Peer-review started: September 1, 2016
First decision: November 10, 2016
Revised: December 20, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: March 28, 2017
Processing time: 209 Days and 0.2 Hours
The pathophysiology of chronic obstructive pulmonary disease (COPD) and Alpha one antitrypsin deficiency is increasingly recognised as complex such that lung function alone is insufficient for early detection, clinical categorisation and dictating management. Quantitative imaging techniques can detect disease earlier and more accurately, and provide an objective tool to help phenotype patients into predominant airways disease or emphysema. Computed tomography provides detailed information relating to structural and anatomical changes seen in COPD, and magnetic resonance imaging/nuclear imaging gives functional and regional information with regards to ventilation and perfusion. It is likely imaging will become part of routine clinical practice, and an understanding of the implications of the data is essential. This review discusses technical and clinical aspects of quantitative imaging in obstructive airways disease.
Core tip: Phenotyping emphysematous patients radiologically allow physicians to diagnose and deliver tailored and targeted therapies that are not possible with spirometry. When patients are divided into chronic bronchitis or emphysema on computed tomography (CT), they have significantly different clinical features and spirometry, demonstrating its ability to characterise phenotypic differences. CT offers accurate mapping and measurement of emphysema whereas magnetic resonance imaging (MRI) can provide functional information relating to ventilation and perfusion. This unique feature of MRI can help prognosticate patients in whom surgery is being considered. CT and MRI have both been sufficiently validated clinically and pathologically.