支气管肺发育不良早产儿肺血管的磁共振成像评估

Neonatology Pub Date : 2024-07-29 DOI:10.1159/000539545
Shanmukha Mukthapuram, Addison Donaher, Nara S Higano, James A Rowe, Jean A Tkach, Jason C Woods, Paul S Kingma
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引用次数: 0

摘要

导言:肺动脉高压常并发支气管肺发育不良(BPD),BPD 合并肺动脉高压的婴儿死亡率较高。目前评估肺动脉高压的方法无法评估这种疾病的主要原因。我们假设患有 BPD 的早产儿肺血管生长会发生改变,而磁共振成像(MRI)可用于评估 BPD 的血管性:在这项观察性队列研究中,患有 BPD 的早产儿(33 例)和对照组(6 例)接受了包括二维飞行时间采集在内的产后胸部核磁共振成像。通过半自动分割测量血管参数,包括血管体积和密度(血管密度=血管体积/肺体积):结果:核磁共振成像上的血管体积随着月经后年龄的增长而增加(877.2 立方毫米/周);但血管密度并无明显变化。血管体积在更严重 BPD 的婴儿中更高(p <0.002),但血管密度在比较轻度、中度和重度 BPD 时没有明显变化。与不需要气管造口术的婴儿相比,需要气管造口术的重度 BPD 婴儿的血管密度呈下降趋势(0.18 mm3/mm3 vs. 0.27 mm3/mm3,p = 0.06)。严重BPD婴儿的血管密度会随着吸入一氧化氮(iNO)治疗天数的增加而增加(0.02 mm3/mm3/iNO周,rho = +0.56,p = 0.03):新生儿核磁共振成像可用于评估患有 BPD 的早产儿的肺血管情况。患有 BPD 的婴儿血管生长会发生改变,血管容量越大,BPD 越严重,而血管密度越低,临床预后越差。在对重度 BPD 进行 iNO 治疗时,血管密度会增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Magnetic Resonance Imaging Assessment of Pulmonary Vascularity in Preterm Infants with Bronchopulmonary Dysplasia.

Introduction: 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.

Methods: 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).

Results: 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).

Conclusion: 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.

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