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Measures of Ventilation Heterogeneity Mapped with Hyperpolarized Helium-3 (HHe-3) MRI Demonstrate a T2-High Phenotype in Asthma
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  • William Teague,
  • Jaime Mata,
  • Kun Qing,
  • Nicholas Tustison,
  • John Mugler,
  • Craig Meyer,
  • Eduard de Lange,
  • Michael Shim,
  • Kristin Wavell,
  • Talissa Altes
William Teague
University of Virginia
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Jaime Mata
University of Virginia School of Medicine
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Kun Qing
University of Virginia School of Medicine
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Nicholas Tustison
University of Virginia School of Medicine
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John Mugler
University of Virginia School of Medicine
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Craig Meyer
University of Virginia School of Medicine
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Eduard de Lange
University of Virginia School of Medicine
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Michael Shim
University of Virginia School of Medicine
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Kristin Wavell
University of Virginia School of Medicine
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Talissa Altes
University of Missouri
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Abstract

Background: HHe-3 MR is a non-invasive imaging method which maps and quantifies regions of ventilation heterogeneity (VH) in the lung. VH is an important feature of asthma, but little is known as to how VH informs patient phenotypes. Purpose: To determine if VH indicators quantified by HHe-3 MRI predict phenotypic characteristics and map to regions of inflammation in children with problematic wheeze/asthma. Methods. Sixty children with poorly-controlled asthma underwent HHe-3 MRI, including 22 with bronchoalveolar lavage (BAL). The HHe-3 signal intensity defined four ventilation compartments. The non-ventilated and hypoventilated compartments divided by the total lung volume defined a VH index (VHI %). Results: Children with VHI % in the upper quartile had significantly greater airflow limitation, bronchodilator responsiveness, blood eosinophils, expired nitric oxide (FeNO), and BAL eosinophilic/ neutrophilic granulocyte patterns compared to children with VHI % in the lower quartile. Lavage return from hypoventilated bronchial segments had greater eosinophil % than from ventilated segments. Conclusion: In children with asthma, greater VHI % as measured by HHe-3 MRI identifies a severe phenotype with higher type 2 inflammatory markers, and maps to regions of lung eosinophilia. Listed on ClinicalTrials.gov (NCT02577497).

Peer review status:ACCEPTED

22 Aug 2020Submitted to Pediatric Pulmonology
24 Aug 2020Submission Checks Completed
24 Aug 2020Assigned to Editor
31 Aug 2020Reviewer(s) Assigned
20 Oct 2020Review(s) Completed, Editorial Evaluation Pending
24 Oct 2020Editorial Decision: Revise Minor
01 Dec 20201st Revision Received
03 Dec 2020Submission Checks Completed
03 Dec 2020Assigned to Editor
03 Dec 2020Reviewer(s) Assigned
28 Dec 2020Review(s) Completed, Editorial Evaluation Pending
08 Jan 2021Editorial Decision: Accept