Search

IntroductionValidation of functional free-breathing MRI involves a comparison to more established or more direct measurements. This procedure is cost-intensive, as it requires access to patient cohorts, lengthy protocols, expenses for consumables, and binds working time. Therefore, the purpose of this study is to introduce a synthetic lung model (ASYLUM), which mimics dynamic MRI acquisition and includes predefined lung abnormalities for an alternative validation approach. The model is evaluated with different registration and quantification methods and compared with real data.MethodsA combination of trigonometric functions, deformation fields, and signal combinations were used to create 20 synthetic image time series. Lung voxels were assigned either to normal or one of six abnormality classes. The images were registered with three registration algorithms. The registered images were further analyzed with three quantification methods: deformation-based or signal-based regional ventilation (JVent/RVent) analysis and perfusion amplitude (QA). The registration results were compared with predefined deformations. Quantification methods were evaluated regarding predefined amplitudes and with respect to sensitivity, specificity, and spatial overlap of defects. In addition, 36 patients with chronic obstructive pulmonary disease were included for verification of model interpretations using CT as the gold standard.ResultsOne registration method showed considerably lower quality results (76% correlation vs. 92/97%, p ≤ 0.0001). Most ventilation defects were correctly detected with RVent and QA (e.g., one registration variant with sensitivity ≥78%, specificity ≥88). Contrary to this, JVent showed very low sensitivity for lower lung quadrants (0–16%) and also very low specificity (1–29%) for upper lung quadrants. Similar patterns of defect detection differences between RVent and JVent were also observable in patient data: Firstly, RVent was more aligned with CT than JVent for all quadrants (p ≤ 0.01) except for one registration variant in the lower left region. Secondly, stronger differences in overlap were observed for the upper quadrants, suggesting a defect bias in the JVent measurements in the upper lung regions.ConclusionThe feasibility of a validation framework for free-breathing functional lung imaging using synthetic time series was demonstrated. Evaluating different ventilation measurements, important differences were detected in synthetic and real data, with signal-based regional ventilation assessment being a more reliable method in the investigated setting.

Abstract To analyze cerebral arteriovenous pulse propagation and to generate phase-resolved pulse amplitude maps from a fast gradient-echo sequence offering flow-related enhancement (FREE). Brain MRI was performed using a balanced steady-state free precession sequence at 3T followed by retrospective k-space gating. The time interval of the pulse wave between anterior-, middle- and posterior cerebral artery territories and the superior sagittal sinus were calculated and compared between and older and younger groups within 24 healthy volunteers. Pulse amplitude maps were generated and compared to pseudo-Continuous Arterial Spin Labeling (pCASL) MRI maps by voxel-wise Pearson correlation, Sørensen-Dice maps and in regards to signal contrast. The arteriovenous delays between all vascular territories and the superior sagittal sinus were significantly shorter in the older age group (11 individuals, ≥ 31 years) ranging between 169 ± 112 and 246 ± 299 ms versus 286 ± 244 to 419 ± 299 ms in the younger age group (13 individuals) (P ≤ 0.04). The voxel-wise pulse wave amplitude values and perfusion-weighted pCASL values correlated significantly (Pearson-r = 0.33, P

PurposeThis study aimed to evaluate the diagnostic performance of perfusion-weighted phase-resolved functional lung (PW-PREFUL) magnetic resonance imaging (MRI) in patients with chronic pulmonary embolism (CPE).Materials and methodsThis study included 86 patients with suspected chronic thromboembolic pulmonary hypertension (CTEPH), who underwent PREFUL MRI and ventilation/perfusion (V/Q) single-photon emission computed tomography/computed tomography (SPECT/CT). PREFUL MRI was performed at 1.5 T using a balanced steady-state free precession sequence during free breathing. Color-coded PW images and quantitative parameters were obtained by postprocessing. Meanwhile, V/Q SPECT/CT imaging was performed as a reference standard. Hypoperfused areas in the lungs were scored for each lobe and segment using V/Q SPECT/CT images and PW-PREFUL MR images, respectively. Normalized perfusion (QN) and perfusion defect percentage (QDP) were calculated for all slices. For intra- and interobserver variability, the MRI images were analyzed 2 months after the first analysis by the same radiologist and another radiologist (11 years of lung MRI experience) blinded to the results of the first reader.ResultsOf the 86 enrolled patients, 77 met the inclusion criteria (36 diagnosed with CPE using V/Q SPECT/CT and 41 diagnosed with non-CPE etiology). For the PW-PREFUL MRI, the sensitivity, specificity, accuracy, and positive and negative predictive values for the diagnosis of CPE were 97, 95, 96, 95, and 98% at the patient level; 91, 94, 93, 91, and 94% at the lobe level, and 85, 94, 92, 88, and 94% at the segment level, respectively. The detection of segmental and subsegmental hypoperfusion using PW-PREFUL MRI revealed a moderate agreement with V/Q SPECT/CT (κ = 0.65; 95% confidence interval: 0.61–0.68). The quantitative results indicated that the QN was lower in the CPE group than in the non-CPE group [median score (interquartile range, IQR) 6.3 (2.8–9.2) vs. 13.0 (8.8–16.7), p

