Incidentally detected pulmonary nodules present a challenge in clinical routine with demand for reliable support systems for risk classification. We aimed to evaluate the performance of the lung-cancer-prediction-convolutional-neural-network (LCP-CNN), a deep learning-based approach, in comparison to multiparametric statistical methods (Brock model and Lung-RADS®) for risk classification of nodules in cohorts with different risk profiles and underlying pulmonary diseases. Retrospective analysis was conducted on non-contrast and contrast-enhanced CT scans containing pulmonary nodules measuring 5–30 mm. Ground truth was defined by histology or follow-up stability. The final analysis was performed on 297 patients with 422 eligible nodules, of which 105 nodules were malignant. Classification performance of the LCP-CNN, Brock model, and Lung-RADS® was evaluated in terms of diagnostic accuracy measurements including ROC-analysis for different subcohorts (total, screening, emphysema, and interstitial lung disease). LCP-CNN demonstrated superior performance compared to the Brock model in total and screening cohorts (AUC 0.92 (95

Die Bildgebung, insbesondere die Computertomographie (CT) und die Magnetresonanztomographie (MRT), spielt eine zentrale Rolle bei Diagnostik, Therapieplanung und Verlaufskontrolle von Aortenerkrankungen. Während der Ultraschall oft der Ersteinschätzung dient, ermöglicht die CT eine zügige und umfassende Abklärung. Die MRT ist eine strahlungs- und ggf. kontrastmittelfreie Alternative und bietet funktionelle Bildgebungsmethoden. Die Positronenemissionstomographie (PET) ist v. a. bei entzündlichen Gefäßerkrankungen relevant. Die Schnittbildgebung hat sich zuletzt deutlich weiterentwickelt, v. a. im Hinblick auf die Bildqualität und die erforderlichen Dosen von ionisierender Strahlung und Kontrastmittel, die räumliche Auflösung und neuere Methoden wie Materialdekomposition und funktionelle Bildgebung. Dieser Artikel gibt einen Überblick über aktuelle Entwicklungen der CT- (CTA) und MR-Angiographie (MRA) sowie über den jeweiligen Einsatz bei ausgewählten Krankheitsbildern der Aorta mit Blick auf die jüngsten Leitlinien.

We hypothesized that semiquantitative visual scoring of lung MRI is suitable for GOLD-grade specific characterization of parenchymal and airway disease in COPD and that MRI scores correlate with quantitative CT (QCT) and pulmonary function test (PFT) parameters. Five hundred ninety-eight subjects from the COSYCONET study (median age = 67 (60–72)) at risk for COPD or with GOLD1-4 underwent PFT, same-day paired inspiratory/expiratory CT, and structural and contrast-enhanced MRI. QCT assessed total lung volume (TLV), emphysema, and air trapping by parametric response mapping (PRMEmph, PRMfSAD) and airway disease by wall percentage (WP). MRI was analyzed using a semiquantitative visual scoring system for parenchymal defects, perfusion defects, and airway abnormalities. Descriptive statistics, Spearman correlations, and ANOVA analyses were performed. TLV, PRMEmph, and MRI scores for parenchymal and perfusion defects were all higher with each GOLD grade, reflecting the extension of emphysema (all p < 0.001). Airway analysis showed the same trends with higher WP and higher MRI large airway disease scores in GOLD3 and lower WP and MRI scores in GOLD4 (p = 0.236 and p < 0.001). Regional heterogeneity was less evident on MRI, while PRMEmph and MRI perfusion defect scores were higher in the upper lobes, and WP and MRI large airway disease scores were higher in the lower lobes. MRI parenchymal and perfusion scores correlated moderately with PRMEmph (r = 0.61 and r = 0.60) and moderately with FEV1/FVC (r = −0.56). Multi-center semiquantitative MRI assessments of parenchymal and airway disease in COPD matched GOLD grade-specific imaging features on QCT and detected regional disease heterogeneity. MRI parenchymal disease scores were correlated with QCT and lung function parameters. Question Do MRI-based scores correlate with QCT and PFT parameters for GOLD-grade specific disease characterization of COPD? Findings MRI can visualize the parenchymal and airway disease features of COPD. Clinical relevance Lung MRI is suitable for GOLD-grade specific disease characterization of COPD and may serve as a radiation-free imaging modality in scientific and clinical settings, given careful consideration of its potential and limitations.

