Assessing lung fibrosis with magnetic resonance imaging
Research type
Research Study
Full title
Investigation into the prognostic indicators of Idiopathic Pulmonary Fibrosis using multimodal imaging techniques including structural-functional MRI assessment.
IRAS ID
186659
Contact name
Jim Wild
Contact email
Sponsor organisation
Sheffield Teaching Hospitals NHS Foundation Trust
Duration of Study in the UK
4 years, 10 months, 31 days
Research summary
Research Summary
Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease with no known cure and a poor prognosis, in spite of recent treatment advances. There is a lack of available tools to guide the doctor when making assessments about which patients are likely to deteriorate quickly and which are likely to live longer.
Lung magnetic resonance imaging (MRI) is beginning to show promise as a clinically relevant tool in assessing different forms of respiratory disease. Low tissue density in the lungs has previously made MRI second best to computed tomography (CT) in the structural assessment of the lungs. However, recent advances such as hyperpolarised gas and contrast enhanced imaging have widened the scope in the ability of MRI to provide valuable structural and functional information in lung disease.
We propose a pilot observational study designed to identify the ability of sequential MRI scan indices to predict disease progression and prognosis in IPF. Patients with definite IPF will be diagnosed and identified at relevant lung disease multidisciplinary team meetings and approached in the Northern General Hospital Interstitial Lung Disease Clinic, in Sheffield.
Participants will be invited to three visits at the Academic Department of Radiology at the Royal Hallamshire Hospital in Sheffield for MRI scans, which involve the use of inhaled xenon gas and injected gadolinium contrast. One scan protocol will be performed at baseline, with further single scan protocols at three, six and 12 months. Participants will also undergo lung function tests at these visits (measurements of lung volumes). Patients will have CT scan at baseline and 12 months.
The values derived from these scans will be correlated with current clinical tests of lung function, computed tomography scans and lung vessel blood pressure changes measured by echocardiography in order to investigate its potential to predict outcomes in patients with IPF.
Summary of Results
In this study, we used hyperpolarised gas magnetic resonance imaging (MRI) to explore physiological changes in the lung in 51 patients with idiopathic pulmonary fibrosis (IPF), the most progressive form of lung scarring.We found that assessing the gas diffusion capability of the lungs with hyperpolarised xenon allowed regional changes to be visualised and that these changes were more sensitive to short term deterioration of the condition than existing lung function measurements. We found that the integrity of the lung microstructure could be measured with an MRI technique that measures the Brownian motion of gases in the air sacs and that this was closely related to areas of lung scarring on structural imaging. The time taken for blood to flow through the lungs was increased in regions of lung scarring and this may allow us to identify disease in the blood vessels at an earlier stage.
The results have allowed this technology to play a role in pharmaceutical trials to more effectively measure the improvements seen with therapy and therefore help to identify treatments for future use in lung scarring conditions.
REC name
North West - Liverpool Central Research Ethics Committee
REC reference
15/NW/0750
Date of REC Opinion
17 Nov 2015
REC opinion
Further Information Favourable Opinion