New MRI Study Uncovers Hidden Lung Abnormalities in Children With Long COVID

Long COVID is more than just lingering symptoms—it may have a hidden biological basis that standard medical tests fail to detect.

A groundbreaking study using advanced MRI technology has uncovered significant lung abnormalities in children and adolescents suffering from long COVID, particularly in blood flow and air movement. These findings help explain persistent symptoms like chronic fatigue and shortness of breath, offering a new path for diagnosing and managing this condition.

MRI Reveals Lung Abnormalities in Children with Long COVID

A new study published today (February 25) in Radiology, the journal of the Radiological Society of North America (RSNA), reveals that an advanced type of MRI has detected significant lung abnormalities in children and adolescents with long COVID.

Long COVID, or post-COVID-19 condition, occurs when symptoms persist for more than 12 weeks after a COVID-19 infection. While children and teens generally experience a milder form of the condition, symptoms like chronic fatigue, headaches, and difficulty concentrating can interfere with school and social activities.

A Need for Better Testing

In adults, chest CT scans are commonly used to assess lung function in long COVID cases. However, this method is not usually recommended for children due to radiation exposure and the potential need for contrast agents.

Instead, young patients suspected of having long COVID are typically evaluated through pulmonary function tests, echocardiography, and medical history reviews. Unfortunately, these standard tests often show normal lung and heart function, even in children experiencing ongoing symptoms.

“Parents should understand that their children’s persistent symptoms after COVID-19 may have a measurable physiological basis, even when standard medical tests appear normal,” said lead study author Gesa H. Pöhler, M.D., a senior physician in the Department of Diagnostic and Interventional Radiology at Hannover Medical School in Germany.

The researchers employed phase-resolved functional lung (PREFUL) MRI. This advanced MRI technology can analyze lung ventilation (air movement in and out of the lungs) and perfusion (blood flow through the lungs). PREFUL MRI doesn’t require the use of radiation or intravenous contrast agents and can be done while the patient breathes freely, making it a suitable procedure for children.

Images show exemplary coronal sections of phase-resolved functional lung MRI ventilation and perfusion maps in a 15-year-old female participant with post-COVID-19 condition (PCC) and in a sex- and age-matched healthy control participant. (A, B) Images show regional ventilation, with values of (A) 0.1 mL/mL in the participant with PCC and (B) 0.5 mL/mL in the healthy control participant. Regarding dynamic ventilation (C, D), images show the flow-volume loop correlation metric, with (C) the participant with PCC at 0.98 arbitrary units (au) and (D) the healthy control participant at 0.99 au. (E, F) Images show perfusion maps depicting a median quantified perfusion of 27 mL/min per 100 mL for the participant with PCC and 89 mL/min per 100 mL for the healthy control participant. Credit: Radiological Society of North America (RSNA)

First Evidence of Lung Perfusion Abnormalities

“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,” Dr. Pöhler said.

For the prospective study, conducted between April 2022 and 2023, the researchers enrolled 54 patients ranging in age from 11 to 17 years. Half of the patients were diagnosed with long COVID, and the other half were healthy controls. A self-reported assessment called the bell score was used to assess symptom severity in patients with long COVID.

Functional Lung MRI Defect Maps Pediatric COVID 19 — Images show exemplary coronal sections of phase-resolved functional lung MRI defect maps in a pediatric participant with post-COVID-19 condition (PCC) and cardiopulmonary symptoms and a healthy control patient. (A) Images in a 17-year-old male participant with PCC show a ventilation defect percentage (VDP) of 17%, a perfusion defect percentage (QDP) of 16%, a ventilation/perfusion (V/Q) match healthy (VQM [H]) percentage of 64%, and a V/Q mismatch defect (VQM [D]) of 3%. (B) Images in a healthy control participant, with a ventilation defect percentage of 9%, a perfusion defect percentage of 5%, a V/Q match healthy percentage of 86%, and no V/Q mismatch defect. Credit: Radiological Society of North America (RSNA)

Blood Flow Reduction and Fatigue Connection

Compared to healthy controls, children and adolescents with long COVID had significantly reduced blood flow in the lungs. A reduction in blood flow patterns in organs or other areas of the body can result in a lack of sufficient oxygen and nutrients.

The most prevalent symptom of fatigue affected all but one patient with long COVID.

“Importantly, the severity of fatigue symptoms correlated with these blood flow changes, suggesting a possible biological basis for the patients’ ongoing symptoms,” Dr. Pöhler said.

In addition to poor blood flow, a subgroup of long COVID patients with cardiopulmonary symptoms, such as shortness of breath, also showed a reduction of air movement and reach in the lungs.

Functional Lung MRI Perfusion Maps Bell Score COVID 19 — Dorsal, medial, and ventral phase-resolved functional lung MRI perfusion maps show distinct perfusion phenotypes related to the severity of chronic fatigue assessed with the Bell score in three participants with post-COVID-19 condition and in a healthy control participant. The top row shows maps from a 17-year-old male healthy control participant with a median quantified perfusion of 81 mL/min per 100 mL. The second row from the top shows maps from a 17-year-old male participant with a Bell score of 90 and a quantified perfusion of 59 mL/min per 100 mL. The second row from the bottom shows maps from a 16-year-old female participant with a Bell score of 60 with a quantified perfusion of 48 mL/min per 100 mL. The bottom row shows maps from a 15-year-old male participant with a Bell score of 30 and a quantified perfusion of 32 mL/min per 100 mL. Credit: Radiological Society of North America (RSNA)

Future Implications for Long COVID Monitoring

The researchers suggest that continuous monitoring of lung abnormalities in children with long COVID at various stages of the condition could help guide therapeutic interventions and monitoring strategies.

