Hidden lung damage from COVID-19 revealed in new study
01/12/2020
This article is more than three years old.
Early findings from a study into longer-term damage in patients recovering from COVID-19 suggest that cutting-edge scanning techniques may detect previously unseen lung damage.
The research by the universities of Oxford and Sheffield is the first in Europe to use hyperpolarised Xenon gas with MRI scanning to identify the impact on lung function as patients recover from COVID-19, when standard MR and CT scans may be normal. The study is being supported by the NIHR Oxford Biomedical Research Centre.
In some people, the symptoms of COVID-19 can continue for many months after the infection, with many complaining of persistent breathlessness and fatigue. The virus may affect the function of the lung in ways that are not yet fully understood.
Professor Fergus Gleeson, Professor of Radiology at the University of Oxford, is collaborating with Professor Jim Wild, Professor of MR Physics at the University of Sheffield, to investigate possible reasons for patients remaining short of breath following treatment for COVID-19 pneumonia, even after discharge.
They are working with an initial group of 40 patients, 20 of them at Oxford University Hospitals (OUH) NHS Foundation Trust, over the next six months. So far, the hyperpolarised xenon MRI technique has identified weakened lung function in all patients who have taken part in the study – this damage to lungs from COVID-19 is not visible on a standard MRI or CT scan.
Professor Gleeson, a consultant radiologist at OUH and the university’s head of academic radiology, said: “We may be getting an insight into why some patients have symptoms long after they have left hospital, and when other tests are normal. This may help us identify patients that may potentially benefit from treatment even after discharge, for example with steroids or other therapies.”
Hyperpolarised xenon MRI is unique in its ability to measure gas transfer in the lungs with imaging and to identify where the damage caused by COVID-19 pneumonia has occurred.
The study follows up patients for six months after leaving hospital. Early data suggests that the ability to transfer oxygen from the lungs into the blood stream when breathing is visibly impaired for some time, even after hospital discharge following COVID-19 pneumonia.
This reduction in the function of the lungs can be detected in this research study, and may be an explanation for some patients experiencing persistent symptoms, even with seemingly 'normal' results from standard GP and hospital tests.
The striking early results have resulted in discussions to expand the study to involve more patients in the community, to identify the overall prevalence of lung damage and the speed of recovery from this virus.
Prof Gleeson is now working with others providing follow-up services for patients post COVID-19 pneumonia to identify further patients feeling long-term ill health after COVID-19 who may wish to join the study.
Professor Wild, head of imaging and NIHR research professor of magnetic resonance physics at University of Sheffield, said:
"Hyperpolarised xenon MRI offers a unique means of imaging gas exchange impairment in the lungs and identifying whether this is due to early signs of alveolar , interstitial (fibrotic), microvascular changes or a combination of all. By following up these changes with time alongside proton structural MRI we can complement the information from CT and lung function tests."
The study is funded by the NCIMI (the National Consortium of Intelligent Medical Imaging) and the University of Oxford. It forms part of the university's C-MORE (Capturing the MultiORgan Effects of COVID-19) study, and will be linked to the major national follow-up study PHOSP-COVID, led by the University of Leicester, which investigating the long-term effects of COVID-19 on hospitalised patients.
Dr Claire Bloomfield, CEO of NCIMI said:
"It's critical that we understand more about the long-term impact of COVID-19 , to ensure patients can get the best possible help with their care. NCIMI is delighted to be able to support this intelligent medical imaging research, calling on expertise from our partners and support from Innovate UK to deliver insights to improve care."
The purpose of the C-MORE-POST study is to understand in greater detail the effects of COVID-19 on the lungs, in particular how long symptoms last and whether the cause of long lasting symptoms can be identified.
The team are collecting additional lung scans using CT scans which will be analysed in detail using computer software that can identify parts of the lung that may have been affected by the virus but which are not be visible using normal scan review techniques. They are then asking a smaller group of patients to consider having hyperpolarised Xenon MRI scans, which can observe gas crossing from one part of the lung to another.
NCIMI’s mission is to integrate medical imaging, such as CT and MRI scans, with artificial intelligence and machine learning to improve patient care by transforming how medical professionals diagnose diseases and chronic conditions.
By compiling this data and engaging with patients, it is hoped that diagnosis and prevention of disease can be speeded up and whilst lowering costs, and so improving treatment options for patients.
Based at University of Oxford’s Big Data Institute, NCIMI brings together more than 25 partners including NHS trusts, medical tech companies, charities and patient groups. Current projects cover a wide range of conditions, including childhood obesity, endometriosis, diabetes, and cardiovascular disease. It is funded by Innovate UK through the Industrial Strategy Challenge Fund.