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Quantitative CT scans of lung parenchymal pathology in premature infants ages 0-6 years
David R Spielberg1,2, Laura L Walkup1,2, Jill M Stein3
1Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Quantitative CT scans reveal lung abnormalities in premature infants with bronchopulmonary dysplasia (BPD). These BPD-related lung pathologies decrease with age, suggesting a potential for improved clinical outcome definitions.
Area of Science:
- Medical imaging
- Pediatric pulmonology
- Quantitative computed tomography
Background:
- Bronchopulmonary dysplasia (BPD) is a complex lung disease affecting premature infants.
- Understanding BPD's heterogeneous nature and its progression is crucial for infant respiratory health.
- Quantitative CT techniques offer potential for detailed lung assessment in BPD.
Purpose of the Study:
- To evaluate quantitative CT for assessing lung parenchymal heterogeneity in BPD patients.
- To determine how lung pathologies in BPD change over a broad age range.
- To correlate CT findings with clinical outcomes in BPD.
Main Methods:
- Retrospective analysis of chest CT scans in children aged 0-6 years (BPD patients and healthy controls).
- Quantification of lung opacities, lucencies, and spatial heterogeneity using CT attenuation, manual segmentation, and Ochiai scoring.
- Assessment of clinical outcomes including BPD severity, respiratory support, wheezing, and exacerbations.
Main Results:
- Lung heterogeneity was significantly greater in BPD patients compared to controls.
- The difference in lung attenuation between BPD patients and controls decreased with age.
- Opacities and lucencies quantified via CT generally decreased over time in BPD patients.
Conclusions:
- Quantitative CT effectively distinguishes BPD patients from healthy controls based on lung opacities, lucencies, and heterogeneity.
- These lung abnormalities in BPD decrease with increasing age.
- Clinical BPD severity assessment may benefit from evaluating respiratory support over multiple time points.
Background:
Bronchopulmonary dysplasia (BPD) is a common, heterogeneous disease in premature infants. We hypothesized that quantitative CT techniques could assess lung parenchymal heterogeneity in BPD patients across a broad age range and demonstrate how pathologies change over time.
Methods:
A cross-sectional, retrospective study of children age 0-6 years with non-contrast chest CT scans was conducted. BPD subjects met NICHD/NHLBI diagnostic criteria for BPD and were excluded for congenital lung/airway abnormalities or other known/suspected pulmonary diagnoses; control subjects were not premature and had normal CT scan findings. Radiologic opacities, lucencies, and spatial heterogeneity were quantified via: 1) thresholding using CT-attenuation (HU); 2) manual segmentation; and 3) Ochiai reader-scoring system. Clinical outcomes included BPD severity by NICHD/NHLBI criteria, respiratory support at NICU discharge, wheezing, and respiratory exacerbations.
Results:
Heterogeneity (standard deviation) of lung attenuation in BPD was significantly greater than in controls (difference 36.4 HU [26.1-46.7 HU], P < 0.001); the difference between the groups decreased 0.58 HU per month of age (0.08-1.07 HU per month, P = 0.02). BPD patients had greater amounts of opacities and lucencies than controls except with automated quantification of lucencies. Cross-sectionally, lucencies per Ochiai score and opacities per manual segmentation decreased with time. No approach measured a statistically significant relationship to BPD clinical severity.
Conclusions:
Opacities, lucencies, and overall heterogeneity of lungs via quantitative CT can distinguish BPD patients from healthy controls, and these abnormalities decrease with age across BPD patients. Defining BPD severity by clinical outcomes such as respiratory support at several time points (vs a single time point, per current guidelines) may be meaningful.
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