Phase-Resolved Functional Lung (PREFUL) MRI May Reveal Distinct Pulmonary Perfusion Defects in Postacute COVID-19 Syndrome: Sex, Hospitalization, and Dyspnea Heterogeneity.
perfusion defect percentage
phase‐resolved functional lung
postacute COVID‐19 syndrome
ventilation–perfusion match
Journal
Journal of magnetic resonance imaging : JMRI
ISSN: 1522-2586
Titre abrégé: J Magn Reson Imaging
Pays: United States
ID NLM: 9105850
Informations de publication
Date de publication:
17 Jun 2024
17 Jun 2024
Historique:
revised:
08
05
2024
received:
28
03
2024
accepted:
10
05
2024
medline:
18
6
2024
pubmed:
18
6
2024
entrez:
18
6
2024
Statut:
aheadofprint
Résumé
Pulmonary perfusion defects have been observed in patients with coronavirus disease 2019 (COVID-19). Currently, there is a need for further data on non-contrast-enhanced MRI in COVID patients. The early identification of heterogeneity in pulmonary perfusion defects among COVID-19 patients is beneficial for their timely clinical intervention and management. To investigate the utility of phase-resolved functional lung (PREFUL) MRI in detecting pulmonary perfusion disturbances in individuals with postacute COVID-19 syndrome (PACS). Prospective. Forty-four participants (19 females, mean age 64.1 years) with PACS and 44 healthy subjects (19 females, mean age 59.5 years). Moreover, among the 44 patients, there were 19 inpatients and 25 outpatients; 19 were female and 25 were male; 18 with non-dyspnea and 26 with dyspnea. 3-T, two-dimensional (2D) spoiled gradient-echo sequence. Ventilation and perfusion-weighted maps were extracted from five coronal slices using PREFUL analysis. Subsequently, perfusion defect percentage (QDP), ventilation defect percentage (VDP), and ventilation-perfusion match healthy (VQM) were calculated based on segmented lung parenchyma ventilation and perfusion-weighted maps. Additionally, clinical features, including demographic data (such as sex and age) and serum biomarkers (such as D-dimer levels), were evaluated. Spearman correlation coefficients to explore relationships between clinical features and QDP, VDP, and VQM. Propensity score matching analysis to reduce the confounding bias between patients with PACS and healthy controls. The Mann-Whitney U tests and Chi-squared tests to detect differences between groups. Multivariable linear regression analyses to identify factors related to QDP, VDP, and VQM. A P-value <0.05 was considered statistically significant. QDP significantly exceeded that of healthy controls in individuals with PACS (39.8% ± 15.0% vs. 11.0% ± 4.9%) and was significantly higher in inpatients than in outpatients (46.8% ± 17.0% vs. 34.5% ± 10.8%). Moreover, males exhibited pulmonary perfusion defects significantly more frequently than females (43.9% ± 16.8% vs. 34.4% ± 10.2%), and dyspneic participants displayed significantly higher perfusion defects than non-dyspneic patients (44.8% ± 15.8% vs. 32.6% ± 10.3%). QDP showed a significant positive relationship with age (β = 0.50) and D-dimer level (β = 0.72). PREFUL MRI may show pulmonary perfusion defects in patients with PACS. Furthermore, perfusion impairments may be more pronounced in males, inpatients, and dyspneic patients. 2 TECHNICAL EFFICACY: Stage 2.
Sections du résumé
BACKGROUND
BACKGROUND
Pulmonary perfusion defects have been observed in patients with coronavirus disease 2019 (COVID-19). Currently, there is a need for further data on non-contrast-enhanced MRI in COVID patients. The early identification of heterogeneity in pulmonary perfusion defects among COVID-19 patients is beneficial for their timely clinical intervention and management.
PURPOSE
OBJECTIVE
To investigate the utility of phase-resolved functional lung (PREFUL) MRI in detecting pulmonary perfusion disturbances in individuals with postacute COVID-19 syndrome (PACS).
STUDY TYPE
METHODS
Prospective.
SUBJECTS
METHODS
Forty-four participants (19 females, mean age 64.1 years) with PACS and 44 healthy subjects (19 females, mean age 59.5 years). Moreover, among the 44 patients, there were 19 inpatients and 25 outpatients; 19 were female and 25 were male; 18 with non-dyspnea and 26 with dyspnea.
FIELD STRENGTH/SEQUENCE
UNASSIGNED
3-T, two-dimensional (2D) spoiled gradient-echo sequence.
ASSESSMENT
RESULTS
Ventilation and perfusion-weighted maps were extracted from five coronal slices using PREFUL analysis. Subsequently, perfusion defect percentage (QDP), ventilation defect percentage (VDP), and ventilation-perfusion match healthy (VQM) were calculated based on segmented lung parenchyma ventilation and perfusion-weighted maps. Additionally, clinical features, including demographic data (such as sex and age) and serum biomarkers (such as D-dimer levels), were evaluated.
