Table 1.

Proposal for Flexible Lung Magnetic Resonance Protocol in Cystic Fibrosis

Core Protocol	Sequence	Contrast Agent Enhancement	Acquisition Time	Expected Information	Typical Use
Morphology	3D-UTE or 3D-ZTE	None	4-6 min	High-resolution morphology with 3D reformations	Routine
Endogenous contrast	T1w	None	15 s	T1 contrast Characterization of inflammation	Routine
	T2w	None	2-4 min for 2D sequence	T2 contrast	Routine
			8-10 min for 3D sequence	Detection, characterization, quantification of active inflammation
Additional sequences
Perfusion	Contrast- or non-contrast-enhanced sequence	If yes, gadolinium chelate injection	5-30 min	Quantification of perfusion defects	Research,a IRB approval needed for contrast product injection
Ventilation	Contrast- or non-contrast-enhanced sequence	If yes, 129Xe (or oxygen of 19F)	5-30 min	Quantification of ventilation defects	Research,a IRB approval needed for contrast product inhalation
Diffusion	DWI	None	5-20 min	Characterization of abscess	Routine, according to context
				Quantification of inflammation	Researcha

2D = two-dimensional; 3D = three-dimensional; DWI = diffusion-weighted imaging; IRB = institutional review board; T1w = T1 weighted; T2w = T2 weighted; UTE = ultrashort echo time; ZTE = zero echo time.

^aLung MRI in cystic fibrosis is a recent, trained, and expert activity. Therefore, the classification as “routine” or “research” may vary according to country regulations, institutional review board policy, and local technical availability. Gadolinium chelate injection is used routinely in Germany. Xenon-129 inhalation is considered for clinical use in the United Kingdom, and Food and Drug Administration approval is pending in the United States. Conversely, oxygen and ¹⁹F are used for research purposes only. In this table, the core protocol does not require a hardware change, can be performed in < 15 min, and is likely to be applicable across institutions without any concern about radiation and contrast product safety.