Solute carrier family 26, member 9 (SLC26A9) is an epithelial chloride channel that was identified as a genetic modifier of disease severity of cystic fibrosis (CF) and other chronic muco-obstructive lung diseases. However, data on the in vivo role of SLC26A9 function in lung health and disease remain limited. Here, we investigated the effect of genetic deletion of Slc26a9 (Slc26a9-/-) on the pulmonary phenotype of neonatal mice. We found that lack of Slc26a9 causes severe neonatal respiratory distress with high mortality. Histology, immunohistochemistry, and micro-computed tomography imaging studies identified airway obstruction with MUC5B-positive mucus plugs in neonatal Slc26a9-/- mice. Bioelectric measurements demonstrated a reduced transepithelial potential difference indicative of reduced chloride secretion across tracheal explants of neonatal Slc26a9-/-compared with WT mice. In addition, neonatal Slc26a9-/- mice displayed hypoxic degeneration of airway epithelial cells associated with sterile neutrophilic airway inflammation. Collectively, our data show that SLC26A9-mediated chloride secretion is critical for proper mucociliary clearance, respiratory function, and survival after birth, and identify a role for SLC26A9 in neonatal adaptation during the transition from fetal to neonatal life.

Rationale: The progression of lung changes in cystic fibrosis (CF) from infancy through adolescence remains poorly understood as a result of limited longitudinal imaging data. Objectives: To assess changes in lung morphology and perfusion in children with CF through the pediatric age range by longitudinal chest magnetic resonance imaging (MRI). Methods: 1,112 annual chest MRI scans were performed in 226 patients with CF aged 0-18 years. MRI was assessed using a validated MRI scoring system. Results: The MRI global score continuously increased from 5.5 ± 4.6 at infancy (0 yr) to 17.9 ± 8.5 at adolescence (12-18 yr), and the MRI morphology score increased from 5.0 ± 3.9 to 12.3 ± 6.1 (P < 0.001). Bronchiectasis/wall thickening prevalence increased from 89.1% at infancy to approximately 100% at preschool age (1-5 yr), and the subscore increased from 3.1 ± 1.9 at infancy to 6.6 ± 2.1 at adolescence (P < 0.001). Mucus plugging prevalence increased from 55.4% at infancy to 83.0% at adolescence, and the subscore increased from 1.2 ± 1.6 to 3.7 ± 2.6 in the same period (P < 0.001). Perfusion abnormalities were found in 44.4% at infancy, and increased to approximately 90% at preschool age (P < 0.001). The MRI perfusion score increased from 1.1 ± 1.6 at infancy to 5.6 ± 3.0 at adolescence (P < 0.001). Chronic Pseudomonas aeruginosa infection was associated with higher MRI scores at school age (6-11 yr; P < 0.05-0.001). Conclusions: This is the first study to assess longitudinal changes in lung morphology and perfusion in CF throughout the pediatric age range, providing percentiles as age-specific references for lung disease severity. Our data may facilitate the use of MRI as an endpoint in clinical trials in children with CF. Clinical trial registered with www.clinicaltrials.gov (NCT00760071 and NCT02270476).

Imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI), plays a central role in the diagnostics, treatment planning and follow-up of aortic diseases. While ultrasound is often used for the initial assessment, CT enables rapid and comprehensive imaging of the aorta. The MRI is a radiation-free and when necessary, contrast agent-free alternative and provides functional imaging methods. Positron emission tomography (PET) is particularly relevant for inflammatory vascular diseases. Cross-sectional imaging has recently undergone significant development, particularly with respect to image quality and the required doses of ionizing radiation and contrast agents, spatial resolution and newer methods, such as material decomposition and functional imaging. This article provides an overview of current developments in CT angiography (CTA) and magnetic resonance angiography (MRA) and their use in selected aortic diseases in the context of the latest guidelines.