STATISTICAL TESTS
METHODS
Spearman correlation coefficients to explore relationships between clinical features and QDP, VDP, and VQM. Propensity score matching analysis to reduce the confounding bias between patients with PACS and healthy controls. The Mann-Whitney U tests and Chi-squared tests to detect differences between groups. Multivariable linear regression analyses to identify factors related to QDP, VDP, and VQM. A P-value <0.05 was considered statistically significant.
RESULTS
RESULTS
QDP significantly exceeded that of healthy controls in individuals with PACS (39.8% ± 15.0% vs. 11.0% ± 4.9%) and was significantly higher in inpatients than in outpatients (46.8% ± 17.0% vs. 34.5% ± 10.8%). Moreover, males exhibited pulmonary perfusion defects significantly more frequently than females (43.9% ± 16.8% vs. 34.4% ± 10.2%), and dyspneic participants displayed significantly higher perfusion defects than non-dyspneic patients (44.8% ± 15.8% vs. 32.6% ± 10.3%). QDP showed a significant positive relationship with age (β = 0.50) and D-dimer level (β = 0.72).
DATA CONCLUSION
CONCLUSIONS
PREFUL MRI may show pulmonary perfusion defects in patients with PACS. Furthermore, perfusion impairments may be more pronounced in males, inpatients, and dyspneic patients.
EVIDENCE LEVEL
METHODS
2 TECHNICAL EFFICACY: Stage 2.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Beijing Hospitals Authority's Ascent Plan under Grant
ID : DFL20220303
Organisme : Beijing Hospitals Authority Clinical Medicine Development of Special Funding
ID : ZLRK202306
Organisme : Beijing Key Specialists in Major Epidemic Prevention and Control
Informations de copyright
© 2024 International Society for Magnetic Resonance in Medicine.
Références
Nalbandian A, Sehgal K, Gupta A, et al. Post‐acute COVID‐19 syndrome. Nat Med 2021;27(4):601‐615.
Chopra V, Flanders SA, O'Malley M, Malani AN, Prescott HC. Sixty‐day outcomes among patients hospitalized with COVID‐19. Ann Intern Med 2021;174(4):576‐578.
Potalivo A, Montomoli J, Facondini F, et al. Sixty‐day mortality among 520 Italian hospitalized COVID‐19 patients according to the adopted ventilatory strategy in the context of an integrated multidisciplinary clinical organization: A population‐based cohort study. Clin Epidemiol 2020;12:1421‐1431.
Kooner HK, McIntosh MJ, Matheson AM, et al. Postacute COVID‐19 syndrome: (129)Xe MRI ventilation defects and respiratory outcomes 1 year later. Radiology 2023;307(2):e222557.
Eddy RL, Mummy D, Zhang S, et al. Cluster analysis to identify long COVID phenotypes using (129)Xe magnetic resonance imaging: A multi‐centre evaluation. Eur Respir J 2024;63(3):2302301.
Kern AL, Vogel‐Claussen J. Hyperpolarized gas MRI in pulmonology. Br J Radiol 2018;91(1084):20170647.
Mo X, Jian W, Su Z, et al. Abnormal pulmonary function in COVID‐19 patients at time of hospital discharge. Eur Respir J 2020;55(6):2001217.
Huang Y, Tan C, Wu J, et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir Res 2020;21(1):163.
Wang C, Li H, Xiao S, et al. Abnormal dynamic ventilation function of COVID‐19 survivors detected by pulmonary free‐breathing proton MRI. Eur Radiol 2022;32(8):5297‐5307.
Voskrebenzev A, Gutberlet M, Klimeš F, et al. Feasibility of quantitative regional ventilation and perfusion mapping with phase‐resolved functional lung (PREFUL) MRI in healthy volunteers and COPD, CTEPH, and CF patients. Magn Reson Med 2018;79(4):2306‐2314.
Cobes N, Guernou M, Lussato D, et al. Ventilation/perfusion SPECT/CT findings in different lung lesions associated with COVID‐19: A case series. Eur J Nucl Med Mol Imaging 2020;47(10):2453‐2460.
Lieveld AWE, Azijli K, Teunissen BP, et al. Chest CT in COVID‐19 at the ED: Validation of the COVID‐19 reporting and data system (CO‐RADS) and CT severity score: A prospective, multicenter, observational study. Chest 2021;159(3):1126‐1135.
Mohamed I, de Broucker V, Duhamel A, et al. Pulmonary circulation abnormalities in post‐acute COVID‐19 syndrome: Dual‐energy CT angiographic findings in 79 patients. Eur Radiol 2023;33(7):4700‐4712.
Yu JZ, Granberg T, Shams R, et al. Lung perfusion disturbances in nonhospitalized post‐COVID with dyspnea – A magnetic resonance imaging feasibility study. J Intern Med 2022;292(6):941‐956.
