than the minimum clinical important difference was observed for 8 of the 14 patients evaluated.
  
  
  
  There was CT and MRI evidence of structure-function abnormalities in patients with bronchiectasis; in approximately half, there was evidence of ventilation improvements after airway clearance therapy.
authors.affiliation: Robarts Research Institute, The University of Western Ontario, London, Canada; Department of Medical Biophysics, The University of Western Ontario, London, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Svenningsen
authors.affiliation: Robarts Research Institute, The University of Western Ontario, London, Canada; Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Canada.
authors.forename: Fumin
authors.initials: F
authors.lastname: Guo
authors.affiliation: Division of Respirology, Department of Medicine, The University of Western Ontario, London, Canada.
authors.forename: David G
authors.initials: DG
authors.lastname: McCormack
authors.affiliation: Robarts Research Institute, The University of Western Ontario, London, Canada; Department of Medical Biophysics, The University of Western Ontario, London, Canada; Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Canada. Electronic address: gparraga@robarts.ca.
authors.forename: Grace
authors.initials: G
authors.lastname: Parraga
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001987:Bronchiectasis / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D016022:Case-Control Studies; D045853:Exhalation / Q000502:physiology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D012119:Respiration; D013147:Spirometry / Q000379:methods; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000379:methods; D014797:Vital Capacity / Q000502:physiology
keywords: Bronchiectasis; airway clearance therapy; magnetic resonance imaging; ventilation