School-age structural and functional MRI and lung function in children following lung resection for congenital lung malformation in infancy

Abstract

Background The management of asymptomatic congenital lung malformations is debated. Particularly, there is a lack of information regarding long-term growth and development of the remaining lung in children following lung resection for congenital lung malformations. In addition to conventional pulmonary function tests, we used novel functional magnetic resonance imaging (MRI) methods to measure perfusion and ventilation. Objective To assess functionality of the remaining lung expanded into the thoracic cavity after resection of congenital lung malformations. Materials and methods A prospective, cross-sectional pilot study in five children who had surgery for congenital lung malformations during infancy. Participants had structural and functional MRI as well as spirometry, body plethysmography and multiple breath washout at school age. Results Structural MRI showed an expansion of the remaining lung in all cases. Fractional ventilation and relative perfusion of the expanded lung were locally decreased in functional MRI. In all other parts of the lungs, fractional ventilation and relative perfusion were normal in all children. There was an association between overall impairment of perfusion and elevated lung clearance index. The results of spirometry and body plethysmography varied between patients, including normal lung function, restriction and obstruction. Conclusion Fractional ventilation and relative perfusion maps from functional MRI specifically locate impairment of the remaining lung after lung resection. These changes are not captured by conventional measures such as structural MRI and standard pulmonary function tests. Therefore, following lung resection for congenital lung malformation, children should be investigated more systematically with functional lung MRI.

Should asymptomatic patients with congenital lung malformations undergo surgery? A decision analysis

“…More detailed follow‐up of postsurgical outcomes in patients with large lesions will help to better inform this decision. Also, novel functional magnetic resonance imaging methods have been applied in recent research to measure perfusion and ventilation among pediatric patients, 34 suggesting the potential to evaluate the fractional function of both the lesion and the remaining healthy lung tissue before surgery.…”