Imaging Breakthrough Aids BPD Diagnosis and Care

Researchers at Cincinnati Children’s Bronchopulmonary Dysplasia Center have found that neonatal MRI can correctly assess pulmonary vascularity in preterm infants with bronchopulmonary dysplasia (BPD).

Pulmonary hypertension often complicates BPD. 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.

In a study published in Neonatology and led by Paul Kingma, MD, PhD, investigators hypothesized that preterm infants with BPD experience altered pulmonary vascular growth. They tested whether MRI can be used to assess vascularity in BPD.

Visualizing Abnormal Vessels in Premature Lungs

With help from Jason Woods, PhD, the team used ultrashort echo time (UTE) MRI to capture images of vascular growth in the lungs of premature babies. A UTE MRI combines with 2D time-of-flight acquisition to visualize the developing blood vessels.

The study found:

• Infants with BPD experience altered lung vascular growth.
• Higher vascular volume is associated with more severe BPD.
• Lower vascular density trends toward worse clinical outcomes.
• Vascular density increases with increasing days of inhaled nitric oxide therapy in infants with severe BPD.

As directors of the Bronchopulmonary Dysplasia Center, Kingma and Woods developed the UTE MRI technique to enable assessment of lung vascularity. Before this advancement, care teams used an ultrasound of the heart to get secondary information about blood flow and vessels in the lungs.

“This opens up new possibilities,” Kingma says. “It lets us see the severity of the pulmonary hypertension and abnormal vessels and allows us to find the best way to address the condition.”

Care teams will be able to:

• Determine treatments that encourage vessel and lung growth
• Predict how babies with specific vasculature will do in the future

As care teams improve diagnosis and therapy for babies with BPD, they also learn more by utilizing other types of MRI.

For example, Woods and his team created a more sophisticated technique that combines a hyperpolarized version of the noble gas xenon (Xe) with radiation-free MRI. Xe MRI is a safer, faster, more precise way to assess alveoli airspace size, gas exchange and lung ventilation.

“We can look at the nitty gritty of how the lungs are developing,” Kingma says.

Advances in BPD Clinical Care

Cincinnati Children’s provides a full BPD team to care for the most complex cases. Neonatologists work together with cardiologists, pulmonologists, radiologists and respiratory therapists to manage all aspects of care.

Combined with the UTE and Xe MRI imaging advancements, Kingma and Woods have also expanded into examining new ways to assess and manage cystic fibrosis and developmental defects of the esophagus and trachea, Kingma says. His group collaborates with colleagues in developmental biology to uncover the genetic causes of these conditions.

Formed in 2018, the BPD Center has greatly improved care for patients with severe BPD. The team-based approach has:

• Decreased the need for tracheostomy and long-term ventilation
• Reduced length of stay
• Reduced mortality by half

Families come to Cincinnati Children’s from across the U.S. to find care for their children with severe BPD. Many of these babies stay at Cincinnati Children’s for about 18 months. Kingma says these newborns typically spend six to nine months in the NICU before moving to a transitional care unit.

The pulmonary medicine team manages their care until they can return home.

“It’s rewarding to see groups from different divisions and different specialties come together and work very cooperatively to care for these babies,” Kingma says. “We’ve significantly improved the clinical care.”

A new outpatient BPD clinic now follows children with varying levels of severity in their conditions. The clinic is continually growing. Kingma and his team plan to follow patients into their teen years to ensure their health and learn more about how a severe BPD diagnosis at birth impacts their lives.

(Published December 2024)

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