SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) is a new coronavirusand identified causative agent of COVID-19 disease. These viruses predominantly causemild colds, but can sometimes cause severe pneumonia and pulmonary skeletal changes. Bylow-field gastric magnetic resonance imaging (NF-MRI), only a small number of structural,scarring changes were seen in a preliminary study of pediatric and adolescent patientswith past SARS-CoV-2 infection. In contrast, however, extensive changes in ventilationand blood flow function of the lungs were seen.The long-term consequences and spontaneous progression of these changes on imaging arecompletely unclear. The aim of this study is to assess the course of these functionallung changes in pediatric and adolescent patients and to validate them with otherstandard clinical procedures.
SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) is a new coronavirus
and identified causative agent of COVID-19 disease. They predominantly cause mild colds
but can sometimes cause severe pneumonia and pulmonary skeletal disease. While the
molecular basis for the changes in lung tissue or multi-organ involvement have been
described, the age-specific long-term consequences, especially in children and
adolescents, remain largely unexplained and misunderstood today.
Early publications from the primarily affected Chinese provinces described rather mild,
partly asymptomatic courses in children. This is consistent with the observation that the
risk of severe COVID-19 disease increases steeply from the age of 70 years, and is also
determined by the severity of obesity as well as other risk factors. Developmental
expression of tissue factors may be one reason for the relative protection of younger
patients from severe courses of the disease.
However, it is now becoming increasingly clear that some individuals with milder initial
symptoms of COVID-19 may suffer from variable and persistent symptoms for many months
after initial infection - this includes children. A modern low-field MRI is located in
Erlangen, Germany. This technique has already been used to demonstrate persistent damage
to lung tissue in adult patients after COVID-19. The device with a field strength of 0.55
Tesla (T) currently has the world's largest aperture (and is thus particularly suitable
for patients with claustrophobia, among other things), a very quiet operating noise, and
lower energy absorption in the tissue due to the weaker magnetic field than MRI scanners
with 1.5T or 3T. This allows MRI imaging in a very broad pediatric population without the
need for sedation.
To date, no structural changes were revealed by means of this MRI technique - however,
large defects in the area of ventilation and blood flow function of the lung are apparent
in specific functional sequences. The aim of this study is to assess the course of these
functional lung changes in pediatric and adolescent patients and to validate them with
other standard clinical procedures.
Diagnostic Test: Low-field magnetic resonance imaging
Functional and morphologic imaging of the lungs
Other Name: LF-MRI
Diagnostic Test: Nailfold capillaroscopy
Imaging of nailfold microvasculature
Diagnostic Test: Spiroergometry
Cardiopulmonary exercise testing
Diagnostic Test: Realtime deformability cytometry
High-throughput measurement of cell deformability and physical properties
Other Name: RT-DC
Control arm:
Inclusion Criteria:
- Proof of SARS-CoV-2 infection and at least 2/3 times complete vaccination before
infection (at least 14 days) (complete vaccination status according to German
recommendations)
- Long Covid criteria not met according to AWMF S1 guideline
Exclusion Criteria:
- Acute SARS-CoV-2 infection and need for isolation
- Necessary quarantine
- Pregnancy, lactation
- Indication of acute infection
- Known pleural or pericardial effusion
- Critical condition (need for respiratory support, ventilation, oxygen
administration, shock, symptomatic heart failure)
- Marked thoracic deformities
- Previous lung surgery
- Injuries that do not allow for physical stress testing
- Refusal of MRI imaging
- General contraindications to MRI examinations (e.g., electrical implants such as
pacemakers or perfusion pumps, etc.)
- History, clinical, or other suspicion of pulmonary disease
- Current respiratory infection/symptomatology
- Pain leading to respiratory limitation
- Inhaled therapy (e.g., steroids or beta-mimetics)
- Immunosuppression
- Any condition that may lead to respiratory limitation (e.g., pain disorder)
- Obesity (>97% of age percentile)
Recovered arm:
Inclusion Criteria:
- Positive SARS-CoV-2 infection confirmed by PCR
- Long Covid criteria not met according to AWMF S1 guideline
Exclusion Criteria:
- Acute SARS-CoV-2 infection and need for isolation
- Necessary quarantine
- Pregnancy, lactation
- Indication of acute infection
- Known pleural or pericardial effusion
- Critical condition (need for respiratory support, ventilation, oxygen
administration, shock, symptomatic heart failure)
- Marked thoracic deformities
- Previous lung surgery
- Injuries that do not allow for physical stress testing
- Refusal of MRI imaging
- General contraindications to MRI examinations (e.g., electrical implants such as
pacemakers or perfusion pumps, etc.)
Long Covid arm:
Inclusion Criteria:
- Positive SARS-CoV-2 infection confirmed by PCR
- Long Covid criteria according to AWMF S1 guideline fulfilled
Exclusion Criteria:
- Acute SARS-CoV-2 infection and need for isolation
- Necessary quarantine
- Pregnancy, lactation
- Indication of acute infection
- Known pleural or pericardial effusion
- Critical condition (need for respiratory support, ventilation, oxygen
administration, shock, symptomatic heart failure)
- Marked thoracic deformities
- Previous lung surgery
- Injuries that do not allow for physical stress testing
- Refusal of MRI imaging
- General contraindications to MRI examinations (e.g., electrical implants such as
pacemakers or perfusion pumps, etc.)
University Hospital Erlangen
Erlangen, Bavaria, Germany
Investigator: Ferdinand Knieling, MD
Contact: +49913185
ki-forschung@uk-erlangen.de
Ferdinand Knieling, MD
+49913185 - 33118
ferdinand.knieling@uk-erlangen.de
Ferdinand Knieling, MD, Principal Investigator
University Hospital Erlangen