Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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High-resolution computed tomography findings of lung parenchyme changes in very low birth weight infants treated with oxygen

산소 치료를 받은 극소저출생 체중아에서 폐 실질변화에 관한 고해상컴퓨터 단층촬영술 소견에 관한 연구

  • Jin, Young Man (Department of Pediactrics, College of Medicine Dankook University) ;
  • Chung, David Chanwook (Department of Pediactrics, College of Medicine Dankook University) ;
  • Chang, Young Pyo (Department of Radiology, College of Medicine Dankook University) ;
  • Lee, Yung Suk (Department of Radiology, College of Medicine Dankook University) ;
  • Lee, En Sun (Department of Radiology, College of Medicine Dankook University)
  • 진용만 (단국대학교 의과대학 소아과학교실) ;
  • 정찬욱 (단국대학교 의과대학 소아과학교실) ;
  • 장영표 (단국대학교 의과대학 소아과학교실) ;
  • 이영석 (단국대학교 의과대학 영상의학교실) ;
  • 이인선 (단국대학교 의과대학 영상의학교실)
  • Received : 2007.01.05
  • Accepted : 2007.02.15
  • Published : 2007.03.15
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Abstract

Purpose : The objective of this study is to observe high-resolution computed tomography (HRCT) findings of lung parenchyme in very low birth weight (VLBW) infants between the corrected age of 38-42 weeks who were treated with oxygen after birth, and to compare them to the clinical severity of bronchopulmonary dysplasia (BPD). Methods : The lungs of fourty-four VLBW infants with gestational ages of less than 32 weeks and birth weights of less than 1,500 g who were treated with oxygen after birth were examined using HRCT taken when the corrected age was between 38-42 weeks. Common findings among the infants and the frequency of their occurrences were noted. Total CT scores obtained by the summation of air trapping and actelectasis scores and the ratio of bronchus-to-pulmonary artery diameter were used to quantitatively evaluate HRCT findings and correlate them with the clinical severity of BPD as defined by Jobe-Bancalari diagnostic criteria. Results : 1) The most common findings in HRCT images of the lungs were air trapping (56%), atelectasis (70.5%), linear opacity (77%), and distortion of the bronchopulmonary bundle (65.9%). These findings were more commonly observed in infants with BPD in a mixed pattern than those without (P<0.05). However, abnormal findings were also found in HRCT images of some infants without BPD. In infants with BPD, air trapping, atelectasis and total CT scores were higher than those without BPD. Also infants with BPD had a lower bronchus-to-pulmonary artery diameter than those without BPD (P<0.05). 2) The total CT scores (r=0.799, P<0.0001) and the ratio of bronchus-to-pulmonary artery diameter (r=0.576, P<0.0001) showed a linear correlation with the clinical severity of BPD. Conclusion : HRCT findings in VLBW infants between the corrected age of 38-42 weeks who had been treated with oxygen after birth are useful in revealing pathologic changes in the lung parenchyme and show a good correlation with the clinical severity of BPD.

