Low-field Magnetic Resonance Imaging in Pediatric Post Covid-19

NCT ID: NCT05445531

Last Updated: 2022-07-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

111 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-07-08

Study Completion Date

2023-03-31

Brief Summary

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SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) is a new coronavirus and identified causative agent of COVID-19 disease. These viruses predominantly cause mild colds, but can sometimes cause severe pneumonia and pulmonary skeletal changes. By low-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 patients with past SARS-CoV-2 infection. In contrast, however, extensive changes in ventilation and blood flow function of the lungs were seen.

The long-term consequences and spontaneous progression of these changes on imaging are completely unclear. 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.

Detailed Description

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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.

Conditions

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COVID-19 COVID-19 Respiratory Infection Long COVID

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Control

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 STIKO, German vaccination committee)

Group Type ACTIVE_COMPARATOR

Low-field magnetic resonance imaging

Intervention Type DIAGNOSTIC_TEST

Functional and morphologic imaging of the lungs

Nailfold capillaroscopy

Intervention Type DIAGNOSTIC_TEST

Imaging of nailfold microvasculature

Spiroergometry

Intervention Type DIAGNOSTIC_TEST

Cardiopulmonary exercise testing

Realtime deformability cytometry

Intervention Type DIAGNOSTIC_TEST

High-throughput measurement of cell deformability and physical properties

Recovered

Positive SARS-CoV-2 infection confirmed by PCR; Long Covid criteria according to AWMF S1 guideline not fulfilled.

Group Type ACTIVE_COMPARATOR

Low-field magnetic resonance imaging

Intervention Type DIAGNOSTIC_TEST

Functional and morphologic imaging of the lungs

Nailfold capillaroscopy

Intervention Type DIAGNOSTIC_TEST

Imaging of nailfold microvasculature

Spiroergometry

Intervention Type DIAGNOSTIC_TEST

Cardiopulmonary exercise testing

Realtime deformability cytometry

Intervention Type DIAGNOSTIC_TEST

High-throughput measurement of cell deformability and physical properties

Long Covid

Positive SARS-CoV-2 infection confirmed by PCR; Long Covid criteria according to AWMF S1 guideline fulfilled.

Group Type EXPERIMENTAL

Low-field magnetic resonance imaging

Intervention Type DIAGNOSTIC_TEST

Functional and morphologic imaging of the lungs

Nailfold capillaroscopy

Intervention Type DIAGNOSTIC_TEST

Imaging of nailfold microvasculature

Spiroergometry

Intervention Type DIAGNOSTIC_TEST

Cardiopulmonary exercise testing

Realtime deformability cytometry

Intervention Type DIAGNOSTIC_TEST

High-throughput measurement of cell deformability and physical properties

Interventions

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Low-field magnetic resonance imaging

Functional and morphologic imaging of the lungs

Intervention Type DIAGNOSTIC_TEST

Nailfold capillaroscopy

Imaging of nailfold microvasculature

Intervention Type DIAGNOSTIC_TEST

Spiroergometry

Cardiopulmonary exercise testing

Intervention Type DIAGNOSTIC_TEST

Realtime deformability cytometry

High-throughput measurement of cell deformability and physical properties

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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LF-MRI RT-DC

Eligibility Criteria

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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


* Positive SARS-CoV-2 infection confirmed by PCR
* Long Covid criteria not met according to AWMF S1 guideline


* 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.)
* 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:


* 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:


* 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.)
Minimum Eligible Age

5 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Erlangen-Nürnberg Medical School

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ferdinand Knieling, MD

Role: PRINCIPAL_INVESTIGATOR

University Hospital Erlangen

Locations

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University Hospital Erlangen

Erlangen, Bavaria, Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Ferdinand Knieling, MD

Role: CONTACT

+49913185 ext. 33118

Facility Contacts

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Ferdinand Knieling, MD

Role: primary

+49913185 ext. 33118

References

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Reference Type BACKGROUND
PMID: 33046696 (View on PubMed)

