View Abstract

A2320 - Diagnosis of Bronchopulmonary Dysplasia Using Magnetic Resonance Imaging Analysis
Author Block: K. Förster1, S. Sass2, A. Pomschar3, H. Ehrhardt4, L. Nährlich5, A. Schulze1, A. Flemmer1, C. Huebener6, O. Eickelberg7, F. Theis2, O. Dietrich3, B. Ertl-Wagner3, A. Hilgendorff8; 1Neonatology, Dr. von Hauner Children's Hospital, München, Germany, 2Helmholtz Zentrum München, München, Germany, 3Radiology, Ludwig-Maximilians-University Hospital Munich, München, Germany, 4Neonatology, University Hospital of Giessen and Marburg, Giessen, Germany, 5University Hospital of Giessen and Marburg, Giessen, Germany, 6Perinatal Center Grosshadern, Clinic for Gynaecology and Obstetrics, München, Germany, 7UC Denver, Denver, CO, United States, 8Comprehensive Pneumology Center, Helmholtz Zentrum Muenchen, Munich, Germany.
Diagnosis of Bronchopulmonary Dysplasia
using magnetic resonance imaging analysis
Kai Förster1,5§, Steffen Sass2, Andreas Pomschar4, Harald Ehrhardt3, Lutz
Nährlich3, Andreas Schulze1, Andreas W. Flemmer1, Christoph Hübener6, Oliver
Eickelberg5, Fabian J. Theis2,7, Olaf Dietrich4, Birgit Ertl-Wagner4§, Anne
Hilgendorff1,5
1Dept. of Neonatology, Perinatal Center Grosshadern, Dr. von Hauner Children`s Hospital,
Ludwig-Maximilians-University, Munich, Germany
2Institute of Computational Biology, Helmholtz Zentrum München, Munich, Germany
3Department of General Pediatrics and Neonatology, University Hospital of Giessen and
Marburg, Giessen, Germany, Member of the German Lung Research Center (DZL)
4Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich,
Germany, Member of the German Lung Research Center (DZL)
5Comprehensive Pneumology Center, Helmholtz Zentrum München, Munich, Germany,
Member of the German Lung Research Center (DZL)
6Clinic for Gynaecology and Obstetrics, Perinatal Center Grosshadern, Ludwig-Maximilians-
University, Munich, Germany
7Department of Mathematics, Technical University of Munich, Germany
Rationale: Neonatal chronic lung disease, i.e. BPD, stems from pre- and postnatal
injury and determines long-term development. Currently, the diagnosis still solely
refers to the duration of oxygen dependency. In order to establish sensitive imaging
protocols for the diagnosis of BPD we employed advanced MRI protocols to
sensitively detect pulmonary structural changes and developed a practical scoring
system.
Method: Preterm infants (27±2 wks, n=40) were included for advanced MR imaging
(3-Tesla), complemented by infant lung function testing (ILFT). Key findings were
confirmed in an independent study cohort. Statistical analysis used penalized and
Poisson regression analysis. MRI scoring (6-point Likert Scale) was performed by a
consensus panel assessing interstitial thickening, emphysema, atelectasis, increased
airway signal and gradients of signal intensities.
Results: Structural changes in the lungs of infants with BPD were quantifiable by
MRI analysis at time of clinical diagnosis. Whereas all disease grades were
characterized by increased T2-relaxation times and associated with a longer duration
of oxygen exposure, higher disease grades were mirrored by decreased T1-
relaxation times. MRI findings were confirmed by respective changes in ILFT.
Morpho-functional MR-scoring correlated all BPD cases as well as a longer duration
of oxygen exposure with a higher score in interstitial thickening, whereas moderate
and severe cases showed significantly increased scores for emphysema.
Conclusions: Diagnosis of BPD in the preterm infant by the use of advanced MRI is
a critical step towards accurate, yet practical BPD diagnosis enabling the initiation of
individualized treatment strategies and adequate disease monitoring.