A new study has uncovered significant lung abnormalities in children and teens suffering from long Covid using an advanced MRI technique known as PREFUL MRI that doesn’t require radiation or contrast dyes. The findings were published in the Journal Radiology.
Adults with lingering lung issues after Covid are recommended chest scans to ascertain the damages. In the case of children with long Covid, these scans are not normally used because they expose young patients to radiation and require intravenous contrast agents, which can be uncomfortable and invasive for them. This makes lung perfusion, or how blood flows in and out of the lungs, harder to detect for kids.
Children and teens with long Covid have significant lung abnormalities detected with an advanced form of magnetic resonance imaging (MRI), called free-breathing phase-resolved functional lung (PREFUL) MRI. The findings were published yesterday in Radiology.In case of children, pulmonary function tests, heart ultrasounds (echocardiograms), and medical history are used to detect lung abnormalities. However, in many children with Post Covid functions, these tests fail to present the true picture despite breathing difficulties, chest pain, or extreme fatigue, which makes diagnosing and understanding pediatric long Covid problematic.
“Because of radiation exposure and the necessity for intravenous contrast agent, CT [computed tomography] is not used as a standard diagnostic tool in children suspected of having PCC,” the authors wrote. “Instead, pulmonary function tests and echocardiography, along with a comprehensive review of medical history, are performed to rule out pulmonary and cardiac differential diagnoses. However, these examinations frequently show normal lung and cardiac function in symptomatic patients, complicating the diagnostic process.”
PREFUL MRI is short for free-breathing phase-resolved functional lung MRI. Unlike traditional imaging, PREFUL MRI allows doctors to scan the lungs while children simply breathe normally. Also, it’s entirely radiation-free and doesn’t require any contrast dye, which makes the technique safer for young patients.
For the study, a total of 54 participants – 27 with long Covid and 27 without it, underwent PREFUL from April 2022 to April 2023. Half of the participants had long Covid, while the other half had no history of the condition. The average age was 15 years old. The imaging assessed regional ventilation (oxygen flow), flow-volume loop correlation metric (FVL-CM), quantified perfusion (blood flow), ventilation and perfusion defect percentages, and ventilation-perfusion ratios.
The findings of the study
The scans revealed that children and teens with long Covid showed clear signs of lung injury, the damage that was invisible on standard tests. Their lungs had reduced blood flow (perfusion), and there were ventilation-perfusion mismatches, meaning areas of the lung weren’t properly balancing airflow and blood flow.
It was also found that the degree of lung damage directly correlated with some of the most common and debilitating symptoms of long Covid, including chronic fatigue and increased heart rate.
“Our research provides the first comprehensive evidence of measurable regional lung perfusion abnormalities in pediatric post-Covid-19 condition using radiation-free, contrast-free lung imaging,” said Gesa H. Pöhler, MD, a senior physician at the Hannover Medical School in Germany and first author of the study, in a news release from the Radiological Society of North America.
“Quantitative lung MRI establishes a potential imaging biomarker profiling and helps to enable disease severity follow-up for this complex condition in the future,” Pöhler said.
“Further investigations should prioritize multicenter longitudinal studies with larger cohorts to validate these findings and evaluate the progression of lung abnormalities at various stages after Covid-19 infection,” the author said.