Bronchopulmonary dysplasia from chest radiographs to magnetic resonance imaging and computed tomography: adding value

Abstract

Bronchopulmonary dysplasia (BPD) is a common long-term complication of preterm birth. The chest radiograph appearance and survivability have evolved since the first description of BPD in 1967 because of improved ventilation and clinical strategies and the introduction of surfactant in the early 1990s. Contemporary imaging care is evolving with the recognition that comorbidities of tracheobronchomalacia and pulmonary hypertension have a great influence on outcomes and can be noninvasively evaluated with CT and MRI techniques, which provide a detailed evaluation of the lungs, trachea and to a lesser degree the heart. However, echocardiography remains the primary modality to evaluate and screen for pulmonary hypertension. This review is intended to highlight the important findings that chest radiograph, CT and MRI can contribute to precision diagnosis, phenotyping and prognosis resulting in optimal management and therapeutics.

Physical activity levels, pulmonary function, and MRI in children born extremely preterm: A comparison between children with and without bronchopulmonary dysplasia

“…Some of these factors may also be independent of or indirectly related to the diagnosis of BPD and may not be captured in this study, such as leg discomfort or being shorter than children without BPD, which may result in a greater number of steps needed to travel the same distance 35 . Tests which evaluate the lung function or structure, such as pulmonary MRI, may provide us with new information for diagnosis and classification of prematurity‐associated lung disease, which may correlate better with functional measures such as physical activity 24,26,36–38 …”

“…Participants underwent a lung MRI to assess for average total proton density (at a lung volume of functional residual capacity plus 1 L), which is a marker of lung tissue inhomogeneity, and average proton density at full expiration, which is an exploratory surrogate measure of gas trapping. 19,24 Novel research has identified correlations between pulmonary function and proton density, [25][26][27] but MRI measures provide different information about lung architecture. 19 Complete methods for the MRI have been previously described.…”

Physical activity level in children born extremely preterm: a comparison between children with and without bronchopulmonary dysplasia

“…Diagnosing BPD relies on clinical characteristics and treatment, rather than physiologic or histologic changes, which may lead to misdiagnosis or misclassification of disease [28][29][30] . Tests which evaluate the lung function or structure, such as pulmonary MRI, may provide us with new information for diagnosis and classification of prematurity-associated lung disease, and may correlate better with functional measures such as physical activity 20,22,[31][32][33] .…”

“…Pulmonary MRI: Participants underwent a lung MRI to assess for average total proton density (at a lung volume of functional residual capacity plus one litre), which is a marker of lung tissue inhomogeneity, and average proton density at full expiration, which is an exploratory surrogate measure of gas trapping 13,20 . Novel research has identified correlations between pulmonary function and proton density, [21][22][23] but MRI measures provide different information about lung architecture 13 .…”

Diagnosis and management of pulmonary hypertension in infants with bronchopulmonary dysplasia: a guide for paediatric respiratory specialists

“…BPD is characterised microscopically by simplified enlarged alveoli and, in severe cases, decreased pulmonary vascular development [ 5 , 7 ]. BPD is thought to be caused by a variety of antenatal and postnatal insults on the immature lung, clinically manifesting as a requirement for prolonged respiratory support and typical chest radiography findings of patchy hyperinflation with mixed areas of density and hyper-lucency [ 8 ].…”