ABSTRACT Background Magnetic resonance imaging (MRI) has emerged as a radiation‐free alternative for evaluating interstitial lung disease (ILD), but its diagnostic performance relative to computed tomography (CT) remains variably reported. Purpose To evaluate the diagnostic performance of pulmonary MRI for ILD detection and identification of key imaging hallmarks, using CT as the primary reference standard. Study Type Systematic review and meta‐analysis of observational studies. Population Twenty‐five studies including 959 participants were included in the qualitative synthesis; nine studies ( n = 473) were eligible for quantitative meta‐analysis. Field Strength/Sequence MRI field strengths ranged from 0.55 to 3.0 T and included ultrashort echo‐time (UTE), zero echo‐time (ZTE), T2‐weighted fast spin‐echo, and gradient‐echo–based sequences with slice thickness ranging from 1 to 20 mm. Assessment MRI performance was evaluated against CT for global ILD detection and imaging hallmarks including ground‐glass opacities, nodules, traction bronchiectasis, reticulations, and honeycombing. Statistical Tests Pooled sensitivity and specificity were estimated jointly using a bivariate hierarchical model of Reitsma et al.; heterogeneity was assessed with I 2 statistics ( p < 0.10). Leave‐one‐out sensitivity analyses were performed. Results Pooled sensitivity was 0.91 (95% CI: 0.84–0.95; I 2 : 42.1%) and pooled specificity was 0.86 (95% CI: 0.73–0.93; I 2 : 62.6%) and summary SROC AUC of 0.939. In a predefined subanalysis restricted to UTE/ZTE thin‐slice protocols (four studies), sensitivity was 0.93 (95% CI: 0.87–0.97; I 2 : 0.0%) and specificity was 0.92 (95% CI: 0.78–0.98; I 2 : 51.3%). Data Conclusion Pulmonary MRI demonstrates high diagnostic performance for ILD detection, with results suggesting protocol‐dependent performance and improved consistency under optimized UTE/ZTE thin‐slice acquisitions. Evidence Level 3. Technical Efficacy Stage 2.
Paulo et al. (2026) studied this question.