Keywords: Hyperpolarized MR (Gas), LungPost-acute COVID-19 syndrome (PACS) is an umbrella term for symptoms and poor quality-of-life, four weeks+ after acute COVID-19 infection, reported in up to 30% of COVID-19 survivors. The longitudinal trajectory of PACS remains largely unknown. 129Xe MRI ventilation defects did not help to explain longitudinal quality-of-life outcomes in PACS and thus, texture analysis was used to evaluate potential ventilation features that could explain quality-of-life. We identified the 129Xe MRI ventilation texture features that predicted clinically relevant quality-of-life improvements 15-months post-infection, outperforming clinical models. These findings also suggest that ventilation texture features capture underlying pathophysiology not reflected by ventilation-defect-percent.
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