3D MRI of lungs seen to help measure Trikafta response in study

Better resolution with new tech can detect changes from treatment

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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A technician prepares to start a patient on an MRI scan.

A three-dimensional MRI scan of the lungs can be used to monitor responses by cystic fibrosis (CF) patients to the approved CF medication Trikafta (elexacaftor/tezacaftor/ivacaftor), a new study reports.

Indeed, the new 3D technology was found to work better than traditional two-dimensional MRI scans in assessing the effects of Trikafta use among people with CF, according to researchers.

“In contrast to 2D alternatives, 3D techniques offer whole lunge coverage [with] better spatial resolution,” the team wrote, noting that Trikafta was found to lead to “improvements … [in] clinical outcome parameters” among patients.

The study, “Effect of CFTR modulator therapy with elexacaftor/tezacaftor/ivacaftor on pulmonary ventilation derived by 3D phase-resolved functional lung MRI in cystic fibrosis patients,” was published in European Radiology.

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Improvements seen in patients treated with approved CF medication Trikafta

CF is caused by gene mutations that interfere with the activity or production of the CFTR protein. Trikafta is a triple-combination medication containing three CFTR modulators, which are compounds that can help to boost the functionality of the CFTR protein in people with CF caused by certain mutations.

The treatment was approved in the U.S. in October 2019. Clinical trials testing the therapy have shown that Trikafta can improve lung function in patients with eligible mutations.

Imaging of the lungs can be valuable in tracking the progression of CF and monitoring patients’ responses to treatments like Trikafta. Several different lung imaging technologies are available — including MRI, which uses powerful magnets and radio waves to image the body’s internal structures.

Traditional MRI takes two-dimensional pictures, but in recent years scientists have developed new technology that can image the lungs in three dimensions. This technology, called a 3D phase-resolved functional lung (PREFUL) MRI, was expected to offer better resolution to detect changes than traditional 2D MRI.

Now, researchers in Germany used 3D PREFUL MRI to analyze the lungs of 23 people with CF. Among them were 13 females and 10 males, with a mean age of 21. The patients were assessed before treatment with Trikafta, then again after a few months on the therapy.

“The objective of this study was to investigate if the ventilation parameters derived by 3D PREFUL are suitable to measure response to [Trikafta] therapy and their association with improvements in clinical outcome measures in CF patients,” the scientists wrote.

Our study demonstrates that [Trikafta] therapy leads to improvement in lung ventilation determined by 3D PREFUL MRI in CF patients.

The results showed that nearly every parameter measured by 3D PREFUL MRI — including assessments of lung morphology, or tissue shape, and the lung’s ability to take in air — showed significant improvement following treatment with Trikafta.

“Our study demonstrates that ETI [Trikafta] therapy leads to improvement in lung ventilation determined by 3D PREFUL MRI in CF patients,” the researchers wrote.

Standardized measures of lung function, such as spirometry — measures based on how much air someone can forcibly blow out — also showed improvements. The extent of improvement on these standardized measures was not significantly correlated with the improvements seen on 3D PREFUL MRI; however, after Trikafta treatment, measures of lung function and measures based on 3D PREFUL MRI were correlated with each other.

The researchers noted that these analyses were limited by the small number of patients included in the study, highlighting a need for additional research to further explore the potential utility of 3D PREFUL MRI in CF care.

However, the team concluded that the 3D MRI appear to be “a very promising tool to monitor CFTR modulator-induced … changes in CF patients.”