MR imaging of pulmonary lung nodules during one lung flooding: first morphological evaluation using an ex vivo human lung model
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Magnetic resonance imaging in pulmonary oncology is limited because of unfavourable physical and physiological conditions in ventilated lung. Previous work showed operability of One Lung Flooding using saline in vivo in MR units, and that valuable conditions for ultrasound and thermal-based interventions exist. Therefore, this study investigates the morphological details of human lung during Lung Flooding to evaluate its further value focusing on MR-guided interventions.
Materials and methods
MR imaging was performed on 20 human lung lobes containing lung cancer and metastases. Lobes were intraoperatively flooded with saline and imaged using T1w Gradient Echo and T2 Spin Echo sequences at 1.5 T. Additionally, six patients received pre-operative MRI.
During lung flooding, all lung tumours and metastases were visualized and clearly demarked from the surrounding lung parenchyma. The tumour mass appeared hyperintense in T1w and hypointense in T2w MR imaging. Intra-pulmonary bronchial structures were well differentiated in T2w and calcification in T1w MR sequences.
Superior conditions with new features of lung MRI were found during lung flooding with an unrestricted visualization of malignant nodules and clear demarcation of intra-pulmonary structures. This could lead to new applications of MR-based pulmonary interventions such as laser or focused ultrasound-based thermal ablations.
KeywordsMRI One lung flooding Lung imaging Lung cancer MR intervention HIFU
Bronco alveolar carcinoma
Fraction inspired oxygen
Focused ultrasound surgery
Half-Fourier acquisition single-shot turbo spin echo sequence
High-intensity focused ultrasound
Invasive mammary ductal carcinoma
Left upper lobe
Left lower lobe
Maximum intensity projection
Magnet resonance imaging
Non-small cell lung cancer
One lung flooding
Positron emission tomography
Pancreatic ductal carcinoma
Renal cell carcinoma
Right middle lobe
Right upper lobe
Right lower lobe
Region of interest
Specific absorption rate
FW and TGL developed the study design and conception. TGL performed clinical selection of cases and performed surgical resection. FW performed ex vivo lung preparation. Acquisition of MR data and statistics were performed by JB and FW. FW, JB, and TGL were drafting the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests, neither financial nor non-financial. This research was supported by the FUS Foundation, Charlottesville, VA, USA (FUS325) and the SRH Waldklinikum Gera, Germany.
All surgical procedures were performed at the clinic for thoracic and vascular surgery of the SRH Wald-Klinikum Gera, Germany. The use of human tissue for this study was approved by the ethics committee of the Medical Association of Thuringia (TLLV) and patients were informed prior to surgery. This article does not contain any studies with animals performed by any of the authors.
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