“Quantitative lung MRI establishes a potential imaging biomarker profiling and helps to enable disease severity follow-up for this complex condition in the future,” Dr. Pöhler said.

Reference: “Phase-resolved Functional Lung MRI Reveals Distinct Lung Perfusion Phenotype in Children and Adolescents with Post–COVID-19 Condition” by Gesa H. Pöhler, Andreas Voskrebenzev, Marc-Luca Heinze, Valentina Skeries, Filip Klimeš, Julian Glandorf, Jan Eckstein, Nigar Babazade, Marius Wernz, Alexander Pfeil, Gesine Hansen, Frank K. Wacker, Jens Vogel-Claussen, Martin Wetzke and Diane Miriam Renz, 25 February 2025, Radiology.
DOI: 10.1148/radiol.241596

Collaborating with Dr. Pöhler were Andreas Voskrebenzev, Ph.D., Marc-Luca Heinze, Valentina Skeries, M.D., Filip Klimeš, Ph.D., Julian Glandorf, M.D., Jan Eckstein, M.D., Nigar Babazade, Marius Wernz, B.S., Alexander Pfeil, M.D., Gesine Hansen, M.D., Frank K. Wacker, M.D., Jens Vogel-Claussen, M.D., Martin Wetzke, M.D., and Diane Miriam Renz, M.D.

Read The Article

News

Study Shows Brain Signals Only Matter if They Arrive on Time

Signals are processed only if they reach the brain during brief receptive cycles. This timing mechanism explains how attention filters information and may inform therapies and brain-inspired technologies. It has long been recognized that [...]

Does Space-Time Really Exist?

Is time something that flows — or just an illusion? Exploring space-time as either a fixed “block universe” or a dynamic fabric reveals deeper mysteries about existence, change, and the very nature of reality. [...]

Unlocking hidden soil microbes for new antibiotics

Most bacteria cannot be cultured in the lab-and that's been bad news for medicine. Many of our frontline antibiotics originated from microbes, yet as antibiotic resistance spreads and drug pipelines run dry, the soil [...]

By working together, cells can extend their senses beyond their direct environment

The story of the princess and the pea evokes an image of a highly sensitive young royal woman so refined, she can sense a pea under a stack of mattresses. When it comes to [...]

Overworked Brain Cells May Hold the Key to Parkinson’s

Scientists at Gladstone Institutes uncovered a surprising reason why dopamine-producing neurons, crucial for smooth body movements, die in Parkinson’s disease. In mice, when these neurons were kept overactive for weeks, they began to falter, [...]

Old tires find new life: Rubber particles strengthen superhydrophobic coatings against corrosion

Development of highly robust superhydrophobic anti-corrosion coating using recycled tire rubber particles. Superhydrophobic materials offer a strategy for developing marine anti-corrosion materials due to their low solid-liquid contact area and low surface energy. However, [...]

This implant could soon allow you to read minds

Mind reading: Long a science fiction fantasy, today an increasingly concrete scientific goal. Researchers at Stanford University have succeeded in decoding internal language in real time thanks to a brain implant and artificial intelligence. [...]

A New Weapon Against Cancer: Cold Plasma Destroys Hidden Tumor Cells

Cold plasma penetrates deep into tumors and attacks cancer cells. Short-lived molecules were identified as key drivers. Scientists at the Leibniz Institute for Plasma Science and Technology (INP), working with colleagues from Greifswald University Hospital and [...]

This Common Sleep Aid May Also Protect Your Brain From Alzheimer’s

Lemborexant and similar sleep medications show potential for treating tau-related disorders, including Alzheimer’s disease. New research from Washington University School of Medicine in St. Louis shows that a commonly used sleep medication can restore normal sleep patterns and [...]

Sugar-Coated Nanoparticles Boost Cancer Drug Efficacy

A team of researchers at the University of Mississippi has discovered that coating cancer treatment carrying nanoparticles in a sugar-like material increases their treatment efficacy. They reported their findings in Advanced Healthcare Materials. Over a tenth of breast [...]

Nanoparticle-Based Vaccine Shows Promise in Fighting Cancer

In a study published in OncoImmunology, researchers from the German Cancer Research Center and Heidelberg University have created a therapeutic vaccine that mobilizes the immune system to target cancer cells. The researchers demonstrated that virus peptides combined [...]

Quantitative imaging method reveals how cells rapidly sort and transport lipids

Lipids are difficult to detect with light microscopy. Using a new chemical labeling strategy, a Dresden-based team led by André Nadler at the Max Planck Institute of Molecular Cell Biology and Genetics (MPI-CBG) and [...]

Ancient DNA reveals cause of world’s first recorded pandemic

Scientists have confirmed that the Justinian Plague, the world’s first recorded pandemic, was caused by Yersinia pestis, the same bacterium behind the Black Death. Dating back some 1,500 years and long described in historical texts but [...]

“AI Is Not Intelligent at All” – Expert Warns of Worldwide Threat to Human Dignity

Opaque AI systems risk undermining human rights and dignity. Global cooperation is needed to ensure protection. The rise of artificial intelligence (AI) has changed how people interact, but it also poses a global risk to human [...]

Nanomotors: Where Are They Now?

First introduced in 2004, nanomotors have steadily advanced from a scientific curiosity to a practical technology with wide-ranging applications. This article explores the key developments, recent innovations, and major uses of nanomotors today. A [...]

Study Finds 95% of Tested Beers Contain Toxic “Forever Chemicals”

Researchers found PFAS in 95% of tested beers, with the highest levels linked to contaminated local water sources. Per- and polyfluoroalkyl substances (PFAS), better known as forever chemicals, are gaining notoriety for their ability [...]