• Review •
Current status of magnetic resonance imaging in connective tissue disease-associated interstitial lung disease
Cite this article as: YANG T Y, PU D D, YU N. Current status of magnetic resonance imaging in connective tissue disease-associated interstitial lung disease[J]. Chin J Magn Reson Imaging, 2025, 16(3): 167-172. DOI:10.12015/issn.1674-8034.2025.03.028.
| [Abstract] High-resolution computed tomography (HRCT), regarded as the "gold standard" for the diagnosis of connective tissue disease-interstitial lung disease (CTD-ILD), due to the problem of radiation exposure, its application in the long-term dynamic monitoring of diseases is restricted. Magnetic resonance imaging (MRI), a non-radiation and multi-parameter imaging technology, can provide quantitative information on lung ventilation, perfusion, tissue hardness, and biomechanical properties. It enables the non-invasive assessment of pathological changes and disease progression in CTD-ILD. This article systematically reviews the current application status of MRI in CTD-ILD. It focuses on analyzing the potential of techniques such as ultrashort echo time (UTE), Magnetic resonance elastography (MRE), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and hyperpolarized 129Xe magnetic resonance imaging (HP 129Xe MRI) in the diagnosis, classification, and efficacy evaluation of CTD-ILD. Moreover, it explores the limitations of current technologies and future development directions, aiming to provide new ideas for optimizing the clinical management of CTD-ILD. |
| [Keywords] connective tissue disease-related interstitial lung disease；magnetic resonance imaging；ultrashort echo time series；hyperpolarized 129Xe magnetic resonance imaging；molecular imaging |
YANG Tengyue1
PU Doudou2
YU Nan1,
2*
1 School of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang 712046, China
2 Department of Medical Imaging, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712000, China
Corresponding author: YU N, E-mail: yunan0512@sina.com
Conflicts of interest None.
| Received 2025-01-07 |
| Accepted 2025-03-10 |
| DOI: 10.12015/issn.1674-8034.2025.03.028 |
| Cite this article as: YANG T Y, PU D D, YU N. Current status of magnetic resonance imaging in connective tissue disease-associated interstitial lung disease[J]. Chin J Magn Reson Imaging, 2025, 16(3): 167-172. DOI:10.12015/issn.1674-8034.2025.03.028. |
[1]
2018 Chinese expert-based consensus statement regarding the diagnosis and treatment of interstitial lung disease associated with connective tissue diseases[J]. Chin J Intern Med, 2018, 57(8): 558-565.
DOI:
10.3760/cma.j.issn.0578-1426.2018.08.005.
[2]
YOO H, HINO T, HWANG J, et al. Connective tissue disease-related interstitial lung disease (CTD-ILD) and interstitial lung abnormality (ILA): Evolving concept of CT findings, pathology and management[J/OL]. Eur J Radiol Open, 2022, 9: 100419 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/35445144/.
DOI:
10.1016/j.ejro.2022.100419.
[3]
GUIOT J, MIEDEMA J, CORDEIRO A, et al. Practical guidance for the early recognition and follow-up of patients with connective tissue disease-related interstitial lung disease[J/OL]. Autoimmun Rev, 2024, 23(6): 103582 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/39074630/.
DOI:
10.1016/j.autrev.2024.103582.
[4]
KUWANA M, BANDO M, KAWAHITO Y, et al. Identification and management of connective tissue disease-associated interstitial lung disease: evidence-based Japanese consensus statements[J]. Expert Rev Respir Med, 2023, 17(1): 71-80.
DOI:
10.1080/17476348.2023.2176303.
[5]
JOY G M, ARBIV O A, WONG C K, et al. Prevalence, imaging patterns and risk factors of interstitial lung disease in connective tissue disease: a systematic review and meta-analysis[J/OL]. Eur Respir Rev, 2023, 32(167): 220210 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/36889782/.
DOI:
10.1183/16000617.0210-2022.
