Abstract
Mechanical ventilation (MV) and supplementation of oxygen-enriched gas, often needed in postnatal resuscitation procedures, are known to be main risk factors for impaired pulmonary development in the preterm and term neonates. Unfortunately, current imaging modalities lack in sensitivity for the detection of early stage lung injury. The present study reports a new imaging approach for diagnosis and staging of early lung injury induced by MV and hyperoxia in neonatal mice. The imaging method is based on the Talbot-Lau x-ray grating interferometry that makes it possible to quantify the x-ray small-angle scattering on the air-tissue interfaces. This so-called dark-field signal revealed increasing loss of x-ray small-angle scattering when comparing images of neonatal mice undergoing hyperoxia and MV-O2 with animals kept at room air. The changes in the dark field correlated well with histologic findings and provided superior differentiation than conventional x-ray imaging and lung function testing. The results suggest that x-ray dark-field radiography is a sensitive tool for assessing structural changes in the developing lung. In the future, with further technical developments x-ray dark-field imaging could be an important tool for earlier diagnosis and sensitive monitoring of lung injury in neonates requiring postnatal oxygen or ventilator therapy.
Highlights
Mechanical ventilation (MV) and supplementation of oxygen-enriched gas, often needed in postnatal resuscitation procedures, are known to be main risk factors for impaired pulmonary development in the preterm and term neonates
Bringing together the need for a sensitive diagnostic tool in neonatal chronic lung disease and the novel technique of x-ray dark-field imaging in this study, we evaluated for the first time the capability of grating-based x-ray dark-field radiography to detect very early changes in morphology of the neonatal developing lung undergoing injury induced by hyperoxia and mechanical ventilation (MV) using a unique, pre-clinical mouse model[3,28,29,30,31]
Dark-field radiograms showed an increase in signal heterogeneity in neonatal mice undergoing 8 hours of MV-O2 (Fig. 2), which, apart from the overall signal decay, reflects inhomogeneity in lung injury and consecutive remodeling
Summary
Mechanical ventilation (MV) and supplementation of oxygen-enriched gas, often needed in postnatal resuscitation procedures, are known to be main risk factors for impaired pulmonary development in the preterm and term neonates. Thereby, information about the small-angle x-ray scattering registered in the dark field[19,20] has been shown to significantly increase lung tissue visibility on radiographic images in mice[21] and to improve the detection of calcifications in mammographic scans[22]. The acquisition of this imaging modality is based on the introduction of a three-grating Talbot-Lau interferometer into the x-ray beam. It could be demonstrated that detection of changes to the lung structure can be significantly improved based on dark field compared to absorption x-ray imaging as shown by the analysis of pulmonary emphysema[23,24,25,26] and fibrosis[27] in mice
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