Mukthapuram Shanmukha, Donaher Addison, Higano Nara S, Rowe James A, Tkach Jean A, Woods Jason C, Kingma Paul S
The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Cincinnati Bronchopulmonary Dysplasia Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Neonatology. 2025;122(1):76-83. doi: 10.1159/000539545. Epub 2024 Jul 29.
Pulmonary hypertension often complicates bronchopulmonary dysplasia (BPD) and infants with BPD plus pulmonary hypertension experience higher mortality rates. Current methods to evaluate pulmonary hypertension fail to evaluate the primary cause of this disease. We hypothesize that preterm infants with BPD experience altered pulmonary vascular growth and that magnetic resonance imaging (MRI) can be used to assess vascularity in BPD.
In this observational cohort study, preterm infants with BPD (n = 33) and controls (n = 6) received a postnatal chest MRI that included a 2-dimensional time-of-flight acquisition. Semi-automatic segmentation was performed to measure vascularity parameters including vascular volume and density (vascular density = vascular volume/lung volume).
Vascular volume on MRI increases with post-menstrual age (877.2 mm3/week); however, the vascular density does not significantly change. Vascular volume is higher in infants with more severe BPD (p < 0.002), but vascular density did not significantly change when comparing mild, moderate, and severe BPD. Vascular density in infants with severe BPD requiring tracheostomy trended lower when compared to infants not requiring tracheostomy (0.18 mm3/mm3 vs. 0.27 mm3/mm3, p = 0.06). Vascular density increases with increasing days of inhaled nitric oxide (iNO) therapy in infants with severe BPD (0.02 mm3/mm3/week of iNO, rho = +0.56, p = 0.03).
Neonatal MRI can be used to assess pulmonary vascularity in preterm infants with BPD. Infants with BPD experience altered vascular growth and while higher vascular volume is associated with more severe BPD, lower vascular density trends toward worse clinical outcomes. Vascular density increases with iNO therapy in severe BPD.
肺动脉高压常使支气管肺发育不良（BPD）复杂化，患有BPD合并肺动脉高压的婴儿死亡率更高。目前评估肺动脉高压的方法未能评估该疾病的主要病因。我们推测患有BPD的早产儿肺血管生长发生改变，磁共振成像（MRI）可用于评估BPD中的血管情况。
在这项观察性队列研究中，患有BPD的早产儿（n = 33）和对照组（n = 6）接受了产后胸部MRI检查，其中包括二维时间飞跃采集。进行半自动分割以测量血管参数，包括血管容积和密度（血管密度 = 血管容积/肺容积）。
MRI上的血管容积随孕龄增加而增加（877.2立方毫米/周）；然而，血管密度没有显著变化。患有更严重BPD的婴儿血管容积更高（p < 0.002），但在比较轻度、中度和重度BPD时，血管密度没有显著变化。与不需要气管切开术的婴儿相比，需要气管切开术的重度BPD婴儿的血管密度有降低趋势（0.18立方毫米/立方毫米对0.27立方毫米/立方毫米，p = 0.06）。重度BPD婴儿的血管密度随吸入一氧化氮（iNO）治疗天数增加而增加（iNO治疗每周增加0.02立方毫米/立方毫米，rho = +0.56，p = 0.03）。
新生儿MRI可用于评估患有BPD的早产儿的肺血管情况。患有BPD的婴儿血管生长发生改变，虽然较高的血管容积与更严重的BPD相关，但较低的血管密度提示临床结局更差。重度BPD中血管密度随iNO治疗增加。
