362 - Lung Magnetic Resonance Imaging (MRI) And Respiratory Function Assessment At Term In Preterm Infants Not Affected By Bronchopulmonary Dysplasia (BPD)

Publication Number: 362.5617

giulia Ricci, Ospedale dei Bambini Vittore Buzzi, Milano, Lombardia, Italy; Gianluca Lista, NICU V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Francesca Castoldi, NICU V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Alice M. Munari, V.buzzi children's hospital, Milano, Lombardia, Italy; Salvatore zirpoli, V. Buzzi Children's Hospital Milan, Milan, Lombardia, Italy; Valeria Calcaterra, Buzzi Childern's Hospital Milano and University of Pavia, Pavia, Milano, Lombardia, Italy; Lucia Labati, Buzzi Children's Hospital, Milan, Lombardia, Italy; Gianvincenzo Zuccotti, University of Milan, Milan, Lombardia, Italy; Paola Fontana, NICU, Buzzi Children's Hospital, ASST FBF SACCO, MILAN, Milan, Lombardia, Italy; Enrica Lupo, Children's Hospital, Milan, Lombardia, Italy; Petrina Bastrenta, NICU V.Buzzi Children's Hospital, Milan, Italy, Milan, Lombardia, Italy; Francesca Viaroli, NICU V. Buzzi children’s hospital, Milan, Lombardia, Italy; Paola Azzurra. La Verde, Childrens' Hospital V. Buzzi, Milan,Lombardia, Italy, Milano, Lombardia, Italy; Ilaria Stucchi, NICU V.BUZZI, CHILDREN'S HOSPITAL, Milan, Lombardia, Italy; Valentina Pivetti, NICU V.Buzzi Childrens' Hospital, Milan, Lombardia, Italy; Fabio Meneghin, NICU V. Buzzi Children’s Hospital, Milan, Lombardia, Italy; Silvia Bianchi, NICU V. Buzzi Children's Hospital, milan, Lombardia, Italy; Irene Daniele, NICU V. Buzzi, Children’s Hospital, Milan, Lombardia, Italy; Sara Gatto, NICU - V.Buzzi Childrens’ Hospital, Milan, Lombardia, Italy; Valeria Anna Manfredini, NICU V.BUZZI Children's Hospital, MILAN, Lombardia, Italy; Samantha Rossi, NICU V. Buzzi Children's Hospital, Milan, Lombardia, Italy; Cristina Ferrè, NICU Childrens' Hospital V.Buzzi, Milan, Lombardia, Italy, Legnano, Lombardia, Italy; Francesco Cavigioli, Buzzi Children's Hospital, Milan, Lombardia, Italy

Background: Premature infants without BPD may have significant changes in lung function and anatomy resulting in respiratory complications and morbidity, but less research is available. Respiratory function tests can detect and quantify respiratory capacity abnormalities early in the follow-up of premature infants, despite neonatal limitations. In infants with BPD, lung MRI scored disease severity and morbidity at discharge better than clinical severity stratification. Combining these two advanced diagnostic tools can help develop personalized therapeutic strategies and cut respiratory complications.

Objective: To determine the correlation between respiratory function test results and any lung parenchymal injury detected by lung MRI at term in two groups of infants < 36 wks GA without BPD (group 1: GA < 32+6 wks; group 2: GA 32+6-35+6 wks) in a pilot prospectic observational study.

Design/Methods: Preterm infants not BPD received at term equivalent age a routine brain MRI and a lung MRI (turbo spin echo and gradient echo sequences during natural sleep), scored with the modified Ochiai system and our new BPDMRI score (four hyperaeration and four parenchymal variables). Pulmonary function tests were assessed in spontaneous sleep at term by flow-volume (F/V) curve measurement at current volume (PFR) during a complete cycle. We correlated respiratory function test results with MRI results by Pearson's correlation coefficient. We studied the inter-reader reproducibility of the scores.

Results: We studied 20 preterm infants not BPD: group 1=n 10; GA 30.4±1.5wks; BW 1318±347g; respiratory support 9.3±7.9days; O2 therapy 22.4±7.2days; group 2 =n 10; GA 34.7±0.9 wks; BW2051±468g; respiratory support 1.6±2.2days (p=0.02 vs Gr 1); O2 therapy 2.7±2.1days (p=0.00 vs Gr1). The two groups showed significant differences at term in respiratory function as well as in modified Ochiai scores and BPDMRI score (Table 1 and 2). A negative correlation was found between the MODIFIED OCHIAI score and BPDMRI score and the Z-score tPTEF/tE in all infants (r=-0.52; r=-0.59); inverse correlation was stronger (r=-0.656) in group 2 (Table 3). Good inter-reader reproducibility.

Conclusion(s): This pilot study supports the diagnostic utility of respiratory function tests and lung MRI to assess lung parenchyma and function in preterm infants, BPD diagnosis aside.
In our population of preterm infants without BPD, poor respiratory function at term correlated significantly with higher lung MRI scores revealing severe lung structural abnormalities, recommending an adequate follow-up reinforced by hospital-territory integration and family counselling.

Representative lung MRI images of infants in Gr 1 and 2, together with the modified Ochiai score


Respiratory function tests and lung MRI scores of infants in Group 1 vs Group 2
Student’s t-test: p<0.05; TOT I: score assessed by less experienced radiologist; TOT III: score assessed by more experienced radiologist;

Correlation between respiratory function (tPTEF/tE Z-score) and MRI assessment scores in our population: impaired respiratory function correlates with more severe structural abnormalities
* significant correlation;
TOT I: score assessed by less experienced radiologist; TOT III: score assessed by experienced radiologist;

Representative lung MRI images of infants in Gr 1 and 2, together with the modified Ochiai score


Respiratory function tests and lung MRI scores of infants in Group 1 vs Group 2
Student’s t-test: p<0.05; TOT I: score assessed by less experienced radiologist; TOT III: score assessed by more experienced radiologist;

Correlation between respiratory function (tPTEF/tE Z-score) and MRI assessment scores in our population: impaired respiratory function correlates with more severe structural abnormalities
* significant correlation;
TOT I: score assessed by less experienced radiologist; TOT III: score assessed by experienced radiologist;