Phase‐resolved functional lung (PREFUL) MRI is a proton‐based, contrast agent‐free technique derived from the Fourier decomposition approach to measure regional ventilation and perfusion dynamics during free‐breathing. Besides the necessity of extensive PREFUL postprocessing, the utilized MRI sequence must fulfill specific requirements. This study investigates the impact of sequence selection on PREFUL‐MRI–derived functional parameters by comparing the standard spoiled gradient echo (SPGRE) sequence with a lung‐optimized balanced steady‐state free precession (bSSFP) sequence, thereby facilitating PREFULs clinical application in pulmonary disease assessment. This study comprised a prospective dataset of healthy volunteers and a retrospective dataset of patients with suspected chronic thromboembolic pulmonary hypertension. Both cohorts underwent PREFUL‐MRI with both sequences to assess the correspondence of PREFUL ventilation and perfusion parameters (A). Additionally, healthy subjects were scanned a second time to evaluate repeatability (B), whereas patients received dynamic contrast‐enhanced (DCE)‐MRI, considered the perfusion gold standard for comparison with PREFUL‐MRI (C). Signal‐to‐noise ratio (SNR), calculated from the unprocessed images, was compared alongside median differences of PREFUL‐MRI–derived parameters using a paired Wilcoxon signed rank test. Further evaluations included calculation of the Pearson correlation, intraclass‐correlation coefficient for repeatability assessment, and spatial overlap (SO) for regional comparison of PREFUL‐MRI and DCE‐MRI. bSSFP showed a clear SNR advantage over SPGRE (median: 23 vs. 9, p < 0.001). (A) Despite significant differences, parameter values were strongly correlated (r ≥ 0.75). After thresholding, binary maps showed high healthy overlap across both cohorts (SOHealthy > 86%) and high defect overlap in the patient cohort (SODefect ≥ 48%). (B) bSSFP demonstrated slightly higher repeatability across most parameters. (C) Both sequences demonstrated comparable correspondence to DCE‐MRI, with SPGRE excelling in absolute quantification and bSSFP in spatial agreement. Although bSSFP showed superior SNR results, both sequences displayed spatial defect concordance and highly correlated PREFUL parameters with deviations regarding repeatability and alignment with DCE‐MRI. [ABSTRACT FROM AUTHOR]

Background: Non‐contrast‐enhanced 1H magnetic resonance imaging (MRI) with full lung coverage shows promise for assessment of regional lung ventilation but a comparison with direct ventilation measurement using 19F MRI is lacking. Purpose: To compare ventilation parameters calculated using 3D phase‐resolved functional lung (PREFUL) MRI with 19F MRI. Study Type: Prospective. Population: Fifteen patients with asthma, 14 patients with chronic obstructive lung disease, and 13 healthy volunteers. Field Strength/Sequence: A 3D gradient‐echo pulse sequence with golden‐angle increment and stack‐of‐stars encoding at 1.5 T. Assessment: All participants underwent 3D PREFUL MRI and 19F MRI. For 3D PREFUL, static regional ventilation (RVent) and dynamic flow‐volume cross‐correlation metric (FVL‐CM) were calculated. For both parameters, ventilation defect percentage (VDP) values and ventilation defect (VD) maps (including a combination of both parameters [VDPCombined]) were determined. For 19F MRI, images from eight consecutive breaths under volume‐controlled inhalation of perfluoropropane were acquired. Time‐to‐fill (TTF) and wash‐in (WI) parameters were extracted. For all 19F parameters, a VD map was generated and the corresponding VDP values were calculated. Statistical Tests: For all parameters, the relationship between the two techniques was assessed using a Spearman correlation (r). Differences between VDP values were compared using Bland–Altman analysis. For regional comparison of VD maps, spatial overlap and Sørensen–Dice coefficients were computed. Results: 3D PREFUL VDP values were significantly correlated to VDP measures by 19F (r range: 0.59–0.70). For VDPRVent, no significant bias was observed with VDP of the third and fourth breath (bias range = −6.8:7.7%, P range = 0.25:0.30). For VDPFVL‐CM, no significant bias was found with VDP values of fourth–eighth breaths (bias range = −2.0:12.5%, P range = 0.12:0.75). The overall spatial overlap of all VD maps increased with each breath, ranging from 61% to 81%, stabilizing at the fourth breath. Data Conclusion: 3D PREFUL MRI parameters showed moderate to strong correlation with 19F MRI. Depending on the 3D PREFUL VD map, the best regional agreement was found to 19F VD maps of third–fifth breath. Level of Evidence: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

