Pulmonary CT and MRI phenotypes that help explain chronic pulmonary obstruction disease pathophysiology and outcomes

Hoffman, Eric A.; Lynch, David A.; Barr, R. Graham; Beek, Edwin Jacques Rudolph van; Párraga, Grace; Investigators, Iwpfi

doi:10.1002/jmri.25010

Cited by 62 publications

(55 citation statements)

References 156 publications

(205 reference statements)

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“…Magnetic resonance imaging (MRI) is another modality that can provide functional images of the lungs in COPD [123,124]. There are a number of challenges in using MR to image the lungs including the low concentrations of protons, multiple air tissue interfaces and relatively poor spatial resolution.…”

Section: Other Imaging Modalitiesmentioning

confidence: 99%

“…Uptake is significantly increased in COPD [121] and is associated with FEV1 and emphysema severity [121,122]. With SPECT, perfusion and ventilation imaging can be performed with either a vascular or inhaled tracer.Magnetic resonance imaging (MRI) is another modality that can provide functional images of the lungs in COPD [123,124]. There are a number of challenges in using MR to image the lungs including the low concentrations of protons, multiple air tissue interfaces and relatively poor spatial resolution.…”

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Present and future utility of computed tomography scanning in the assessment and management of COPD

Ostridge

Wilkinson

2016

Eur Respir J

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likely to have important implications for understanding disease progression and the future management of this condition [2]. There are currently no significant diseasemodifying medications for COPD and there have not been the improvements in outcome seen in other chronic diseases. Other tools are required in addition to spirometry to help explain the heterogeneity and provide further insights into approaches to study and treat COPD. CT has current practical applications in the routine management and investigation of the disease and with the development of novel analysis techniques has the potential to provide further details about the pulmonary and extra-pulmonary manifestations of COPD. Computed Tomography in Current Clinical PractisePrior to the 1970s histological and post mortem studies were required to study structural changes of the lung. The introduction of CT made it possible to visualise the thorax and assess lung structure non-invasively. In COPD CT can identify key morphological features, including emphysema, bronchial wall thickening and gas trapping. These pathologies contribute directly to airflow obstruction and therefore CT has the potential to provide vital insights into the underlying pathophysiological changes of COPD. Despite this, routine CT imaging has not necessarily been widely adopted in clinical practise and its place in the management and investigation of COPD has not been firmly established. The GOLD guidelines do not routinely recommend CT scanning in COPD and only advise that it may be helpful in differential diagnosis or when surgical options are being considered [3]. This general ambivalence is highlighted by a study of attitudes in respiratory physicians and surgeons in the UK where only 32% thought it necessary for patients with severe COPD to have a CT scan [4].There are a number of reasons why the use of CT has not become routine in COPD. One of the most important is the perceived notion that using CT does not alter management, although this is not strictly true. The National Emphysema Treatment Trial (NETT) demonstrated that patients with advanced upper lobe emphysema and limited exercise ability improved after lung volume reduction surgery [5]. There has also been considerable progress and experience in using endobronchial treatments for severe emphysema including coils, valves, sealant and airway bypass. In the correct patients with severe heterogeneous emphysema these treatments can lead to significant improvement in pulmonary physiology and functional capacity [6, 7]. CT imaging can also identify bullous disease, which may be amenable to surgery and bullectomy can lead to improved health status [8]. It therefore seems clear that patients with severe COPD require CT imaging to determine which patients are appropriate for these techniques.CT imaging can also detect concomitant pulmonary pathology in COPD. Bronchiectasis is particularly prevalent, with studies demonstrating 50% of COPD patients having CT evidence of the disease [9][10][11]. When present bronchiectasis is asso...

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Section: Other Imaging Modalitiesmentioning

confidence: 99%

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confidence: 99%

Present and future utility of computed tomography scanning in the assessment and management of COPD

Ostridge

Wilkinson

2016

Eur Respir J

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“…The comparative contributions of CT and MRI to an improved understanding of the lungs has been recently reviewed [20]. Typically imaging is performed at full inspiration (total lung capacity (TLC)) ( Figure 1A ) and at end expiration either at residual volume (RV) or functional residual capacity (FRC) ( Figure 1B ).…”

Section: Introductionmentioning

confidence: 99%

Using imaging as a biomarker for asthma

Trivedi

Hall

Hoffman

et al. 2017

Journal of Allergy and Clinical Immunology

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There have been significant advancements in the various imaging techniques that are being used in the evaluation of patients with asthma, both from a clinical and research perspective. Imaging characteristics can be used to identify specific asthmatic phenotypes and provide a more detailed understanding of endotypes contributing to the pathophysiology of the disease. Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) can be used to assess pulmonary structure and function. It has been shown that specific airway and lung density measurements by CT correlate with clinical parameters including severity of disease and pathology but also provide unique phenotypes. Hyperpolarized 129Xe and 3He are gases used as contrast media for MRI that provide measurement of distal lung ventilation reflecting small airway disease. PET scanning can be useful to identify and target lung inflammation in asthma. Furthermore, imaging techniques can serve as a potential biomarker and be used to assess response to therapies, including newer biological treatments and bronchial thermoplasty.

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“…Computed tomography (CT) is increasingly used in clinical practice and offers an opportunity to detect disease early. 4,5 Multiple large cohort studies have used a combination of inspiratory and expiratory scans, enabling the application of advanced postimage processing to further the detection and characterization of disease. 6,7 In this review, we provide an overview of traditional and novel CT measures of COPD and discuss several recent applications of CT image matching techniques.…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography Image Matching in Chronic Obstructive Pulmonary Disease

Bodduluri

Bhatt

Reinhardt

2016

Crit Rev Biomed Eng

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Chronic obstructive pulmonary disease (COPD), characterized by progressive airflow obstruction due to the combined effects of emphysema and small airways disease, is associated with high morbidity and mortality. The complex link between emphysema and airways disease is associated with significant heterogeneity in clinical presentation. Spirometry is the current gold standard for diagnosis and stratification of the severity of airflow obstruction in COPD. Although spirometry is simple to use, it does not enable the separation of emphysema from airways disease. Computed tomography (CT), on the other hand, provides the anatomic localization of disease and has been increasingly used to phenotype COPD. The majority of current CT measures are extracted from a single-volume CT scan and although useful to characterize emphysema and airways disease, they do not link structural and functional abnormalities. Alternatively, CT image matching combines information from both inspiratory and expiratory CT scans, thus enabling determination of functional changes such as regional ventilation and mechanical properties of the lung. In this review, we discuss recent applications of CT image matching that provide clinically meaningful information beyond spirometry and single-volume CT scan measures.

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Pulmonary CT and MRI phenotypes that help explain chronic pulmonary obstruction disease pathophysiology and outcomes

Cited by 62 publications

References 156 publications

Present and future utility of computed tomography scanning in the assessment and management of COPD

Present and future utility of computed tomography scanning in the assessment and management of COPD

Using imaging as a biomarker for asthma

Computed Tomography Image Matching in Chronic Obstructive Pulmonary Disease

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