Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.
Pediatr Radiol. 2022 Jun;52(7):1255-1265. doi: 10.1007/s00247-022-05317-7. Epub 2022 Mar 19.
The management of asymptomatic congenital lung malformations is debated. Particularly, there is a lack of information regarding long-term growth and development of the remaining lung in children following lung resection for congenital lung malformations. In addition to conventional pulmonary function tests, we used novel functional magnetic resonance imaging (MRI) methods to measure perfusion and ventilation.
To assess functionality of the remaining lung expanded into the thoracic cavity after resection of congenital lung malformations.
A prospective, cross-sectional pilot study in five children who had surgery for congenital lung malformations during infancy. Participants had structural and functional MRI as well as spirometry, body plethysmography and multiple breath washout at school age.
Structural MRI showed an expansion of the remaining lung in all cases. Fractional ventilation and relative perfusion of the expanded lung were locally decreased in functional MRI. In all other parts of the lungs, fractional ventilation and relative perfusion were normal in all children. There was an association between overall impairment of perfusion and elevated lung clearance index. The results of spirometry and body plethysmography varied between patients, including normal lung function, restriction and obstruction.
Fractional ventilation and relative perfusion maps from functional MRI specifically locate impairment of the remaining lung after lung resection. These changes are not captured by conventional measures such as structural MRI and standard pulmonary function tests. Therefore, following lung resection for congenital lung malformation, children should be investigated more systematically with functional lung MRI.
无症状先天性肺畸形的处理存在争议。特别是，对于先天性肺畸形肺切除术后儿童剩余肺的长期生长和发育情况，相关信息有限。除了常规的肺功能测试外，我们还使用了新型的功能性磁共振成像（MRI）方法来测量灌注和通气。
评估先天性肺畸形肺切除术后胸腔内扩张的剩余肺的功能。
这是一项在 5 名婴幼儿先天性肺畸形手术患者中进行的前瞻性、横断面研究。参与者在学龄期进行了结构性和功能性 MRI 检查，以及肺活量测定、体描法和多次呼吸冲洗。
结构 MRI 显示所有病例的剩余肺均有扩张。功能 MRI 显示扩张肺的局部通气分数和相对灌注分数降低。在所有其他肺部区域，所有儿童的通气分数和相对灌注分数均正常。整体灌注受损与肺清除指数升高之间存在关联。肺活量测定和体描法的结果在患者之间存在差异，包括正常肺功能、限制和阻塞。
功能 MRI 的通气分数和相对灌注图可特异性定位肺切除术后剩余肺的损伤。这些变化无法通过结构 MRI 和标准肺功能测试等常规措施捕捉到。因此，对于先天性肺畸形肺切除术后的儿童，应更系统地使用功能性肺 MRI 进行检查。
