Sunday, June 1, 2025
6/1/2025
Physiologic phenotyping of chronic lung disease of prematurity using MRI - Abstract. The goal of our project is to implement a novel scoring system for chronic lung disease of prematurity previously known as bronchopulmonary dysplasia (BPD) in premature infants using structural and functional magnetic resonance imaging (MRI) which identifies the primary cause of the disease subtypes. Currently, there is no means in the clinic to identify the cause of BPD in each infant and whether it has affected the large airways, lung parenchyma or pulmonary perfusion. Clinical care only assesses the degree of respiratory support or oxygen that each infant needs and for what time period without knowledge of the underlying cause of the disease. However, specific treatment would differ knowing that the large airways or tracheal area was decreased in comparison with an infant having pulmonary hypertension and perfusion abnormalities. Our preliminary data in 25 premature infants has shown that novel MRI techniques can be used to non-invasively (without radiation) and without the need for sedation or administration of Gadolinium based contrast agents to quantitate both lung structure and function in this vulnerable population. Our overarching hypothesis is that we can use these sequences that measure both ventilation and perfusion to quantify BPD-specific contributions of Airways, Lung Parenchyma and Perfusion. Specifically, in aim1 we will implement a novel ALP scoring system for BPD phenotypes which identifies the relative contributions of Airways, Lung parenchyma and Perfusion. We will enroll 95 premature infants with all grades of BPD (I, II & III) in the neonatal intensive care unit (NICU). Our center is only one of three in the nation offering high-resolution MRI to infants directly in the NICU. Specific MRI sequences will include anatomic sequences such as BLADE, STARVIBE and PETRA to image the tracheal airway, lung volume and parenchymal structure. We will also use a novel phase-resolved functional lung (PREFUL) sequence to measure both ventilation and perfusion defects as well as pulmonary perfusion. One strength of this proposal is that the PREFUL MRI acquisition uses a routine 2D fast gradient echo (GRE) multi-phase sequence that may be readily implemented using product sequences on most if not all MRI scanners even those outside the NICU. The total scan time will only be approximately 15 minutes. Our aim 2 will then investigate the association between the ALP score and patient specific outcomes including death before discharge, length of time in the NICU, tracheostomy, need for vasodilator or inhaled pulmonary medications. Our study is the first to add real-time function assessment of lung perfusion and ventilation to structural MR markers of BPD in this vulnerable population of premature infants in the NICU.
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