Phenotyping emphysema and airways disease: Clinical value of quantitative radiological techniques

Table 5 Magnetic resonance imaging modalities to phenotype and treat chronic obstructive pulmonary disease

Phenotype	MRI modality	Findings	Suggested treatments
Airways disease	Hyperpolarised MRI	Detailed anatomical information of airway inflammation, oedema and mucus plugging[84,85]	Nebulised antibiotics Chest clearance techniques[83]
		Regional information re. lung volumes, e.g., focal bronchoconstriction	Broncho-thermoplasty[91] BVRS
Emphysema	Hyperpolarised MRI	Global high ADC[87]	Early disease detection
		Low PaO2[92]	Future alpha one augmentation therapy1
	Oxygen enhanced MRI	↑↓Relative enhancement signal[93,94]	Targets for resection
			Early emphysema detection
	Dynamic contrast MRI	Global microvascular reduction blood flow[95]	Lifestyle moderation
		Focal defects, small pulmonary emboli	Anticoagulation
		Increased pulmonary pressure	Treat as pulmonary hypertension

Potential treatments based on the phenotypes identified by the technique, but that have not yet been tested are noted by

¹in the table. MRI: Magnetic resonance imaging; BVRS: Bronchoscopic volume reduction surgery; ADC: Apparent diffusion co-efficient; KCO: Transfer co-efficient.