Terminal Airspace Enlargement Measured Using Pulmonary Functional MRI Predicts CT Airway Loss in COPD

The onset and progression of chronic obstructive pulmonary disease (COPD) is currently believed to initiate in the small-airways and progresses to emphysema or terminal airspace (alveolar) enlargement and destruction. MRI apparent-diffusion-coefficient (ADC) provides a way to measure subclinical emphysematous destruction in patients. Here we investigated the relationship between pulmonary functional MRI measurements of terminal airspace enlargement using 3He MRI-ADC and CT airway changes in ex-smokers with COPD. MRI-ADC values at baseline were uniquely predictive of worsening CT total-airway-count and airway wall-area after three-years. MRI captures evidence of mild or subclinical emphysema and its relationship with terminal airway obliteration in COPD.