Quantifying Prematurity-Related Lung Disease in Adulthood using Magnetic Resonance Imaging (MRI) in adolescent sheep born premature: A pilot study

Abstract Background Magnetic resonance imaging (MRI) is known to offer the best structural and functional pulmonary assessment and is a promising tool for monitoring and tracking disease progression in prematurity-related lung disease (PRLD). Objective We aimed to test the feasibility of capturing anatomical correlates of PRLD with MRI using the bronchopulMonary rottErdam mRi morpholoGy scorE (MERGE-BPD score), and correlating imaging with histological, and functional, lung analysis. Materials and methods In this pilot study, 8 sheep from a larger cohort underwent pulmonary MRI at 1 year of age: 4 term-born lambs and 4 preterm-born lambs, of which two were exposed to intra-amniotic lipopolysaccharide (LPS). Besides MRI, lung function was measured using respiratory oscillometry, and histological analysis was performed on post-mortem lung tissue. Statistics were performed using the Kruskal-Wallis test and the Mann-Whitney test, and Z-scores were calculated. Results Areas of hyperintensity of lung parenchyma could be identified in all preterm-born animals and in one of the four term-born sheep. MRI changes are associated with histological changes driven by inflammation (− 0.97, 1.24, and 0.48 (overall p 0.04)) and mucus plugging (− 0.87, 0.86, and 0.82 (overall p 0.07)). Bronchial hyperreactivity was significantly different between the three groups (p 0.05). Conclusion We demonstrate that pulmonary MRI complements conventional lung function and histological analysis by detecting subtle abnormalities in prematurity-related lung diseases. It has the potential to become a valuable, safe, and radiation-free tool for predicting lung function trajectories in children and gaining a deeper understanding of pathophysiological mechanisms following preterm birth.