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Förster, K. ; Marchi, H. ; Stöcklein, S.* ; Dietrich, O.* ; Ehrhardt, H.* ; Wielpütz, M.O.* ; Flemmer, A.W.* ; Schubert, B. ; Mall, M.A.* ; Ertl-Wagner, B.* ; Hilgendorff, A.

MRI based scoring of the diseased lung in the preterm infant with BPD.

Am. J. Physiol. Lung Cell Mol. Physiol. 324, L114-L122 (2022)

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OBJECTIVE: Neonatal chronic lung disease lacks standardised assessment of lung structural changes. METHOD AND RESULTS: We addressed this clinical need by the development of a novel scoring system (UNSEAL BPD (UNiforme Scoring of the disEAsed Lung in BPD)) using T2-weighted single-shot fast-spin-echo sequences from 3T MRI in very premature infants with and without bronchopulmonary dysplasia (BPD). Quantification of interstitial and airway remodeling, emphysematous changes and ventilation inhomogeneity was achieved by consensus scoring on a 5-point Likert scale. We successfully identified moderate and severe disease by logistic regression (AUC 0.89) complemented by classification tree analysis revealing gestational age-specific structural changes. We demonstrated substantial inter-reader reproducibility (weighted Cohen's kappa 0.69) and disease specificity (AUC=0.91). CONCLUSION: Our novel MRI score enables the standardised assessment of disease characteristic structural changes in the preterm lung exhibiting significant potential as a quantifiable endpoint in early intervention clinical trials and long-term disease monitoring.

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