[6]
SHAH GUPTA R, KOTECI A, MORGAN A, et al. Incidence and prevalence of interstitial lung diseases worldwide: a systematic literature review[J/OL]. BMJ Open Respir Res, 2023, 10(1): e001291 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/37308252/.
DOI:
10.1136/bmjresp-2022-001291.
[7]
ZOU Q H, LU Y W, ZHOU J G, et al. Recommendations for the diagnosis and treatment of connective tissue disease-associated interstitial lung disease in China[J]. Chin J Intern Med, 2022, 61(11): 1217-1223.
DOI:
10.3760/cma.j.cn112138-20220525-00406.
[8]
WU T T, ZHOU H J, XU S L, et al. Clinical and HRCT features of amyopathic dermatomyositis associated with interstitial lung disease: a retrospective study of 128 patients with connective tissue disease-related interstitial lung disease[J]. Am J Med Sci, 2023, 365(5): 429-436.
DOI:
10.1016/j.amjms.2022.12.001.
[9]
JOKERST C, YADDANAPUDI K, CHAUDHARY S, et al. Imaging innovations in the screening, diagnosis, and monitoring of systemic autoimmune disease-related interstitial lung disease[J/OL]. EMJ Radiol, 2024: 71-81 [2025-01-06]. https://www.sciencedirect.com/science/article/abs/pii/S0121812323000579.
DOI:
10.33590/emjradiol/11000033.
[10]
DE PAULA W D, RODRIGUES M P, FERREIRA N M C, et al. Lung MRI to predict response or lack of response to treatment in interstitial lung disease: initial observations on SSFSE/PROPELLER T2 match/mismatch[J]. Expert Rev Respir Med, 2021, 15(2): 285-292.
DOI:
10.1080/17476348.2020.1828070.
[11]
MONTESI S B, CARAVAN P. Novel imaging approaches in systemic sclerosis-associated interstitial lung disease[J/OL]. Curr Rheumatol Rep, 2019, 21(6): 25 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/31025121/.
DOI:
10.1007/s11926-019-0826-9.
[12]
SU N L, E L N. Multimodality imaging assessment of interstitial lung disease[J]. Chin J Radiol, 2022, 56(11): 1271-1275.
DOI:
10.3760/cma.j.cn112149-20220211-00108.
[13]
GEIGER J, ZEIMPEKIS K G, JUNG A, et al. Clinical application of ultrashort echo-time MRI for lung pathologies in children[J/OL]. Clin Radiol, 2021, 76(9): 708.e9-708708.e17 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/34120734/.
DOI:
10.1016/j.crad.2021.05.015.
[14]
CHASSAGNON G, MARTIN C, MARINI R, et al. Use of elastic registration in pulmonary MRI for the assessment of pulmonary fibrosis in patients with systemic sclerosis[J]. Radiology, 2019, 291(2): 487-492.
DOI:
10.1148/radiol.2019182099.
[15]
LANDINI N, ORLANDI M, OCCHIPINTI M, et al. Ultrashort echo-time magnetic resonance imaging sequence in the assessment of systemic sclerosis-interstitial lung disease[J]. J Thorac Imaging, 2023, 38(2): 97-103.
DOI:
10.1097/RTI.0000000000000637.
[16]
LANDINI N, ORLANDI M, CALISTRI L, et al. Advanced and traditional chest MRI sequence for the clinical assessment of systemic sclerosis related interstitial lung disease, compared to CT: disease extent analysis and correlations with pulmonary function tests[J/OL]. Eur J Radiol, 2024, 170: 111239 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/38056347/.
DOI:
10.1016/j.ejrad.2023.111239.
[17]
HOCHHEGGER B, LONZETTI L, RUBIN A, et al. Chest MRI with CT in the assessment of interstitial lung disease progression in patients with systemic sclerosis[J]. Rheumatology, 2022, 61(11): 4420-4426.
