Experimental and quantitative imaging techniques in interstitial lung disease
Open accessAbstract
Interstitial lung diseases (ILDs) are a heterogeneous group of conditions, with a wide and complex variety of imaging features. Difficulty in monitoring, treating and exploring novel therapies for these conditions is in part due to the lack of robust, readily available biomarkers. Radiological studies are vital in the assessment and follow-up of ILD, but currently CT analysis in clinical practice is qualitative and therefore somewhat subjective. In this article, we report on the role of novel and quantitative imaging techniques across a range of imaging modalities in ILD and consider how they may be applied in the assessment and understanding of ILD. We critically appraised evidence found from searches of Ovid online, PubMed and the TRIP database for novel and quantitative imaging studies in ILD. Recent studies have explored the capability of texture-based lung parenchymal analysis in accurately quantifying several ILD features. Newer techniques are helping to overcome the challenges inherent to such approaches, in particular distinguishing peripheral reticulation of lung parenchyma from pleura and accurately identifying the complex density patterns that accompany honeycombing. Robust and validated texture-based analysis may remove the subjectivity that is inherent to qualitative reporting and allow greater objective measurements of change over time. In addition to lung parenchymal feature quantification, pulmonary vessel volume analysis on CT has demonstrated prognostic value in two retrospective analyses and may be a sign of vascular changes in ILD which, to date, have been difficult to quantify in the absence of overt pulmonary hypertension. Novel applications of existing imaging techniques, such as hyperpolarised gas MRI and positron emission tomography (PET), show promise in combining structural and functional information. Although structural imaging of lung tissue is inherently challenging in terms of conventional proton MRI techniques, inroads are being made with ultrashort echo time, and dynamic contrast-enhanced MRI may be used for lung perfusion assessment. In addition, inhaled hyperpolarised 129 Xenon gas MRI may provide multifunctional imaging metrics, including assessment of ventilation, intra-acinar gas diffusion and alveolar-capillary diffusion. PET has demonstrated high standard uptake values (SUVs) of 18 F-fluorodeoxyglucose in fibrosed lung tissue, challenging the assumption that these are ‘burned out’ and metabolically inactive regions. Regions that appear structurally normal also appear to have higher SUV, warranting further exploration with future longitudinal studies to assess if this precedes future regions of macroscopic structural change. Given the subtleties involved in diagnosing, assessing and predicting future deterioration in many forms of ILD, multimodal quantitative lung structure-function imaging may provide the means of identifying novel, sensitive and clinically applicable imaging markers of disease. Such imaging metrics may provide mechanistic and phenotypic information that can help direct appropriate personalised therapy, can be used to predict outcomes and could potentially be more sensitive and specific than global pulmonary function testing. Quantitative assessment may objectively assess subtle change in character or extent of disease that can assist in efficacy of antifibrotic therapy or detecting early changes of potentially pneumotoxic drugs involved in early intervention studies.
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HP 129Xe MRI has shown potential for evaluating global and regional gas exchange, and when inhaled it dissolves into lung tissue and binds to red blood cells, allowing functional assessment of alveolar-capillary diffusion, ventilation and intra-acinar gas diffusion.
“Hyperpolarized (HP) xenon 129 ( 129 Xe) magnetic resonance imaging (MRI) has shown potential for evaluating global and regional gas exchange. When inhaled, HP 129 Xe has the property to dissolve into the lung tissue and bind to red blood cells (RBC). It can therefore be used as a probe for functional assessment of alveolar-capillary diffusion, ventilation and intra-acinar gas”
From Pulmonary fibrosis: Emerging diagnostic and therapeutic strategies (2023) · cites this paper as Weatherley et al., 2019
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- [25]Asakura AGT, Iwasawa T Classification system of the CT images with nonspecific interstitial pneumonia. Journal of the Institute of Image Electronics Engineers of Japan 2004; 33: 180– 8.
- [30]Maldonado F, Raghunath S, Aubry MC, et al Validation of CALIPER (Computer-aided lung informatics for pathology evaluation and rating) for the non-invasive assessment of pulmonary nodules of the adenocarcinoma spectrum. European Respiratory Journal 2012; 40.
- [59]Appelt S, Ben-Amar Baranga A, Erickson CJ, et al Theory of spin-exchange optical pumping of 3He and 129Xe. Physical Review A 1998; 58: 1412– 39.
Cited by
Sorted by citations
Pulmonary fibrosis: Emerging diagnostic and therapeutic strategies
Selvarajah, B., Platé, M., & Chambers, R. C. (2023) · Molecular Aspects of Medicine · doi:10.1016/j.mam.2023.101227 · Cited by 57 · see citing works
Tibiletti, M., Eaden, J. A., Naish, J. H., Hughes, P. J. C., Waterton, J. C., Heaton, M. J., Chaudhuri, N., Skeoch, S., Bruce, I. N., Bianchi, S., et al. (2023) · Magnetic Resonance Imaging · doi:10.1016/j.mri.2022.10.005 · Cited by 13 · see citing works
Self-citation
- Authors
- Weatherley, N. D., Eaden, J. A., Stewart, N. J., Bartholmai, B. J., Swift, A. J., Bianchi, S. M., & Wild, J. M.
- Affiliations
- University of Sheffield (GB)
- Mayo Clinic (US)
- Sheffield Teaching Hospitals NHS Foundation Trust (GB)
- Corresponding author
- Wild, Jim M
- ORCID
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2019-03-18
- Volume
- 74
- Issue
- 6
- Pages
- 611-619
- ISSN
- 0040-6376 (ISSN-L)
- 1468-3296
- PMC
- PMC6585263
- OpenAlex
- W2922500394
- Cited by
- 87
- References
- 89
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 10 · 2023: 13 · 2022: 13 · 2021: 23 · 2020: 10 · 2019: 2
- FWCI
- 2.02
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Thorax (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- European Union Horizon 2020 Research and Innovation Programme
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Medical Imaging and Pathology Studies
- Keywords
- interstitial lung disease, quantitative imaging, texture analysis, lung parenchyma, honeycombing, pulmonary blood flow, 18F-FDG PET, pulmonary fibrosis, biomarkers, pulmonary hypertension, alveolar-capillary diffusion
- MeSH terms
- Contrast Media, Diagnosis, Differential, Humans, Lung Diseases, Interstitial
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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