Utilising hyperpolarised xenon and dynamic contrast enhanced MRI to assess the potential pulmonary sequelae of bleomycin therapy - a pilot study

Motivation: Drug-induced interstitial lung disease (DI-ILD) is particularly difficult to diagnose. We sought to assess whether MR imaging biomarkers can provide new insights into the changes caused by bleomycin. Goal(s): To evaluate if hyperpolarised xenon and dynamic contrast-enhanced MRI can better describe pathophysiological changes from bleomycin chemotherapy. Approach: A single-centre prospective study with imaging: prior to chemotherapy, 1-6 weeks post cycle 1, 8-14 weeks post cycle 3 OR 4 and 24-28 weeks following completion of chemotherapy. Results: Eleven patients were recruited. RBC:M ratio and PBV changes suggesting inflammatory rather than fibrotic alterations in this cohort of patients. Impact: Improved early diagnosis of drug-induced lung toxicity using a combination of structural and functional MRI may directly influence how inflammatory and fibrotic ILD is managed, particularly in patients undergoing novel therapies.