DOI:
10.1093/rheumatology/keac148.
[18]
YANG X Y, LIU M, DUAN J H, et al. Three-dimensional ultrashort echo time magnetic resonance imaging in assessment of idiopathic pulmonary fibrosis, in comparison with high-resolution computed tomography[J]. Quant Imaging Med Surg, 2022, 12(8): 4176-4189.
DOI:
10.21037/qims-21-1133.
[19]
ORLANDI M, LANDINI N, CERINIC M M, et al. Pulmonary magnetic resonance imaging in systemic sclerosis: a jump in the future to unravel inflammation in interstitial lung disease[J]. Clin Rheumatol, 2021, 40(9): 3461-3464.
DOI:
10.1007/s10067-021-05869-3.
[20]
WANG G Q. Value of application of MRI fat suppression technique STIR sequence in detecting sacroiliac joint in ankylosing spondylitis[J]. Heilongjiang Med J, 2024, 48(22): 2735-2737.
DOI:
10.3969/j.issn.1004-5775.2024.22.014.
[21]
MAKOL A, NAGARAJA V, AMADI C, et al. Recent innovations in the screening and diagnosis of systemic sclerosis-associated interstitial lung disease[J]. Expert Rev Clin Immunol, 2023, 19(6): 613-626.
DOI:
10.1080/1744666X.2023.2198212.
[22]
GARGANI L, BRUNI C, DE MARCHI D, et al. Lung magnetic resonance imaging in systemic sclerosis: a new promising approach to evaluate pulmonary involvement and progression[J]. Clin Rheumatol, 2021, 40(5): 1903-1912.
DOI:
10.1007/s10067-020-05491-9.
[23]
BAE K, JEON K N, HWANG M J, et al. Application of highly flexible adaptive image receive coil for lung MR imaging using zero TE sequence: comparison with conventional anterior array coil[J/OL]. Diagnostics, 2022, 12(1): 148 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/35054316/.
DOI:
10.3390/diagnostics12010148.
[24]
LIN Q X, CHENG C, BAO Y Y, et al. A clinically-recommended MR whole lung imaging protocol using free-breathing 3D isotropic zero echo time sequence[J/OL]. Heliyon, 2024, 10(13): e34098 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/39071690/.
DOI:
10.1016/j.heliyon.2024.e34098.
[25]
UFUK F, KURNAZ B, PEKER H, et al. Comparing three-dimensional zero echo time (3D-ZTE) lung MRI and chest CT in the evaluation of systemic sclerosis-related interstitial lung disease[J/OL]. Eur Radiol, 2024 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/39592487/.
DOI:
10.1007/s00330-024-11216-2.
[26]
WEI X D, QI S, WEI X H, et al. Inflammation activity affects liver stiffness measurement by magnetic resonance elastography in MASLD[J]. Dig Liver Dis, 2024, 56(10): 1715-1720.
DOI:
10.1016/j.dld.2024.04.031.
[27]
GIDENER T, DIERKHISING R A, MARA K C, et al. Change in serial liver stiffness measurement by magnetic resonance elastography and outcomes in NAFLD[J]. Hepatology, 2023, 77(1): 268-274.
DOI:
10.1002/hep.32594.
[28]
FAKHOURI F, KANNENGIESSER S, PFEUFFER J, et al. Free-breathing MR elastography of the lungs: an in vivo study[J]. Magn Reson Med, 2022, 87(1): 236-248.
DOI:
10.1002/mrm.28986.
[29]
FAKHOURI F, JOSEPH M, BALLINGER M, et al. Magnetic resonance elastography (MRE) of bleomycin-induced pulmonary fibrosis in an animal model[J]. Invest Radiol, 2023, 58(4): 299-306.
DOI:
10.1097/RLI.0000000000000935.
