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. 2022 Dec;305(3):709-717.
doi: 10.1148/radiol.220069. Epub 2022 May 24.

Lung Abnormalities Detected with Hyperpolarized 129Xe MRI in Patients with Long COVID

Affiliations

Lung Abnormalities Detected with Hyperpolarized 129Xe MRI in Patients with Long COVID

James T Grist et al. Radiology. 2022 Dec.

Erratum in

Abstract

Background Post-COVID-19 condition encompasses symptoms following COVID-19 infection that linger at least 4 weeks after the end of active infection. Symptoms are wide ranging, but breathlessness is common. Purpose To determine if the previously described lung abnormalities seen on hyperpolarized (HP) pulmonary xenon 129 (129Xe) MRI scans in participants with post-COVID-19 condition who were hospitalized are also present in participants with post-COVID-19 condition who were not hospitalized. Materials and Methods In this prospective study, nonhospitalized participants with post-COVID-19 condition (NHLC) and posthospitalized participants with post-COVID-19 condition (PHC) were enrolled from June 2020 to August 2021. Participants underwent chest CT, HP 129Xe MRI, pulmonary function testing, and the 1-minute sit-to-stand test and completed breathlessness questionnaires. Control subjects underwent HP 129Xe MRI only. CT scans were analyzed for post-COVID-19 interstitial lung disease severity using a previously published scoring system and full-scale airway network (FAN) modeling. Analysis used group and pairwise comparisons between participants and control subjects and correlations between participant clinical and imaging data. Results A total of 11 NHLC participants (four men, seven women; mean age, 44 years ± 11 [SD]; 95% CI: 37, 50) and 12 PHC participants (10 men, two women; mean age, 58 years ±10; 95% CI: 52, 64) were included, with a significant difference in age between groups (P = .05). Mean time from infection was 287 days ± 79 (95% CI: 240, 334) and 143 days ± 72 (95% CI: 105, 190) in NHLC and PHC participants, respectively. NHLC and PHC participants had normal or near normal CT scans (mean, 0.3/25 ± 0.6 [95% CI: 0, 0.63] and 7/25 ± 5 [95% CI: 4, 10], respectively). Gas transfer (Dlco) was different between NHLC and PHC participants (mean Dlco, 76% ± 8 [95% CI: 73, 83] vs 86% ± 8 [95% CI: 80, 91], respectively; P = .04), but there was no evidence of other differences in lung function. Mean red blood cell-to-tissue plasma ratio was different between volunteers (mean, 0.45 ± 0.07; 95% CI: 0.43, 0.47]) and PHC participants (mean, 0.31 ± 0.10; 95% CI: 0.24, 0.37; P = .02) and between volunteers and NHLC participants (mean, 0.37 ± 0.10; 95% CI: 0.31, 0.44; P = .03) but not between NHLC and PHC participants (P = .26). FAN results did not correlate with Dlco) or HP 129Xe MRI results. Conclusion Nonhospitalized participants with post-COVID-19 condition (NHLC) and posthospitalized participants with post-COVID-19 condition (PHC) showed hyperpolarized pulmonary xenon 129 MRI and red blood cell-to-tissue plasma abnormalities, with NHLC participants demonstrating lower gas transfer than PHC participants despite having normal CT findings. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Parraga and Matheson in this issue.

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Conflict of interest statement

Disclosures of conflicts of interest: J.T.G. No relevant relationships. G.J.C. No relevant relationships. H.W. No relevant relationships. M.K. No relevant relationships. M.C. No relevant relationships. G.A.E. No relevant relationships. A.L. No relevant relationships. V.M. No relevant relationships. K.J. No relevant relationships. S.C. No relevant relationships. A.E. No relevant relationships. M.D. No relevant relationships. A.M. No relevant relationships. R.T. British Heart Foundation intermediate clinical fellowship; institutional funding from Janssen-Cilag; support to attend meetings from Janssen-Cilag. RFS GE Healthcare employee; stock options in GE Healthcare. B.R. Grants from British Heart Foundation and Oxford Centre of Research Excellence. P.A.R. No relevant relationships. J.M.W. No relevant relationships. E.F. Conference presentations for palliative care general medicine national training course; on the Celltrion advisory board for Regdanviman F.G. Equipment from Polarean and GE Healthcare; grant from Innovate UK; consulting fees from Sensyne; on the advisory boards of AstraZeneca and Polarean; president of the European Society of Thoracic Imaging; stock in Optellum, RAIQC, and OxSonics.

