Detection of regional radiation-induced lung injury using hyperpolarized 129Xe chemical shift imaging in a rat model involving partial lung irradiation:

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Detection of regional radiation-induced lung injury using hyperpolarized 129Xe chemical shift imaging in a rat model involving partial lung irradiation: Proof-of-concept demonstration Brandon Zanette, MSc, Elaine Stirrat, BSc, Salomeh Jelveh, MSc, Andrew Hope, MD, Giles Santyr, PhD Advances in Radiation Oncology Volume 2, Issue 3, Pages 475-484 (July 2017) DOI: 10.1016/j.adro.2017.05.005 Copyright © 2017 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 1 Example irradiation treatment plan with cone beam computed tomography scan in the coronal view. Red indicates isodose of 95% of total dose (20 Gy), green indicates 50% of dose (treated volume), light purple indicates 2% of dose, and dark purple indicates 1% of dose. Yellow line indicates the lung contours. Advances in Radiation Oncology 2017 2, 475-484DOI: (10.1016/j.adro.2017.05.005) Copyright © 2017 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 2 (A) Representative whole-lung 129Xe magnitude spectrum from nonirradiated rat lung. Representative 2-dimensional chemical shift imaging images from a nonirradiated rat showing all 3 compartments (B-D). Corresponding segmented tissue and red blood cell (RBC) images normalized by gas images for a representative nonirradiated (E, F) and irradiated (G, H) rat. Arrow 1 indicates increased tissue signal in the irradiated (right) compared with the contralateral (left) lung. Arrow 2 indicates increased RBC signal in the region of irradiation (medial). Advances in Radiation Oncology 2017 2, 475-484DOI: (10.1016/j.adro.2017.05.005) Copyright © 2017 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 3 Two-dimensional chemical shift imaging measurements of right-to-left asymmetry. Top row shows asymmetric signal intensity parameter (κ) in the (A) pulmonary tissue (PT) and (B) red blood cell (RBC) compartments. Bottom row shows asymmetric signal heterogeneity parameter (η) in the (C) PT and (D) RBC compartments. Advances in Radiation Oncology 2017 2, 475-484DOI: (10.1016/j.adro.2017.05.005) Copyright © 2017 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 4 (A) Coronal tissue section of the right lung from a representative irradiated rat with evidence of radiation-induced lung injury. (B-D) Different regions of damage at 20× magnification emphasizing the heterogeneous nature of the injury. (B) Regions outside the radiation field were characterized by moderate radiation pneumonitis and significant red blood cells. The lung regions within the radiation field were characterized by tissue thickening (C) as well as airway destruction and a loss of tissue (D). All regions within the beam portal had significantly decreased red blood cells (C, D) compared with regions outside. Advances in Radiation Oncology 2017 2, 475-484DOI: (10.1016/j.adro.2017.05.005) Copyright © 2017 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 5 Quantitative histological results showing measurements of regional asymmetry of relative pulmonary tissue and red blood cell (RBC) distribution (A, B) and heterogeneity (C, D). (E) Spearman correlation of ηRBC and κPRA illustrating increasing RBC signal heterogeneity in the right lung with decreasing RBC distribution. The dashed line is a linear fit to guide the eye. Advances in Radiation Oncology 2017 2, 475-484DOI: (10.1016/j.adro.2017.05.005) Copyright © 2017 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions