Breaking new ground in COPD imaging: 3D-PREFUL MRI versus traditional techniques

COPD is the third leading cause of death worldwide, and the disease is still not well-known and research applications to investigate the disease process are needed [1]. Functional pulmonary imaging is a growing field of investigation, allowing to explore novel facets of airway diseases [2]. Indeed, morphological imaging of airways using CT is limited because of the spatial resolution of the technique, allowing direct visualization of no more than 10 to 13 out of 27 bronchial generations in humans. Thus, less than half of the airway tree can be directly seen and investigated, although the distal airways are more likely to be involved in chronic airway conditions such as asthma and COPD [3]. Thus, developing imaging modalities to explore this lung compartment is crucial. Functional imaging, especially by using lung MRI, allows to explore this distal airway compartment, with the use of both qualitative and quantitative evaluations. For this, the current Gold Standard is lung MRI with hyperpolarized noble gases such as Helium or ¹²⁹Xenon (¹²⁹Xe) imaging. Of note, these advanced techniques have been recently acknowledged for clinical use in several countries such as the United Kingdom or the USA, where phase 4 approval by the Food and Drug Administration was obtained recently, in 2022 (IND 123577). However, lung MRI with ¹²⁹Xe is cost-effective and requires a specific adaptation of MRI machines and a specific staff of both trained physicians and technicians dedicated to the completion of this technology. …