Weis Meike, Zoellner Frank G, Hagelstein Claudia, Schoenberg Stefan O, Zahn Katrin, Schaible Thomas, Neff K Wolfgang
1 Institute of Clinical Radiology and Nuclear Medicine, Heidelberg University, University Medical Center Mannheim, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany.
2 Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
AJR Am J Roentgenol. 2016 Jun;206(6):1315-20. doi: 10.2214/AJR.15.14860. Epub 2016 Mar 24.
In severe cases of congenital diaphragmatic hernia (CDH), extracorporeal membrane oxygenation (ECMO) therapy improves survival. Later on, lung morbidity mainly defines development. The purpose of this study was to investigate whether 2-year-old children who need ECMO therapy after delivery have reduced perfusion MRI values as a sign of more severe lung hypoplasia than do children who do not need ECMO.
After CDH repair, 38 children underwent dynamic contrast-enhanced MRI with a 3D time-resolved angiography with stochastic trajectories sequence. Fifteen (39%) of the children had received ECMO therapy in the neonatal period. Pulmonary blood flow (PBF), pulmonary blood volume (PBV), and mean transit time were calculated for both lungs. In addition, the ratio of ipsilateral to contralateral lung was calculated for all parameters.
In all children, those with and those without ECMO requirement, PBF and PBV were significantly reduced on the ipsilateral side (p < 0.05). Children who had received ECMO therapy had significantly reduced PBF and PBV values on the ipsilateral side (p < 0.05) compared with children who had not needed ECMO therapy. The ratios of ipsilateral to contralateral lung for PBF and PBV were also significantly reduced after ECMO.
Two-year-old children undergoing CDH repair who had needed neonatal ECMO had significantly reduced perfusion MRI values in the ipsilateral lung in comparison with children who had not needed ECMO. Perfusion MRI measurements are associated with the severity of lung hypoplasia and may therefore be helpful in follow-up investigations.
在先天性膈疝（CDH）的严重病例中，体外膜肺氧合（ECMO）治疗可提高生存率。随后，肺部发病率主要决定发育情况。本研究的目的是调查与不需要ECMO的儿童相比，出生后需要ECMO治疗的2岁儿童灌注磁共振成像（MRI）值是否降低，以此作为更严重肺发育不全的标志。
38例CDH修复术后儿童接受了动态对比增强MRI检查，采用三维时间分辨对比剂动态增强血管造影随机轨迹序列。其中15例（39%）儿童在新生儿期接受了ECMO治疗。计算双侧肺的肺血流量（PBF）、肺血容量（PBV）和平均通过时间。此外，计算所有参数的同侧肺与对侧肺的比值。
在所有儿童中，无论是否需要ECMO治疗，同侧的PBF和PBV均显著降低（p<0.05）。与不需要ECMO治疗的儿童相比，接受ECMO治疗的儿童同侧的PBF和PBV值显著降低（p<0.05）。ECMO治疗后，PBF和PBV的同侧肺与对侧肺的比值也显著降低。
与不需要ECMO的儿童相比，接受CDH修复术且新生儿期需要ECMO的2岁儿童同侧肺的灌注MRI值显著降低。灌注MRI测量与肺发育不全的严重程度相关，因此可能有助于随访研究。
