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Magnetic resonance imaging of lung water content and distribution in term and preterm infants
Eleri W Adams1, Serena J Counsell, Joseph V Hajnal
1Department of Paediatrics, Imperial College School of Medicine, Queen Mary's University Hospital, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
Insights
Preterm infants have higher lung water content than term infants, with uneven distribution contributing to respiratory issues. Prone positioning improves lung liquid distribution in preterm neonates.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Medical Imaging
Background:
- Increased lung liquid can lead to respiratory disease in preterm infants.
- Heterogeneous lung disease in preterm infants may stem from uneven lung liquid distribution.
Purpose of the Study:
- To investigate lung water content and distribution in preterm and term infants using magnetic resonance imaging.
- To compare lung water in preterm versus term infants and assess the impact of position on lung liquid distribution in preterm infants.
Main Methods:
- Magnetic resonance imaging (MRI) was used to assess lung water content and distribution in 16 preterm and 9 term infants.
- Relative proton density was quantified as an index of lung water.
- Regional signal distribution was compared between dependent and nondependent lung regions in different positions (prone/supine).
Main Results:
- Preterm infants exhibited higher relative proton density (lung water) compared to term infants (p < 0.008).
- Lung water was greater in dependent lung regions, especially in preterm infants (p < 0.001).
- Repositioning preterm infants showed rapid signal redistribution, with more even distribution in the prone position (p < 0.001).
Conclusions:
- Lung water content is elevated in preterm infants compared to term infants.
- Gravity-related changes in lung water distribution suggest dependent atelectasis in preterm infants.
- Prone positioning may promote more even lung liquid distribution in preterm neonates.
Abstract:
An increase in lung liquid may contribute to respiratory disease in preterm infants. Uneven distribution of lung liquid may cause heterogeneity in the lung disease seen in these infants. We used magnetic resonance imaging to investigate lung water content and distribution in 16 preterm (24-31 weeks) and 9 term infants in the first week of life. Images of lung parenchyma were examined and relative proton density quantified to give an index of lung water. Lung water content and distribution were compared between preterm and term infants, and in preterm infants regional signal distribution between dependent and nondependent lung on T1 weighted images was also compared after turning between prone and supine positions. Relative proton density was higher in preterm than in term lung (p < 0.008) and greater in dependent than in nondependent regions, particularly in the preterm (p < 0.001). Repositioning preterm infants rapidly redistributed signal intensities, with more even distribution lying prone than supine (p < 0.001). Small, low-signal regions were seen in the lung parenchyma in preterm but not in term infants, which may indicate peribronchial fluid or overdistension of compliant lung units. We conclude that lung water content is higher in preterm than in term infants and is associated with gravity-related changes consistent with dependent atelectasis.