목 적 : 산소치료를 받았던 극소저출생 체중아에서 교정 주령 38에서 42주에 폐 HRCT를 시행하여 폐 실질 내의 변화를 관찰하고 기관지폐이형성증의 임상적 중증도와 비교 하고자 하였다. 방 법 : 산소 치료 받은 재태연령 32주미만, 출생체중 1,500 g미만의 극소저출생 체중아 44명을 대상으로 출생 후 교정주령 38-42주에 폐 HRCT를 시행하였다. 흔히 관찰되는 폐 HRCT 소견들을 기술하고 그들의 빈도를 구했다. 폐 HRCT 소견에서 폐 손상 정도를 정량적으로 표시한 공기폐색 점수, 무기폐 점수, 총 CT 점수와 기관지-폐동맥 직경 비를 기관지 폐이형성증 환아군과 기관지폐이형성증이 없는 환아군 사이에 비교하고, Jobe-Bancalari 진단 기준에 의한 기관지폐이형성증의 임상적 중증도와 비교하였다. 결 과 : 1) 폐 HRCT 소견은 공기 폐색(56.8%), 무기폐(70.5 %), 선상 음영 증가(77.3%), 기관지-폐혈관 다발의 변형(65.9%) 등이 흔히 관찰되었다. 이들 소견들은 기관지폐이형성증이 있는 환아 군에서 기관지폐이형성증이 없는 환아 군에 비해 통계적으로 의미 있게 혼재되어 자주 관찰되었으나(P<0.05), 기관지폐이형성증이 없는 환아 군 일부에서도 관찰되었다. 공기폐색 점수, 무기폐 점수, 총 CT 점수는 기관지폐이형성증이 있는 환아 군에서 기관지폐이형성증이 없는 환아 군에 비해 통계적으로 의미 있게 높았고(P<0.05), 기관지-폐동맥 직경 비는 통계적으로 의미 있게 낮았다(P<0.05). 총 CT 점수(r=0.799, P<0.0001)와 기관지-폐동맥 직경 비(r=0.576, P<0.0001)는 임상적 기관지폐이형성증의 중증도와 통계적으로 의미 있는 직선의 상관관계를 보였다. 결 론 : 산소치료를 받았던 극소저출생 체중아를 대상으로 신생아기에 촬영한 폐 HRCT 소견은 폐 실질 내의 변화를 잘 반영하고, 기관지폐이형성증의 임상적 중증도와 의미 있는 상관관계를 보였다.

