PULMONARY SARCOIDOSIS MRI could offer clinicians a radiation-free way to assess both structural changes and regional lung function in patients with the disease, according to a small prospective study.
While chest CT remained the reference standard for morphological assessment, low-field MRI provided complementary information and functional measurements that correlated with pulmonary function testing (PFT), supporting its potential role in longitudinal monitoring of selected patients.
Sarcoidosis is an inflammatory disease characterised by granuloma formation that can affect multiple organs. Pulmonary involvement is common and may progress to irreversible pulmonary fibrosis. Although chest CT is considered the imaging gold standard, repeated exposure to ionising radiation can be a concern, particularly for younger patients who may require ongoing imaging surveillance.
Radiation-Free Imaging Provides Functional Insights
The study assessed the feasibility and diagnostic performance of 0.55-T low-field lung MRI in 15 patients with pulmonary sarcoidosis, including eight women and seven men, alongside 30 healthy volunteers with an equal sex distribution. Researchers combined morphological imaging with functional proton MRI to evaluate regional ventilation and perfusion, using CT as the reference standard for structural findings.
MRI demonstrated its highest sensitivity for detecting consolidations at 86%. Performance was moderate for nodules (67%) and ground-glass opacities (70%), while sensitivity was lower for reticulations (29%) and traction bronchiectases (27%) when compared with CT. Inter-reader and inter-modality agreement were both moderate.
Functional MRI Correlated with Lung Function
Functional imaging identified significantly greater ventilation defect percentage (VDP), perfusion defect percentage (QDP) and ventilation-perfusion overlap (VQO) in patients with pulmonary sarcoidosis than in healthy volunteers, with all comparisons reaching statistical significance (p<0.01).
The MRI-derived functional measurements also correlated with measures of respiratory function. VDP showed a strong correlation with the residual volume to total lung capacity (RV/TLC) ratio (r=0.90; p<0.001), while QDP correlated with forced expiratory volume in one second (FEV1) (r=0.63; p=0.01).
The findings indicate that low-field lung MRI provides radiation-free structural assessment alongside regional functional information that complements CT. Although agreement with CT for structural abnormalities was moderate and sensitivity varied according to lesion type, the combination of anatomical and functional assessment may support follow-up imaging in selected patients with pulmonary sarcoidosis rather than replacing CT.
Reference
Pradella M et al. Feasibility of lung imaging at 0.55T for assessment of interstitial lung disease in patients with pulmonary sarcoidosis. Eur Radiol. 2026;DOI:10.1007/s00330-026-12708-z.
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