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. 2025 Jul 22:13:1568172.
doi: 10.3389/fped.2025.1568172. eCollection 2025.

Non-contrast enhanced functional lung MRI in children: systematic review

Carmen Streibel  1   2   3 , Grzegorz Bauman  4   5 , Oliver Bieri  4   5 , Orso Pusterla  1   4   5 , Enno Stranzinger  6 , Marion Curdy  1 , Philipp Latzin  1 , Elisabeth Kieninger  1
Affiliations

Non-contrast enhanced functional lung MRI in children: systematic review

Carmen Streibel et al. Front Pediatr. .

Abstract

Objectives: Magnetic resonance imaging (MRI) of the lung is well suited for repeated measurements especially in children due to the absence of ionizing radiation. Furthermore, non-contrast-enhanced (NCE) functional MRI techniques provide localized functional information on ventilation and perfusion without specialized set-ups (e.g., hyperpolarized gases) using standard clinical MRI systems. Current NCE-MRI techniques in the pediatric setting are matrix-pencil decomposition (MP)-MRI, phase-resolved functional lung (PREFUL)-MRI, self-gated non-contrast-enhanced functional lung (SENCEFUL)-MRI and Fourier decomposition (FD)-MRI. In this article, we comprehensively discuss these innovative techniques.

Study design: We review relevant functional NCE-MRI techniques based on a systematic literature research in MEDLINE, Embase, Cochrane Library, ClinicalTrials.gov and ICTRP. Core concepts were: 1. Aspects regarding lungs 2. MP-, PREFUL-, SENCEFUL and FD-MRI, and 3. children. Consecutively, we included 30 reports.

Results: Functional NCE-MRI in the pediatric setting has been successfully validated and used in observational studies covering a great variety of lung diseases. In contrast to initial implementation studies additionally reporting on clinical findings, later studies focus primarily on clinical topics. Heterogeneous study designs and examination protocols hamper the direct comparability between the different NCE-MRI techniques in terms of their performance against current functional imaging standards or specific objectives.

Conclusion: Their easy applicability makes NCE-MRI techniques highly attractive for widespread clinical use. Following successful implementation studies, still varying test protocols and approaches for calculating outcome values must next be compared and standardized.

Keywords: MP-MRI; MRI; children; functional lung MRI; lung function; lung imaging; 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
General workflow of functional non-contrast-enhanced MRI scans of the lung. I.: A standard clinical MRI scanner without any specialized set-up is used (a) to examine the lung at multiple slice locations (b). At each slice location, a time resolved image series is acquired during ongoing breathing and heartbeat (c). II.: The images are of each series are adjusted for respiratory motion (registration) (d) and the image area depicting lung tissue is selected (segmentation) (e). Periodic signal intensity modulations over time caused by respiration and blood-flow are analyzed voxel wise (f). III.: As the amplitudes of the modulations correspond to regional ventilation and perfusion, quantitative color maps can be calculated (g). Areas with a level of ventilation or perfusion below a certain threshold are marked as impaired (classification) (h), returning defect maps and the affected relative lung volume (VDP, ventilation defect percentage; QDP, perfusion defect percentage) as numeric outcome values (i). MRI, magnetic resonance imaging.
Figure 2
Figure 2
PRISMA 2020 flow diagram.
See this image and copyright information in PMC

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