Hyperpolarized 129Xe Pulmonary MRI and Asymptomatic Atrial Septal Defect

Alexander M Matheson; Robin S P Cunningham; Elianna Bier; Junlan Lu; Bastiaan Dreihuys; J Geoffrey Pickering; Pantelis Diamantouros; Ali Islam; J Michael Nicholson; Grace Parraga; Sarah Blissett

doi:10.1016/j.chest.2021.11.020

Hyperpolarized ¹²⁹Xe Pulmonary MRI and Asymptomatic Atrial Septal Defect

Chest. 2022 Apr;161(4):e199-e202. doi: 10.1016/j.chest.2021.11.020.

Affiliations

¹ Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada.
² Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC.
³ Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada; Division of Cardiology, Department of Medicine, Western University, London, Canada.
⁴ Division of Cardiology, Department of Medicine, Western University, London, Canada.
⁵ Department of Medical Imaging, Western University, London, Canada.
⁶ Division of Respirology, Department of Medicine, Western University, London, Canada.
⁷ Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada; Department of Medical Imaging, Western University, London, Canada; Division of Respirology, Department of Medicine, Western University, London, Canada. Electronic address: gparraga@robarts.ca.

PMID: 35396051
DOI: 10.1016/j.chest.2021.11.020

Abstract

In an asymptomatic 19-year-old who regularly underwent cardiopulmonary fitness testing for national lifeguard-accreditation, ¹²⁹Xe MRI unexpectedly revealed an abnormally augmented RBC signal and RBC-to-alveolar-capillary-tissue ratio with spatially homogeneous ventilation, tissue barrier, and RBC images. Pulmonary function was normal, but cardiopulmonary follow-up including transthoracic and transesophageal echocardiogram, heart catheterization, and contrast-enhanced cardiac CT imaging led to the diagnosis of a large (20 × 27 mm) secundum atrial septal defect (ASD) with a net right-to-left shunt (Qp:Qs = 0.5) and normal pulmonary pressures. This novel, unexpected case revealed that ¹²⁹Xe RBC signal intensity likely reflected erythrocytosis, compensatory to the abnormal cardiovascular hemodynamics that resulted from a large congenital ASD. Unlike ASD cases that present with dyspnea and exercise limitation, this ¹²⁹Xe MRI abnormality was detected in an asymptomatic teenager. This is the first report of asymptomatic adult congenital heart disease diagnosed subsequent to novel ¹²⁹Xe MRI that led to early intervention, avoiding long-term complications of cyanosis, including ventricular fibrosis and thromboembolic and bleeding risks.

Keywords: atrial septal defect; dissolved phase (129)Xe MRI; gas-exchange spectroscopy; healthy volunteer; hyperpolarized (129)Xe MRI.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Cardiac Catheterization
Heart Defects, Congenital*
Heart Septal Defects, Atrial* / diagnostic imaging
Humans
Lung
Magnetic Resonance Imaging
Xenon Isotopes
Young Adult

Substances

Xenon Isotopes