Purpose: To apply velocity selective arterial spin labeling (VSASL) combined with a navigator-based (NAV) prospective motion compensation method for a free-breathing liver perfusion measurement without contrast agent. Methods: Sinc-modulated Velocity Selective Inversion (sinc-VSI) pulses were applied as labeling and control pulses. In order to account for respiratory motion, a navigator was employed in the form of a single gradient-echo projection readout, located at the diaphragm along the inferior-superior direction. Prior to each transverse imaging slice of the spin-echo EPI based readouts, navigator and fat suppression were incorporated. Motion data was obtained from the navigator and transmitted back to the sequence, allowing real-time adjustments to slice positioning. The sinc-VSI without velocity-selective gradients during the control condition but with velocity-selective gradients along all three directions during labeling was chosen for the VSASL. The VSASL was compared with pseudo-continuous ASL (pCASL) methods, which selectively tagged the moving spins using a tagging plane placed at the portal vein and hepatic artery. Results: The motion caused by respiratory activity was effectively computed using the navigator signal. The coefficients of variation (CoV) of average liver voxel in NAV were significantly decreased when compared to breath-hold (BH), with an average reduction of 29.4 +/- 18.44% for control images, and 29.89 +/- 20.83% for label images (p < 0.001). The resulting maps of normalized ASL signal (normalized to M-0) showed significantly higher perfusion weightings in the NAV-compensated VSASL, when compared to the NAV-compensated pCASL techniques. Conclusions: This study demonstrates the feasibility of using a navigator-based prospective motion compensation technique in conjunction with VSASL for the measurement of liver perfusion without the use of contrast agents while allowing for free-breathing.

Functional thoracic MRI provides regional assessment of the three principal components of lung function: ventilation, perfusion, and gas exchange. It offers advantages over pulmonary function tests like spirometry, which yield only global measurements. MRI enables comprehensive evaluation of respiratory mechanics, including chest wall and diaphragm motion, dynamic large airway instability, and lung ventilation using various contrast mechanisms and gas agents. Perfusion imaging, with or without exogenous contrast material, further supports the assessment of mechanical lung properties in both healthy and diseased states. Advanced MRI techniques also allow for quantification of distal airspace dimensions and gas exchange or diffusion capacity using inert noble gases, at both global and regional levels. Dynamic contrast-enhanced perfusion MRI enables assessment of key pathophysiologic mechanisms, such as hypoxic pulmonary vasoconstriction, and provides direct visualization of ventilation-perfusion mismatch across various lung diseases. Emerging noninvasive, non-contrast-enhanced techniques, including combined ventilation-perfusion imaging based on signal oscillations from blood flow and respiration, hold substantial promise for clinical translation. This review provides an overview of recent advances in functional thoracic MRI for evaluating regional lung function and pathophysiology.

Zystische und noduläre Lungenkrankheiten umfassen ein breites Spektrum von Erkrankungen mit unterschiedlichsten Ätiologien und klinisch-radiologischem Erscheinungsbild. Dabei ist ihre Unterscheidung für das Patientenmanagement von entscheidender Bedeutung, kann jedoch aufgrund von Krankheiten, die Merkmale beider Kategorien und überlappende radiologische Muster aufweisen, komplex sein. Detaillierte Beschreibung bildgebender Merkmale von zystischen und nodulären Lungenkrankheiten in der hochauflösenden Computertomographie (CT), vorrangig anhand ihrer Ätiologie, um eine präzisere Differenzialdiagnose dieser Erkrankungen zu ermöglichen. Narratives Review anhand aktueller Literatur zu dem Thema aus klinisch-radiologischer Sicht. Diese Arbeit kategorisiert systematisch die Differenzialdiagnosen zystischer und nodulärer Lungenerkrankungen und bietet Einblicke in ihre radiologischen Muster und Ätiologien. Sie unterstreicht hierbei die Bedeutung der CT in der Diagnostik dieser Erkrankungen und zeigt die Bedeutung von multidisziplinären Boards, die Fachwissen aus der Radiologie, Pneumologie, Rheumatologie und Pathologie vereinen. Die sichere Differenzialdiagnose zystischer und nodulärer Lungenkrankheiten, insbesondere allein anhand ihrer radiologischen Merkmale, bleibt aufgrund ihrer Überlappungen und dynamischen Natur schwierig. Multidisziplinäre Boards sollten klinischer Standard zur präzisen differenzialdiagnostischen Aufarbeitung dieser Erkrankungen sein, da sie die Anamnese, die Symptomatik, die radiologischen Befunde und, sofern nötig, die histopathologischen Untersuchungen vereinen und somit einen robusteren Rahmen für Diagnose und Management bieten.