Figures

None
Graphical abstract
Study flowchart. Hb = hemoglobin.
Figure 1:
Study flowchart. Hb = hemoglobin.
Example CT, proton (1H), and proton and red blood cell-to-tissue
plasma (RBC:TP) images in participants with post-COVID-19 condition. Top
row: Images in a participant with an RBC:TP value of 0.49. Middle row:
Images in a participant with an RBC:TP value of 0.31. Bottom row: Images in
a participant with an RBC:TP value of 0.24. Imaging revealed little to no
discernible damage on CT scans, yet highly heterogeneous and low RBC:TP
values in the lungs of nonhospitalized participants with post-COVID-19
condition.
Figure 2:
Example CT, proton (1H), and proton and red blood cell-to-tissue plasma (RBC:TP) images in participants with post-COVID-19 condition. Top row: Images in a participant with an RBC:TP value of 0.49. Middle row: Images in a participant with an RBC:TP value of 0.31. Bottom row: Images in a participant with an RBC:TP value of 0.24. Imaging revealed little to no discernible damage on CT scans, yet highly heterogeneous and low RBC:TP values in the lungs of nonhospitalized participants with post-COVID-19 condition.
Example CT, proton (1H), and proton and red blood cell-to-tissue
plasma (RBC:TP) images in posthospitalized participants with post-COVID-19
condition. Top row: Images in a participant with an RBC:TP value of 0.59.
Middle row: Images in a participant with an RBC:TP value of 0.31. Bottom
row: Images in a participant with an RBC:TP value of 0.16. Imaging revealed
minimal damage on CT scans, yet highly heterogeneous and low RBC:TP values
in the lungs of posthospitalized participants.
Figure 3:
Example CT, proton (1H), and proton and red blood cell-to-tissue plasma (RBC:TP) images in posthospitalized participants with post-COVID-19 condition. Top row: Images in a participant with an RBC:TP value of 0.59. Middle row: Images in a participant with an RBC:TP value of 0.31. Bottom row: Images in a participant with an RBC:TP value of 0.16. Imaging revealed minimal damage on CT scans, yet highly heterogeneous and low RBC:TP values in the lungs of posthospitalized participants.
Comparison of red blood cell-to-tissue plasma (RBC:TP) (A) mean, (B)
SD, and (C) coefficient of variation (CoV) between healthy posthospitalized
participants with post-COVID-19 condition (HLC) and nonhospitalized
participants with post-COVID-19 condition (NHLC). Results show a significant
decrease in RBC:TP in participants in comparison with control subjects.
* = significant after correction for multiple comparisons.
Figure 4:
Comparison of red blood cell-to-tissue plasma (RBC:TP) (A) mean, (B) SD, and (C) coefficient of variation (CoV) between healthy posthospitalized participants with post-COVID-19 condition (HLC) and nonhospitalized participants with post-COVID-19 condition (NHLC). Results show a significant decrease in RBC:TP in participants in comparison with control subjects. * = significant after correction for multiple comparisons.
Correlation results. There were significant positive correlations
between (A) gas transfer (Dlco) and red blood cell–to-tissue plasma
(RBC:TP) SD in the NHLC group and (B) RBC:TP SD and CT score in the PHC
group. Results show that abnormally low Dlco measurements are linked to
changes in RBC:TP.
Figure 5:
Correlation results. There were significant positive correlations between (A) gas transfer (Dlco) and red blood cell–to-tissue plasma (RBC:TP) SD in the NHLC group and (B) RBC:TP SD and CT score in the PHC group. Results show that abnormally low Dlco measurements are linked to changes in RBC:TP.
Three-dimensional rendering of (A) full-scale airway network (FAN),
(B) FAN modeling, and (C, D) hyperpolarized xenon imaging in NHLC (C) and
PHC (D) participants. Results from both low-resolution and ventilation
imaging are similar and did not correlate with clinical or dissolved-phase
imaging results.
Figure 6:
Three-dimensional rendering of (A) full-scale airway network (FAN), (B) FAN modeling, and (C, D) hyperpolarized xenon imaging in NHLC (C) and PHC (D) participants. Results from both low-resolution and ventilation imaging are similar and did not correlate with clinical or dissolved-phase imaging results.

Comment in

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