CT biomarkers of emphysema (15th percentile of the CT density histogram, HU15%) and airways disease (wall thickness of airways with 10 mm internal perimeter, Pi10) have shown promise for providing prognostic information.2 Although recent data3 showed that the change in CT emphysema may be used to estimate the efficacy of therapy in patients with α-1-antitrypsin-deficiency, thus far none of the currently developed CT biomarkers have been shown to reflect changes in outcomes that are important to patients with COPD. MRI with inhaled noble gases provide highly sensitive and unique microstructural and functional information in COPD.4 MRI biomarkers of COPD are highly reproducible,5 are associated with COPD outcomes6 and detect changes with greater sensitivity and before disease-related changes can be detected by CT or FEV1. Here we evaluated longitudinal changes in both CT and MRI measurements of COPD. Based on previous longitudinal results,8 ,10 we hypothesised that 3He MRI biomarkers would predict quality-of-life and FEV1 changes in COPD, and that longitudinal changes in MRI biomarkers would be correlated with changes in COPD quality-of-life measures