Background:Computed tomography pulmonary angiography (CTPA) is frequently performed in patients with pulmonary hypertension (PH) and may aid non-invasive estimation of pulmonary hemodynamics. We, therefore, investigated automated volumetry of intrapulmonary vasculature on CTPA, separated into core and peel fractions of the lung volume and its potential to differentially reflect pulmonary hemodynamics in patients with pre- and postcapillary PH. Methods:A retrospective case-control study of 72 consecutive patients with PH according to the 2022 joint guidelines of the European Society of Cardiology and the European Respiratory Society who underwent right heart catheterization (RHC) and CTPA within 7 days between August 2013 and February 2016 at Thoraxklinik at Heidelberg University Hospital (Heidelberg, Germany) was conducted. Vessel segmentation was performed using the in-house software YACTA. Vascular volumes in different core and peel fractions of the lung were corrected for body surface area. Spearman correlation coefficients with mean pulmonary arterial pressure (mPAP), pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) were calculated, and a linear regression analysis was done to account for potential confounders. Results:Median age of the study sample was 71.5 years [interquartile range (IQR), 60.0-77.0 years], 48 (66.67%) were female. Median mPAP was 35.5 mmHg (IQR, 27.0-47.2 mmHg). Postcapillary PH was present in 24/72 (33.3%) patients and precapillary PH in 48/72 (66.7%) patients. Moderate to strong correlations between core intrapulmonary vessel volumes and mPAP were observed in postcapillary PH patients with a maximum at 50% core lung volume (r=0.71, P<0.001). No significant influence of age or sex on this relationship was identified. Correlation with RHC measurements was weak or negligible in patients with precapillary PH. Conclusions:Automated volumetry of vessels in the core lung strongly correlated with mPAP in patients with postcapillary PH and has potential for non-invasive assessment of postcapillary PH in patients undergoing CTPA.

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease, which is usually diagnosed late in advanced stages. Little is known about the subclinical development of IPF. We previously generated a mouse model with conditional Nedd4-2 deficiency (Nedd4-2-/-) that develops IPF-like lung disease. The aim of this study was to characterize the onset and progression of IPF-like lung disease in conditional Nedd4-2-/- mice by longitudinal micro-computed tomography (CT). In vivo micro-CT was performed longitudinally in control and conditional Nedd4-2-/- mice at 1, 2, 3, 4, and 5 mo after doxycycline induction. Furthermore, terminal in vivo micro-CT followed by pulmonary function testing and post mortem micro-CT was performed in age-matched mice. Micro-CT images were evaluated for pulmonary fibrosis using an adapted fibrosis scoring system. Histological assessment of lung collagen content was conducted as well. Micro-CT is sensitive to detect the onset and progression of pulmonary fibrosis in vivo and to quantify distinct radiological IPF-like features along disease development in conditional Nedd4-2-/- mice. Nonspecific interstitial alterations were detected from 3 mo, whereas key features such as honeycombing-like lesions were detected from 4 mo onward. Pulmonary function correlated well with in vivo (r = -0.738) and post mortem (r = -0.633) micro-CT fibrosis scores and collagen content. Longitudinal micro-CT enables in vivo monitoring of the onset and progression and detects radiological key features of IPF-like lung disease in conditional Nedd4-2-/- mice. Our data support micro-CT as a sensitive quantitative endpoint for the preclinical evaluation of novel antifibrotic strategies.NEW & NOTEWORTHY IPF diagnosis, particularly in early stages, remains challenging. In this study, micro-CT is used in conditional Nedd4-2-/- mice to closely monitor the onset and progression of progressive pulmonary fibrosis in vivo. Together with high-resolution post mortem micro-CT, this allowed us to track how nonspecific lung lesions develop into key IPF-like features. This approach offers a noninvasive method to monitor pulmonary fibrosis, providing a quantitative endpoint for the preclinical evaluation of novel antifibrotic strategies.

