Dynamic contrast-enhanced MRI quantifies microvascular changes in lung transplant recipients with chronic lung allograft dysfunction.

Detecting chronic lung allograft dysfunction (CLAD) remains difficult due to the lack of sensitive diagnostic markers. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can quantify microvascular perfusion and extravascular extracellular space. We performed DCE-MRI on 10 participants with CLAD (4 BOS, 3 RAS, 1 mixed, 2 undefined) and 12 without CLAD, and calculated peak enhancement (PE), wash-in rate (kwashin), area under the first 60 s of the dynamic curve (iAUC60), and wash-out rate (kwashout) from signal intensity/time curves of lung regions of interest. Compared with participants without CLAD (age 61 [44-71]), those with CLAD (age 61 [54-68]) demonstrated a lower PE (p = 0.02), slower kwashin (p = 0.01), and reduced iAUC60 (p = 0.01), consistent with microvascular perfusion abnormalities. The kwashout was reduced in the lungs of CLAD participants, reflecting an increased extracellular extravascular space (p = 0.02). These findings support DCE-MRI as an important tool for detecting CLAD pathophysiology.