[30]
MARINELLI J P, LEVIN D L, VASSALLO R, et al. Quantitative assessment of lung stiffness in patients with interstitial lung disease using MR elastography[J]. J Magn Reson Imaging, 2017, 46(2): 365-374.
DOI:
10.1002/jmri.25579.
[31]
BENSAMOUN S F, MCGEE K P, CHAKOUCH M, et al. Monitoring of lung stiffness for long-COVID patients using magnetic resonance elastography (MRE)[J/OL]. Magn Reson Imag, 2025, 115: 110269 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/39491570/.
DOI:
10.1016/j.mri.2024.110269.
[32]
ROMEI C, TURTURICI L, TAVANTI L, et al. The use of chest magnetic resonance imaging in interstitial lung disease: a systematic review[J/OL]. Eur Respir Rev, 2018, 27(150): 180062 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/30567932/.
DOI:
10.1183/16000617.0062-2018.
[33]
CHEN X H, ZHOU Z P, YANG X G, et al. Dynamic enhanced MRI in distinguishing usual from non-specific interstitial pneumonia[J]. Chin J Med Imag, 2021, 29(10): 1007-1011.
DOI:
10.3969/j.issn.1005-5185.2021.10.011.
[34]
GRIST J T, COLLIER G J, WALTERS H, et al. Lung abnormalities detected with hyperpolarized 129Xe MRI in patients with long COVID[J]. Radiology, 2022, 305(3): 709-717.
DOI:
10.1148/radiol.220069.
[35]
BIER E A, ALENEZI F, LU J L, et al. Noninvasive diagnosis of pulmonary hypertension with hyperpolarised 129Xe magnetic resonance imaging and spectroscopy[J]. ERJ Open Res, 2022, 8(2): 00035-02022.
DOI:
10.1183/23120541.00035-2022.
[36]
HALL C S. Invisible insights: probing lung function with 129Xe MRI[J]. Acad Radiol, 2024, 31(10): 4217-4220.
DOI:
10.1016/j.acra.2024.08.062.
[37]
WANG J M, ROBERTSON S H, WANG Z Y, et al. Using hyperpolarized 129Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis[J]. Thorax, 2018, 73(1): 21-28.
DOI:
10.1136/thoraxjnl-2017-210070.
[38]
HAHN A D, CAREY K J, BARTON G P, et al. Hyperpolarized 129Xe MR spectroscopy in the lung shows 1-year reduced function in idiopathic pulmonary fibrosis[J]. Radiology, 2022, 305(3): 688-696.
DOI:
10.1148/radiol.211433.
[39]
MATA J, GUAN S, QING K, et al. Evaluation of regional lung function in pulmonary fibrosis with xenon-129 MRI[J]. Tomography, 2021, 7(3): 452-465.
DOI:
10.3390/tomography7030039.
[40]
QING K, ALTES T A, MUGLER J P, et al. Hyperpolarized xenon-129: a new tool to assess pulmonary physiology in patients with pulmonary fibrosis[J/OL]. Biomedicines, 2023, 11(6): 1533 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/37371626/.
DOI:
10.3390/biomedicines11061533.
[41]
COLLIER G J, EADEN J A, HUGHES P J C, et al. Dissolved 129 Xe lung MRI with four-echo 3D radial spectroscopic imaging: Quantification of regional gas transfer in idiopathic pulmonary fibrosis[J]. Magn Reson Med, 2021, 85(5): 2622-2633.
DOI:
10.1002/mrm.28609.
[42]
MUMMY D G, BIER E A, WANG Z Y, et al. Hyperpolarized 129Xe MRI and spectroscopy of gas-exchange abnormalities in nonspecific interstitial pneumonia[J]. Radiology, 2021, 301(1): 211-220.
DOI:
10.1148/radiol.2021204149.
[43]
OHNO Y, NISHIO M, KOYAMA H, et al. Oxygen-enhanced MRI for patients with connective tissue diseases: comparison with thin-section CT of capability for pulmonary functional and disease severity assessment[J]. Eur J Radiol, 2014, 83(2): 391-397.
