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. 2022 Jun;55(6):1696-1707.
doi: 10.1002/jmri.28165. Epub 2022 Mar 21.

Clinical Feasibility of Structural and Functional MRI in Free-Breathing Neonates and Infants

Brandon Zanette  1 , Eric M Schrauben  1 , Samal Munidasa  1   2 , Datta S Goolaub  1 , Anuradha Singh  3 , Ailish Coblentz  3   4 , Elaine Stirrat  1 , Marcus J Couch  1   2 , Robert Grimm  5 , Andreas Voskrebenzev  6   7 , Jens Vogel-Claussen  6   7 , Ravi T Seethamraju  8 , Christopher K Macgowan  1   2 , Mary-Louise C Greer  3   4 , Emily W Y Tam  9   10 , Giles Santyr  1   2
Affiliations

Clinical Feasibility of Structural and Functional MRI in Free-Breathing Neonates and Infants

Brandon Zanette et al. J Magn Reson Imaging. 2022 Jun.

Abstract

Background: Evaluation of structural lung abnormalities with magnetic resonance imaging (MRI) has previously been shown to be predictive of clinical neonatal outcomes in preterm birth. MRI during free-breathing with phase-resolved functional lung (PREFUL) may allow for complimentary functional information without exogenous contrast.

Purpose: To investigate the feasibility of structural and functional pulmonary MRI in a cohort of neonates and infants with no cardiorespiratory disease. Macrovascular pulmonary blood flows were also evaluated.

Study type: Prospective.

Population: Ten term infants with no clinically defined cardiorespiratory disease were imaged. Infants recruited from the general population and neonatal intensive care unit (NICU) were studied.

Field strength/sequence: T1 -weighted VIBE, T2 -weighted BLADE uncorrected for motion. Ultrashort echo time (UTE) and 3D-flow data were acquired during free-breathing with self-navigation and retrospective reconstruction. Single slice 2D-gradient echo (GRE) images were acquired during free-breathing for PREFUL analysis. Imaging was performed at 3 T.

Assessment: T1 , T2 , and UTE images were scored according to the modified Ochiai scheme by three pediatric body radiologists. Ventilation/perfusion-weighted maps were extracted from free-breathing GRE images using PREFUL analysis. Ventilation and perfusion defect percent (VDP, QDP) were calculated from the segmented ventilation and perfusion-weighted maps. Time-averaged cardiac blood velocities from three-dimensional-flow were evaluated in major pulmonary arteries and veins.

Statistical test: Intraclass correlation coefficient (ICC).

Results: The ICC of replicate structural scores was 0.81 (95% CI: 0.45-0.95) across three observers. Elevated Ochiai scores, VDP, and QDP were observed in two NICU participants. Excluding these participants, mean ± standard deviation structural scores were 1.2 ± 0.8, while VDP and QDP were 1.0% ± 1.1% and 0.4% ± 0.5%, respectively. Main pulmonary arterial blood flows normalized to body surface area were 3.15 ± 0.78 L/min/m2 .

Data conclusion: Structural and functional pulmonary imaging is feasible using standard clinical MRI hardware (commercial whole-body 3 T scanner, table spine array, and flexible thoracic array) in free-breathing infants.

Evidence level: 2 TECHNICAL EFFICACY: Stage 1.

Keywords: blood flow; free-breathing; function; infants; lung; structure.

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References

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