PurposeTo improve automated lung segmentation on 2D lung MR images using balanced augmentation and artificially-generated consolidations for training of a convolutional neural network (CNN).Materials and methodsFrom 233 healthy volunteers and 100 patients, 1891 coronal MR images were acquired. Of these, 1666 images without consolidations were used to build a binary semantic CNN for lung segmentation and 225 images (187 without consolidations, 38 with consolidations) were used for testing. To increase CNN performance of segmenting lung parenchyma with consolidations, balanced augmentation was performed and artificially-generated consolidations were added to all training images. The proposed CNN (CNNBal/Cons) was compared to two other CNNs: CNNUnbal/NoCons-without balanced augmentation and artificially-generated consolidations and CNNBal/NoCons-with balanced augmentation but without artificially-generated consolidations. Segmentation results were assessed using Sørensen-Dice coefficient (SDC) and Hausdorff distance coefficient.ResultsRegarding the 187 MR test images without consolidations, the mean SDC of CNNUnbal/NoCons (92.1 ± 6% (mean ± standard deviation)) was significantly lower compared to CNNBal/NoCons (94.0 ± 5.3%, P = 0.0013) and CNNBal/Cons (94.3 ± 4.1%, P = 0.0001). No significant difference was found between SDC of CNNBal/Cons and CNNBal/NoCons (P = 0.54). For the 38 MR test images with consolidations, SDC of CNNUnbal/NoCons (89.0 ± 7.1%) was not significantly different compared to CNNBal/NoCons (90.2 ± 9.4%, P = 0.53). SDC of CNNBal/Cons (94.3 ± 3.7%) was significantly higher compared to CNNBal/NoCons (P = 0.0146) and CNNUnbal/NoCons (P = 0.001).ConclusionsExpanding training datasets via balanced augmentation and artificially-generated consolidations improved the accuracy of CNNBal/Cons, especially in datasets with parenchymal consolidations. This is an important step towards a robust automated postprocessing of lung MRI datasets in clinical routine.

Non‐contrast enhanced 1H magnetic resonance imaging (MRI) is promising for ventilation/perfusion (V/Q) assessment of the lung but the influence of the echo time (TE) on V/Q parameters is lacking. Therefore, the purpose of this study was to investigate the influence of different TEs on pulmonary V/Q parameters derived by phase‐resolved functional lung (PREFUL) MRI using a multi‐echo ultrashort TE (UTE) acquisition. A 2D multi‐echo UTE sequence with radial center out readout and tiny golden angle increment was developed. Forty‐eight participants were enrolled in this study: 25 healthy subjects, six patients with asthma, and 17 patients with pulmonary fibrosis. Participants underwent two acquisitions of 2D multi‐echo UTE MRI with three TEs per acquisition (TE1–6: 0.07, 0.82, 1.72, 2.47, 3.37, and 4.12 ms). Regional ventilation (RVent), flow‐volume loop cross‐correlation metric (FVL‐CM), and normalized perfusion‐weighted signal (QN) maps were calculated. V/Q defect percentages (VDP/QDP) were determined. To assess repeatability, the measurement was repeated in healthy subjects. Median and interquartile range of RVent, FVL‐CM, QN, VDP, and QDP were calculated. To assess significant differences between parameters obtained at different TEs, Friedman's test and Dunnett's test were performed. Pearson correlation coefficients between RVent derived at TE1 and the difference in RVent between TE2,3 and TE1 were calculated. For repeatability assessment, coefficient of variation (CoV) and intraclass correlation coefficient (ICC) were determined. Significant differences were found comparing V/Q parameters obtained at TE3–6 compared to TE1. CoV increased with TE. For ICC, values between 0.35 (QDP at TE1) and 0.83 (VDPRVent at TE2) were obtained for T1,2. Statistically significant differences for ventilation and perfusion parameters derived by PREFUL were found for TE3–6 compared to TE1. All V/Q parameters were well repeatable for TE1–2. With increasing TE and respiratory volume, RVent shows a T2*‐dependency leading to biased ventilation assessment compared to TE1. [ABSTRACT FROM AUTHOR]

