Functional imaging of COPD by CT and MRI

2021 ◽  
pp. 20201005
Author(s):  
David A Lynch
Keyword(s):  
Functional Imaging ◽  
Pulmonary Vascular Disease ◽  
Wall Thickening ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Lung Dysfunction ◽  
Apparent Diffusion ◽  
Hyperpolarized Gas Mri ◽  
Contrast Ct ◽  
Ct And Mri

This commentary reviews the contribution of imaging by CT and MRI to functional assessment in chronic obstructive pulmonary disease (COPD). CT can help individualize the assessment of COPD by quantifying emphysema, air trapping and airway wall thickening, potentially leading to more specific treatments for these distinct components of COPD. Longitudinal changes in these metrics can help assess progression or improvement. On hyperpolarized gas MRI, the apparent diffusion coefficient of provides an index of airspace enlargement reflecting emphysema. Perfusion imaging and measurement of pulmonary vascular volume on non-contrast CT provide insight into the contribution of pulmonary vascular disease to pulmonary impairment. Functional imaging is particularly valuable in detecting early lung dysfunction in subjects with inhalational exposures.

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

2016 ◽  
Vol 48 (1) ◽  
pp. 216-228 ◽  
Author(s):  
Kristoffer Ostridge ◽  
Tom M.A. Wilkinson
Keyword(s):  
Computed Tomography ◽  
Clinical Applications ◽  
Wall Thickening ◽  
Chronic Obstructive ◽  
Clinical Tool ◽  
Obstructive Pulmonary Disease ◽  
Lung Structure ◽  
Computed Tomography Scanning ◽  
Underlying Mechanisms ◽  
Future Utility

Computed tomography (CT) is the modality of choice for imaging the thorax and lung structure. In chronic obstructive pulmonary disease (COPD), it used to recognise the key morphological features of emphysema, bronchial wall thickening and gas trapping. Despite this, its place in the investigation and management of COPD is yet to be determined, and it is not routinely recommended. However, lung CT already has important clinical applications where it can be used to diagnose concomitant pathology and determine which patients with severe emphysema are appropriate for lung volume reduction procedures. Furthermore, novel quantitative analysis techniques permit objective measurements of pulmonary and extrapulmonary manifestations of the disease. These techniques can give important insights into COPD, and help explore the heterogeneity and underlying mechanisms of the condition. In time, it is hoped that these techniques can be used in clinical trials to help develop disease-specific therapy and, ultimately, as a clinical tool in identifying patients who would benefit most from new and existing treatments. This review discusses the current clinical applications for CT imaging in COPD and quantification techniques, and its potential future role in stratifying disease for optimal outcome.

Lung transplantation

2010 ◽  
pp. 3476-3485
Author(s):  
P. Hopkins ◽  
K. McNeil
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cystic Fibrosis ◽  
Lung Transplantation ◽  
Therapeutic Option ◽  
Pulmonary Vascular Disease ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Obstructive Pulmonary Disease ◽  
Substance Addiction ◽  
Recipient Selection

Lung transplantation offers the only therapeutic option for many patients with a variety of endstage pulmonary and cardiopulmonary diseases, but donors are scarce and the major challenge facing lung transplantation (as with all solid organ transplants) is the critical shortage of donor organs. Recipient selection—emphysema/chronic obstructive pulmonary disease (COPD), cystic fibrosis, idiopathic pulmonary fibrosis, and pulmonary vascular disease are the main disease groups referred for lung transplantation. Most patients are listed for transplantation when their survival is estimated to be less than 2 years without a transplant. Exclusion criteria include malignancy (excluding localized skin malignancies) within the last 2 years, inability to cooperate or comply with medical therapy/instruction, recent substance addiction, active or noncurable extrapulmonary infection, significant chest wall/spinal deformity, and significant extrathoracic organ dysfunction....

scholarly journals Distal airway dysfunction identifies pulmonary inflammation in asymptomatic smokers

2016 ◽  
Vol 2 (4) ◽  
pp. 00066-2016 ◽  
Author(s):  
Kenneth I. Berger ◽  
Deepak R. Pradhan ◽  
Roberta M. Goldring ◽  
Beno W. Oppenheimer ◽  
William N. Rom ◽  
...  
Keyword(s):  
Transforming Growth Factor ◽  
Pulmonary Inflammation ◽  
Chronic Obstructive ◽  
Forced Oscillation Technique ◽  
Obstructive Pulmonary Disease ◽  
Transforming Growth Factor Α ◽  
Distal Airway ◽  
Lung Dysfunction ◽  
Distal Lung ◽  
Factor Α

Smoking induced inflammation leads to distal airway destruction. However, the relationship between distal airway dysfunction and inflammation remains unclear, particularly in smokers prior to the development of airway obstruction.Seven normal controls and 16 smokers without chronic obstructive pulmonary disease (COPD) were studied. Respiratory function was assessed using the forced oscillation technique (FOT). Abnormal FOT was defined as elevated resistance at 5 Hz (R5). Parameters reflecting distal lung function included frequency dependence of resistance (R5–20) and dynamic elastance (X5). Inflammation was quantified in concentrated bronchoalveolar lavage utilising cell count differential and cytokines expressed as concentration per mL epithelial lining fluid.All control subjects and seven smokers had normal R5. Nine smokers had elevated R5 with abnormal R5–20 and X5, indicating distal lung dysfunction. The presence of abnormal FOT was associated with two-fold higher lymphocyte and neutrophil counts (p<0.025) and with higher interleukin (IL)-8, eotaxin and fractalkine levels (p<0.01). Reactivity of R5–20 and X5 correlated with levels of IL-8, eotaxin, fractalkine, IL-12p70 and transforming growth factor-α (r>0.47, p<0.01).Distal airway dysfunction in smokers without COPD identifies the presence of distal lung inflammation that parallel reported observations in established COPD. These findings were not evident on routine pulmonary function testing and may allow the identification of smokers at risk of progression to COPD.

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