Hyperpolarised xenon-129 diffusion-weighted magnetic resonance imaging for assessing lung microstructure in idiopathic pulmonary fibrosis

Hyperpolarised 129-xenon ( Xe) magnetic resonance imaging (MRI) shows promise in monitoring the progression of idiopathic pulmonary fibrosis (IPF) due to the lack of ionising radiation and the ability to quantify functional impairment. Diffusion-weighted (DW)-MRI with hyperpolarised gases can provide information about lung microstructure. The aims were to compare Xe DW-MRI measurements with pulmonary function tests (PFTs), and to assess whether they can detect early signs of disease progression in patients with newly diagnosed IPF. This is a prospective, single-centre, observational imaging study of patients presenting with IPF to Northern General Hospital (Sheffield, UK). Hyperpolarised Xe DW-MRI was performed at 1.5 T on a whole-body General Electric HDx scanner and PFTs were performed on the same day as the MRI scan. There was an increase in global Xe apparent diffusion coefficient (ADC) between the baseline and 12-month visits (mean 0.043 cm ·s , 95% CI 0.040-0.047 cm ·s mean 0.045 cm ·s , 95% CI 0.040-0.049 cm ·s ; p=0.044; n=20), with no significant change in PFTs over the same time period. There was also an increase in Xe ADC in the lower zone (p=0.027), and an increase in Xe mean acinar dimension in the lower zone (p=0.033) between the baseline and 12-month visits. Xe DW-MRI measurements correlated strongly with diffusing capacity of the lung for carbon monoxide (% predicted), transfer coefficient of the lung for carbon monoxide ( ) and (% predicted). Xe DW-MRI measurements appear to be sensitive to early changes of microstructural disease that are consistent with progression in IPF at 12 months. As new drug treatments are developed, the ability to quantify subtle changes using Xe DW-MRI could be particularly valuable.