Tracking interstitial lung disease in systemic sclerosis: integrating lung magnetic resonance imaging into a...

To assess the utility of lung magnetic resonance imaging (MRI) for monitoring interstitial lung disease (ILD) in patients with systemic sclerosis (SSc), using high-resolution CT (HRCT) as the reference. Additionally, we explored associations between MRI sequences and common imaging and functional parameters in SSc-ILD evaluation.

SSc patients with ILD requiring treatment initiation or change underwent lung assessment at baseline and after 6 months, including MRI (T2-weighted, T1 post-contrast, and T2 star sequences), HRCT, lung ultrasound, and pulmonary function tests. Six-month MRI and HRCT were qualitatively evaluated for improvement, stability, or progression. A follow-up HRCT was performed 2 years after enrolment.

Fourteen SSc-ILD patients (64.3% female, mean age 48.3 years) were enrolled. MRI showed improvement in 1 patient, stability in 9, and progression in 4; in 2 progressed cases, inflammation decreased while fibrotic features increased. T1 contrast sequence significantly correlated with pleural irregularities on ultrasound (ρ=0.55; p=0.04) and DLCO (ρ=-0.65; p=0.01). MRI and HRCT findings at 6 months were concordant in 64.3% of cases, with fair agreement (weighted κ=0.25). MRI outcomes at 6 months matched HRCT findings at 2 years in 92.8% of patients (13/14).

Lung MRI is a promising adjunctive tool for monitoring SSc-ILD and may provide complementary information to HRCT on early imaging changes, particularly the transition from inflammation to fibrosis. Among MRI sequences, T1 post-contrast best correlated with functional and ultrasound findings, supporting its role in fibrosis assessment.