Persistent 129Xe MRI Pulmonary and CT Vascular Abnormalities in Symptomatic Individuals with Post-acute COVID-19 Syndrome

Background: In patients with post-acute COVID-19 syndrome (PACS), abnormal gas-transfer and pulmonary vascular density have been reported, but such findings have not been related to each other or to symptoms and exercise limitation. The pathophysiologic drivers of PACS in patients previously infected with COVID-19 who were admitted to in-patient treatment in hospital (or everhospitalized patients) and never-hospitalized patients are not well understood. Purpose: To determine the relationship of persistent symptoms and exercise limitation with xenon 129 (Xe-129) MRI and CT pulmonary vascular measurements in individuals with PACS. Materials and Methods: In this prospective study, patients with PACS aged 18-80 years with a positive polymerase chain reaction COVID-19 test were recruited from a quaternary-care COVID-19 clinic between April and October 2021. Participants with PACS underwent spirometry, diffusing capacity of the lung for carbon monoxide (DLco), Xe-129 MRI, and chest CT. Healthy controls had no prior history of COVID-19 and underwent spirometry, DLco, and Xe-129 MRI. The Xe-129 MRI red blood cell (RBC) to alveolar-barrier signal ratio, RBC area under the receiver operating characteristic curve (AUC), CT volume of pulmonary vessels with cross-sectional area 5 mm(2) or smaller (BV5), and total blood volume were quantified. St George's Respiratory Questionnaire, International Physical Activity Questionnaire, and modified Borg Dyspnea Scale measured quality of life, exercise limitation, and dyspnea. Differences between groups were compared with use of Welch t-tests or Welch analysis of variance. Relationships were evaluated with use of Pearson (r) and Spearman (r) correlations. Results: Forty participants were evaluated, including six controls (mean age +/- SD, 35 years +/- 15, three women) and 34 participants with PACS (mean age, 53 years +/- 13, 18 women), of whom 22 were never hospitalized. The Xe-129 MRI RBC:barrier ratio was lower in ever-hospitalized participants (P =.04) compared to controls. BV5 correlated with RBC AUC (rho =.44, P =.03). The Xe-129 MRI RBC:barrier ratio was related to DLco (r =.57, P =.002) and forced expiratory volume in 1 second (rho =.35, P =.03); RBC AUC was related to dyspnea (rho = 2.35, P =.04) and International Physical Activity Questionnaire score (rho =.45, P =.02). Conclusion: Xenon 129 (Xe-129) MRI measurements were lower in participants previously infected with COVID-19 who were admitted to in-patient treatment in hospital with post-acute COVID-19 syndrome, 34 weeks +/- 25 after infection compared to controls. The Xe-129 MRI measures were associated with CT pulmonary vascular density, diffusing capacity of the lung for carbon monoxide, exercise capacity, and dyspnea. (c) RSNA, 2022