Keywords

Acknowledgement

Supported by : 단국대학교

References

  1. Northway WH Jr, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med 1967;276:357-68 https://doi.org/10.1056/NEJM196702162760701
  2. Bancalari E, Claure N, Sosenko IR. Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition. Semin Neonatol 2003;8:63-71 https://doi.org/10.1016/S1084-2756(02)00192-6
  3. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9 https://doi.org/10.1164/ajrccm.163.7.2011060
  4. Banks-Randall BA, Ballard RA. Bronchopulmonary dysplasia. In : Taeusch HW, Ballard RA, Gleason CA. Avery's diseases of the newborn. 8th ed. Philadelphia: Elsevier Saunders; 2004:723-36
  5. Bancalari E. Changes in the pathogenesis and prevention of chronic lung disease of prematurity. Am J Perinatol 2001; 18:1-10 https://doi.org/10.1055/s-2001-12940
  6. Fitzgerald P, Donoghue V, Gorman W. Bronchopulmonary dysplasia: a radiographic and clinical review of 20 patients. Br J Radiol 1990;63:444-7 https://doi.org/10.1259/0007-1285-63-750-444
  7. Mortensson W, Lindroth M. The course of bronchopulmonary dysplasia. A radiographic follow-up. Acta Radiol Diagn(Stockh) 1986;27:19-22
  8. Oppermann HC, Wille L, Bleyl U, Obladen M. Bronchopulmonary dysplasia in premature infants. A radiological and pathological correlation. Pediatr Radiol 1977;5:137-41 https://doi.org/10.1007/BF00973978
  9. Kuhn JP. High-resolution computed tomography of pediatric pulmonary parenchymal disorders. Radiol Clin North Am 1993;31:533-51
  10. Howling SJ, Northway WH Jr, Hansell DM, Moss RB, Ward S, Muller NL. Pulmonary sequelae of bronchopulmonary dysplasia survivors: high-resolution CT findings. Am J Roentgenol 2000;174:1323-6 https://doi.org/10.2214/ajr.174.5.1741323
  11. Kubota J, Ohki Y, Inoue T, Sakurai M, Shigeta M, Mochizuki H, et al. Ultrafast CT scoring system for assessing bronchopulmonary dysplasia: reproducibility and clinical correlation. Radiat Med 1998;16:167-74
  12. Oppenheim C, Mamou-Mani T, Sayegh N, de Blic J, Scheinmann P, Lallemand D. Bronchopulmonary dysplasia: value of CT in identifying pulmonary sequelae. AJR Am J Roentgenol 1994;163:169-72 https://doi.org/10.2214/ajr.163.1.8010206
  13. Hertzog JH, Cartie RJ, Hauser GJ, Dalton HJ, Cleary K. The use of a mobile computed tomography scanner in the pediatric intensive care unit to evaluate airway stenting and lung volumes with varying levels of positive endexpiratory pressure. Pediatr Crit Care Med 2001;2:346-8 https://doi.org/10.1097/00130478-200110000-00012
  14. Kuhn JP, Brody AS. High-resolution CT of pediatric lung disease. Radiol Clin North Am 2002;40:89-110 https://doi.org/10.1016/S0033-8389(03)00111-8
  15. Aquino SL, Schechter MS, Chiles C, Ablin DS, Chipps B, Webb WR. High-resolution inspiratory and expiratory CT in older children and adults with bronchopulmonary dysplasia. Am J Roentgenol 1999;173:963-7 https://doi.org/10.2214/ajr.173.4.10511158
  16. Reittner P, Fotter R, Tillich M, Popper H, Lindbichler F, Reiterer F. High-resolution CT findings in Wilson-Mikity syndrome: a case report. Pediatr Radiol 1998;28:691-3 https://doi.org/10.1007/s002470050441
  17. Chung YH, Lee YS, Kim JH, Han H, Chung HS, Cha YM, et al. High-resolution CT findings in infants with bronchopulmonary dysplasia: Preliminary report. J Kor Radiol Soc 1996;35:131-5 https://doi.org/10.3348/jkrs.1996.35.1.131
  18. Bomsel F. Radiologic study of hyaline membrane disease: 110 cases. J Radiol Electrol Med Nucl 1970;51:259-68
  19. International Committee for Classification of ROP. An international classification of retinopathy of prematurity. Pediatrics 1984;74:127-33
  20. Stocker JT. Pathologic features of long-standing 'healed' bronchopulmonary dysplasia: a study of 28 3- to 40-monthold infants. Hum Pathol 1986;17:943-61 https://doi.org/10.1016/S0046-8177(86)80646-3
  21. Erickson AM, de la Monte SM, Moore GW, Hutchins GM. The progression of morphologic changes in bronchopulmonary dysplasia. Am J Pathol 1987;127:474-84
  22. Takemura T, Akamatsu H. Ultrastructural study on the pulmonary parenchyma of the neonates following prolonged mechanical ventilation. Acta Pathol Jpn 1987;37:1115-26
  23. Van Lierde S, Cornelis A, Devlieger H, Moerman P, Lauweryns J, Eggermont E. Different patterns of pulmonary sequelae after hyaline membrane disease: heterogeneity of bronchopulmonary dysplasia? A clinicopathologic study. Biol Neonate 1991;60:152-62 https://doi.org/10.1159/000243402
  24. Coalson JJ. Pathology of new bronchopulmonary dysplasia. Semin Neonatol 2003;8:73-81 https://doi.org/10.1016/S1084-2756(02)00193-8
  25. Charafeddine L, D'Angio CT, Phelps DL. Atypical chronic lung disease patterns in neonates. Pediatrics 1999;103(4 Pt1):759-65 https://doi.org/10.1542/peds.103.4.759
  26. Sahni R, Ammari A, Suri MS, Milisavljevic V, Ohira-Kist K, Wung JT, et al. Is the new definition of bronchopulmonary dysplasia more useful? J Perinatol 2005;25:41-6 https://doi.org/10.1038/sj.jp.7211210
  27. Coalson JJ, Winter VT, Siler-Khodr T, Yoder BA. Neonatal chronic lung disease in extremely immature baboons. Am J Respir Crit Care Med 1999;160:1333-46 https://doi.org/10.1164/ajrccm.160.4.9810071
  28. Husain AN, Siddiqui NH, Stocker JT. Pathology of arrested acinar development in postsurfactant bronchopulmonary dysplasia. Hum Pathol 1998;29:710-7 https://doi.org/10.1016/S0046-8177(98)90280-5
  29. Thibeault DW, Mabry SM, Ekekezie II, Truog WE. Lung elastic tissue maturation and perturbations during the evolution of chronic lung disease. Pediatrics 2000;106:1452-9 https://doi.org/10.1542/peds.106.6.1452
  30. Jobe AH, Ikegami M. Lung development and function in preterm infants in the surfactant treatment era. Annu Rev Physiol 2000;62:825-46 https://doi.org/10.1146/annurev.physiol.62.1.825