Shareable abstract The study by Cazier and co-workers promotes current efforts to diagnose and treat CF lung disease as early as possible in order to prevent structural lung damage, and to target initially reversible changes before persistent airway damage is establishedhttps://bit.ly/42K7tYW

Die zystische Fibrose (CF) ist eine komplexe Systemerkrankung mit Beteiligung von zahlreichen Organsystemen. Bei gebesserten Therapiemöglichkeiten und steigender Lebenserwartung von Menschen mit CF (MmCF) stehen zunehmend auch die extrapulmonalen Manifestationen im Fokus. Nahezu alle MmCF weisen bereits ab Geburt radiologische Veränderungen der oberen Atemwege im Sinne einer CF-assoziierten chronischen Rhinosinusitis auf (CF-CRS). Es wird eine aktuelle Übersicht über die CF-CRS aus Perspektive der Hals‑, Nasen‑, Ohrenheilkunde (HNO) gegeben und dem Leser Hintergrundwissen und aktuelle Entwicklungen vermittelt. Der Cystic-Fibrosis-Transmembrane-Conductance-Regulator(CFTR)-Gendefekt führt über eine gesteigerte Sekretviskosität und reduzierte mukoziliären Clearance der sinunasalen Mukosa zu einer chronischen Infektion und Inflammation der oberen Atemwege und konsekutiv zu einer CF-CRS. Die Klinik der CF-CRS weist ein breites Spektrum von asymptomatischen bis hochsymptomatischen Verläufen auf. Die CF-CRS wird klinisch und radiologisch diagnostiziert. Als konservative Therapiemaßnahmen werden sinunasale Kochsalzspülungen empfohlen. Auch topische Kortikosteroide werden häufig eingesetzt. Die operative Therapie ist therapierefraktären, nicht auf konservative Therapien einschließlich der Modulator-Behandlung ansprechenden, symptomatischen Patienten vorbehalten. In Abhängigkeit von der zugrunde liegenden CFTR-Mutation sind die CFTR-Modulatoren (CFTRm) die Therapie der Wahl. Sie verbessern nicht nur die pulmonalen und gastrointestinalen Manifestationen der CF, sondern haben ebenfalls einen positiven Effekt auf die CF-CRS. Die HNO ist Teil des interdisziplinären Behandlungsteams für MmCF. Abhängig von der Symptomlast und dem Therapieansprechen sollte die CF-CRS konservativ und/oder chirurgisch therapiert werden. Die modernen CFTRm haben einen positiven Effekt auf den klinischen Verlauf der CF-CRS.

