Dynamic contrast-enhanced MRI quantifies microvascular changes in lung transplant recipients with chronic lung...

Detecting chronic lung allograft dysfunction (CLAD) remains difficult due to the lack of sensitive diagnostic markers. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can quantify microvascular perfusion and extravascular extracellular space. We performed DCE-MRI on 10 participants with CLAD (4 BOS, 3 RAS, 1 mixed, 2 undefined) and 12 without CLAD, and calculated peak enhancement (PE), wash-in rate (k_washin), area under the first 60 s of the dynamic curve (iAUC₆₀), and wash-out rate (k_washout) from signal intensity/time curves of lung regions of interest. Compared with participants without CLAD (age 61 [44-71]), those with CLAD (age 61 [54-68]) demonstrated a lower PE (p = 0.02), slower k_washin (p = 0.01), and reduced iAUC₆₀ (p = 0.01), consistent with microvascular perfusion abnormalities. The k_washout was reduced in the lungs of CLAD participants, reflecting an increased extracellular extravascular space (p = 0.02). These findings support DCE-MRI as an important tool for detecting CLAD pathophysiology.