Purpose or Case Report: BPD is associated with pulmonary hypertension (PH) and patients with BPD-associated PH (BPD-PH) have increased morbidity and mortality. Noninvasive assessment of BPD-PH has traditionally relied on echocardiograms. However, recent advances have allowed the use of MRI in the assessment of respiratory and cardiac disease in infants with BPD. In adults and older pediatric patients, increased left ventricular eccentricity index (MR-EI) and decreased MRI septal curvature correlate with increased mean pulmonary artery pressure and pulmonary vascular resistance. The current study sought to determine the relationship of MR-EI and septal curvature in neonates with BPD and BPD-PH with short term respiratory outcomes and need for pulmonary vasodilator therapies.
Methods & Materials: 35 moderate or severe BPD and 11 mild BPD or control infants were imaged without contrast between 38 and 47 weeks post-menstrual age on a neonatal-sized, NICU-sited 1.5T MRI scanner. MR indices including MR-EI and septal curvature were determined and compared to BPD severity and clinical outcomes including hospital length of stay (LOS), duration of respiratory support, respiratory support level at discharge and pulmonary vasodilator therapy.
Results: Results: MR-EI was directly associated and septal curvature was inversely associated with BPD severity. In a univariate analysis, MR-EI and septal curvature (p-values reported) were associated with increased hospital LOS (P=0.004), duration of respiratory support (P<0.0001), respiratory support at hospital discharge (P<0.0001) and need for pulmonary vasodilator therapy (P<0.0001). In multivariable analysis, MR-EI, BPD severity, and birth weight were associated with hospital LOS (r = 0.49) and duration of respiratory support (r = 0.55), septal curvature and BPD severity were associated with respiratory support at hospital discharge (r = 0.47), and septal curvature was associated with need for pulmonary vasodilator therapy (r = 0.66, p = 0.0014).

Conclusions: MRI-derived indices including MR-EI and septal curvature correlate significantly with clinical outcomes including hospital LOS, duration of respiratory support, respiratory support level at hospital discharge, and pulmonary vasodilator therapy in neonates with BPD and BPD-PH.