New Scan Method Unveils Lung Function Secrets

A new method of scanning lungs developed by Newcastle University researchers shows the treatment effects on lung function in real time and enables experts to see transplanted lungs’ functioning. The advancement could help medics sooner identify any decline in lung function.

The scan method has enabled the United Kingdom-based team to examine the way air moves in and out of the lungs during breathing in patients with asthma, chronic obstructive pulmonary disease (COPD), and lung transplant recipients.

Publishing papers in Radiology and JHLT Open, the team explained the method of using a special gas called perfluoropropane, that is visible on an MRI scanner. The gas can be safely inhaled and exhaled by patients; once the gas is used, scans are then taken to determine where in the lungs the gas has reached.

“Our scans show where there is patchy ventilation in patients with lung disease, and show us which parts of the lung improve with treatment,” said project lead Pete Thelwall, professor of Magnetic Resonance Physics and director of the Centre for In Vivo Imaging at Newcastle University. “For example, when we scan a patient as they use their asthma medication, we can see how much of their lungs and which parts of their lung are better able to move air in and out with each breath.”

Using the new scanning method, the team revealed parts of the lung that air cannot properly reach during breathing. By measuring the amount of the lung that is well-ventilated versus poorly ventilated, experts can assess the effects of a patient’s respiratory disease, and they can locate and visualize the lung regions with ventilation defects.

Demonstrating that the scans work in patients with asthma or COPD, the team—comprised of experts from universities and NHS Trusts in Newcastle and Sheffield—published the first paper in Radiology.

The new scanning technique allows the team to quantify the degree of improvement in ventilation when patients have a treatment—in this case a widely used inhaler, the bronchodilator, salbutamol. This shows the imaging methods could be valuable in clinical trials of new lung disease treatments.

Use in Lung Transplants

A study published in JHLT Open examined patients who had previously received a lung transplant for very severe lung disease at the Newcastle upon Tyne Hospitals NHS Foundation Trust. It demonstrates how the team further developed the imaging method to provide lung function measurements that could be used to better support lung transplant recipients in the future. The measurement sensitivity means medics can spot early changes in lung function, thereby allowing them to identify lung problems earlier and provide better patient care.

In research studies, the team scanned transplant recipients’ lungs over multiple breaths in and out, collecting MRI pictures that showed how the air containing the gas reached different areas of the lung. The team scanned patients who either had normal lung function or who were experiencing chronic rejection after a lung transplant, which is a common issue in lung transplant recipients as their immune system attacks the donor lungs. In those with chronic rejection, the scans showed poorer movement of air to the lungs’ edges, most likely due to damage in the lungs’ very small breathing tubes (airways), a feature typical of chronic rejection also known as chronic lung allograft dysfunction.

“We hope this new type of scan might allow us to see changes in the transplant lungs earlier and before signs of damage are present in the usual blowing tests. This would allow any treatment to be started earlier and help protect the transplanted lungs from further damage,” stated study co-author Andrew Fisher, professor of Respiratory Transplant Medicine at Newcastle Hospitals NHS Foundation Trust and Newcastle University. 

The team claims this scan method can potentially be used to manage lung transplant recipients and other lung diseases in the future, bringing a sensitive measurement that may spot early changes in lung function and enable better management of these conditions.

This work on lung imaging has been funded by the Medical Research Council and by The Rosetrees Trust.

References
Assessing Lung Ventilation and Bronchodilator Response in Asthma and Chronic Obstructive Pulmonary Disease with Fluorine 19 MRI. Pippard BJ, Neal MA, Holland CW, Maunder AM, Forrest I, Lawson RA, Fisher HF, Matthews JNS, Wild JM, Simpson AJ, Thelwall, PE. Radiology. Doi: https://doi.org/10.1148/radiol.240949 (n.b. live date 24th Dec)
Dynamic 19F-MRI of pulmonary ventilation in lung transplant recipients with and without chronic lung allograft dysfunction. Neal MA, Bos S, Holland CW, Hollingsworth KG, Meachery G, Nair A, Lordan JL, Fisher AJ, Thelwall, PE. JHLT Open. Doi: https://www.jhltopen.org/article/S2950-1334(24)00116-2/fulltext