Background: Detection of pulmonary perfusion defects is the recommended approach for diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). This is currently achieved in a clinical setting using scintigraphy. Phase‐resolved functional lung (PREFUL) magnetic resonance imaging (MRI) is an alternative technique for evaluating regional ventilation and perfusion without the use of ionizing radiation or contrast media. Purpose: To assess the feasibility and image quality of PREFUL‐MRI in a multicenter setting in suspected CTEPH. Study Type: This is a prospective cohort sub‐study. Population: Forty‐five patients (64 ± 16 years old) with suspected CTEPH from nine study centers. Field Strength/Sequence: 1.5 T and 3 T/2D spoiled gradient echo/bSSFP/T2 HASTE/3D MR angiography (TWIST). Assessment: Lung signal‐to‐noise ratio (SNR) and contrast‐to‐noise ratio (CNR) were compared between study centers with different MRI machines. The contrast between normally and poorly perfused lung areas was examined on PREFUL images. The perfusion defect percentage calculated using PREFUL‐MRI (QDPPREFUL) was compared to QDP from the established dynamic contrast‐enhanced MRI technique (QDPDCE). Furthermore, QDPPREFUL was compared between a patient subgroup with confirmed CTEPH or chronic thromboembolic disease (CTED) to other clinical subgroups. Statistical Tests: t‐Test, one‐way analysis of variance (ANOVA), Pearson's correlation. Significance level was 5%. Results: Significant differences in lung SNR and CNR were present between study centers. However, PREFUL perfusion images showed a significant contrast between normally and poorly perfused lung areas (mean delta of normalized perfusion −4.2% SD 3.3) with no differences between study sites (ANOVA: P = 0.065). QDPPREFUL was significantly correlated with QDPDCE (r = 0.66), and was significantly higher in 18 patients with confirmed CTEPH or CTED (57.9 ± 12.2%) compared to subgroups with other causes of PH or with excluded PH (in total 27 patients with mean ± SD QDPPREFUL = 33.9 ± 17.2%). Data Conclusion: PREFUL‐MRI could be considered as a non‐invasive method for imaging regional lung perfusion in multicenter studies. Level of Evidence: 3 Technical Efficacy: Stage 1 [ABSTRACT FROM AUTHOR]

Abstract For sensitive diagnosis and monitoring of pulmonary disease, ionizing radiation‐free imaging methods are of great importance. A noncontrast and free‐breathing proton magnetic resonance imaging (MRI) technique for assessment of pulmonary perfusion is phase‐resolved functional lung (PREFUL) MRI. Since there is no validation of PREFUL MRI across different centers and scanners, the purpose of this study was to compare perfusion‐weighted PREFUL MRI with the well‐established dynamic contrast‐enhanced (DCE) MRI across two centers on scanners from two different vendors. Sixteen patients with cystic fibrosis (CF) (Center 1: 10 patients; Center 2: 6 patients) underwent PREFUL and DCE MRI at 1.5T in the same imaging session. Normalized perfusion‐weighted values and perfusion defect percentage (QDP) values were calculated for the whole lung and three central slices (dorsal, central, ventral of the carina). Obtained parameters were compared using Pearson correlation, Spearman correlation, Bland–Altman analysis, Wilcoxon signed‐rank test, and Wilcoxon rank‐sum test. Moderate‐to‐strong correlations between normalized perfusion‐weighted PREFUL and DCE values were found (posterior slice: r = 0.69, p 0.07). The feasibility of PREFUL MRI across two different centers and two different vendors was shown in patients with CF and obtained results were in agreement with DCE MRI.