Rationale: Primary ciliary dyskinesia (PCD) and cystic fibrosis (CF) are characterized by inherited impaired mucociliary clearance leading to chronic progressive lung disease as well as chronic rhinosinusitis (CRS). The diseases share morphological and functional commonalities on magnetic resonance imaging (MRI) of the lungs and paranasal sinuses, but comparative MRI studies are lacking. Objectives: To determine whether PCD shows different associations of pulmonary and paranasal sinus abnormalities on MRI and lung function test results in children (infants to adolescents) compared with children with CF. Methods: Eighteen children with PCD (median age, 9.5 [IQR, 3.4-12.7] yr; range, 0-18 yr) and 36 age-matched CF transmembrane conductance regulator modulator-naive children with CF (median age, 9.4 [3.4-13.2] yr; range, 0-18 yr) underwent same-session chest and paranasal sinus MRI as well as spirometry (to determine forced expiratory volume in 1 s percent predicted) and multiple-breath washout (to determine lung clearance index z-score). Pulmonary and paranasal sinus abnormalities were assessed using previously validated chest MRI and CRS-MRI scoring systems. Results: Mean chest MRI global score was similar in children with PCD and CF (15.0 [13.5-20.8] vs. 15.0 [9.0-15.0]; P = 0.601). Consolidations were more prevalent and severe in children with PCD (56% vs. 25% and 1.0 [0.0-2.8] vs. 0.0 [0.0-0.3], respectively; P < 0.05). The chest MRI global score correlated moderately with forced expiratory volume in 1 second percent predicted in children with PCD and children with CF (r = -0.523 and -0.687; P < 0.01) and with lung clearance index in children with CF (r = 0.650; P < 0.001) but not in PCD (r = 0.353; P = 0.196). CRS-MRI sum score and mucopyocele subscore were lower in children with PCD than in children with CF (27.5 [26.3-32.0] vs. 37.0 [37.8-40.0] and 2.0 [0.0-2.0] vs. 7.5 [4.8-9.0], respectively; P < 0.01). CRS-MRI sum score did not correlate with chest MRI score in PCD (r = 0.075-0.157; P = 0.557-0.788) but correlated moderately with MRI morphology score in CF (r = 0.437; P < 0.01). Conclusions: MRI detects differences in lung and paranasal sinus abnormalities between children with PCD and those with CF. Lung disease does not correlate with CRS in PCD but correlates in CF.

INTRODUCTION:Previous studies using magnetic resonance imaging (MRI) demonstrated early onset and progression of chronic rhinosinusitis (CRS) from infancy to school age, and response to lumacaftor/ivacaftor (LUM/IVA) therapy in children with cystic fibrosis (CF). However, the effect of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) on CRS detected by MRI in children with CF and at least one F508del mutation, and potential incremental effects of ELX/TEZ/IVA compared to LUM/IVA in F508del homozygous children have not been studied. METHODS:30 children with CF with at least one F508del mutation underwent three longitudinal paranasal sinus MRI before (MRI1), without (n = 16) or with LUM/IVA therapy (n = 14, MRI2), and with ELX/TEZ/IVA therapy (MRI3, mean age at therapy initiation 11.1 ± 3.4y, range 6-16y). MRI were evaluated using the CRS-MRI score. RESULTS:After therapy initiation with ELX/TEZ/IVA, the prevalence and in maxillary and sphenoid sinuses the dominance of mucopyoceles decreased (35% vs. 0 %, p<0.001 and 26% vs. 8 %, p < 0.05, respectively). This leads to a reduction in mucopyocele subscore (-3.4 ± 1.9, p < 0.001), and sinus subscores in MRI3 (maxillary sinus: -5.3 ± 3.1, p < 0.001, frontal sinus: -1.0 ± 1.9, p < 0.01, sphenoid subscore: -2.8 ± 3.5, p < 0.001, ethmoid sinus: -1.7 ± 1.9, p < 0.001). The CRS-MRI sum score decreased after therapy initiation with ELX/TEZ/IVA by -9.6 ± 5.5 score points (p < 0.001). The strength in reduction of mucopyoceles subscore and CRS-MRI sum score was independent of a pretreatment with LUM/IVA from MRI1-MRI2 (p = 0.275-0.999). CONCLUSIONS:ELX/TEZ/IVA therapy leads to improvement of CRS in eligible children with CF. Our data support the role of MRI for comprehensive monitoring of CRS disease severity and response to therapy in children with CF.

