Respiration; international review of thoracic diseases · 2025
Pilot Evaluation of Functional Lung Imaging via X-Ray Velocimetry for the Assessment of Regional Ventilation in Severe Lung Disease.
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Snell Gregory, Levvey Bronwyn, Nilsen Kris, Westall Glen, Pirakalathanan Piraveen, Kirkness Jason, Siddharthan Trishul, Fouras Andreas, Eikelis Nina
Аннотация
INTRODUCTION: Standard methods for diagnosing lung diseases are sub-optimal in detecting regional disease. X-ray velocimetry (XV), a novel functional lung imaging technology, holds the potential to uncover unique patterns of regional lung ventilation. This study aims to explore the application of XV in subjects with severe respiratory diseases to determine if there are regional ventilation differences and to compare the regional ventilation metrics with pulmonary function tests (PFT).
METHODS: In this proof-of-concept study, XV and PFT measurements were performed in subjects with severe lung disorders, referred for lung transplantation and compared with healthy controls. XV utilized fluoroscopic lung images of tidal breathing co-registered to each subject's CT chest scan to quantify voxel-wise tidal ventilation. The XV measurements included ventilation heterogeneity (VH), mean specific ventilation (MSV), and low ventilation region (LVR).
RESULTS: Forty subjects (59.3 years; 45% females) with severe lung disease were compared to 8 healthy controls (44.8 years, 25% females). XV metrics were different between those with severe lung disease and healthy controls (MSV: 0.099 ± 0.03 vs. 0.194 ± 0.03; VH: 73.1 ± 19.2 vs. 49.7 ± 11.2; LVR: 53.5 ± 17.8 vs. 11.4 ± 2.7, p < 0.01). There were negative, strong correlations for LVR with spirometric measurements of airflow limitation (FEV1 and FEV1/FVC) and trapping (RV/TLC). In addition, XV imaging highlighted regional ventilation changes at an individual and group level for subjects with obstructive and non-obstructive lung disease.
CONCLUSION: In patients with end-stage lung disease, XV was shown to highlight LVRs that correlate with airflow limitation and trapping and demonstrate disease-specific variations in regional ventilation that warrant further investigation.
METHODS: In this proof-of-concept study, XV and PFT measurements were performed in subjects with severe lung disorders, referred for lung transplantation and compared with healthy controls. XV utilized fluoroscopic lung images of tidal breathing co-registered to each subject's CT chest scan to quantify voxel-wise tidal ventilation. The XV measurements included ventilation heterogeneity (VH), mean specific ventilation (MSV), and low ventilation region (LVR).
RESULTS: Forty subjects (59.3 years; 45% females) with severe lung disease were compared to 8 healthy controls (44.8 years, 25% females). XV metrics were different between those with severe lung disease and healthy controls (MSV: 0.099 ± 0.03 vs. 0.194 ± 0.03; VH: 73.1 ± 19.2 vs. 49.7 ± 11.2; LVR: 53.5 ± 17.8 vs. 11.4 ± 2.7, p < 0.01). There were negative, strong correlations for LVR with spirometric measurements of airflow limitation (FEV1 and FEV1/FVC) and trapping (RV/TLC). In addition, XV imaging highlighted regional ventilation changes at an individual and group level for subjects with obstructive and non-obstructive lung disease.
CONCLUSION: In patients with end-stage lung disease, XV was shown to highlight LVRs that correlate with airflow limitation and trapping and demonstrate disease-specific variations in regional ventilation that warrant further investigation.