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

## TL;DR

This study uses a new MRI technique to detect early lung damage in childhood cancer survivors, even before symptoms appear.

## Contribution

The study introduces PREFUL low-field MRI as a novel method for detecting subclinical pulmonary dysfunction in childhood cancer survivors.

## Key findings

- Significant time-dependent ventilation and perfusion defects were detected in asymptomatic survivors.
- A strong negative correlation was found between time since treatment and defect-free lung tissue in ALL patients.
- PREFUL MRI may serve as a sensitive tool for early detection of long-term pulmonary toxicity.

## Abstract

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.

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.

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.

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.

Dierl, Hinsen et al. investigate long term pulmonary toxicity in pediatric cancer survivors by the use of Free-breathing phase-resolved functional lung (PREFUL) MRI on a low-field system. Subclinical and time-dependent reduction in pulmonary ventilation and perfusion is revealed.

Treatment of children and adolescents with cancer has led to a steady improvement in cure rates. At the same time, our knowledge of the possible long-term effects of conventional chemotherapy-based treatment in children remains limited. In this study, we performed a type of scan called PREFUL MRI in children and adolescents after treatment for acute lymphoblastic leukemia and Hodgkin’s disease that did not require treatment with chemicals called contrast agents or ionizing radiation. Our results show that following treatment there is an increasing and time-dependent dysfunction in the lungs, despite there being no clinical symptoms. Our imaging method might be an effective and highly sensitive tool for early detection of long-term toxicity after cancer treatment. It could also be used to monitor the side effects of new cancer treatments.