Laura Walkup PhD, Presenter: Nothing to Disclose

Jean A. Tkach PhD, Abstract Co-Author: Nothing to Disclose

Robert Thomen, Abstract Co-Author: Nothing to Disclose

Stephanie Merhar, Abstract Co-Author: Nothing to Disclose

Raouf S. Amin MD, Abstract Co-Author: Nothing to Disclose

Paul Kingma, Abstract Co-Author: Nothing to Disclose

Jason C. Woods PhD, Abstract Co-Author: Nothing to Disclose

Neonatal pulmonary imaging poses difficulties because of small size, respiratory motion, and the delicate nature of moving infants to and from the NICU. While CT is the current clinical gold standard for diagnostic pulmonary imaging, it is not routine for the longitudinal evaluation of most neonatal pulmonary abnormalities within the NICU. Our goal was to use our institution’s one-of-a-kind NICU MRI scanner to investigate the feasibility of performing pulmonary MRI in conditions that are present in our NICU (bronchopulmonary dysplasia [BPD] and congenital diaphragmatic hernia [CDH]), since they are poorly understood both physiologically and radiologically.

Pulmonary MRI was performed on a small-footprint 1.5T MRI scanner developed for orthopedic use (marketed as GE Optima MR430s) that was modified and adapted for use in our institution’s NICU. Free-breathing FrFSE (TE/TR 3000/11.8, ETL=5 or 11) and FGRE (TE/TR 1.9/6.8, 7-10° FA) images were obtained for a small group of non-sedated NICU patients (1 BPD, 2 CDH, 3 control). Images were evaluated qualitatively and a quantitative assessment of approximate lung density obtained by normalizing the lung signal to nearby soft tissues.

Both FrFSE and GRE images were generally of high (diagnostic) quality and demonstrated very few motion artifacts for quietly-breathing babies, with parenchymal SNR of around 5. Pulmonary abnormalities were visually apparent in many cases: pleural effusion, multiple local areas of atelectasis, alveolar simplification, and parenchymal opacities were all observed, with quantitative results that matched visual inspection. MR images for one CDH patient revealed regions of air-trapping undetected in chest x-ray.

We have demonstrated that free-breathing pulmonary MRI in the NICU is feasible and can produce diagnostic-quality images that may be used in detection and longitudinal assessment of various pulmonary abnormalities, including BPD and CDH. The MR images obtained were of diagnostic-quality, compared well to CT in the opinion of our clinical radiologist, and did not require sedation. 

Pulmonary MRI in the NICU provides diagnostic-quality images for the assessment of neonatal pathologies and will add to our knowledge of normal and aberrant lung development.

Walkup, L, Tkach, J, Thomen, R, Merhar, S, Amin, R, Kingma, P, Woods, J, Pulmonary MRI in the NICU: Initial Experience Imaging BPD and CDH with a Small-Footprint Scanner.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005591.html