Effect of inspiratory and expiratory breathhold on pulmonary perfusion - Assessment by pulmonary perfusion magnetic resonance Imaging

Rationale and Objectives: The effect of breathholding on pulmonary perfusion remains largely unknown. The aim of this study was to assess the effect of inspiratory and expiratory breathhold on pulmonary perfusion using quantitative pulmonary perfusion magnetic resonance imaging (MRI). Methods and Results: Nine healthy volunteers (median age, 28 years; range, 20-45 years) were examined with contrast-enhanced time-resolved 3-dimensional pulmonary perfusion MRI (FLASH 313, TR/TE: 1.9/0.8 ms; flip angle: 40degrees; GRAPPA) during end-inspiratory and expiratory breathholds. The perfusion parameters pulmonary blood flow (PBF), pulmonary blood volume (PBV), and mean transit time (MTT) were calculated using the indicator dilution theory. As a reference method, end-inspiratory and expiratory phase-contrast (PC) MRI of the pulmonary arterial blood flow (PABF) was performed. Results: There was a statistically significant increase of the PBF (Delta = 182 mL/100mL/min), PBV (Delta = 12 mL/100 mL), and PABF (Delta = 0.5 L/min) between inspiratory and expiratory breathhold measurements (P < 0.0001). Also, the MTT was significantly shorter (Delta = -0.5 sec) at expiratory breathhold (P = 0.03). Inspiratory PBF and PBV showed a moderate correlation (r = 0.72 and 0.61, P less than or equal to0.008) with inspiratory PABF. Conclusion: Pulmonary perfusion during breathhold depends on the inspiratory level. Higher perfusion is observed at expiratory breathhold.