Dr. Joseph Mammarappallil, PhD, an assistant professor in Duke's cardiothoracic division, and colleagues reviewed three soldiers who presented to local U.S. Department of Veterans Affairs (VA) clinics with reactive airway disease, postdeployment dyspnea, and decreased respiratory fitness. All three subjects were exposed to aerosolized contaminants during their deployment in Iraq or Afghanistan.
The soldiers underwent exams to determine pulmonary function, as well as CT studies. For their fluorine-19 MRI scans, each patient inhaled a mixture of 79% perfluoropropane (PFP) and 21% oxygen for several minutes. The protocol included inhaling and exhaling three times, followed by a six-second breath-hold at total lung capacity. During this exercise, clinicians obtained 3D MR images of air spaces in the lungs.
The soldiers' spirometry tests, which measured the speed at which their lungs were able to inhale and exhale air, were normal. CT scans showed normal results for one patient, while the other two had mild basilar or lobular areas of air trapping.
With fluorine-19 MRI, one soldier's results showed close to normal lung function, but the other two men's scans resembled those of patients diagnosed with chronic obstructive pulmonary disease (COPD). Mammarappallil and colleagues also noticed on fluorine-19 MRI a delayed intake of PFP gas in certain lung regions in the two subjects with suspected war lung injury.
Fluorine-19 MRI "has the potential to detect airway abnormalities at earlier time points than current techniques," according to the researchers. "This may ultimately lead to better diagnosis of challenging airway abnormalities, such as war lung injury, and perhaps a tool for evaluation of interventions."
