Xenon-129 MRI detects ventilation deficits in paediatric stem cell transplant patients unable to perform spirometry

Early detection of pulmonary morbidity following haematopoietic stem cell transplantation (HSCT) remains an important challenge for intervention, primarily due to the insensitivity of spirometry to early change, and in paediatrics, patient compliance provides additional challenges. Regional lung ventilation abnormalities in paediatric HSCT patients were quantified using hyperpolarised xenon-129 (¹²⁹Xe) magnetic resonance imaging (MRI) and compared to spirometry.

Medically stable, paediatric allogeneic HSCT patients (n=23, ages 6-16 years) underwent an outpatient MRI scan where regional ventilation was quantified with a breath-hold of hyperpolarised ¹²⁹Xe gas. Ventilation deficits, regions of the lung that ventilate poorly due to obstruction, were quantified as a ventilation defect percentage (VDP) and compared to forced expiratory volume in 1 s (FEV₁), FEV₁/forced vital capacity (FVC) ratio, and forced expiratory flow at 25-75% of FVC (FEF_25-75%) from spirometry using linear regression.

The mean±sd ¹²⁹Xe VDP was 10.5±9.4% (range 2.6-41.4%). ¹²⁹Xe VDP correlated with FEV₁, FEV₁/FVC ratio and FEF_25-75% (p≤0.02 for all comparisons). Ventilation deficits were detected in patients with normal spirometry (i.e. FEV₁ >80%), supporting the sensitivity of ¹²⁹Xe MRI to early obstruction reported in other pulmonary conditions. Seven (30%) patients could not perform spirometry, yet ventilation deficits were observed in five of these patients, detecting abnormalities that otherwise may have gone undetected and untreated until advanced.

Lung ventilation deficits were detected using hyperpolarised ¹²⁹Xe gas MRI in asymptomatic paediatric HSCT patients and in a subgroup who were unable to perform reliable spirometry. ¹²⁹Xe MRI provides a reliable imaging-based assessment of pulmonary involvement in this potentially difficult to diagnose paediatric population.