Multireader Determination of Clinically Significant Obstruction Using Hyperpolarized Xe-Ventilation MRI.

Ebner, Lukas; Virgincar, Rohan S; He, Mu; Choudhury, Kingshuk R; Robertson, Scott H; Christe, Andreas; Mileto, Achille; Mammarapallil, Joseph G; McAdams, H Page; Driehuys, Bastiaan; Roos, Justus E (2019). Multireader Determination of Clinically Significant Obstruction Using Hyperpolarized Xe-Ventilation MRI. American Journal of Roentgenology, 212(4), pp. 758-765. American Roentgen Ray Society 10.2214/AJR.18.20036

Text AJR.18_ebner.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (1MB)

OBJECTIVE

The objective of our study was to identify the magnitude and distribution of ventilation defect scores (VDSs) derived from hyperpolarized (HP) Xe-MRI associated with clinically relevant airway obstruction.

MATERIALS AND METHODS

From 2012 to 2015, 76 subjects underwent HP Xe-MRI (48 healthy volunteers [mean age ± SD, 54 ± 17 years]; 20 patients with asthma [mean age, 44 ± 20 years]; eight patients with chronic obstructive pulmonary disease [mean age, 67 ± 5 years]). All subjects underwent spirometry 1 day before MRI to establish the presence of airway obstruction (forced expiratory volume in 1 second-to-forced vital capacity ratio [FEV/FVC] < 70%). Five blinded readers assessed the degree of ventilation impairment and assigned a VDS (range, 0-100%). Interreader agreement was assessed using the Fleiss kappa statistic. Using FEV/FVC as the reference standard, the optimum VDS threshold for the detection of airway obstruction was estimated using ROC curve analysis with 10-fold cross-validation.

RESULTS

Compared with the VDSs in healthy subjects, VDSs in patients with airway obstruction were significantly higher (p < 0.0001) and significantly correlated with disease severity (r = 0.66, p < 0.0001). Ventilation defects in subjects with airway obstruction did not show a location-specific pattern (p = 0.158); however, defects in healthy control subjects were more prevalent in the upper lungs (p = 0.014). ROC curve analysis yielded an optimal threshold of 12.4% ± 6.1% (mean ± SD) for clinically significant VDS. Interreader agreement for Xe-MRI was substantial (κ = 0.71).

CONCLUSION

This multireader study of a diverse cohort of patients and control subjects suggests a Xe-ventilation MRI VDS of 12.4% or greater represents clinically significant obstruction.

Interest & Impact

Downloads

1 since deposited on 21 May 2019
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item