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Quantitative cardiopulmonary magnetic resonance imaging in neonatal congenital diaphragmatic hernia
Jean A Tkach1,2, Nara S Higano3,4,5,6, Michael D Taylor7
1Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA. jean.tkach@cchmc.org.
Insights
Magnetic Resonance Imaging (MRI) can assess cardiopulmonary hemodynamics and lung volume in infants with congenital diaphragmatic hernia (CDH). This noninvasive method quantifies abnormalities and asymmetries, aiding in the evaluation of critically ill neonates.
Area of Science:
- Neonatal imaging
- Pediatric cardiology
- Pulmonary medicine
Background:
- Congenital diaphragmatic hernia (CDH) in infants often leads to pulmonary arterial hypertension, impaired cardiac function, and lung hypoplasia.
- These conditions increase morbidity and mortality in neonates.
- There is a lack of noninvasive methods to quantify these cardiopulmonary abnormalities in early infancy.
Purpose of the Study:
- To assess the feasibility of using MRI to quantify cardiopulmonary hemodynamics and function in infants with CDH.
- To investigate left-right blood flow and lung volume discrepancies in infants with CDH.
Main Methods:
- A prospective MRI study was conducted on 23 neonates, including those with isolated left CDH (pre-repair and post-repair) and controls.
- A 1.5-tesla (T) scanner was used to calculate MRI-based pulmonary arterial blood flow, left ventricular eccentricity index, cardiac function, and lung volume.
- Statistical analysis involved the Wilcoxon rank sum test and Fisher exact test for group comparisons.
Main Results:
- Infants with CDH (pre- and post-repair) showed elevated right-to-left ratios for pulmonary artery blood flow and lung volume compared to controls.
- Significant differences in the end-systolic eccentricity index were observed between pre-repair CDH, post-repair CDH, and controls.
Conclusions:
- Cardiopulmonary MRI is a feasible and viable method for serial evaluation of hemodynamics and function in critically ill infants.
- MRI effectively captures left-right asymmetries in pulmonary blood flow and lung volume in infants with CDH.
Background:
Pulmonary arterial hypertension, impaired cardiac function and lung hypoplasia are common in infants with congenital diaphragmatic hernia (CDH) and are associated with increased morbidity and mortality. Robust noninvasive methods to quantify these abnormalities in early infancy are lacking.
Objective:
To determine the feasibility of MRI to quantify cardiopulmonary hemodynamics and function in infants with CDH and to investigate left-right blood flow and lung volume discrepancies.
Materials And Methods:
We conducted a prospective MRI study of 23 neonates (isolated left CDH: 4 pre-repair, 7 post-repair, 3 pre- and post-repair; and 9 controls) performed on a small-footprint 1.5-tesla (T) scanner. We calculated MRI-based pulmonary arterial blood flow, left ventricular eccentricity index, cardiac function and lung volume. Using the Wilcoxon rank sum test for continuous data and Fisher exact test for categorical data, we made pairwise group comparisons.
Results:
The right-to-left ratios for pulmonary artery blood flow and lung volume were elevated in pre-repair and post-repair CDH versus controls (flow: P<0.005; volume: P<0.05 pre-/post-repair). Eccentricity index at end-systole significantly differed between pre-repair and post-repair CDH (P<0.01) and between pre-repair CDH and controls (P<0.001).
Conclusion:
Cardiopulmonary MRI is a viable method to serially evaluate cardiopulmonary hemodynamics and function in critically ill infants and is useful for capturing left-right asymmetries in pulmonary blood flow and lung volume.
