Free-breathing phase-resolved functional lung (PREFUL) low-field magnetic resonance imaging (LF-MRI) of pulmonary dysfunction after surviving childhood cancer.

[BACKGROUND] Childhood cancer survivors have a high risk of chronic multi-organ disease that does not plateau over time. To date, there is a lack of sensitive diagnostic techniques that allow early detection of tissue damage before clinical symptoms occur, particularly regarding pulmonary function. Free-breathing phase-resolved functional lung (PREFUL) low-field magnetic resonance imaging (LF-MRI) may enable visualization and quantification of functional and structural lung damage without the need of specific contrast agents.

[METHODS] In this single-center, cross-sectional diagnostic study, we performed LF-MRI in a cohort of n = 27 children and adolescents (age range: 5 to 17 years) after treatment for acute lymphoblastic leukemia (ALL; n = 21) and Hodgkin's disease (HD; n = 6) to determine the frequency of morphologic and functional lung parenchymal changes.

[RESULTS] Here, we show that despite the absence of clinical symptoms, significant time-dependent pulmonary ventilation and perfusion defects are detected. A negative correlation between the time after the end of therapy and defect-free lung tissue in the cohort of patients treated for ALL (Spearman-coefficient = - 0.69, p = 0.0005) is observed.

[CONCLUSIONS] Our results suggest an increase in pulmonary ventilation and perfusion defects preceding the increase in chronic disease that has already been reported in this patient population. Further research is needed to determine whether the functional abnormalities described in this study are an early morphological correlate of developing organ damage that may become clinically evident over time. PREFUL MRI may be an effective and highly sensitive tool for early detection of these changes in lung function, allowing longitudinal studies for risk stratification and potential future treatment adaptation.