Magnetic resonance imaging methods for structural and functional assessment of the lungs: proton and multi-nuclear

Despite the inherent challenges of magnetic resonance imaging (MRI) of the lungs, a number of quantitative techniques with high functional sensitivity have been established for regional assessment of multiple aspects of pulmonary structure and physiology. Conventional proton-based MR methods provide non-invasive anatomical imaging and diagnostic measures of pulmonary perfusion, ventilation and gas-exchange functions. Mutli-nuclear MRI of the lung, including hyperpolarised noble gas MRI with helium-3 and xenon-129, has matured into a sensitive functional tool for visualisation of pulmonary ventilation, quantification of gas diffusion and evaluation of alveolar structure. These minimally invasive, safe and non-ionising radiation based methods are well-suited to longitudinal assessment of disease progression and treatment response and recent technological and methodological advances are facilitating the dissemination of previously unconventional techniques on a broader clinical scale. In this article, we review the established and developing procedures for proton and multi-nuclear MRI of the pulmonary system, with applicable clinical examples.