Air Raid

Ġabra ta’ poeżiji u proża li tinkludi: Dwejjaq Missirijietna ta’ Rużar Briffa – Xemx ta’ Settembru ta’ Vic. Apap – God Save the King ta’ Ġużè Galea – It-8 ta’ Settembru Londra, 1942 ta’ A. V. Vassallo – Wenzu jsib lil Luċija f’Lazzarett ta’ Dun Pawl – MDLXV ta’ Albert M. Cassola – Innu lil San Duminku ta’ Gużman – Innu lill-Bambina – Il-Għanja tar-Rebħa! ta’ N. Biancardi – Air Raid ta’ E. Agius.N/

Patterns of regional lung physiology in cystic fibrosis using ventilation magnetic resonance imaging and multiple-breath washout

Hyperpolarised helium-3 (3He) ventilation magnetic resonance imaging (MRI) and multiple-breath washout (MBW) are sensitive methods for detecting lung disease in cystic fibrosis (CF). We aimed to explore their relationship across a broad range of CF disease severity and patient age, as well as assess the effect of inhaled lung volume on ventilation distribution.32 children and adults with CF underwent MBW and 3He-MRI at a lung volume of end-inspiratory tidal volume (EIVT). In addition, 28 patients performed 3He-MRI at total lung capacity. 3He-MRI scans were quantitatively analysed for ventilation defect percentage (VDP), ventilation heterogeneity index (VHI) and the number and size of individual contiguous ventilation defects. From MBW, the lung clearance index, convection-dependent ventilation heterogeneity (Scond) and convection-diffusion-dependent ventilation heterogeneity (Sacin) were calculated.VDP and VHI at EIVT strongly correlated with lung clearance index (r=0.89 and r=0.88, respectively), Sacin (r=0.84 and r=0.82, respectively) and forced expiratory volume in 1 s (FEV1) (r=-0.79 and r=-0.78, respectively). Two distinct 3He-MRI patterns were highlighted: patients with abnormal FEV1 had significantly (p<0.001) larger, but fewer, contiguous defects than those with normal FEV1, who tended to have numerous small volume defects. These two MRI patterns were delineated by a VDP of ∼10%. At total lung capacity, when compared to EIVT, VDP and VHI reduced in all subjects (p<0.001), demonstrating improved ventilation distribution and regions of volume-reversible and nonreversible ventilation abnormalities

3D deep convolutional neural network-based ventilated lung segmentation using multi-nuclear hyperpolarized gas MRI

Hyperpolarized gas MRI enables visualization of regional lung ventilation with high spatial resolution. Segmentation of the ventilated lung is required to calculate clinically relevant biomarkers. Recent research in deep learning (DL) has shown promising results for numerous segmentation problems. In this work, we evaluate a 3D V-Net to segment ventilated lung regions on hyperpolarized gas MRI scans. The dataset consists of 743 helium-3 (3He) or xenon-129 (129Xe) volumetric scans and corresponding expert segmentations from 326 healthy subjects and patients with a wide range of pathologies. We evaluated segmentation performance for several DL experimental methods via overlap, distance and error metrics and compared them to conventional segmentation methods, namely, spatial fuzzy c-means (SFCM) and K-means clustering. We observed that training on combined 3He and 129Xe MRI scans outperformed other DL methods, achieving a mean ± SD Dice of 0.958 ± 0.022, average boundary Hausdorff distance of 2.22 ± 2.16 mm, Hausdorff 95th percentile of 8.53 ± 12.98 mm and relative error of 0.087 ± 0.049. Moreover, no difference in performance was observed between 129Xe and 3He scans in the testing set. Combined training on 129Xe and 3He yielded statistically significant improvements over the conventional methods (p < 0.0001). The DL approach evaluated provides accurate, robust and rapid segmentations of ventilated lung regions and successfully excludes non-lung regions such as the airways and noise artifacts and is expected to eliminate the need for, or significantly reduce, subsequent time-consuming manual editing

Lill-kelb

Ġabra ta’ poeżiji u proża li tinkludi: Kemm hu kbir il-amar t’Alla! ta’ R. M. B. – Liż-żahrija ta’ V. M. B. – Il-Ġilju u l-warda ta’ P. P. M. B. – Sika trid tiżżewweġ.... ta’ R. M. B. – Qassis ġdid ta’ Dun Karm – Mhux dejjem tiġi żewġ ta’ T. Z. – Il-bandiera tagħna ta’ Mons. Gauci – Il-ħalliel tal-mejtin ta’ N. Biancardi – Lill-kelb ta’ Dun Karm.N/

Spatial comparison of CT-based surrogates of lung ventilation with hyperpolarized Helium-3 and Xenon-129 gas MRI in patients undergoing radiation therapy

