Characteristics of pulmonary perfusion and ventilation in healthy adults: a prospective observational study with...

Phase-resolved functional lung magnetic resonance imaging (PREFUL-MRI) enables simultaneous, free-breathing, radiation-free assessment of regional lung perfusion and ventilation. This study aimed to provide preliminary reference data for lung perfusion and ventilation using PREFUL-MRI in healthy adults, and to characterize the physiological dependencies of these metrics on two breathing patterns, sex, and age.

In this prospective observational study, 87 healthy adults underwent PREFUL-MRI at 1.5 T during both normal and deep-slow breathing. Perfusion- and ventilation-related metrics were quantified via an automated pipeline. Paired comparisons between breathing states were performed using Wilcoxon signed-rank tests; unpaired comparisons between sexes and age groups (< 45 vs. ≥45 years) used Mann-Whitney U tests, with Holm-Bonferroni and Benjamini-Hochberg false-discovery-rate corrections applied to control for multiple comparisons.

Mean perfusion (7.7% vs. 6.0%, Holm-Bonferroni adjusted p < 0.001) and ventilation defects (8.6% vs. 5.1%, Holm-Bonferroni adjusted p = 0.010) were decreased, and mean ventilation (15.8% vs. 48.3%, Holm-Bonferroni adjusted p < 0.001) and perfusion defects (1.9% vs. 7.9%, Holm-Bonferroni adjusted p = 0.005) increased during deep breathing compared with normal breathing. Twenty-eight participants had increased lung perfusion while 59 had reduced perfusion during deep breathing relative to normal breathing. During normal breathing, men exhibited higher mean ventilation than women (20.2% vs. 14.2%, Holm-Bonferroni adjusted p = 0.018). During deep breathing, men demonstrated higher total perfusion defect percentage and matched ventilation-perfusion defects than women (FDR adjusted q < 0.05). Total perfusion defect percentage was lower in participants aged ≥ 45 years than in those aged < 45 years (1.8% vs. 2.7%, FDR adjusted q = 0.036). Mean flow-volume loop correlations were similar between breathing patterns, sexes, and age groups after multiple comparison correction (p > 0.05).

PREFUL-MRI can captures physiological variations related to breathing pattern, sex, and age in healthy adults. These findings provide a framework for distinguishing normal physiological heterogeneity from pathological change in clinical PREFUL-MRI interpretation.

Not applicable.