The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Department of Physiology and Biophysics, Case Western Reserve School of Medicine, Cleveland, OH.
J Pediatr. 2021 Dec;239:89-94. doi: 10.1016/j.jpeds.2021.07.059. Epub 2021 Jul 30.
To assess the feasibility of magnetic resonance imaging (MRI) for postnatal assessment of pulmonary vascularity in infants with congenital diaphragmatic hernia (CDH).
Infants with prenatally diagnosed CDH (n = 24) received postnatal pulmonary MRI. Infants with nonpulmonary birth defects served as controls (n = 5). Semiautomatic segmentation was performed to obtain total vascular volume using time of flight images to assess vascularity.
Average vascular density (vascular volume/lung volume) in control infants was 0.23 ± 0.06 mm/mm compared with 0.18 ± 0.06 mm/mm in infants with CDH is (P = .09). When stratified further based on CDH severity, the difference between control infants and moderate CDH group was statistically significant. (0.23 mm/mm vs 0.15 mm/mm, P = .01). Ipsilateral vascular density on MRI in infants with CDH significantly correlated with the prenatal pulmonary hypertensive index (P = .0004, Spearman R = +0.87) and with number of days on mechanical ventilation (P = .04, Spearman R = -0.44), total days on inhaled nitric oxide (P = .02, Spearman R = -0.47), use of epoprostenol for acute pulmonary hypertension (PH) (0.14 mm/mm vs 0.20 mm/mm, P = .005), and use of sildenafil for chronic PH (0.15 mm/mm vs 0.19 mm/mm, P = .03).
Our results suggest that postnatal pulmonary vascularity assessed by MRI strongly correlates with prenatal and postnatal markers of PH severity and that pulmonary vascularity may serve as a direct measure of pulmonary vascular hypoplasia in infants with CDH.
评估磁共振成像（MRI）在先天性膈疝（CDH）患儿产后评估肺血管性的可行性。
对产前诊断为 CDH 的婴儿（n=24）进行产后肺 MRI 检查。非肺部出生缺陷的婴儿作为对照组（n=5）。使用飞行时间图像进行半自动分割，以获得总血管容积，从而评估血管性。
对照组婴儿的平均血管密度（血管容积/肺容积）为 0.23±0.06mm/mm，而 CDH 患儿为 0.18±0.06mm/mm（P=0.09）。进一步根据 CDH 严重程度分层，对照组婴儿与中度 CDH 组之间的差异具有统计学意义。（0.23mm/mm 比 0.15mm/mm，P=0.01）。CDH 患儿 MRI 上的同侧血管密度与产前肺动脉高压指数显著相关（P=0.0004，Spearman R=+0.87），与机械通气天数（P=0.04，Spearman R=-0.44）、吸入一氧化氮总天数（P=0.02，Spearman R=-0.47）、急性肺动脉高压（PH）时使用依前列醇（0.14mm/mm 比 0.20mm/mm，P=0.005）、慢性 PH 时使用西地那非（0.15mm/mm 比 0.19mm/mm，P=0.03）相关。
我们的结果表明，MRI 评估的产后肺血管性与产前和产后 PH 严重程度标志物密切相关，并且肺血管性可能作为 CDH 患儿肺血管发育不良的直接测量指标。
