Rationale: Dynamic collapse of the tracheal lumen (tracheomalacia) occurs frequently in premature neonates, particularly in those with common comorbidities such as bronchopulmonary dysplasia. The tracheal collapse increases the effort necessary to breathe (work of breathing [WOB]). However, quantifying the increased WOB related to tracheomalacia has previously not been possible. Therefore, it is also not currently possible to separate the impact of tracheomalacia on patient symptoms from parenchymal abnormalities.Objectives: To measure the increase in WOB due to airway motion in individual subjects with and without tracheomalacia and with different types of respiratory support.Methods: Fourteen neonatal intensive care unit subjects not using invasive mechanical ventilation were recruited. In eight, tracheomalacia was diagnosed via clinical bronchoscopy, and six did not have tracheomalacia. Self-gated three-dimensional ultrashortecho-time magnetic resonance imaging (MRI) was performed on each subject with clinically indicated respiratory support to obtain cine images of tracheal anatomy and motion during the respiratory cycle. The component of WOB due to resistance within the trachea was then calculated via computational fluid dynamics (CFD) simulations of airflow on the basis of the subject's anatomy, motion, and respiratory airflow rates. A second CFD simulation was performed for each subject with the airway held static at its largest (i.e., most open) position to determine the increase in WOB due to airway motion and collapse.Results: The tracheal-resistive component of WOB was increased because of airway motion by an average of 337% 6 295% in subjects with tracheomalacia and 24% 6 14% in subjects without tracheomalacia (P , 0.02). In the tracheomalacia group, subjects who were treated with continuous positive airway pressure (CPAP) using a RAM cannula expended less energy for breathing compared with the subjects who were breathing room air or on a high-flow nasal cannula.Conclusions: Neonatal subjects with tracheomalacia have increased energy expenditure compared with neonates with normal airways, and CPAP may be able to attenuate the increase in respiratory work. Subjects with tracheomalacia expend more energy on the tracheal-resistive component of WOB alone than nontracheomalacia patients expend on the resistive WOB for the entire respiratory system, according to previously reported values. CFD may be able to provide an objective measure of treatment response for children with tracheomalacia.

Stiffness plays an important role in diagnosing renal fibrosis. However, kidney stiffness is altered by perfusion changes in many kidney diseases. Therefore, the aim of the current study is to determine the correlation of kidney stiffness with water intake. We hypothesize that kidney stiffness will increase with 1 L of water intake due to increased water perfusion to the kidneys. Additionally, stiffness of the kidneys will correlate with apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values before and after water intake. A 3 T MRI scanner was used to perform magnetic resonance elastography and diffusion tensor imaging of the kidneys on 24 healthy subjects (age range: 22‐66 years) before and after water intake of 1 L. A 3D T1‐weighted bladder scan was also performed to measure bladder volume before and after water intake. A paired t‐test was performed to evaluate the effect of water intake on the stiffness of kidneys, in addition to bladder volume. A Spearman correlation test was performed to determine the association between stiffness, bladder volume, ADC and FA values of both kidneys before and after water intake. The results show a significant increase in stiffness in different regions of the kidney (ie, percentage increase ranged from 3.6% to 7.5%) and bladder volume after water intake (all P < 0.05). A moderate significant negative correlation was observed between change in kidney stiffness and bladder volume (concordance correlation coefficient = ‐0.468, P < 0.05). No significant correlation was observed between stiffness and ADC or FA values before and after water intake in both kidneys (P > 0.05). Water intake caused a significant increase in the stiffness of the kidneys. The negative correlation between the change in kidney stiffness and bladder volume, before and after water intake, indicates higher perfusion pressure in the kidneys, leading to increased stiffness.

The purpose of this study is 1) to demonstrate reproducibility of spin echo‐echo planar imaging (SE‐EPI) magnetic resonance elastography (MRE) to estimate kidney stiffness; and 2) to compare SE‐EPI MRE and gradient recalled echo (GRE) MRE‐derived stiffness estimations in various anatomical regions of the kidney. Kidney MRE was performed on 33 healthy subjects (8 for SE‐EPI MRE reproducibility and 25 for comparison with GRE MRE; age range: 22–66 years) in a 3 T MRI scanner. To demonstrate SE‐EPI MRE reproducibility, subjects were scanned for the first scan and then asked to leave the scan room and repositioned again for the second (repeat) scan. Similar set‐up was used for GRE MRE as well. The displacement data was then processed to obtain overall stiffness estimates of the kidney. Concordance correlation analyses were performed to determine SE‐EPI MRE reproducibility and agreement between GRE MRE and SE‐EPI MRE derived stiffness. A high concordance correlation (ρc = 0.95; p‐value<0.0001) was obtained for SE‐EPI MRE reproducibility. Good concordance correlation was observed (ρc = 0.84; p < 0.0001 for both kidneys, ρc = 0.91; p < 0.0001 for right kidney and ρc = 0.78; p < 0.0001 for left kidney) between GRE MRE and SE‐EPI MRE derived stiffness measurements. Paired t‐test results showed that stiffness value of medulla was significantly (p < 0.0001) greater than cortex using SE‐EPI MRE as well as GRE MRE. SE‐EPI MRE was reproducible and good agreement was observed in MRE‐derived stiffness measurements obtained using SE‐EPI and GRE sequences. Therefore, SE‐EPI can be used for kidney MRE applications.