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. 2025 Mar 13:13:1519148.
doi: 10.3389/fped.2025.1519148. eCollection 2025.

Non-contrast enhanced functional lung MRI in children: report on 900 own measurements using matrix-pencil decomposition (MP-) MRI

Carmen Streibel  1   2   3 , Grzegorz Bauman  4   5 , Oliver Bieri  4   5 , Orso Pusterla  1   4   5 , Enno Stranzinger  6 , C Corin Willers  1 , Marion Curdy  1 , Carmen Casaulta  1 , Bettina Sarah Frauchiger  1 , Insa Korten  1 , Sophie Yammine  1 , Yasmin Salem  1 , Philipp Latzin  1 , Elisabeth Kieninger  1
Affiliations

Non-contrast enhanced functional lung MRI in children: report on 900 own measurements using matrix-pencil decomposition (MP-) MRI

Carmen Streibel et al. Front Pediatr. .

Abstract

Objectives: Functional imaging of the lungs enables a spatially resolved examination of pulmonary ventilation and perfusion. Non-contrast-enhanced (NCE) magnetic resonance imaging (MRI) techniques do not require specialized set-ups (e.g., hyperpolarized gases), but are applicable on standard clinical MRI scanners. Since patients are not exposed to ionizing radiation during the examinations, NCE-MRI is highly attractive for use in pediatrics, especially in children with chronic lung diseases requiring repeated follow-up measurements.

Study design: We report on our own experience of more than 900 NCE-MRI measurements in children over seven years using matrix pencil decomposition (MP-)MRI. We present original data, i.e., clinical cases in which MP-MRI helped in clinical decision-making together with valuable practical points.

Results: At our center, an optimized workflow including a child-friendly setting and automated provision of outcome protocols led to great acceptance of functional NCE-MRI in patients and clinicians. Within this setting, regular MP-MRI measurements were successfully implemented into clinical routine and proved to be very helpful for surveillance and specific clinical decision-making. We present exemplary cases illustrating the potential of NCE-MRI as a diagnostic tool.

Conclusion: In this article, we summarize our unique experience of a large number of MP-MRI measurements. We give an overview on our workflow including standardized and automated analysis and reporting. The exemplary cases from different disease groups illustrate its value in the clinical setting. In conclusion, visualizing regional functional deficits and respective underlying pathophysiological nature of lung impairment seems promising for increasing use of NCE-MRI in the future.

Keywords: MP-MRI; children; functional lung MRI; lung function; pulmonology.

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Conflict of interest statement

OB has received money from the Swiss National Science Foundation (SNF 320030_149576). PL received within the past 36 months payment by: Grants or contracts (Vertex and OM Pharma - paid to his institution), Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events (Vertex, Vifor, OM Pharma - paid to his institution and to him), Participation on a Data Safety Monitoring Board or Advisory Board (Polyphor, Vertex, OM Pharma, Vifor – paid to his institution and to him, Santhera (DMC), Allecra, Sanofi Aventis – paid to him). EK has within the past 36 months received Speaker Honorar by Sanofi Aventis and Vertex. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
903 MP-MRI measurements in 473 individuals during seven years. (A) MP-MRI measurements sorted by disease groups. (B) Age-Distribution of patients having performed MP-MRI measurements, sorted by sex. n (absolute number of measurements). MRI, magnetic resonance imaging; MP-MRI, matrix pencil decomposition MRI.
Figure 2
Figure 2
Overview on the applied workflow having ensured successful implementation of MP-MRI measurements. MRI, magnetic resonance imaging; Dep., department; min, minutes; MP-MRI, matrix pencil decomposition MRI; T, Tesla; 2D, two dimensional.
Figure 3
Figure 3
Instructions for a playful introduction to an upcoming MP-MRI scan at home—illustration. In preparation for the upcoming MP-MRI measurement, the children and their parents or care givers receive this illustration together with instructions from Table 1 so that they can familiarize themselves with the expected conditions already at home. The numbers in the rectangles refer to the corresponding rows in Table 1.
Figure 4
Figure 4
Case 1. 14-year-old patient with cystic fibrosis (I) at clinical deterioration including mucus plugging of the right upper lobar bronchus (arrow), (II) after bronchoscopic removal of mucus plug, (III) after ELX/TEZ/IVA therapy start and (IV) at follow-up after ELX/TEZ/IVA therapy start. Morphological images (coronal T2 blade FS sequence, 5 mm) (a), fractional ventilation (b) and perfusion (c) maps, masks representing areas with impaired ventilation (d), perfusion (e) and matched ventilation and perfusion defects (f) are shown. On the heat maps, a change of color range towards dark blue indicates severe impairment of lung ventilation or perfusion. ELX/TEZ/IVA, elexacaftor/tezacaftor/ivacaftor combination regimen; FV, fractional ventilation; MP-MRI, matrix-pencil magnetic resonance imaging; Q, perfusion; V, ventilation.
Figure 5
Figure 5
Case 2. 5-year-old patient with necrotizing pneumonia, surgical removal of the right upper lung lobe and remaining right middle and lower lung lobe (arrow) (I) at acute state of disease, (II) at 2-years follow-up and (III) at 5-years follow-up. Morphological images (coronal T2 blade FS sequence, 5 mm) (a), fractional ventilation (b) and perfusion (c) maps, masks representing areas with impaired ventilation (d), perfusion (e) and matched ventilation and perfusion defects (f) are shown. On the heat maps, a change of color range towards dark blue indicates severe impairment of lung ventilation or perfusion. FV, fractional ventilation; MP-MRI, matrix-pencil magnetic resonance imaging; Q, perfusion; V, ventilation.
Figure 6
Figure 6
Case 3. 16-year-old patient with sickle-cell disease. Morphological images (coronal T2 blade FS sequence, 5 mm) (a), fractional ventilation (b) and perfusion (c) maps, masks representing areas with impaired ventilation (d), perfusion (e) and matched ventilation and perfusion defects (f) are shown. On the heat maps, a change of color range towards dark blue indicates severe impairment of lung ventilation or perfusion. FV, fractional ventilation; MP-MRI, matrix-pencil magnetic resonance imaging; Q, perfusion; V, ventilation.
Figure 7
Figure 7
Case 4. 14-year-old patient with bronchiolitis obliterans. Morphological images (coronal T2 blade FS sequence, 5 mm) (a), fractional ventilation (b) and perfusion (c) maps, masks representing areas with impaired ventilation (d), perfusion (e) and matched ventilation and perfusion defects (f) are shown. On the heat maps, a change of color range towards dark blue indicates severe impairment of lung ventilation or perfusion. FV, fractional ventilation; MP-MRI, matrix-pencil magnetic resonance imaging; Q, perfusion; V, ventilation.
Figure 8
Figure 8
Case 5. 9-year-old patient with congenital diaphragmatic hernia (arrow) and post-natal repair using a muscle-flap. Morphological images (coronal T2 blade FS sequence, 5 mm) (a), fractional ventilation (b) and perfusion (c) maps, masks representing areas with impaired ventilation (d), perfusion (e) and matched ventilation and perfusion defects (f) are shown. On the heat maps, a change of color range towards dark blue indicates severe impairment of lung ventilation or perfusion. FV, fractional ventilation; MP-MRI, matrix-pencil magnetic resonance imaging; Q, perfusion; V, ventilation.
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