1 Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology.
2 Department of Radiology, and.
Am J Respir Crit Care Med. 2018 Nov 15;198(10):1302-1311. doi: 10.1164/rccm.201711-2287OC.
Bronchopulmonary dysplasia (BPD) is a serious neonatal pulmonary condition associated with premature birth, but the underlying parenchymal disease and trajectory are poorly characterized. The current National Institute of Child Health and Human Development (NICHD)/NHLBI definition of BPD severity is based on degree of prematurity and extent of oxygen requirement. However, no clear link exists between initial diagnosis and clinical outcomes.
We hypothesized that magnetic resonance imaging (MRI) of structural parenchymal abnormalities will correlate with NICHD-defined BPD disease severity and predict short-term respiratory outcomes.
A total of 42 neonates (20 severe BPD, 6 moderate, 7 mild, 9 non-BPD control subjects; 40 ± 3-wk postmenstrual age) underwent quiet-breathing structural pulmonary MRI (ultrashort echo time and gradient echo) in a neonatal ICU-sited, neonatal-sized 1.5 T scanner, without sedation or respiratory support unless already clinically prescribed. Disease severity was scored independently by two radiologists. Mean scores were compared with clinical severity and short-term respiratory outcomes. Outcomes were predicted using univariate and multivariable models, including clinical data and scores.
MRI scores significantly correlated with severities and predicted respiratory support at neonatal ICU discharge (P < 0.0001). In multivariable models, MRI scores were by far the strongest predictor of respiratory support duration over clinical data, including birth weight and gestational age. Notably, NICHD severity level was not predictive of discharge support.
Quiet-breathing neonatal pulmonary MRI can independently assess structural abnormalities of BPD, describe disease severity, and predict short-term outcomes more accurately than any individual standard clinical measure. Importantly, this nonionizing technique can be implemented to phenotype disease, and has potential to serially assess efficacy of individualized therapies.
支气管肺发育不良（BPD）是一种与早产相关的严重新生儿肺部疾病，但实质病变和病程尚不清楚。目前，美国国立儿童健康与人类发展研究所（NICHD）/NHLBI 制定的 BPD 严重程度定义基于早产程度和氧需求程度。然而，初始诊断与临床结局之间没有明确的联系。
我们假设磁共振成像（MRI）的结构性实质异常与 NICHD 定义的 BPD 疾病严重程度相关，并预测短期呼吸结局。
共有 42 名新生儿（20 名严重 BPD、6 名中度 BPD、7 名轻度 BPD、9 名非 BPD 对照组；校正胎龄 40±3 周）在新生儿 ICU 内新生儿大小的 1.5 T 扫描仪上进行了安静呼吸结构肺部 MRI（超短回波时间和梯度回波），无需镇静或呼吸支持，除非已经临床规定。两名放射科医生独立对疾病严重程度进行评分。平均评分与临床严重程度和短期呼吸结局进行比较。使用单变量和多变量模型（包括临床数据和评分）预测结局。
MRI 评分与严重程度显著相关，并预测新生儿 ICU 出院时的呼吸支持（P<0.0001）。在多变量模型中，MRI 评分是预测呼吸支持时间的最强指标，远远超过临床数据，包括出生体重和胎龄。值得注意的是，NICHD 严重程度水平不能预测出院支持。
安静呼吸新生儿肺部 MRI 可独立评估 BPD 的结构性异常，描述疾病严重程度，并比任何单一临床标准更准确地预测短期结局。重要的是，这种非电离技术可用于表型疾病，并有可能对个体化治疗的疗效进行连续评估。
