Background
Bronchopulmonary dysplasia (BPD) is a chronic lung disease of prematurity defined by requirement for respiratory support at 36 weeks postmenstrual age (PMA), but structural sequelae like lung hyperinflation are often not quantified. Quiet‐breathing, nonsedated magnetic resonance imaging (MRI) allows tomographic quantification of lung volumes and densities. We hypothesized that functional residual capacity (FRC) and intrapleural volume (IV) are increased in BPD and correlate with qualitative radiological scoring of hyperinflation.
Methods
Ultrashort echo time (UTE) MRI of 17 neonates (acquired at ~39 weeks PMA) were reconstructed at end‐expiration and end‐inspiration via the time course of the k0 point in k‐space. Images were segmented to determine total lung, tidal, parenchymal tissue, and vascular tissue volumes. FRC was calculated by subtracting parenchymal and vascular tissue volumes from IV. Respiratory rate (RR) was calculated via the UTE respiratory waveform, yielding estimates of minute ventilation when combined with tidal volumes (TVs). Two radiologists scored hyperinflation on the MR images.
Results
IV at FRC increased in BPD: for control, mild, and severe (patients the median volumes were 32.8, 33.5, and 50.9 mL/kg, respectively. TV (medians: 2.21, 3.64, and 4.84 mL/kg) and minute ventilation (medians: 493, 750, and 991 mL/min) increased with increasing severity of BPD (despite decreasing RR, medians: 75.6, 63.0, and 56.1 breaths/min). FRC increased with increasing severity of BPD (39.3, 38.3, and 56.0 mL, respectively). Findings were consistent with increased hyperinflation scored by radiologists.
Conclusions
This study demonstrates that UTE MRI can quantify hyperinflation in neonatal BPD and that lung volumes significantly increase with disease severity.
Surgery relies on the scalpel; the surgeon’s first instrument in every case. From early knives crafted in the pre-historic era to today, the scalpel has evolved along with medical and surgical fields but maintained its critical role and symbolism of operative intervention. A significant catalyst for change in surgical instrument development in the late 1800s was the evolution of anesthesia and antisepsis. Surgical instruments were affected by harsh sterilization techniques, creating need for a method to maintain surgical scalpel sharpness. Mathilde Schott, an early female biomedical engineering innovator, filed a patent (US431153) in 1890 for a detachable scalpel blade. Schott identified and responded to the needs of surgeons at the turn of the 20th century and created a detachable blade and stabilizing lever. Schott persevered in a society unaccustomed to women leaders, subsequently improving medicine, surgery, and engineering.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.