Ventilation and Perfusion Defects on Phase‐Resolved Functional Lung ( PREFUL ) MRI Predict Silicosis Progression: A Prospective Pilot Study

ABSTRACT Background Silicosis is an occupational lung disease characterized by inflammation and fibrosis. As it is irreversible, early identification of high‐risk individuals is clinically important, but biomarkers for progression remain lacking. Purpose To determine whether ventilation and perfusion defects quantified by phase‐resolved functional lung (PREFUL) MRI can predict silicosis progression. Study Type Prospective. Subjects Thirty participants with silicosis (29 males and 1 female) and 30 healthy controls (29 males and 1 female). Sequence 2D spoiled gradient echo, 3.0 T. Assessment All participants underwent baseline PREFUL MRI, pulmonary function tests (PFTs), and chest CT, with quantitative calculation of ventilation defect percentages (VDP RVent and VDP FVL‐CM ) and perfusion defect percentage (QDP). Silicosis was followed for 1 year with assessments including forced vital capacity percent predicted (FVC% predicted), diffusing capacity of the lungs for carbon monoxide percent predicted (DL co % predicted), symptoms, and CT. Disease progression was defined by any two of: (a) CT evidence of progression, (b) worsening symptoms, or (c) ≥ 10% decline in FVC% predicted or ≥ 15% decline in DLco% predicted. Statistical Tests Spearman correlation coefficients were used to evaluate the correlation between ventilation/perfusion metrics and PFT parameters. Receiver operating characteristic (ROC) curves were used to assess the ability of PREFUL MRI parameters to classify disease progression, reporting the area under the curve (AUC), sensitivity, and specificity. Significance was set at p < 0.05. Results Eight patients progressed and 22 remained stable. Baseline VDP RVent , VDP FVL‐CM , and QDP were significantly higher in progressors (36%, 34%, 40%) than in non‐progressors (22%, 15%, 22%). QDP showed strong predictive performance with AUC of 0.72 (95% CI: 0.51–0.93) for radiological progression, 0.90 (95% CI: 0.79–1.00) for PFTs decline, and 0.97 (95% CI: 0.92–1.00) for global progression. Data Conclusion Increased ventilation and perfusion defects on PREFUL MRI are associated with silicosis progression. Evidence Level 2. Technical Efficacy Stage 2. Trial Registration: NCT06431555