PurposeBrain perfusion imaging is of enormous importance for various neurological diseases. Fast gradient-echo sequences offering flow-related enhancement (FREE) could present a basis to generate perfusion-weighted maps. In this study, we obtained perfusion-weighted maps without contrast media by a previously described postprocessing algorithm from the field of functional lung MRI. At first, the perfusion signal was analyzed in fast low-angle shot (FLASH) and balanced steady-state free precession (bSSFP) sequences. Secondly, perfusion maps were compared to pseudo-continuous arterial spin labeling (pCASL) MRI in a healthy cohort. Thirdly, the feasibility of the new technique was demonstrated in a small selected group of patients with metastases and acute stroke.MethodsOne participant was examined with bSSFP and FLASH sequences at 1.5T and 3T, different flip angles and slice thicknesses. Twenty-five volunteers had bSSFP imaging and pCASL MRI. Three patients with cerebral metastases and one with acute ischemic stroke had bSSFP imaging and were compared to T1 post-contrast images and CT perfusion. Frequency analyses, SNR and perfusion contrast were compared at different flip angles and slice thicknesses. Regional correlations and Sorensen-Dice overlap were calculated in the healthy cohort. Dice overlap of the pathologies in the patient cohort were calculated.ResultsThe bSSFP sequence presented detectable perfusion signal within brain vessel and parenchyma together with superior SNR compared to FLASH. Perfusion contrast and its corticomedullary differentiation increased with flip angle. Mean regional correlation was 0.36 and highly significant between FREE maps and pCASL and grey and white matter Dice match were 72% and 60% in the healthy cohort. Pathologies presented good overlap between FREE perfusion-weighted and T1 post-contrast images.ConclusionThe feasibility of FREE brain perfusion imaging has been shown in a healthy cohort and selected patient cases with brain metastases and acute stroke. The study demonstrates a new approach for non-contrast brain perfusion imaging.

Purpose: Various parameters of regional lung ventilation can be estimated using phase‐resolved functional lung (PREFUL)‐MRI. The parameter "ventilation correlation coefficient (Vent‐CC)" was shown advantageous because it assesses the dynamics of regional air flow. Calculating Vent‐CC depends on a voxel‐wise comparison to a healthy reference flow curve. This work examines the effect of placing a reference region of interest (ROI) in various lung quadrants or in different coronal slices. Furthermore, algorithms for automated ROI selection are presented and compared in terms of test–retest repeatability. Methods: Twenty‐eight healthy subjects and 32 chronic obstructive pulmonary disease (COPD) patients were scanned twice using PREFUL‐MRI. Retrospective analyses examined the homogeneity of air flow curves of various reference ROIs using cross‐correlation. Vent‐CC and ventilation defect percentage (VDP) calculated using various reference ROIs were compared using one‐way analysis of variance (ANOVA). The coefficient of variation was calculated for Vent‐CC and VDP when using different reference selection algorithms. Results: Flow‐volume curves were highly correlated between ROIs placed at various lung quadrants in the same coronal slice (r > 0.97) with no differences in Vent‐CC and VDP (ANOVA: p > 0.5). However, ROIs placed at different coronal slices showed lower correlation coefficients and resulted in significantly different Vent‐CC and VDP values (ANOVA: p < 0.001). Vent‐CC and VDP showed higher repeatability when calculated using the presented new algorithm. Conclusion: In COPD and healthy cohorts, assessing regional ventilation dynamics using PREFUL‐MRI in terms of the Vent‐CC metric showed higher repeatability using a new algorithm for selecting a homogenous reference ROI from the same slice. [ABSTRACT FROM AUTHOR]

The diagnostic strategy for chronic thromboembolic pulmonary hypertension (CTEPH) is composed of two components required for a diagnosis of CTEPH: the presence of chronic pulmonary embolism and an elevated pulmonary artery pressure. The current guidelines require that ventilation–perfusion single-photon emission computed tomography (VQ-SPECT) is used for the first step diagnosis of chronic pulmonary embolism. However, VQ-SPECT exposes patients to ionizing radiation in a radiation sensitive population. The prospective, multicenter, comparative phase III diagnostic trial CTEPH diagnosis Europe - MRI (CHANGE-MRI, ClinicalTrials.gov identifier NCT02791282) aims to demonstrate whether functional lung MRI can serve as an equal rights alternative to VQ-SPECT in a diagnostic strategy for patients with suspected CTEPH. Positive findings are verified with catheter pulmonary angiography or computed tomography pulmonary angiography (gold standard). For comparing the imaging methods, a co-primary endpoint is used. (i) the proportion of patients with positive MRI in the group of patients who have a positive SPECT and gold standard diagnosis for chronic pulmonary embolism and (ii) the proportion of patients with positive MRI in the group of patients with negative SPECT and gold standard. The CHANGE-MRI trial will also investigate the performance of functional lung MRI without i.v. contrast agent as an index test and identify cardiac, hemodynamic, and pulmonary MRI-derived parameters to estimate pulmonary artery pressures and predict 6–12 month survival. Ultimately, this study will provide the necessary evidence for the discussion about changes in the recommendations on the diagnostic approach to CTEPH.