Ziegler CGK, Allon SJ, Nyquist SK, Mbano IM, Miao VN, Tzouanas CN, Cao Y, Yousif AS, Bals J, Hauser BM, Feldman J, Muus C, Wadsworth MH 2nd, Kazer SW, Hughes TK, Doran B, Gatter GJ, Vukovic M, Taliaferro F, Mead BE, Guo Z, Wang JP, Gras D, Plaisant M, Ansari M, Angelidis I, Adler H, Sucre JMS, Taylor CJ, Lin B, Waghray A, Mitsialis V, Dwyer DF, Buchheit KM, Boyce JA, Barrett NA, Laidlaw TM, Carroll SL, Colonna L, Tkachev V, Peterson CW, Yu A, Zheng HB, Gideon HP, Winchell CG, Lin PL, Bingle CD, Snapper SB, Kropski JA, Theis FJ, Schiller HB, Zaragosi LE, Barbry P, Leslie A, Kiem HP, Flynn JL, Fortune SM, Berger B, Finberg RW, Kean LS, Garber M, Schmidt AG, Lingwood D, Shalek AK, Ordovas-Montanes J; HCA Lung Biological Network. Electronic address: [email protected]; HCA Lung Biological Network. SARS-CoV-2 Receptor ACE2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues. Cell. 2020 May 28;181(5):1016-1035.e19. doi: 10.1016/j.cell.2020.04.035. Epub 2020 Apr 27.

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Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 33278357 (View on PubMed)

Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, Zhang W, Wang Y, Bao S, Li Y, Wu C, Liu H, Liu D, Shao J, Peng X, Yang Y, Liu Z, Xiang Y, Zhang F, Silva RM, Pinkerton KE, Shen K, Xiao H, Xu S, Wong GWK; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 Infection in Children. N Engl J Med. 2020 Apr 23;382(17):1663-1665. doi: 10.1056/NEJMc2005073. Epub 2020 Mar 18. No abstract available.

Reference Type BACKGROUND
PMID: 32187458 (View on PubMed)

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PMID: 33442016 (View on PubMed)

Schuler BA, Habermann AC, Plosa EJ, Taylor CJ, Jetter C, Negretti NM, Kapp ME, Benjamin JT, Gulleman P, Nichols DS, Braunstein LZ, Hackett A, Koval M, Guttentag SH, Blackwell TS, Webber SA, Banovich NE; Vanderbilt COVID-19 Consortium Cohort; Human Cell Atlas Biological Network; Kropski JA, Sucre JM. Age-determined expression of priming protease TMPRSS2 and localization of SARS-CoV-2 in lung epithelium. J Clin Invest. 2021 Jan 4;131(1):e140766. doi: 10.1172/JCI140766.

Reference Type BACKGROUND
PMID: 33180746 (View on PubMed)

Heiss R, Grodzki DM, Horger W, Uder M, Nagel AM, Bickelhaupt S. High-performance low field MRI enables visualization of persistent pulmonary damage after COVID-19. Magn Reson Imaging. 2021 Feb;76:49-51. doi: 10.1016/j.mri.2020.11.004. Epub 2020 Nov 18.

Reference Type BACKGROUND
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Shelmerdine SC, Lovrenski J, Caro-Dominguez P, Toso S; Collaborators of the European Society of Paediatric Radiology Cardiothoracic Imaging Taskforce. Coronavirus disease 2019 (COVID-19) in children: a systematic review of imaging findings. Pediatr Radiol. 2020 Aug;50(9):1217-1230. doi: 10.1007/s00247-020-04726-w. Epub 2020 Jun 18.

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Steinberger S, Lin B, Bernheim A, Chung M, Gao Y, Xie Z, Zhao T, Xia J, Mei X, Little BP. CT Features of Coronavirus Disease (COVID-19) in 30 Pediatric Patients. AJR Am J Roentgenol. 2020 Dec;215(6):1303-1311. doi: 10.2214/AJR.20.23145. Epub 2020 May 22.

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Weigelt A, Akhundova G, Raming R, Tratzky JP, Regensburger AP, Kraus C, Waellisch W, Trollmann R, Woelfle J, Dittrich S, Heiss R, Knieling F, Schoeffl I. Light at the end of the tunnel? Follow-up of cardiopulmonary function in children with post-COVID-19. Eur J Pediatr. 2025 Jun 10;184(7):413. doi: 10.1007/s00431-025-06245-y.

Reference Type DERIVED
PMID: 40495009 (View on PubMed)

Other Identifiers

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22-77-Bm

Identifier Type: -

Identifier Source: org_study_id

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