CHANGE-MRI is a diagnostic study for a new method of displaying CTEPH-typical hypoperfusion of the lung.
The aim of the study is to investigate whether the radiation-free magnetic resonance imaging system
(MRI) is equivalent to established methods for the diagnosis of CTEPH. The multicenter study will be
carried out by the University of Sheffield and various sites of the German Center for Lung Research.
Although cardiovascular diseases are known as the most common co-morbidity in patients with COPD, the direct impact of respiratory medication on cardiac function has been under-investigated. In a collaboration of the BREATH research groups of Prof. Hohlfeld at the Fraunhofer Institute for Toxicology and Experimental Medicine, Prof. Welte in the Clinic for Pulmonology and Prof. Vogel-Claussen at the Institute for Diagnostic Radiology of the MHH, a protocol was created in which for the first time, the effect of a combination therapy with two bronchodilators on the improvement of cardiac function in COPD patients with pulmonary hyperinflation was investigated.
Vogel-Claussen J, Schönfeld CO, Kaireit TF, Voskrebenzev A, Czerner CP, Renne J, Tillmann HC, Berschneider K, Hiltl S, Bauersachs J, Welte T, Hohlfeld JM. Effect of Indacaterol/Glycopyrronium on Pulmonary Perfusion and Ventilation in Hyperinflated COPD Patients (CLAIM): A Double- Blind, Randomised, Crossover Trial. Am J Respir Crit Care Med. 2019 Jan 14. doi: 10.1164/rccm. 201805-0995OC. https://www.ncbi.nlm.nih.gov/pubmed/30641027
Hohlfeld JM*, Vogel-Claussen J*, Biller H, Berliner D, Berschneider K, Tillmann HC, Hiltl S, Bauersachs J, Welte T. Effect of lung deflation with indacaterol plus glycopyrronium on ventricular filling in patients with hyperinflation and COPD (CLAIM): a double-blind, randomised, crossover, placebo-controlled, single-centre trial. Lancet Respir Med. 2018 May;6(5):368-378. *contributed equally https://www.ncbi.nlm.nih.gov/pubmed/29477448
DZL-Platform Imaging at BREATH
The platform “Imaging” has been established as a network of complementing expertise and infrastructure within the German Center for Lung Research (DZL) https://www.dzl.de/en/research/overview to ensure scientific exchange and access to cutting-edge imaging technologies in research. Comprising radiology and microscopy, the platform "Imaging" aims to identify and benefit from the interfaces between them. The core function of the platform is to offer, disseminate and share imaging technology and collaborate with disease areas Asthma and Allergy, COPD, Cystic Fibrosis (CF), Diffuse Parenchymal Lung Disease (DPLD), Endstage Lung Disease (ELD), Lung Cancer (LC), Pneumonia and Acute Lung Injury as well as Pulmonary Hypertension (PH).
SPIROMICS – Heart Failure
In collaboration with Prof. Graham Barr (PI, Columbia university) we will start in 2019 the NIH funded multicentre SPIROMICS-Heart Failure study.
The death rate and hospitalizations from chronic obstructive pulmonary disease (COPD) have doubled in the last 50 years. A third of COPD hospitalizations overlap with heart failure with preserved ejection fraction (HFpEF). Yet no large COPD study has ascertained cardiac function. The study will examine heart-lung interactions to suggest new diagnostic and therapeutic strategies for COPD and heart failure.
We serve as the reading center for the assessment of pulmonary microvascular blood flow using MRI in the US multicenter study MESA COPD study (PI R. Graham Barr, MD, DrPH)
Pulmonary vascular changes are thought to occur late in COPD, secondary to severe hypoxemia and acidosis. Bench research, however, has shown endothelial cell dysfunction and vascular endothelial growth factor (VEGF)-mediated apoptosis in early COPD. These observations have revived the “vascular hypothesis” of COPD, which posits that alterations in the pulmonary vasculature lead to loss of lung function.
The MESA COPD Study is a study of smokers nested among these two cohorts, which together provide a well-defined sampling frame of 4,617 participants with prior spirometry and CT measures. A total of 325 participants were characterized with MRI and full-lung CT imaging, spirometry, flow cytometry, and gene expression profiling to test the following hypotheses:
- Functional and structural changes in the pulmonary vasculature and right ventricle assessed with novel CT and MRI measures occur early in COPD;
- Endothelial microparticles, circulating endothelial cells, and endothelial progenitor cells are abnormal early in COPD;
- Plasma VEGF levels and gene expression of apoptotic and nitrogen oxide metabolism pathways in peripheral blood mononucleated cells (PBMCs) are altered early in COPD.
NIH and DFG
REBIRTH Cluster of excellence
We are part of REBIRTH Cluster of excellence Unit 8.5 Functional and Molecular MRI.
Validation of bi- and three-dimensional Fourier Decomposition to assess lung ventilation and perfusion compared to CT, hyperpolarized gases and contrast-enhanced MRI.
Novel promising MRI sequences have been developed that may be sensitive enough to monitor structural abnormalities related to cystic fibrosis (CF) lung disease. Other MRI sequences have been developed that may allow non-invasive monitoring of lung perfusion and ventilation. Lastly, certain MRI sequences could serve to monitor lung inflammation.
Fourier Decomposition Magnetic Resonance Imaging (FD-MRI) is a novel technique to obtain perfusion and ventilation images without using intravenous and gaseous contrast agents. FD-MRI could provide new outcome measures for monitoring CF Lung Disease (CFLD). Before introducing FD-MRI in CF clinical practice, we need to validate it against standard of care imaging, such as Computed Tomography (CT), and with established ventilation and perfusion MRI techniques, such as HyperPolarized gases MRI (HP-MRI) and Contrast Enhanced MRI (CEMRI).
The ultimate goal of this validation plan is to develop an MRI platform that provides information about ventilation, inflammation, perfusion and structure (VIPS-MRI) in a single MRI examination lasting 30 minutes for safe and efficient monitoring of CFLD.
- H.A.W.M. Tiddens, MD, PhD, ErasmusMC-Sophia Children's Hospital, Rotterdam, Netherlands
- Jens Vogel-Claussen, MD, Hannover Medical School, Hannover Germany
- Jim Wild, PhD, University of Sheffield, Sheffield, UK
Cystic Fibrosis Foundation