Ultrashort Echo-Time MRI for the Assessment of Tracheomalacia in Neonates

Hysinger, Erik B.; Bates, Alister J.; Higano, Nara S.; Benscoter, Dan; Fleck, Robert; Hart, Catherine K.; Burg, Gregory; Alarcón, Alessandro de; Kingma, Paul S.; Woods, Jason C.

doi:10.1016/j.chest.2019.11.034

Cited by 42 publications

(39 citation statements)

References 36 publications

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“…In an effort to obtain an objective, purely quantitative measure and avoid radiation and the need for sedation, ultrashort echo‐time (UTE) MRI with respiratory gating has recently been utilized to evaluate TM in neonates with BPD (Figure 1C,F). 24,25 While this technique exposes neonates to minimal risk and permits evaluation of airway dynamics in entire patient populations, UTE MRI is not yet widely available.…”

Section: Dynamic Airway Obstructionmentioning

confidence: 99%

Central airway issues in bronchopulmonary dysplasia

Hysinger

2021

Pediatric Pulmonology

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While there is a very large focus on the abnormalities of parenchymal lung development and extensive efforts to minimize alveolar damage with “gentle ventilation” and noninvasive respiratory support for neonates with bronchopulmonary dysplasia (BPD), there is relatively little consideration for the implications of central airway disease in this patient population. There are significant changes in the structure and conformation of the central airway during the last half of gestation, and premature birth disrupts this natural developmental process. The arrest of maturation results in a smaller airway that is more compliant, easier to deform, and more susceptible to damage. Consequently, neonates with BPD are prone to developing central airway pathology, particularly for patients who require intubation and positive pressure ventilation. Central airway disease can be divided into dynamic and fixed airway obstruction and results in increased respiratory morbidity in neonates with chronic lung disease of prematurity.

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Section: Dynamic Airway Obstructionmentioning

confidence: 99%

Central airway issues in bronchopulmonary dysplasia

Hysinger

2021

Pediatric Pulmonology

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“…Though this may effectively be true for the stenotic tissue, the trachea is highly dynamic during tidal breathing and patient movement. 24,29 Neonates with SGS may have concomitant laryngomalacia and tracheomalacia, which significantly impact airflow dynamics. These are not captured by the simulations used in this study.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Subglottic Stenosis Position Affects Work of Breathing

et al. 2020

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Objectives: Subglottic stenosis (SGS) is the most common type of laryngeal stenosis in neonates. SGS severity is currently graded based on percent area of obstruction (%AO) via the Myer-Cotton grading scale. However, patients with similar %AO can have widely different clinical courses. Computational fluid dynamics (CFD) based on patient-specific imaging can quantify the relationship between airway geometry and flow dynamics. We investigated the effect of %AO and axial position of SGS on work of breathing (WOB) in neonates using magnetic resonance imaging. Methods: High-resolution ultrashort echo-time MRI of the chest and airway was obtained in three neonatal patients with no suspected airway abnormalities; images were segmented to construct three-dimensional (3D) models of the neonatal airways. These models were then modified with virtual SGSs of varying %AO and axial positioning. CFD simulations of peak inspiratory flow were used to calculate patient-specific WOB in nonstenotic and artificially stenosed airway models. Results: CFD simulations demonstrated a relationship between stenosis geometry and WOB increase. WOB rapidly increased with %AO greater than about 70%. Changes in axial position could also increase WOB by approximately the same amount as a 10% increase in %AO. Increased WOB was particularly pronounced when the SGS lumen was misaligned with the glottic jet. Conclusion: The results indicate a strong, predictable relationship between WOB and axial position of the stenotic lumen relative to the glottis, which has not been previously reported. These findings may lead to precision diagnosis and treatment prediction tools in individual patients.

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“…Previously published literature has demonstrated the ability of UTE-MRI to detect tracheomalacia in neonates with respiratory conditions such as bronchopulmonary dysplasia. 24,33 Therefore, the absence of increased airway dynamics in rabbits with SGS in this study is a true observation and not a limitation of UTE-MRI. Furthermore, although there was no dynamic airway collapse, there was a significant increase in eccentricity of the airway from glottis to the mid-point of the trachea post balloon dilation at end-inspiration and end-expiration.…”

Section: Discussionmentioning

confidence: 70%

Quantitative Evaluation of Subglottic Stenosis Using Ultrashort Echo Time MRI in a Rabbit Model

et al. 2021

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Objective/Hypothesis: To assess the ability of ultra-short echo time (UTE)-MRI to detect subglottic stenosis (SGS) and evaluate response to balloon dilation. To correlate measurements from UTE-MRI with endotracheal-tube (ETT)-sizing and to investigate whether SGS causes change in airway dynamics.Study Design: Animal research study. Methods: Eight adult New-Zealand white rabbits were used as they approximate neonatal airway-size. The airways were measured using ETT-sizing and 3D UTE-MRI at baseline, 2 weeks post-cauterization induced SGS injury, and post-balloon dilation treatment. UTE-MR images were acquired to determine airway anatomy and motion. Airways were segmented from MR images. Cross-sectional area (CSA), major and minor diameters (D major and D minor ), and eccentricity were measured.Results: Post-injury CSA at SGS was significantly reduced (mean 38%) compared to baseline (P = .003) using UTE-MRI. ETT-sizing correlated significantly with MRI-measured CSA at the SGS location (r = 0.6; P < .01), particularly at the post-injury timepoint (r = 0.93; P < .01). Outer diameter from ETT-sizing (OD) correlated significantly with D major (r = 0.63; P < .01) from UTE-MRI at the SGS location, especially for the post-injury timepoint (r = 0.91; P < .01). Mean CSA of upper trachea did not change significantly between end-expiration and end-inspiration at any timepoint (all P > .05). Eccentricity of the upper trachea increased significantly post-balloon dilation (P < .05).Conclusions: UTE-MRI successfully detected SGS and treatment response in the rabbit model, with good correlation to ETT-sizing. Balloon dilation increased CSA at SGS, but not to baseline values. SGS did not alter dynamic motion for the trachea in this rabbit model; however, tracheas were significantly eccentric post-balloon dilation. UTE-MRI can detect SGS without sedation or ionizing radiation and may be a non-invasive alternative to ETT-sizing.

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Ultrashort Echo-Time MRI for the Assessment of Tracheomalacia in Neonates

Cited by 42 publications

References 36 publications

Central airway issues in bronchopulmonary dysplasia

Central airway issues in bronchopulmonary dysplasia

Subglottic Stenosis Position Affects Work of Breathing

Quantitative Evaluation of Subglottic Stenosis Using Ultrashort Echo Time MRI in a Rabbit Model

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