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Author Spotlight: Standardization and Best Practices for Advancing Lung Imaging Using 129Xe MRI
Published on: November 21, 2023
Image Phenotyping of Preterm-Born Children Using Hyperpolarized 129Xe Lung Magnetic Resonance Imaging and
Ho-Fung Chan1, Laurie J Smith1, Alberto M Biancardi1
1Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Insights
Preterm birth can lead to lasting lung issues. Bronchopulmonary dysplasia (BPD) in infancy is linked to altered lung microstructure, while prematurity-associated obstructive lung disease (POLD) shows ventilation defects in children.
Area of Science:
- Pediatric pulmonology
- Respiratory imaging
- Neonatal medicine
Background:
- Preterm birth is a known risk factor for reduced childhood lung function.
- The impact of bronchopulmonary dysplasia (BPD) and specific lung function phenotypes on lung microstructure in preterm children remains unclear.
Purpose of the Study:
- To investigate the distinct associations of BPD and current lung function phenotypes with lung ventilation and microstructure in preterm-born children.
- To differentiate the effects of prematurity-associated obstructive lung disease (POLD) and BPD on respiratory outcomes.
Main Methods:
- Utilized hyperpolarized 129Xe ventilation and diffusion-weighted MRI, along with multiple-breath washout (MBW), in 63 children (44 preterm, 19 term-born controls).
- Classified preterm children into groups based on spirometry: POLD, preserved ratio impaired spirometry, and normal spirometry, and also by BPD status.
- Analyzed ventilation heterogeneity using 129Xe MRI and SF6 MBW, and alveolar microstructure using 129Xe diffusion-weighted MRI.
Main Results:
- Children with POLD exhibited significantly increased 129Xe ventilation defect percentage and heterogeneity index.
- Preterm children with BPD showed significantly increased 129Xe apparent diffusion coefficient and alveolar dimensions, indicating microstructural changes.
- MBW metrics were significantly elevated in the POLD group compared to both preterm and term controls.
Conclusions:
- Ventilation abnormalities in childhood are associated with POLD.
- Infancy BPD diagnosis is linked to abnormal lung microstructure in later childhood.
- These findings highlight distinct respiratory impacts of POLD and BPD in preterm-born children.
Abstract:
Rationale: Preterm birth is associated with low lung function in childhood, but little is known about the lung microstructure in childhood. Objectives: We assessed the differential associations between the historical diagnosis of bronchopulmonary dysplasia (BPD) and current lung function phenotypes on lung ventilation and microstructure in preterm-born children using hyperpolarized 129Xe ventilation and diffusion-weighted magnetic resonance imaging (MRI) and multiple-breath washout (MBW). Methods: Data were available from 63 children (aged 9-13 yr), including 44 born preterm (⩽34 weeks' gestation) and 19 term-born control subjects (⩾37 weeks' gestation). Preterm-born children were classified, using spirometry, as prematurity-associated obstructive lung disease (POLD; FEV1 < lower limit of normal [LLN] and FEV1/FVC < LLN), prematurity-associated preserved ratio of impaired spirometry (FEV1 < LLN and FEV1/FVC ⩾ LLN), preterm-(FEV1 ⩾ LLN) and term-born control subjects, and those with and without BPD. Ventilation heterogeneity metrics were derived from 129Xe ventilation MRI and SF6 MBW. Alveolar microstructural dimensions were derived from 129Xe diffusion-weighted MRI. Measurements and Main Results: 129Xe ventilation defect percentage and ventilation heterogeneity index were significantly increased in preterm-born children with POLD. In contrast, mean 129Xe apparent diffusion coefficient, 129Xe apparent diffusion coefficient interquartile range, and 129Xe mean alveolar dimension interquartile range were significantly increased in preterm-born children with BPD, suggesting changes of alveolar dimensions. MBW metrics were all significantly increased in the POLD group compared with preterm- and term-born control subjects. Linear regression confirmed the differential effects of obstructive disease on ventilation defects and BPD on lung microstructure. Conclusion: We show that ventilation abnormalities are associated with POLD, and BPD in infancy is associated with abnormal lung microstructure.
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