Detection of radiation-induced lung injury in non-small cell lung cancer patients using hyperpolarized helium-3 magnetic resonance imaging.

PURPOSE To compare hyperpolarized helium-3 magnetic resonance imaging ((3)He-MRI) acquired from non-small cell lung cancer (NSCLC) patients before and after external beam radiotherapy (EBRT). METHODS AND MATERIALS In an Ethics Committee-approved prospective study, five patients with histologically confirmed NSCLC gave written informed consent to undergo computed tomography (CT) and (3)He-MR ventilation imaging 1 week prior to and 3 months after radiotherapy. Images were registered to pre-treatment CT using anatomical landmark-based rigid registration to enable comparison. Emphysema was graded from examination of the CT. MRI-defined ventilation was calculated as the intersection of (3)He-MRI and CT lung volume as a percentage of the CT lung volume for the whole lung and regions of CT-defined pneumonitis. RESULTS On pre-treatment images, there was a significant correlation between the degree of CT-defined emphysema and (3)He-MRI whole lung ventilation (Spearman's rho=0.90, p=0.04). After radiation therapy, pneumonitis was evident on CT for 3/5 patients. For these cases, (3)He-MRI ventilation was significantly reduced within the regions of pneumonitis (pre: 94.1±2.2%, post: 73.7±4.7%; matched pairs Student's t-test, p=0.02, mean difference=20.4%, 95% confidence interval 6.3-34.6%). CONCLUSIONS This work demonstrates the feasibility of detecting ventilation changes between pre- and post-treatment using hyperpolarized helium-3 MRI for patients with NSCLC. Pre-treatment, the degree of emphysema and (3)He-MRI ventilation were correlated. For three cases of radiation pneumonitis, (3)He-MRI ventilation changes between pre- and post-treatment imaging were consistent with CT evidence of radiation-induced lung injury.

[1]  L. Marks,et al.  Association between RT-induced changes in lung tissue density and global lung function. , 2008, International journal of radiation oncology, biology, physics.

[2]  C I Henschke,et al.  Lung Cancer: Evaluation with MR Imaging During and After Irradiation , 1994, Journal of thoracic imaging.

[3]  John P Mugler,et al.  Emphysema: hyperpolarized helium 3 diffusion MR imaging of the lungs compared with spirometric indexes--initial experience. , 2002, Radiology.

[4]  A. Dirksen,et al.  Hyperpolarised 3He MRI and 81mKr SPECT in chronic obstructive pulmonary disease , 2005, European Journal of Nuclear Medicine and Molecular Imaging.

[5]  H C Charles,et al.  Cystic fibrosis: combined hyperpolarized 3He-enhanced and conventional proton MR imaging in the lung--preliminary observations. , 1999, Radiology.

[6]  D. Sugarbaker,et al.  Clinical radiation pneumonitis and radiographic changes after thoracic radiation therapy for lung carcinoma , 1998, Cancer.

[7]  M. Paley,et al.  3D volume‐localized pO2 measurement in the human lung with 3He MRI , 2005, Magnetic resonance in medicine.

[8]  N. Choi,et al.  Toxicity of thoracic radiotherapy on pulmonary function in lung cancer. , 1994, Lung cancer.

[9]  H. Kauczor,et al.  Functional MR imaging of pulmonary ventilation using hyperpolarized noble gases , 2000 .

[10]  K. Sheng,et al.  A rabbit irradiation platform for outcome assessment of lung stereotactic radiosurgery. , 2009, International journal of radiation oncology, biology, physics.

[11]  J. Wild,et al.  Single‐scan acquisition of registered hyperpolarized 3He ventilation and ADC images using a hybrid 2D gradient‐echo sequence , 2007, Magnetic resonance in medicine.

[12]  E. V. van Beek,et al.  Comparison between 2D and 3D gradient‐echo sequences for MRI of human lung ventilation with hyperpolarized 3He , 2004, Magnetic resonance in medicine.

[13]  J A Purdy,et al.  Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC) , 1999, International journal of radiation oncology, biology, physics.

[14]  Frank R. Korosec,et al.  Early Emphysematous Changes in Asymptomatic Smokers: Detection with 3He MR Imaging , 2006 .

[15]  Yasuji Oshiro,et al.  Risk Factor of Radiation Pneumonitis: Assessment With Velocity-Encoded Cine Magnetic Resonance Imaging of Pulmonary Artery , 2004, Journal of computer assisted tomography.

[16]  John P Mugler,et al.  Evaluation of asthma with hyperpolarized helium-3 MRI: correlation with clinical severity and spirometry. , 2006, Chest.

[17]  Jim M. Wild,et al.  Feasibility of Image Registration and Intensity-Modulated Radiotherapy Planning With Hyperpolarized Helium-3 Magnetic Resonance Imaging for Non–Small-Cell Lung Cancer , 2007, International journal of radiation oncology, biology, physics.

[18]  L. Hedlund,et al.  Proton and hyperpolarized helium magnetic resonance imaging of radiation-induced lung injury in rats. , 2004, International journal of radiation oncology, biology, physics.

[19]  Joe Y. Chang,et al.  Lung Perfusion Imaging Can Risk Stratify Lung Cancer Patients for the Development of Pulmonary Complications after Chemoradiation , 2008, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[20]  D. Gandara,et al.  Radiation pneumonitis following combined modality therapy for lung cancer: analysis of prognostic factors. , 1995, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  John P Mugler,et al.  Functional MRI of the lung using hyperpolarized 3‐helium gas , 2004, Journal of magnetic resonance imaging : JMRI.

[22]  Neil Woodhouse,et al.  An image acquisition and registration strategy for the fusion of hyperpolarized helium-3 MRI and x-ray CT images of the lung , 2008, Physics in medicine and biology.

[23]  R R Miller,et al.  CT in the qualitative assessment of emphysema , 1986, Journal of thoracic imaging.

[24]  Joos V Lebesque,et al.  Regional differences in lung radiosensitivity after radiotherapy for non-small-cell lung cancer. , 2004, International journal of radiation oncology, biology, physics.