Functional pulmonary MRI with ultra-fast steady-state free precession

To date, computed tomography and nuclear medicine techniques are still the reference standard for lung imaging, but radiation exposure is a major concern; especially in case of longitudinal examinations and in children. Therefore, radiation-free imaging is an urgent necessity. Pulmonary magnetic resonance imaging (MRI) is radiation-free, but poses challenges since the low proton density and the presence of strong mesoscopic susceptibility variations considerably reduce the detectable MR signal. As a result, the lung typically appears as a “black hole” with conventional MRI techniques. Recently, ultra-fast balanced steady-state free precession (ufSSFP) methods were proposed for ameliorated lung morphological imaging. In this thesis, ufSSFP is employed to develop and improve several pulmonary functional imaging methods, which can be used in clinical settings using standard MR scanners and equipment.
At every breath, the lung expands and contracts, and at every heartbeat, the blood is pumped through the arteries to reach the lung parenchyma. This creates signal modulations associated with pulmonary blood perfusion and ventilation that are detectable by MRI. The second chapter of this thesis focuses on the optimization of time-resolved two-dimensional (2D) ufSSFP for perfusion-weighted and ventilation-weighted imaging of the lung. Subsequently, in the third chapter, three-dimensional (3D) multi-volumetric ufSSFP breath-hold imaging is used to develop a lung model and retrieve the measure α, a novel ventilation-weighted quantitative parameter.
Oxygen-enhanced MRI exploits the paramagnetic properties of oxygen dissolved in the blood, acting as a weak T1-shortening contrast agent. When breathing pure oxygen, it reaches only ventilated alveoli of the parenchyma and dissolves only in functional and perfused regions. How ufSSFP imaging in combination with a lung model can be used to calculate robust 3D oxygen enhancement maps is described in the fourth chapter. In addition, in the fifth chapter, 2D inversion recovery ufSSFP imaging is employed to map the T1 and T2 relaxation times of the lung, the change of the relaxation times after hyperoxic conditions, as well as the physiological oxygen wash-in and wash-out time (related to the time needed to shorten T1 after oxygen breathing).
The objective of the last chapter of this thesis is the application of 3D ufSSFP imaging before and after intravenous gadolinium-based contrast agent administration for the investigation of signal enhancement ratio (SER) mapping: a rapid technique to visualize perfusion-related diseases of the lung parenchyma.
The techniques presented in this thesis using optimized ufSSFP pulse sequences demonstrated potential to reveal new insights on pulmonary function as well as quantification, and might become part of the future standard for the evaluation and follow-up of several lung pathologies.