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Am J Respir Crit Care Med. 2018 May 23. doi: 10.1164/rccm.201711-2287OC. [Epub ahead of print]

Neonatal Pulmonary MRI of Bronchopulmonary Dysplasia Predicts Short-term Clinical Outcomes.

Author information

1
Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Cincinnati, Ohio, United States.
2
Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio, United States.
3
Cincinnati Children's Hospital Medical Center, Radiology, Cincinnati, Ohio, United States.
4
University of Wisconsin - Madison, Medical Physics, Madison, Wisconsin, United States.
5
Cincinnati Children's Hospital Medical Center, Neonatology and Pulmonary Biology, Cincinnati, Ohio, United States.
6
University of Wisconsin - Madison, Radiology, Madison, Wisconsin, United States.
7
Cincinnati Children's Hospital Medical Center, Radiology, Cincinnati, Ohio, United States ; jason.woods@cchmc.org.

Abstract

RATIONALE:

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 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.

OBJECTIVES:

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.

METHODS:

Forty-two neonates (20 severe BPD, 6 moderate, 7 mild, 9 non-BPD controls; 40±3 weeks post-menstrual age) underwent quiet-breathing structural pulmonary MRI (ultrashort echo-time and gradient echo) in a NICU-sited, neonatal-sized 1.5T scanner, without sedation or respiratory support unless already clinically prescribed. Disease severity was scored independently by two radiologists. Mean scores were compared to clinical severity and short-term respiratory outcomes. Outcomes were predicted using univariate and multivariable models including clinical data and scores.

MEASUREMENTS AND MAIN RESULTS:

MRI scores significantly correlated with severities and predicted respiratory support at NICU 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.

CONCLUSIONS:

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 non-ionizing technique can be implemented to phenotype disease and has potential to serially assess efficacy of individualized therapies.

KEYWORDS:

bronchopulmonary dysplasia; magnetic resonance imaging; neonatal lung disease; outcomes prediction modeling; prematurity

PMID:
29790784
DOI:
10.1164/rccm.201711-2287OC

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