INTEGRATING ADVANCED RADIOLOGICAL IMAGING TECHNIQUES FOR ACCURATE DIAGNOSIS AND MONITORING OF CHRONIC PULMONARY DISEASES IN CLINICAL PRACTICE: A SYSTEMATIC REVIEW

Abstract

Background: Chronic pulmonary diseases represent a leading cause of global morbidity and mortality, with diagnosis and monitoring traditionally reliant on conventional imaging and pulmonary function tests, which have limited sensitivity for early, regional pathophysiology. Advanced radiological techniques like parametric response mapping (PRM) and hyperpolarized gas MRI offer potential for transformative insights, but a synthesized evidence base for their clinical role is needed.

Objective: This systematic review aimed to evaluate the role of advanced radiological imaging techniques in improving diagnostic accuracy, disease monitoring, and treatment planning for chronic pulmonary diseases, compared to standard diagnostic workups alone.

Methods: A systematic review was conducted following PRISMA guidelines. Databases including PubMed, Scopus, Web of Science, and the Cochrane Library were searched for studies published between 2014 and 2024. Inclusion criteria encompassed randomized controlled trials and observational studies investigating advanced imaging (e.g., PRM, DECT, hyperpolarized gas MRI) in adults with chronic obstructive pulmonary disease or interstitial lung disease. Data on study characteristics, outcomes, and risk of bias were extracted and synthesized qualitatively.

Results: Eight studies (n=2,847 participants), including two RCTs and six cohort studies, were included. The evidence consistently demonstrated that advanced imaging provides superior quantitative biomarkers. PRM-derived functional small airway disease significantly predicted FEV1 decline (β = -0.41, p=0.003), and its emphysema quantification was associated with increased mortality (HR: 1.8, 95% CI: 1.3-2.5). Deep learning-based CT phenotyping predicted exacerbation risk (AUC=0.81), outperforming conventional metrics. Hyperpolarized gas MRI detected functional changes not reflected in spirometry.

Conclusion: Advanced radiological imaging techniques provide significant, quantifiable advantages over conventional methods for phenotyping, monitoring progression, and predicting outcomes in chronic pulmonary diseases. They hold strong potential for personalizing patient management, though broader clinical implementation requires standardized protocols and further validation through multi-center trials focused on patient-centered outcomes.