Purpose To develop and apply an image acquisition and analysis strategy for spatial comparison of CT-ventilation images with hyperpolarized gas MRI. Methods 11 lung cancer patients underwent 129Xe and 3He ventilation MRI and co-registered 1H anatomical MRI. Expiratory and inspiratory breath-hold CTs were used for deformable image registration and calculation of three CT-ventilation metrics: Hounsfield unit (CTHU), Jacobian (CTJac) and specific gas volume change (CTSGV). Inspiration CT and hyperpolarized gas ventilation MRI were registered via same-breath anatomical 1H-MRI. Voxel-wise Spearman correlation coefficients were calculated between each CT-ventilation image and its corresponding 3He/129Xe-MRI, and for the mean values in regions of interest (ROIs) ranging from fine to coarse in-plane dimensions of 5x5, 10x10, 15x15 and 20x20, located within the lungs as defined by the same-breath 1H-MRI lung mask. Correlation of 3He and 129Xe-MRI was also assessed. Results Spatial correlation of CT-ventilation against 3He/129Xe-MRI increased with ROI size. For example, for CTHU, mean±SD Spearman coefficients were 0.37±0.19/0.33±0.17 at the voxel-level and 0.52±0.20/0.51±0.18 for 20x20 ROIs, respectively. Correlations were stronger for CTHU than for CTJac or CTSGV. Correlation of 3He with 129Xe-MRI was consistently higher than either gas against CT-ventilation maps over all ROIs (p<0.05). No significant differences were observed between CT-ventilation vs 3He-MRI and CT-ventilation vs 129Xe-MRI. Conclusion Comparison of ventilation-related measures from CT and registered hyperpolarized gas MRI is feasible at a voxel level using a dedicated acquisition and analysis protocol. Moderate correlation between CT-ventilation and MRI exists at a regional level. Correlation between MRI and CT is significantly less than between 3He and 129Xe-MRI, suggesting that CT-ventilation surrogate measures may not be measuring lung ventilation alone

Ninu Cremona

Ġabra ta’ poeżiji u proża li tinkludi: Għawdex ta’ A. Cremona – Meta tixjieħ ta’ A. Cremona –Tmenin! ta’ Ġużè Chetcuti – Lil Ninu Cremona ta’ Rużar Briffa – Is-Sur Nin Cremona poeta, filolgu, folklorista u grammatika f’għeluq it-80 sena tiegħu ta’ Karmenu Vassallo – Li kieku ma kienx... ta’ Karmenu Ellul Galea – Lis-Sur Nin Cremona grammatku, poeta, filolgu u prożatur f’għeluq it-80 sena minn twelidu 27 ta’ Mejju, 1880-1960 ta’ Ġużè Cardona – Xbieha bil-kitba ta’ N. Biancardi – Is-Sur Nin Cremona ta’ Kan. P. Cauchi – Lil Ninu Cremona ta’ Alfred M. Previ – Li ma kontx int, Sur Nin... ta’ Ġużè Cardona – “Ħannieqa ġiżimin” lis-Sur Nin Cremona ta’ Mary Meilak – Lis-Sur Nin Cremona f’għeluq it-tmenin sena ta’ ħajtu tal-Kan. Kap. Ġużeppi Farrugia – Lil Ninu Cremona fl-akkademja li saritlu bil-“B.I.” Victoria, Għawdex, 28. 5. 1960 ta’ M. A. Apap – Lil Ninu Cremona f’għeluq it-tmenin sena mit-twelid tiegħu ta’ Joe Mejlak – Ninu Cremona ta’ Joseph Zammit – Lil Ninu Cremona ta’ Frank Mercieca.peer-reviewe

Lung MRI with hyperpolarised gases : current & future clinical perspectives

The use of pulmonary MRI in a clinical setting has historically been limited. Whilst CT remains the gold-standard for structural lung imaging in many clinical indications, technical developments in ultrashort and zero echo time MRI techniques are beginning to help realise non-ionising structural imaging in certain lung disorders. In this invited review, we discuss a complementary technique – hyperpolarised (HP) gas MRI with inhaled 3He and 129Xe – a method for functional and microstructural imaging of the lung that has great potential as a clinical tool for early detection and improved understanding of pathophysiology in many lung diseases. HP gas MRI now has the potential to make an impact on clinical management by enabling safe, sensitive monitoring of disease progression and response to therapy. With reference to the significant evidence base gathered over the last two decades, we review HP gas MRI studies in patients with a range of pulmonary disorders, including COPD/emphysema, asthma, cystic fibrosis, and interstitial lung disease. We provide several examples of our experience in Sheffield of using these techniques in a diagnostic clinical setting in challenging adult and paediatric lung diseases