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.
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.
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.
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.
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