Assessing the feasibility of neonatal chest MRI for bronchopulmonary dysplasia using a standard 1.5-Tesla scanner

Accurate imaging is essential for assessing structural lung abnormalities in children with bronchopulmonary dysplasia (BPD). Chest MRI offers a radiation-free alternative to CT and enables silent scanning. This study aimed to develop and evaluate a chest MRI protocol for BPD using a standard 1.5-Tesla (T) MRI scanner with a dedicated neonatal chest coil.

In this prospective pilot study, infants underwent feed-and-swaddle chest MRI at ~40 weeks postmenstrual age, and chest CT at six months corrected age. The MRI protocol included free-breathing axial T2-weighted (T2-W) fast spin echo (PROPELLER) and axial proton density-weighted (PD-W) gradient zero echo time (ZTE) sequences. Scans were assessed for image quality, and quantified for normal, hypo-/hyperintense lung tissue and bronchopathy. MRI and CT scores were correlated using Pearson's or Spearman's coefficients, based on data distribution.

Eight infants participated (seven preterm < 28 weeks' gestation with severe BPD; one term neonate with asphyxia). T2-w PROPELLER provided superior soft tissue contrast and fewer artefacts than ZTE. ZTE enabled silent scanning and better visualisation of hypointense structures. Quantitative scores were comparable between PROPELLER and ZTE sequences. Significant correlations were found between MRI and CT scores for normal and hyperintense lung tissue (p < 0.05; r = 0.84-0.96), but not for hypointense regions and bronchopathy.

We developed a feasible and safe chest MRI protocol for imaging severe BPD-related lung abnormalities in neonates using a standard 1.5-T system. While technically promising, MRI is not yet clinically equivalent to CT. Further validation is needed to define its potential role in BPD assessment.

Question Can a standard 1.5 T chest MRI protocol performed without anaesthesia reliably image lung abnormalities in neonates with BPD? Findings T2-W PROPELLER sequence provided superior image quality and fewer artefacts compared to the ZTE, especially in depicting fissures and bronchi. Clinical relevance Our BPD-MRI protocol enables safe, radiation-free lung imaging in neonates with severe BPD without requiring anaesthesia. It offers a technically feasible alternative to CT and may support early structural assessment before discharge in routine clinical care.