Background
Long COVID occurs in lower frequency in children and adolescents than in
adults. Morphologic and free-breathing phase-resolved functional
low-field MRI may identify persistent pulmonary manifestations after
SARS-CoV-2 infection.
Purpose
To characterize both morphologic and functional changes of lung
parenchyma on low-field MRI in children and adolescents with post
COVID-19 compared with healthy controls.
Materials and Methods
Between August and December 2021, a cross-sectional, prospective clinical
trial using low-field MRI was performed in children and adolescents from
a single academic medical center. The primary outcome was the frequency
of morphologic changes on MRI. Secondary outcomes included MRI-derived
functional proton ventilation and perfusion parameters. Clinical
symptoms, the duration from positive RT-PCR test and serological
parameters were compared with imaging results. Nonparametric tests for
pairwise and corrected tests for groupwise comparisons were applied to
assess differences in healthy controls, recovered participants and with
long COVID.
Results
A total of 54 participants post COVID-19 infection (mean age, 11 years
±3 [SD], 56 males) and 9 healthy controls (mean age, 10 years
±3 [SD], 70 males) were included: 29 (54%) in the COVID-19 group
had recovered from infection and 25 (46%) were classified as having long
COVID on the day of enrollment. Morphologic abnormality was identified
in one recovered participant. Both ventilated and perfused lung
parenchyma (V/Q match) was reduced from 81±6.1% in healthy
controls to 62±19% (
P
=.006) in the recovered
group and 60±20% (
P
=.003) in the long COVID
group. V/Q match was lower in post COVID patients with infection less
than 180 days (63±20%,
P
=.03), 180 to 360 days
(63±18%,
P
=0.03) and 360 days ago
(41±12%,
P
<.001) as compared with the
never-infected healthy controls (81±6.1%).
Conclusion
Low-field MRI showed persistent pulmonary dysfunction in both children
and adolescents recovered from COVID-19 and with long COVID.
ClinicalTrials.gov
: NCT04990531
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The frequency and extent of persistent sequelae in children and adolescents after infection with SARS-CoV-2 still needs to be comprehensively determined. In this cross-sectional clinical trial, we used non-invasive, label-free morphologic and free-breathing phase-resolved functional low-field magnetic resonance imaging (LF-MRI) to identify pulmonary changes in children and adolescents from 5 to <18 years after previously PCR-confirmed SARS-CoV-2 infection. While morphological pathologies were less frequent in children, functional LF-MRI visualized widespread ventilation, perfusion and combined ventilation/perfusion defects compared to healthy controls. The loss of functional lung parenchyma was more pronounced in long Covid than recovered patients. While pulmonary dysfunction was persistent even month after primary infection, LF-MRI demonstrated high capability to visualize and detect these changes in children and adolescents. (Clinicaltrials.org ID NCT04990531)
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