Kaireit TF, Voskrebenzev A, Gutberlet M, et al. Comparison of quantitative regional perfusion‐weighted phase resolved functional lung (PREFUL) MRI with dynamic gadolinium‐enhanced regional pulmonary perfusion MRI in COPD patients. J Magn Reson Imaging 2019;49(4):1122‐1132.
Behrendt L, Voskrebenzev A, Klimeš F, et al. Validation of automated perfusion‐weighted phase‐resolved functional lung (PREFUL)‐MRI in patients with pulmonary diseases. J Magn Reson Imaging 2020;52(1):103‐114.
Corman VM, Landt O, Kaiser M, et al. Detection of 2019 novel coronavirus (2019‐nCoV) by real‐time RT‐PCR. Euro Surveill 2020;25(3):2000045.
Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID‐19 patients: Correlation with disease severity and short‐term prognosis. Eur Radiol 2020;30(12):6808‐6817.
Glandorf J, Klimeš F, Behrendt L, et al. Perfusion quantification using voxel‐wise proton density and median signal decay in PREFUL MRI. Magn Reson Med 2021;86(3):1482‐1493.
Klimeš F, Voskrebenzev A, Gutberlet M, et al. Free‐breathing quantification of regional ventilation derived by phase‐resolved functional lung (PREFUL) MRI. NMR Biomed 2019;32(6):e4088.
Heiss R, Tan L, Schmidt S, et al. Pulmonary dysfunction after pediatric COVID‐19. Radiology 2023;306(3):e221250.
Behrendt L, Smith LJ, Voskrebenzev A, et al. A dual center and dual vendor comparison study of automated perfusion‐weighted phase‐resolved functional lung magnetic resonance imaging with dynamic contrast‐enhanced magnetic resonance imaging in patients with cystic fibrosis. Pulm Circ 2022;12(2):e12054.
Lévy S, Heiss R, Grimm R, et al. Free‐breathing low‐field MRI of the lungs detects functional alterations associated with persistent symptoms after COVID‐19 infection. Invest Radiol 2022;57(11):742‐751.
Matheson AM, McIntosh MJ, Kooner HK, et al. Persistent (129)Xe MRI pulmonary and CT vascular abnormalities in symptomatic individuals with post‐acute COVID‐19 syndrome. Radiology 2022;305(2):466‐476.
Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID‐19. Lancet 2020;395(10234):1417‐1418.
Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid‐19. N Engl J Med 2020;383(2):120‐128.
Falahi S, Kenarkoohi A. Sex and gender differences in the outcome of patients with COVID‐19. J Med Virol 2021;93(1):151‐152.
Gebhard C, Regitz‐Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID‐19 outcomes in Europe. Biol Sex Differ 2020;11(1):29.
Haitao T, Vermunt JV, Abeykoon J, et al. COVID‐19 and sex differences: Mechanisms and biomarkers. Mayo Clin Proc 2020;95(10):2189‐2203.
Zhang S, Bai W, Yue J, et al. Eight months follow‐up study on pulmonary function, lung radiographic, and related physiological characteristics in COVID‐19 survivors. Sci Rep 2021;11(1):13854.
Orzes N, Pini L, Levi G, Uccelli S, Cettolo F, Tantucci C. A prospective evaluation of lung function at three and six months in patients with previous SARS‐COV‐2 pneumonia. Respir Med 2021;186:106541.
Wu X, Liu X, Zhou Y, et al. 3‐month, 6‐month, 9‐month, and 12‐month respiratory outcomes in patients following COVID‐19‐related hospitalisation: A prospective study. Lancet Respir Med 2021;9(7):747‐754.
Price LC, Garfield B, Bloom C, et al. Persistent isolated impairment of gas transfer following COVID‐19 pneumonitis relates to perfusion defects on dual‐energy computed tomography. ERJ Open Res 2022;8(4):00224‐2022.
Wu J, Wu X, Zeng W, et al. Chest CT findings in patients with coronavirus disease 2019 and its relationship with clinical features. Invest Radiol 2020;55(5):257‐261.
Idilman IS, Telli Dizman G, Ardali Duzgun S, et al. Lung and kidney perfusion deficits diagnosed by dual‐energy computed tomography in patients with COVID‐19‐related systemic microangiopathy. Eur Radiol 2021;31(2):1090‐1099.
Aydin S, Kantarci M, Karavas E, Unver E, Yalcin S, Aydin F. Lung perfusion changes in COVID‐19 pneumonia: A dual energy computerized tomography study. Br J Radiol 2021;94(1125):20201380.
Santamarina MG, Boisier D, Contreras R, Baque M, Volpacchio M, Beddings I. COVID‐19: A hypothesis regarding the ventilation‐perfusion mismatch. Crit Care 2020;24(1):395.