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Region of interest-based versus whole-lung segmentation-based approach for MR lung perfusion quantification in 2-year-old children after congenital diaphragmatic hernia repair

  • Paediatric
  • Published:
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Abstract

Objective

With a region of interest (ROI)-based approach 2-year-old children after congenital diaphragmatic hernia (CDH) show reduced MR lung perfusion values on the ipsilateral side compared to the contralateral. This study evaluates whether results can be reproduced by segmentation of whole-lung and whether there are differences between the ROI-based and whole-lung measurements.

Methods

Using dynamic contrast-enhanced (DCE) MRI, pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) were quantified in 30 children after CDH repair. Quantification results of an ROI-based (six cylindrical ROIs generated of five adjacent slices per lung-side) and a whole-lung segmentation approach were compared.

Results

In both approaches PBF and PBV were significantly reduced on the ipsilateral side (p always <0.0001). In ipsilateral lungs, PBF of the ROI-based and the whole-lung segmentation-based approach was equal (p=0.50). In contralateral lungs, the ROI-based approach significantly overestimated PBF in comparison to the whole-lung segmentation approach by approximately 9.5 % (p=0.0013).

Conclusions

MR lung perfusion in 2-year-old children after CDH is significantly reduced ipsilaterally. In the contralateral lung, the ROI-based approach significantly overestimates perfusion, which can be explained by exclusion of the most ventral parts of the lung. Therefore whole-lung segmentation should be preferred.

Key Points

• Ipsilaterally, absolute lung perfusion after CDH is reduced in whole-lung analysis.

• Ipsilaterally, the ROI- and whole-lung-based approaches generate identical results.

• Contralaterally, the ROI-based approach significantly overestimates perfusion results.

• Whole lung should be analysed in MR lung perfusion imaging.

• MR lung perfusion measurement is a radiation-free parameter of lung function.

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Abbreviations

AIF:

Arterial input function

CDH:

Congenital diaphragmatic hernia

DCE-MRI:

Dynamic contrast-enhanced magnetic resonance imaging

ECMO:

Extracorporeal membrane oxygenation

MTT:

Mean transit time

PBF:

Pulmonary blood flow

PBV:

Pulmonary blood volume

ROI:

Region of interest

TWIST:

Time-resolved angiography with stochastic trajectories (TWIST)

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Acknowledgements

The scientific guarantor of this publication is Prof. Dr. K.W. Neff. The Insitute of Clinical Radiology and Nuclear Medicine Mannheim has research cooperations with Siemens Healthcare. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in Weidner M, Zoellner FG, Hagelstein C, et al. (2014) High temporal versus high spatial resolution in MR quantitative pulmonary perfusion imaging of two-year old children after congenital diaphragmatic hernia repair. Eur Radiol 24(10):2427–34. Methodology: Performed at one institution.

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Authors and Affiliations

  1. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany

    M. Weis, V. Sommer, C. Hagelstein, S. O. Schoenberg & K. W. Neff

  2. Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    F. G. Zöllner

  3. Department of Paediatric Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

    K. Zahn

  4. Department of Paediatrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    T. Schaible

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  1. M. Weis
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  2. V. Sommer
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  3. F. G. Zöllner
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  4. C. Hagelstein
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  5. K. Zahn
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  6. T. Schaible
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  7. S. O. Schoenberg
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  8. K. W. Neff
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Correspondence to M. Weis.

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Weis, M., Sommer, V., Zöllner, F.G. et al. Region of interest-based versus whole-lung segmentation-based approach for MR lung perfusion quantification in 2-year-old children after congenital diaphragmatic hernia repair. Eur Radiol 26, 4231–4238 (2016). https://doi.org/10.1007/s00330-016-4330-6

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  • DOI: https://doi.org/10.1007/s00330-016-4330-6

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