Cardiopulmonary magnetic resonance imaging in children after lung transplantation: Preliminary observations

Background: Lung transplantation carries a guarded prognosis and is burdened by short-term and long-term complications that affect the airway, lungs, and vasculature. In this pilot study we aimed to assess the feasibility of magnetic resonance imaging (MRI) in 8 pediatric patients after lung transplantation. Methods: The 8 patients in the study were aged between 9 and 17 years and were clinically stable. The scan protocol included MR angiography, phase contrast imaging of the pulmonary arteries and veins, ventricular volumetry, lung parenchyma imaging, and lung volumetry. Results: This protocol was successfully done in all patients. Lung volumes measured by MRI correlated well with those by body plethysmography (r = 0.83, p = 0.01). Angiography detected caliber differences between the donor and recipient pulmonary arteries in 5 patients. One patient had hemodynamically relevant pulmonary vein stenosis, as evidenced by MR angiography, a reduction in ipsilateral flow, and an abnormal pulmonary venous flow profile. Three patients had mild left (2 patients) or right (1 patient) ventricular systolic dysfunction. One patient had left main bronchus compression, and 3 patients showed varying degrees of pleural thickening. Conclusions: Our preliminary experience suggests that cardiopulmonary MRI is feasible in pediatric lung transplant recipients and that it provides clinically useful information, especially on the vascular and bronchial anastomoses. However, the value of MRI for routine follow-up in pediatric lung transplant patients needs to be determined in a larger cohort.