Objectives A prospective, multi-centre study to evaluate concordance of morphologic lung MRI and CT in chronic obstructive pulmonary disease (COPD) phenotyping for airway disease and emphysema. Methods A total of 601 participants with COPD from 15 sites underwent same-day morpho-functional chest MRI and paired inspiratory-expiratory CT. Two readers systematically scored bronchial wall thickening, bronchiectasis, centrilobular nodules, air trapping and lung parenchyma defects in each lung lobe and determined COPD phenotype. A third reader acted as adjudicator to establish consensus. Inter-modality and inter-reader agreement were assessed using Cohen’s kappa (im-κ and ir-κ). Results The mean combined MRI score for bronchiectasis/bronchial wall thickening was 4.5/12 (CT scores, 2.2/12 for bronchiectasis and 6/12 for bronchial wall thickening; im-κ, 0.04–0.3). Expiratory right/left bronchial collapse was observed in 51 and 47/583 on MRI (62 and 57/599 on CT; im-κ, 0.49–0.52). Markers of small airways disease on MRI were 0.15/12 for centrilobular nodules (CT, 0.34/12), 0.94/12 for air trapping (CT, 0.9/12) and 7.6/12 for perfusion deficits (CT, 0.37/12 for mosaic attenuation; im-κ, 0.1–0.41). The mean lung defect score on MRI was 1.3/12 (CT emphysema score, 5.8/24; im-κ, 0.18–0.26). Airway-/emphysema/mixed COPD phenotypes were assigned in 370, 218 and 10 of 583 cases on MRI (347, 218 and 34 of 599 cases on CT; im-κ, 0.63). For all examined features, inter-reader agreement on MRI was lower than on CT. Conclusion Concordance of MRI and CT for phenotyping of COPD in a multi-centre setting was substantial with variable inter-modality and inter-reader concordance for single diagnostic key features. Clinical relevance statement MRI of lung morphology may well serve as a radiation-free imaging modality for COPD in scientific and clinical settings, given that its potential and limitations as shown here are carefully considered. Key Points • In a multi-centre setting, MRI and CT showed substantial concordance for phenotyping of COPD (airway-/emphysema-/mixed-type). • Individual features of COPD demonstrated variable inter-modality concordance with features of pulmonary hypertension showing the highest and bronchiectasis showing the lowest concordance. • For all single features of COPD, inter-reader agreement was lower on MRI than on CT.

BackgroundPrevious studies showed that contrast-enhanced (CE) morpho-functional magnetic resonance imaging (MRI) detects abnormalities in lung morphology and perfusion in patients with cystic fibrosis (CF). Novel matrix pencil decomposition MRI (MP-MRI) enables quantification of lung perfusion and ventilation without intravenous contrast agent administration.ObjectivesTo compare MP-MRI with established morpho-functional MRI and spirometry in patients with CF.MethodsThirty-nine clinically stable patients with CF (mean age 21.6 ± 10.7 years, range 8–45 years) prospectively underwent morpho-functional MRI including CE perfusion MRI, MP-MRI and spirometry. Two blinded chest radiologists assessed morpho-functional MRI and MP-MRI employing the validated chest MRI score. In addition, MP-MRI data were processed by automated software calculating perfusion defect percentage (QDP) and ventilation defect percentage (VDP).ResultsMP perfusion score and QDP correlated strongly with the CE perfusion score (both r = 0.81; p < 0.01). MP ventilation score and VDP showed strong inverse correlations with percent predicted FEV1 (r = −0.75 and r = −0.83; p < 0.01). The comparison of visual and automated parameters showed that both MP perfusion score and QDP, and MP ventilation score and VDP were strongly correlated (r = 0.74 and r = 0.78; both p < 0.01). Further, the MP perfusion score and MP ventilation score, as well as QDP and VDP were strongly correlated (r = 0.88 and r = 0.86; both p < 0.01).ConclusionMP-MRI detects abnormalities in lung perfusion and ventilation in patients with CF without intravenous or inhaled contrast agent application, and correlates strongly with the well-established CE perfusion MRI score and spirometry. Automated analysis of MP-MRI may serve as quantitative noninvasive outcome measure for diagnostic monitoring and clinical trials.