DOI:
10.1016/j.ejrad.2013.11.001.
[44]
TIBILETTI M, EADEN J A, NAISH J H, et al. Imaging biomarkers of lung ventilation in interstitial lung disease from 129Xe and oxygen enhanced 1H MRI[J/OL]. Magn Reson Imaging, 2023, 95: 39-49 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/36252693/.
DOI:
10.1016/j.mri.2022.10.005.
[45]
RAJAGOPAL S, BOGAARD H J, ELBAZ M S M, et al. Emerging multimodality imaging techniques for the pulmonary circulation[J/OL]. Eur Respir J, 2024, 64(4): 2401128 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/39209480/.
DOI:
10.1183/13993003.01128-2024.
[46]
TSUCHIYA N, YAMASHIRO T, MURAYAMA S. Decrease of pulmonary blood flow detected by phase contrast MRI is correlated with a decrease in lung volume and increase of lung fibrosis area determined by computed tomography in interstitial lung disease[J]. Eur J Radiol, 2016, 85(9): 1581-1585.
DOI:
10.1016/j.ejrad.2016.06.011.
[47]
TSUCHIYA N, IWASAWA T, OGURA T, et al. Pulmonary flow assessment by phase-contrast MRI can predict short-term mortality of fibrosing interstitial lung diseases[J]. Acta Radiol, 2020, 61(10): 1350-1358.
DOI:
10.1177/0284185120901503.
[48]
MONTESI S B, DÉSOGÈRE P, FUCHS B C, et al. Molecular imaging of fibrosis: recent advances and future directions[J]. J Clin Invest, 2019, 129(1): 24-33.
DOI:
10.1172/JCI122132.
[49]
IBHAGUI O Y, LI D J, HAN H W, et al. Early detection and staging of lung fibrosis enabled by collagen-targeted MRI protein contrast agent[J]. Chem Biomed Imaging, 2023, 1(3): 268-285.
DOI:
10.1021/cbmi.3c00023.
[50]
MA H, ZHOU I Y, IRIS CHEN Y, et al. Tailored chemical reactivity probes for systemic imaging of aldehydes in fibroproliferative diseases[J/OL]. bioRxiv, 2023: 2023.04.20.537707 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/37131719/.
DOI:
10.1101/2023.04.20.537707.
[51]
MONTESI S B, RAO R, LIANG L L, et al. Gadofosveset-enhanced lung magnetic resonance imaging to detect ongoing vascular leak in pulmonary fibrosis[J/OL]. Eur Respir J, 2018, 51(5): 1800171 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/29622569/.
DOI:
10.1183/13993003.00171-2018.
[52]
BERGMANN C, DISTLER J H W, TREUTLEIN C, et al. 68Ga-FAPI-04 PET-CT for molecular assessment of fibroblast activation and risk evaluation in systemic sclerosis-associated interstitial lung disease: a single-centre, pilot study[J/OL]. Lancet Rheumatol, 2021, 3(3): e185-e194 [2025-01-06]. https://pubmed.ncbi.nlm.nih.gov/38279381/.
DOI:
10.1016/S2665-9913(20)30421-5.
[53]
BENLALA I, ALBAT A, BLANCHARD E, et al. Quantification of MRI T2 interstitial lung disease signal-intensity volume in idiopathic pulmonary fibrosis: a pilot study[J]. J Magn Reson Imaging, 2021, 53(5): 1500-1507.
DOI:
10.1002/jmri.27454.
[54]
WEATHERLEY N D, EADEN J A, HUGHES P J C, et al. Quantification of pulmonary perfusion in idiopathic pulmonary fibrosis with first pass dynamic contrast-enhanced perfusion MRI[J]. Thorax, 2021, 76(2): 144-151.
DOI:
10.1136/thoraxjnl-2019-214375.
