Hyperpolarized 129 Xe MRI in Pediatric Hematopoietic Stem Cell Transplant Recipients With and Without Bronchiolitis Obliterans Syndrome

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ABSTRACT Background Bronchiolitis obliterans syndrome (BOS) is the most common non‐infectious complication of allogenic hematopoietic stem cell transplantation (HSCT) and is associated with poor outcomes. Hyperpolarized 129 Xe MRI (Xe‐MRI) holds promise for sensitive and non‐ionizing imaging of lung ventilation in children and has been explored in the post‐HSCT population. However, previous work was weighted towards children without BOS. In this pilot cross‐sectional study, we hypothesize that ventilation abnormalities measured with Xe‐MRI are increased in pediatric post‐HSCT participants with BOS compared to those without. Methods Two groups of pediatric post‐HSCT participants were recruited: those with a diagnosis or clinical findings consistent with BOS and those without. Xe‐MRI was performed to calculate the ventilation defect percentage (VDP) and ventilation heterogeneity index (VHI) in all subjects. Group‐wise differences were tested with Mann‐Whitney U ‐test. Xe‐MRI was compared to same‐day spirometry and nitrogen multiple breath washout (MBW). Results Twelve (6 non‐BOS and 6 BOS) participants aged 9–17 years (median 12.5 years) were recruited. VDP (median [range]) was elevated ( p < 0.05) in participants with BOS (11.8 [4.3, 20.8]%) compared to those without BOS (4.0 [3.1, 4.9]%). A similar elevation ( p < 0.01) in VHI was observed in those with BOS (12.1 [8.3, 16.3])%) compared to those without (7.4 [7.4, 8.1]%). Both VDP and VHI were correlated with forced expiratory volume in 1‐second (FEV 1 ) and the lung clearance index (LCI), while VDP also correlated with FEV 1 over forced vital capacity ratio (FEV 1 /FVC). Conclusion Xe‐MRI ventilation measures were elevated in pediatric post‐HSCT participants within the BOS group compared to those without BOS and correlated with same‐day spirometry and MBW.

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