129 Xe MRI as a measure of clinical disease severity for pediatric asthma

• Published in: Journal of allergy and clinical immunology 2021-06, Vol.147 (6), p.2146
• Main Authors: Lin, Nancy Y, Roach, David J, Willmering, Matthew M, Walkup, Laura L, Hossain, Md Monir, Desirazu, Priyanka, Cleveland, Zackary I, Guilbert, Theresa W, Woods, Jason C
• Format: Article
• Language: English
• Subjects: Adolescent; Adults; Airway management; Asthma; Asthma - diagnosis; Asthma - therapy; Case-Control Studies; Child; Children; Contrast Media; Cooperation; Corticosteroids; COVID-19; Defects; Disease prevention; Drug dosages; Female; Gases; Health services utilization; Humans; Image processing; Lungs; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Pediatrics; Phenotypes; Pulse oximetry; Respiratory Function Tests; ROC Curve; Severity of Illness Index; Spirometry; Xenon Isotopes
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2020.11.010

Measurement of regional lung ventilation with hyperpolarized Xe magnetic resonance imaging ( Xe MRI) in pediatric asthma is poised to advance our understanding of disease mechanisms and pathophysiology in a disorder with diverse clinical phenotypes. Xe MRI has not been investigated in a pediatric asthma cohort. We hypothesized that Xe MRI is feasible and can demonstrate ventilation defects that relate to and predict clinical severity in a pediatric asthma cohort. Thirty-seven children (13 with severe asthma, 8 with mild/moderate asthma, 16 age-matched healthy controls) aged 6 to 17 years old were imaged with Xe MRI. Ventilation defect percentage (VDP) and image reader score were calculated and compared with clinical measures at baseline and at follow-up. Children with asthma had higher VDP (P = .002) and number of defects per image slice (defects/slice) (P = .0001) than children without asthma. Children with clinically severe asthma had significantly higher VDP and number of defects/slice than healthy controls. Children with asthma who had a higher number of defects/slice had a higher rate of health care utilization (r = 0.48; P = .03) and oral corticosteroid use (r = 0.43; P = .05) at baseline. Receiver-operating characteristic analysis demonstrated that the VDP and number of defects/slice were predictive of increased health care utilization, asthma, and severe asthma. VDP correlated with FEV (r = -0.35; P = .04) and FEV /forced vital capacity ratio (r = -0.41; P = .01). Xe MRI correlates with asthma severity, health care utilization, and oral corticosteroid use. Because delineation of clinical severity is often difficult in children, Xe MRI may be an important biomarker for severity, with potential to identify children at higher risk for exacerbations and improve outcomes.