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Objectives <p>Idiopathic pulmonary fibrosis (IPF) is the most common interstitial lung disease. New non-invasive tools to monitor pulmonary function, disease progression, and therapeutic response are needed. The study was aimed to investigate the role of hyperpolarized 3He and 129Xe MRI in IPF compared with pulmonary function tests and CT.</p> Methods <p>A systematic literature review was performed in accordance with the PRISMA guidelines. A specific question based on PICO method was formulated to develop the search strategy, which was limited to English language articles focused on functional hyperpolarized gas MRI on patients affected by IPF. Exclusion criteria were represented by preclinical studies, studies on animals, studies on explanted lungs, conference abstracts, reviews, and case reports. Search was conducted up to September 30, 2025, via PubMed, Embase, Web of Science, and Scopus databases. Data extracted included gas volume inhaled, MRI metrics and sequences, CT imaging comparison, and pulmonary function tests comparison. QUADAS-2 and QUADAS-C were used to assess the risk of bias.</p> Results <p>The inclusion criteria were met by 19 studies, which analyzed a minimum of 3 and a maximum of 34 patients. 129Xe was the most frequently employed gas. No defined MRI protocol emerged from the selected studies. A comparison between CT and hyperpolarized gas MRI showed conflicting results, whereas good correlations were observed between hyperpolarized gas MRI, spirometry, and DLco parameters. For example, the correlation between RBC to barrier and DLco was particularly strong (<i>R</i> = 0.94, <i>p</i> &lt; 0.01). Finally, an overall medium/low risk of bias was found.</p> Conclusions <p>Hyperpolarized gas MRI was a potentially promising technique to assess disease progression, response to therapy and prognosis. Nevertheless, such technique needed standardized longitudinal multicenter clinical trials and larger samples to define imaging protocols and to test its capability in detecting IPF changes over time. CT must still be considered crucial in the diagnosis of IPF since typical hyperpolarized gas MRI metrics of IPF remain to be defined at present.</p>

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Functional hyperpolarized gas magnetic resonance imaging of idiopathic pulmonary fibrosis: a systematic review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月7日

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  • David Zaccagnini,
  • Andrea Magnini,
  • Lorenzo Cinci,
  • Linda Calistri,
  • Diletta Cozzi,
  • Nicholas Landini,
  • Vittorio Miele,
  • Cosimo Nardi

摘要

Objectives

Idiopathic pulmonary fibrosis (IPF) is the most common interstitial lung disease. New non-invasive tools to monitor pulmonary function, disease progression, and therapeutic response are needed. The study was aimed to investigate the role of hyperpolarized 3He and 129Xe MRI in IPF compared with pulmonary function tests and CT.

Methods

A systematic literature review was performed in accordance with the PRISMA guidelines. A specific question based on PICO method was formulated to develop the search strategy, which was limited to English language articles focused on functional hyperpolarized gas MRI on patients affected by IPF. Exclusion criteria were represented by preclinical studies, studies on animals, studies on explanted lungs, conference abstracts, reviews, and case reports. Search was conducted up to September 30, 2025, via PubMed, Embase, Web of Science, and Scopus databases. Data extracted included gas volume inhaled, MRI metrics and sequences, CT imaging comparison, and pulmonary function tests comparison. QUADAS-2 and QUADAS-C were used to assess the risk of bias.

Results

The inclusion criteria were met by 19 studies, which analyzed a minimum of 3 and a maximum of 34 patients. 129Xe was the most frequently employed gas. No defined MRI protocol emerged from the selected studies. A comparison between CT and hyperpolarized gas MRI showed conflicting results, whereas good correlations were observed between hyperpolarized gas MRI, spirometry, and DLco parameters. For example, the correlation between RBC to barrier and DLco was particularly strong (R = 0.94, p < 0.01). Finally, an overall medium/low risk of bias was found.

Conclusions

Hyperpolarized gas MRI was a potentially promising technique to assess disease progression, response to therapy and prognosis. Nevertheless, such technique needed standardized longitudinal multicenter clinical trials and larger samples to define imaging protocols and to test its capability in detecting IPF changes over time. CT must still be considered crucial in the diagnosis of IPF since typical hyperpolarized gas MRI metrics of IPF remain to be defined at present.