Functional Pulmonary Magnetic Resonance Imaging for Detection of Ischemic Injury in a Porcine Ex-Vivo Lung Perfusion System Prior to Transplantation

Publication date: Available online 19 June 2018
Source:Academic Radiology
Author(s): Julius Renne, Marcel Gutberlet, Andreas Voskrebenzev, Agilo Kern, Till Kaireit, Jan B Hinrichs, Peter Braubach, Christine S Falk, Klaus Höffler, Gregor Warnecke, Patrick Zardo, Axel Haverich, Frank Wacker, Jens Vogel-Claussen, Norman Zinne
Rationale and ObjectivesTo evaluate the feasibility of multiparametric magnetic resonance imaging (MRI) of the lungs to detect impaired organ function in a porcine model of ischemic injury within an ex-vivo lung perfusion system (EVLP) prior to transplantation.Materials and MethodsTwelve pigs were anesthetized, and left lungs were clamped to induce warm ischemia for 3hours. Right lungs remained perfused as controls. Lungs were removed and installed in an EVLP for 12hours. Lungs in the EVLP were imaged repeatedly using computed tomography, proton MRI (¹H-MRI) and fluorine MRI (¹⁹F-MRI). Dynamic contrast-enhanced derived parenchymal blood volume, oxygen washout times, and ¹⁹F washout times were calculated. PaO2 was measured for ischemic and normal lungs, wet/dry ratio was determined, histologic samples were assessed, and cytokines in the lung tissue were analyzed. Statistical analysis was performed using nonparametric testing.ResultsEleven pigs were included in the final analysis. Ischemic lungs showed significantly higher wet/dry ratios (p = 0.024), as well as IL-8 tissue levels (p = 0.0098). Histologic assessment as well as morphologic scoring of computed tomography and ¹H-MRI did not revealsignificant differences between ischemic and control lungs. ¹⁹F washout (p = 0.966) and parenchymal blood flow (p = 0.32) were not significantly different. Oxygen washout was significantly prolonged in ischemic lungs compared to normal control lungs at the beginning (p = 0.018) and further prolonged at the end of the EVLP run (p = 0.005).ConclusionMultiparametric pulmonary MRI is feasible in lung allografts within an EVLP system. Oxygen-enhanced imaging seems to be a promising marker for ischemic injury, enabling detection of affected lung segments prior to transplantation.



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