Assessment of lung function in neonates and infants

新生儿和婴儿肺功能评估

基本信息

批准号：
8531345
负责人：
Iulian Constantin Ruset
金额：
$ 24.17万
依托单位：
XEMED, LLC
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-15 至 2015-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8531345
关键词：
2 year old 6 year old Acute Adult Age Air Alveolar Asthma Biological Markers Bolus Infusion Boxing Breathing Bronchopulmonary Dysplasia Caring Chest Child Childhood Chronic Disease Chronic lung disease Clinical Clinical Treatment Clinical Trials Communities Cystic Fibrosis Development Devices Diagnosis Diagnostic Diagnostic Imaging Diffusion Diffusion weighted imaging Dimensions Disease Dose Early Diagnosis Elements Engineering Environmental air flow Event Exposure to Functional Magnetic Resonance Imaging Gases Helium Hypoxia Image Imaging Device Imaging Techniques Infant Infant Care Injury Institutional Review Boards Intubation Ionizing radiation Length Lung Lung diseases Magnetic Resonance Imaging Maps Measurement Mechanical Ventilators Medical Methods Monitor Morbidity - disease rate Motion Neonatal Intensive Care Neonatal Intensive Care Units Noble Gases Outcome Outcome Measure Patient Care Patients Pattern Perinatal Phase Physiologic pulse Pneumonia Premature Infant Protocols documentation Pulmonary function tests Quantitative Evaluations Reporting Research Research Infrastructure Research Personnel Resolution Respiratory physiology Risk Safety Sedation procedure Severities Severity of illness Simulate Solutions Spirometry Structure Symptoms System Techniques Technology Testing Tissues Toddler Tracer Trees Ventilator Very Low Birth Weight Infant Weaning Work X-Ray Computed Tomography Xenon age group base cost design early cystic fibrosis imaging modality infrastructure development injured lung imaging neonate novel premature success

项目摘要

DESCRIPTION (provided by applicant): Assessment of lung function in neonates and infants Lung disease is the most common chronic disease of childhood, but methods for assessing lung disease such as spirometry cannot be performed by young children. Thus clinicians have only parental reports of patient symptoms upon which to base treatment decisions. Further, clinical trials of treatments for lung disease are difficult to perform in the absence of a quantitative outcome. Therefore many treatments for lung disease have not been tested in young children. Hyperpolarized (HP) noble gas magnetic resonance imaging is a technique for imaging the lung functional microstructure that provides a quantitative evaluation of lung disease severity in three-dimensions with high resolution. Ventilation imaging depicts regional patency of the airway tree, even down to the smallest airways. Ventilation abnormalities reveal the earliest signs of obstructive disease, such as cystic fibrosis and asthma. Diffusion weighted imaging quantifies the Brownian-motion length-scale of gas atoms. By mapping out acinar dimension regionally, diffusion weighted imaging is exquisitely sensitive to underdeveloped or injured alveolar tissues. Since hyperpolarized gas MRI does not use ionizing radiation, it is well-suited for use in children and infants. What is needed are safe and effective devices and methods for administering and imaging hyperpolarized noble gas in neonates and infants. We propose to develop a simple and elegant method for administering hyperpolarized helium-3 (HHe) to neonates and infants. New MR-compatible gas flow technologies will be developed, compared, and incorporated into a novel pass-though junction box which can substitute a small bolus of HHe for an equal amount of air. Its mostly passive and intrinsically safe design features will allow its use with either fre- breathing infants or with neonates on a mechanical ventilator. We will test the device by imaging free-breathing healthy adults while they are simulating the breathing volumes and patterns of infants. We further propose to adapt our 32-element chest coil which we successfully employed for accelerated structure-function imaging in adults. First we down-size it for subjects 13kg and under, and in year 2 optimize a second chest coil design for neonates under 4.5kg. We will submit IRB filings for these devices as non-significant medical risk devices. Working with our academic collaborators, we will first acquire accelerated hyperpolarized helium-3 images in free-breathing 1-2 year old infants, five who are healthy normals and two with chronic lung disease of prematurity (bronchopulmonary dysplasia, BPD). We will compare accelerated spiral and Cartesian imaging protocols exploiting the parallel coil. After regulatory review, we will proceed to imaging two neonates on ventilators just before they are extubated. One subject will be a neonate born prematurely who has early BPD. The second subject will be a neonate under care due to an hypoxic ischemic event. This subject's lungs should be structurally normal.

描述（由申请人提供）：对新生儿和婴儿肺病中肺功能的评估是最常见的儿童慢性疾病，但是评估肺部疾病（例如肺活量测定法）的方法不能由幼儿进行。因此，临床医生只有父母报告患者症状以基于治疗的决定。此外，在没有定量结果的情况下，很难进行肺部疾病治疗的临床试验。因此，尚未对幼儿进行许多有关肺部疾病的治疗方法。超极化（HP）贵重气体磁共振成像是一种成像肺功能微观结构的技术，可在三维中对肺部疾病严重程度进行定量评估，以高分辨率分辨率。通风成像描绘了气道树的区域通畅，甚至到达最小的气道。通风异常揭示了阻塞性疾病的最早迹象，例如囊性纤维化和哮喘。扩散加权成像量化了气体原子的布朗运动长度尺度。通过在区域绘制腺泡维度，扩散加权成像对欠发达或受伤的肺泡组织非常敏感。由于超极化气MRI不使用电离辐射，因此非常适合儿童使用和婴儿。需要的是在新生儿和婴儿中使用和成像超极化气体的安全有效的设备和方法。我们建议开发一种简单而优雅的方法，用于将超极化的氦3（HHE）用于新生儿和婴儿。将开发，比较并将其纳入新的传球盒中，尽管可以将一小件HHE的大满蛋替换为相等数量的空气，但将开发，比较并掺入新的新型MR兼容气流技术。它的大部分是被动且内在安全的设计功能将允许其与呼吸呼吸的婴儿或机械呼吸机上的新生儿一起使用。我们将通过模拟婴儿的呼吸量和婴儿模拟自由呼吸健康的成年人来测试该设备。我们进一步提议适应我们的32个元素胸圈线圈，我们成功地用于成人加速结构功能成像。首先，我们为13公斤及以下的受试者缩小大小，并在第二年优化了4.5公斤以下的新生儿的第二个胸部线圈设计。我们将向这些设备提交IRB文件作为非重要的医疗风险设备。与我们的学术合作者合作，我们将首先在自由呼吸的1-2岁婴儿中获得加速的超极化氦-3图像，五名健康正常和两个患有慢性肺早产疾病（支气管肺发育不良，BPD，BPD）。我们将比较利用平行线圈的加速螺旋和笛卡尔成像协议。经过监管审查后，我们将在拔管呼吸机之前对两名新生儿进行成像。一个主题将是早产BPD的新生儿。由于缺氧性缺血事件，第二个受试者将是新生儿。该受试者的肺应在结构上正常。