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RATIONALE AND OBJECTIVES: The long-term trajectories of pulmonary perfusion and ventilation after recovery from SARS-CoV-2 infection are lacking. This study aims to longitudinally assess changes in perfusion (QDP) and ventilation (VDP) defects using phase-resolved functional lung (PREFUL) MRI in post-SARS-CoV-2 infection. MATERIALS AND METHODS: This prospective study was conducted from January to May 2023 and included non-hospitalized, COVID-19-positive patients with pneumonia or symptoms suggestive of pneumonia, as well as healthy controls. Serial MRI scans were performed at acute, 3, 6, and 12 months after symptom onset, and healthy controls underwent only one MRI scan. Longitudinal comparisons of QDP and VDP(Combined) were employed by linear mixed-effects models. Long COVID was defined as persistent SARS-CoV-2 symptoms for at least three months, with associated factors identified through logistic regression. RESULTS: A total of 60 participants (median age 68.5 years; 30 female) were included. VDP(Combined) was 21 %, 18 %, 16 %, and 13 % at the acute phase, 3 months, 6 months, and 12 months, respectively, with a significant difference observed in the longitudinal comparison (P = 0.034). Moreover, at 12 months, VDP(Combined) showed no significant difference compared to the healthy control (P = 0.280). QDP also decreased (42 %, 36 %, 35 %, and 19 % at acute, 3 months, 6 months, and 12 months, respectively; P < 0.001), but remained significantly higher than in healthy controls at 12 months (P < 0.001). At follow-up, 55 % of participants (33 of 60) had long COVID, with higher acute-phase QDP associated with increased odds of developing long COVID (odds ratio, 1.20; P = 0.001). CONCLUSION: Pulmonary perfusion impairment persists up to 12 months following SARS-CoV-2 infection. Severe perfusion defects during acute phase are a risk factor for the development of long COVID.
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