Objectives <p>Severe asthma patients are prone to severe exacerbations with a need of hospital admission increasing the economic burden on healthcare systems. T2w lung MRI was found to be useful in the assessment of bronchial inflammation. The main goal of this study is to compare quantitative MRI T2 signal bronchial intensity between patients with severe and non-severe asthma.</p> Methods <p>This is an ancillary study of a prospective single-center study (NCT03089346). We assessed the mean T2 intensity MRI signal of the bronchial wall area (BrWall_T2-MIS) in 15 severe and 15 age and sex-matched non-severe asthmatic patients. They also have had pulmonary function tests (PFTs), fractional exhaled nitric oxide (FeNO) and blood eosinophils count (Eos). Comparisons between the two groups were performed using Student’s <i>t</i>-test. Correlations were assessed using Pearson coefficients. Reproducibility was assessed using intraclass correlation coefficient and Bland-Altman analysis.</p> Results <p>BrWall_T2-MIS was higher in severe than in non-severe asthma patients (74 ± 12 vs 49 ± 14; respectively <i>p</i> &lt; 0.001). BrWall_T2-MIS showed a moderate inverse correlation with PFTs in the whole cohort (<i>r</i> = −0.54, <i>r</i> = −0.44 for FEV1(%pred) and FEV1/FVC respectively, <i>p</i> ≤ 0.01) and in the severe asthma group (<i>r</i> = −0.53, <i>r</i> = −0.44 for FEV1(%pred) and FEV1/FVC respectively, <i>p</i> ≤ 0.01). Eos was moderately correlated with BrWall_T2-MIS in severe asthma group (<i>r</i> = 0.52, <i>p</i> = 0.047). Reproducibility was almost perfect with ICC = 0.99 and mean difference in Bland-Altman analysis of −0.15 [95% CI = −0.48–0.16].</p> Conclusion <p>Quantification of bronchial wall T2w signal intensity appears to be able to differentiate severe from non-severe asthma and correlates with obstructive PFTs’ parameters and inflammatory markers in severe asthma.</p> Critical relevance statement <p>The development of non-ionizing imaging biomarkers could play an essential role in the management of patients with severe asthma in the current era of biological therapies.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Severe asthma exhibits severe exacerbations with a high burden on healthcare systems.</p> </ItemContent> <ItemContent> <p>T2w bronchial wall signal intensity is related to inflammatory biomarker in severe asthma.</p> </ItemContent> <ItemContent> <p>T2w MRI may represent a non-invasive tool to follow up severe asthma patients.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>