PurposeThe purpose of this study is to evaluate the influence of different field strengths on perfusion and ventilation parameters, SNR and CNR derived by PREFUL MRI using predefined sequence parameters.MethodsData sets of free breathing 2d FLASH lung MRI were acquired from 15 healthy subjects at 1.5T and 3T (Magnetom Avanto and Skyra, Siemens Healthcare, Erlangen, Germany) with a maximum period of 3 days in between. The processed functional parameters regional ventilation (RVent), perfusion (Q), quantified perfusion (QQuant), perfusion defect percentage (QDP), ventilation defect percentage (VDP) and ventilation-perfusion match (VQM) were compared for systematic differences. Signal- and contrast-to-noise ratio (SNR and CNR) of both acquisitions were analyzed.ResultsRVent, Q, VDP, SNR and CNR presented no significant differences between 1.5T and 3T. QQuant (1.5T vs. 3T, P = 0.04), and QDP (1.5T vs. 3T, P≤0.01) decreased significantly at 3T. Consequently, VQM increased significantly (1.5T vs. 3T, P≤0.01). Skewness and kurtosis of the Q-values increased significantly at 3T (P≤0.01). The mean Sørensen-Dice coefficients between both series were 0.91 for QDP and 0.94 for VDP. The Bland-Altman analysis of both series showed mean differences of 4.29% for QDP, 1.23% for VDP and -5.15% for VQM. Using the above-mentioned parameters for three-day repeatability at two different scanners and field strengths, the retrospective power calculation showed, that a sample size of 15 can detect differences of 3.7% for QDP, of 2.9% for VDP and differences of 2.6% for VQM.ConclusionSignificant differences in QDP may be related to field inhomogeneities, which is expressed by increasing skewness and kurtosis at 3T. QQuant reveals only poor reproducibility between 1.5T and 3T. RVent, Q, VDP, SNR and CNR were not altered significantly at the used sequence parameters. Healthy participants with minimal defects present high spatial agreement of QDP and VDP.

IntroductionEx-vivo lung perfusion (EVLP) is an emerging technique promising an expansion of the donor pool and improvements in the outcome after lung transplantation. Reliable biomarkers for local assessment of organ function in the EVLP system are intensely sought after. This study aims to evaluate the feasibility of multiparametric functional magnetic resonance imaging (fMRI) in an EVLP system in a porcine aspiration model.Material and methodsSeven female pigs were anesthetized and gastric juice was instilled in the right lower lobe bronchus to simulate aspiration. Left lungs served as control. Lungs were removed and installed in a modified EVLP system. In the 12-hour EVLP run three sequential MRI scans were performed. Oxygen-washout time, Fourier Decomposition derived ventilation and perfusion, and dynamic contrast enhanced imaging derived perfusion were calculated. PaO2:FiO2 ratio was determined and correlated. End-point histology and computed tomography served as control.ResultsAll animals completed the protocol. MRI structural images showed infiltrates in lungs after aspiration comparable to CT scans. Ventilation was significantly (p = 0.016) reduced while perfusion was increased (p = 0.016) in lungs after aspiration. Non-contrast dependent Fourier decomposition perfusion showed good correlation (R2 = 0.67) to dynamic contrast enhanced derived perfusion. Oxygen washout time was significantly increased (p = 0.016) in lungs after aspiration and showed a correlation with the PaO2:FiO2 ratio (R2 = 0.54).ConclusionMultiparametric fMRI for local assessment of organ function is feasible in EVLP and detects alterations in lung function following aspiration with correlation to clinical parameters. fMRI may improve organ assessment in ex-vivo perfusion systems, leading to a better selection of segments suitable for transplant.