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Tracking interstitial lung disease in systemic sclerosis: integrating lung magnetic resonance imaging into a clinically oriented multimodal follow-up strategy
M. Di Battista1, C. Romei2, S. Barsotti3, A. Marcucci4, V. Uggenti5, G. Ghezzi6, A. Delle Sedie7, A. Della Rossa8, E. Neri9, M. Mosca10
- Rheumatology Unit, University of Pisa, Italy. dibattista.marco91@gmail.com
- Department of Translational Research, Academic Radiology, University of Pisa, Italy.
- Division of Rheumatology, Versilia Hospital ASL Toscana Nord-Ovest, Camaiore, Italy.
- Department of Translational Research, Academic Radiology, University of Pisa, Italy.
- Department of Translational Research, Academic Radiology, University of Pisa, Italy.
- Rheumatology Unit, University of Pisa, Italy.
- Rheumatology Unit, University of Pisa, Italy.
- Rheumatology Unit, University of Pisa, Italy.
- Department of Translational Research, Academic Radiology, University of Pisa, Italy.
- Rheumatology Unit, University of Pisa, Italy.
CER19952
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Received: 23/03/2026
Accepted : 20/04/2026
In Press: 15/06/2026
Abstract
OBJECTIVES:
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.
METHODS:
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.
RESULTS:
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).
CONCLUSIONS:
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.
