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Quantitative cardiopulmonary magnetic resonance imaging in neonatal congenital diaphragmatic hernia

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Abstract

Background

Pulmonary arterial hypertension, impaired cardiac function and lung hypoplasia are common in infants with congenital diaphragmatic hernia (CDH) and are associated with increased morbidity and mortality. Robust noninvasive methods to quantify these abnormalities in early infancy are lacking.

Objective

To determine the feasibility of MRI to quantify cardiopulmonary hemodynamics and function in infants with CDH and to investigate left–right blood flow and lung volume discrepancies.

Materials and methods

We conducted a prospective MRI study of 23 neonates (isolated left CDH: 4 pre-repair, 7 post-repair, 3 pre- and post-repair; and 9 controls) performed on a small-footprint 1.5-tesla (T) scanner. We calculated MRI-based pulmonary arterial blood flow, left ventricular eccentricity index, cardiac function and lung volume. Using the Wilcoxon rank sum test for continuous data and Fisher exact test for categorical data, we made pairwise group comparisons.

Results

The right-to-left ratios for pulmonary artery blood flow and lung volume were elevated in pre-repair and post-repair CDH versus controls (flow: P<0.005; volume: P<0.05 pre−/post-repair). Eccentricity index at end-systole significantly differed between pre-repair and post-repair CDH (P<0.01) and between pre-repair CDH and controls (P<0.001).

Conclusion

Cardiopulmonary MRI is a viable method to serially evaluate cardiopulmonary hemodynamics and function in critically ill infants and is useful for capturing left–right asymmetries in pulmonary blood flow and lung volume.

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Acknowledgments

The authors would like to acknowledge and thank Erin Watters for her patient recruitment efforts. This work was supported by the Cincinnati Children’s Research Foundation (Research Innovation and Pilot Fund and Academic and Research Committee Fund); authors J.C. Woods and N.S. Higano were supported in part by NIH R01 HL146689. Subsets of this work were presented at the 24th Annual Meeting & Exhibition of the International Society for Magnetic Resonance in Medicine (ISMRM), Singapore, May 7–13, 2016, and at the American Thoracic Society International Conference, Washington, DC, May 19–24, 2017.

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Authors and Affiliations

  1. Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA

    Jean A. Tkach, Nara S. Higano & Jason C. Woods

  2. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Jean A. Tkach

  3. Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Nara S. Higano & Jason C. Woods

  4. Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Nara S. Higano & Jason C. Woods

  5. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Nara S. Higano, Paul S. Kingma & Jason C. Woods

  6. Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Michael D. Taylor & Ryan A. Moore

  7. Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Monir Hossain & Guixia Huang

  8. Department of Pulmonary Medicine, Texas Children’s Hospital, Houston, TX, USA

    David R. Spielberg

  9. Department of Radiology, University of Iowa, Iowa City, IA, USA

    Sean B. Fain

  10. Department of Medical Physics, University of Wisconsin, Madison, WI, USA

    Sean B. Fain

  11. Division of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Paul S. Kingma

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  1. Jean A. Tkach
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  2. Nara S. Higano
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Correspondence to Jean A. Tkach.

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Tkach, J.A., Higano, N.S., Taylor, M.D. et al. Quantitative cardiopulmonary magnetic resonance imaging in neonatal congenital diaphragmatic hernia. Pediatr Radiol 52, 2306–2318 (2022). https://doi.org/10.1007/s00247-022-05384-w

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  • DOI: https://doi.org/10.1007/s00247-022-05384-w

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