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Klin Padiatr 2024; 236(02): 106-115
DOI: 10.1055/a-2214-7217
Original Article

Impact of Reanalysis of Nitrogen Multiple-Breath Washout on its Relationship with Chest Magnetic Resonance Imaging Findings in Clinically Stable and Pulmonary Exacerbated Children with Cystic Fibrosis

Auswirkung der Reanalyse des Stickstoff-Multiple-Breath Washouts auf die Beziehung zu Lungenmagnetresonanztomographiebefunden bei klinisch stabilen und pulmonal exazerbierten Kindern mit Mukoviszidose
Maria Meißner   *
1   Dept. of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
,
Eva Steinke   *
1   Dept. of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
2   associated partner site, German Center for Lung Research (DZL), Berlin, Germany
3   Berlin Institute of Health (BIH) at Charité, Berlin Institute of Health (BIH) at Charité, Berlin, Germany
,
Mark Oliver Wielpütz
4   Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
5   Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
6   Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
,
Cornelia Joachim
7   Department of Pediatrics, Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, University of Heidelberg, Heidelberg, Germany
,
Olaf Sommerburg
5   Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
7   Department of Pediatrics, Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, University of Heidelberg, Heidelberg, Germany
,
Marcus Alexander Mall
1   Dept. of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
2   associated partner site, German Center for Lung Research (DZL), Berlin, Germany
3   Berlin Institute of Health (BIH) at Charité, Berlin Institute of Health (BIH) at Charité, Berlin, Germany
,
Mirjam Stahl
1   Dept. of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
2   associated partner site, German Center for Lung Research (DZL), Berlin, Germany
3   Berlin Institute of Health (BIH) at Charité, Berlin Institute of Health (BIH) at Charité, Berlin, Germany
› Author Affiliations Funding Information Deutsche Forschungsgemeinschaft — http://dx.doi.org/10.13039/501100001659; STA 1685/1–1 BIH Charité (Junior/Advanced) Clinician Scientist Program — n. a. German Federal Ministry of Education and Research — 82DZL00401, 82DZL004A1 and 82DZL009B1 to M.A.M. German Cystic Fibrosis Association Mukoviszidose e.V. — grant 15/01 to M.S.
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Abstract

Rationale Multiple-breath washout (MBW)-derived lung clearance index (LCI) detects lung disease in children with cystic fibrosis (CF). Correction of a cross-talk error in the software of the MBW device Exhalyzer D in a new software version has generated significant interest regarding its impact on previous MBW findings. Since LCI and chest magnetic resonance imaging (MRI) correlated before in CF children, this study aims to reassess previous MBW data after correction.

Patients/Methods Reanalysis of the main findings from a previously published study comparing MBW and MRI in a pediatric CF cohort by reassessment of nitrogen (N2) MBW of 61 stable children with CF, 75 age-matched healthy controls (HC), and 15 CF children with pulmonary exacerbation (PEx) in the corrected software version.

Results The corrected LCI (N2LCIcor) decreased in the entire cohort (−17.0 (11.2)%), HC (−8.5 (8.2)%), stable CF children (−22.2 (11.1)%), and within the PEx group at baseline, at PEx and after antibiotic therapy (−21.5 (7.3)%; −22.5 (6.1)%; −21.4 (6.6)%; all P<0.01). N2LCIcor and N2LCIpre correlated with chest MRI scores in stable CF (r=0.70 to 0.84; all P<0.01) without a significant difference between N2LCIcor and N2LCIpre. Change in LCI from baseline to PEx and from PEx to after therapy decreased from N2LCIpre to N2LCIcor, but these changes remained significant (all P=0.001).

Discussion/Conclusions Our results indicate that N2LCIcor is significantly lower than N2LCIpre, but key results published in the original study demonstrating N2MBW and MRI as complementary methods for clinical surveillance in children with CF remain unaffected.

Zusammenfassung

Hintergrund Der mittels Multiple-Breath Washout (MBW) bestimmte Lung Clearance Index (LCI) erkennt Lungenveränderungen bei Kindern mit zystischer Fibrose (CF). Die Korrektur eines crosstalk-Fehlers in der Software des MBW-Geräts Exhalyzer D in einer neuen Softwareversion hat großes Interesse an den Auswirkungen auf frühere MBW-Ergebnisse geweckt. Da LCI und Magnetresonanztomographie (MRT) bei CF-Kindern früher korrelierten, zielt diese Studie darauf ab, frühere Ergebnisse nach der Korrektur zu reevaluieren.

Patienten/Methoden Reanalyse wichtigster Ergebnisse einer publizierten Studie zum Vergleich von MBW- und MRT-Ergebnissen in pädiatrischer CF-Kohorte mittels Reanalyse von Stickstoff (N2)-MBWs von 61 stabilen CF-Kindern, 75 altersgleichen gesunden Kontrollen (HC) und 15 CF-Kindern mit pulmonaler Exazerbation (PEx) in der korrigierten Software-Version.

Ergebnisse Signifikante Abnahme des korrigierten LCI (N2LCIcor) in Gesamtkohorte (−17.0 (11.2)%), HC (−8.5 (8.2)%), stabilen CF-Kindern (−22.2 (11.1)%) und in der PEx-Gruppe zu Beginn, bei PEx und nach Antibiotikatherapie (−21.5 (7.3)%; −22.5 (6.1)%; −21.4 (6.6)%; alle P<0.01). N2LCIcor und N2LCIpre korrelierten mit MRT-Scores bei stabiler CF (r=0.70 bis 0.84; alle P<0.01) ohne signifikanten Unterschied zwischen N2LCIcor und N2LCIpre. Die Veränderung des LCI vom Ausgangswert zur PEx und von PEx bis nach Therapie nahm von N2LCIpre zu N2LCIcor ab, aber die Veränderungen blieben signifikant (alle P=0.001).

Diskussion/Schlussfolgerungen Unsere Ergebnisse zeigen, dass der N2LCIcor signifikant niedriger ist als der N2LCIpre, aber die in der ursprünglichen Studie veröffentlichten Schlüsselergebnisse, die N2MBW und MRT als komplementäre Methoden für die klinische Überwachung bei Kindern mit CF belegen, bleiben davon unberührt.

Key words

cystic fibrosis - multiple-breath washout - lung clearance index - magnetic resonance imaging - noninvasive monitoring - lung disease

Schlüsselwörter

Mukoviszidose - Multiple-Breath-Washout - Lung Clearance Index - Magnetresonanztomographie - nichtinvasive Überwachung - Lungenerkrankung

* M.M. and E.S. contributed equally as first authors




Publication History

Article published online:
18 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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