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Lung structure and function on MRI in preterm born school children with and without BPD: A feasibility study
Bernadette B L J Elders1,2, Harm A W M Tiddens1,2, Mariëlle W H Pijnenburg1
1Department of Paediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Insights
Magnetic resonance imaging (MRI) effectively detects lung damage in school-aged children with and without bronchopulmonary dysplasia (BPD), correlating well with spirometry. This safe, radiation-free imaging method aids long-term follow-up for preterm infants.
Area of Science:
- Pediatric Pulmonology
- Medical Imaging
- Neonatology
Background:
- Bronchopulmonary dysplasia (BPD) is a common respiratory complication of prematurity, causing structural lung changes and impaired respiratory outcomes.
- Preterm children without BPD can also experience similar adverse respiratory outcomes.
- A safe imaging modality is needed for assessing disease severity and risk stratification in preterm children with and without BPD.
Purpose of the Study:
- To develop a magnetic resonance imaging (MRI) protocol for evaluating preterm children with and without BPD at school age.
- To assess structural and functional lung damage using MRI.
- To correlate MRI findings with spirometry results.
Main Methods:
- MRI scans were performed on healthy volunteers, preterm children with BPD, and preterm children without BPD (median age range: 8.8-15.6 years).
- Images were analyzed for abnormalities, bronchopathy, and architectural distortion.
- Ventilation and perfusion defects were assessed using Fourier Decomposition (FD) MRI and correlated with spirometry.
Main Results:
- Children with BPD showed significantly higher percentages of diseased lung on MRI compared to preterm children without BPD and healthy controls.
- The percentage of diseased lung correlated negatively with key spirometry measures, including FEV1, FEV1/FVC, and FEF75.
- Ventilation and perfusion defects identified by FD MRI corresponded to hypointense regions on expiratory MRI.
Conclusions:
- Chest MRI is a sensitive and safe imaging method for identifying structural and functional lung damage in school-aged preterm children, with or without BPD.
- MRI findings correlate well with spirometry, providing valuable insights into respiratory health.
- The proposed MRI protocol, free from ionizing radiation, contrast agents, and anesthesia, is suitable for the long-term follow-up of preterm children.
Background And Objective:
The most common respiratory complication of prematurity is bronchopulmonary dysplasia (BPD), leading to structural lung changes and impaired respiratory outcomes. However, also preterm children without BPD may show similar adverse respiratory outcomes. There is a need for a safe imaging modality for preterm children with and without BPD for disease severity assessment and risk stratification. Our objective was to develop a magnetic resonance imaging (MRI) protocol in preterm children with and without BPD at school age.
Methods:
Nine healthy volunteers (median age 11.6 [range: 8.8-12.8] years), 11 preterm children with BPD (11.0 [7.2-15.6] years), and 9 without BPD (11.1 [10.7-12.6] years) underwent MRI. Images were scored on hypo- and hyperintense abnormalities, bronchopathy, and architectural distortion. MRI data were correlated to spirometry. Ventilation and perfusion defects were analyzed using Fourier Decomposition (FD) MRI.
Results:
On MRI, children with BPD had higher %diseased lung (9.1 (interquartile range [IQR] 5.9-11.6)%) compared to preterm children without BPD (3.4 (IQR 2.5-5.4)%, p < 0.001) and healthy volunteers (0.4 (IQR 0.1-0.8)%, p < 0.001). %Diseased lung correlated negatively with %predicted FEV1 (r = -0.40, p = 0.04), FEV1 /FVC (r = -0.49, p = 0.009) and FEF75 (r = -0.63, p < 0.001). Ventilation and perfusion defects on FD sequence corresponded to hypointense regions on expiratory MRI.
Conclusion:
Chest MRI can identify structural and functional lung damage at school age in preterm children with and without BPD, showing a good correlation with spirometry. We propose MRI as a sensitive and safe imaging method (without ionizing radiation, contrast agents, or the use of anesthesia) for the long-term follow-up of preterm children.
