Current Advances in COPD Imaging

Objective

To review the recent advances in available technologies for imaging COPD and present the novel optical coherence tomography (OCT) airway imaging technology.

Materials and Methods

This is an unstructured review of published evidence of available pulmonary imaging technologies along with a demonstration of state-of-the-art OCT imaging technology of in vivo human and animal airways.

Results

Advanced imaging techniques such as Magnetic Resonance (MR) imaging using hyperoloarized noble gases, micro-Computed Tomography (micro-CT), and OCT aim to further our understanding of COPD. Lung densitometry can aid in identifying an exacerbation prone phenotype which may have implications for targeting specific therapies to these individuals. MR ventilation scans have the ability to provide a functional and regional distribution of airflow obstruction offering insight into the airway and parenchymal changes induced by COPD. Micro-CT gives a near microscopic view of the terminal bronchioles and alveoli permitting study of the microarchitecture of the lung ex vivo . Optical coherence tomography can visualize the microstructure of the airway walls (epithelium, smooth muscle, blood vessels, cartilage) permitting real time in vivo as well as longitudinal evaluation of airway changes in patients with COPD.

Conclusion

Advanced imaging techniques play a vital role in expanding our current understanding of COPD.

Introduction

Chronic obstructive lung disease (COPD) is an exceedingly common and debilitating disease affecting approximately 6.5% of adults in the United States ( ). A disease primarily brought on by tobacco smoke and environmental exposures ( ), it accounts for approximately 10 million physician office visits, 1.5 million Emergency Department visits, and 700,000 hospitalizations annually in the United States ( ). For these reasons, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was implemented in 1998, focusing on awareness of the burden of disease and to encourage greater research interest in this area ( ). Despite the increased awareness of COPD, the mortality rate has not decreased ( ). COPD is now the fourth leading cause of death worldwide and the World Health Organization has projected it to be the third leading cause by 2030, trailing only heart disease and stroke ( ).

The mainstay of clinical evaluation and management of COPD is based on symptom assessment and spirometry. At this time, thoracic imaging is only supplemental, aiding in prediction of acute exacerbations ( , ) and planning for advanced procedures such as lung volume reduction surgery ( ) or endobronchial valve/coiling ( ). However, advanced thoracic imaging techniques play a vital role in the research arena, aiding and advancing our understanding of COPD. The most common clinical imaging techniques performed in patients with COPD are plain film X-ray and standard multidetector computed tomography (MDCT). These imaging techniques are robust, well validated, and allow indirect visualization of emphysema, air trapping, and hyperinflation. However, their current resolution and limitations do not permit functional evaluation or direct visualization of the microarchitecture, such as alveoli and terminal bronchioles, which are the site of pathology in COPD.

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Lung Densitometry

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Magnetic Resonance Imaging

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Micro-CT

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Optical Coherence Tomography

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Future Work

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Summary

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Acknowledgment

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