Spatial Heterogeneity of Excess Lung Fluid in Cystic Fibrosis: Generalized, Localized Diffuse, and Localized Presentations

Magnetic resonance (MR) imaging has demonstrated that CF subjects have a significantly higher lung density (e.g., fluid content) when compared with healthy control subjects, but, at present, there are no techniques to quantify the spatial presentation of these lung abnormalities. The excess fluid in MR lung images for CF subjects with mild (n = 4), moderate (n = 5), and severe (n = 4) disease and age- and sex-matched healthy controls (n = 13) in both the right and left lungs was identified and quantified using a thresholding-based image segmentation technique using healthy controls as a baseline. MR lung images were categorized into one of three spatial presentation groups based on their regional and global percent area of the lung covered by excess fluid (i.e., spatial distribution): (i) generalized for sparse, (ii) localized diffuse for a moderate focality, and (iii) localized for a strong focality. A total of 96% of the controls presented as generalized. CF subjects populated all three presentation groups and an individual’s right and left lungs did not always categorize identically. The developed metrics for categorization provide a quantification method to describe the spatial presentation of CF disease and suggests the heterogeneous nature of the disease.