Functional MRI predicts CTD-ILD progression better than standard tests

An MRI technique that maps lung ventilation and perfusion without contrast agents or radiation has proved effective for predicting disease progression in connective tissue disease-associated interstitial lung disease (CTD-ILD).

The technique performs better for this indication than do standard clinical tools such as chest CT and pulmonary function tests, according to a team led by Tao Ouyang, MD, PhD, of Beijing Chaoyang Hospital and Capital Medical University in China. The study findings were published April 28 in Radiology.

"[Our study found that in] participants with CTD-ILD, ventilation and perfusion parameters derived from [phase-resolved functional lung] PREFUL MRI characterized distinct pulmonary perfusion phenotypes in CTD-ILD and were associated with disease progression over one year," the group noted.

CTD-ILD is a "spatially and temporally heterogeneous disease," the researchers explained, and determining whether it is in a progressive stage is key to guiding clinical management. Ouyang and colleagues used the PREFUL technique to determine whether CTD-ILD is associated with ventilation and perfusion parameters and if so, whether these parameters can help predict its progression. They conducted a study that consisted of a cohort of 172 participants, some of whom had no pulmonary disease and some of whom had CTD-ILD; patients underwent baseline PREFUL MRI, chest CT, and pulmonary function tests between May 2024 and April 2025. Those with CTD-ILD were followed for a year. The team defined CTD-ILD progression as a decline in forced vital capacity of more than 5% or a decline in diffusing capacity of lung for carbon monoxide of more than 10%; CT evidence of disease progression; or worsening respiratory symptoms.

The investigators reported the following:

• Compared with controls, CTD-ILD patients showed reduced dynamic ventilation and lower perfusion at follow-up (both, p 
• At baseline, compared with stable CTD-ILD, progressive CTD-ILD was associated with a higher perfusion defect and lower healthy ventilation and perfusion matches (both, p
• A multiparametric PREFUL model achieved the highest predictive performance compared with other logistic models (AUC, 0.87).

The bottom line? Integrating physiologic functional testing with PREFUL MRI may improve and optimize the prediction of CTD-ILD disease progression, the team concluded.

In an accompanying editorial, Amir Rahsepar, MD, and Fereidoun Abtin, MD, both of the University of California, Los Angeles, noted "although PREFUL MRI is not yet positioned for immediate, routine clinical use in the management of CTD-ILD, the research presented here makes a convincing case for its future integration."

Access the full study here.