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Morphological and functional imaging in COPD with CT and MRI: present and future

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Abstract

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. COPD is defined by irreversible airflow obstruction. It is a heterogeneous disease affecting the airways (i.e. chronic bronchitis, airway collapse), the parenchyma (i.e. hyperinflation, air trapping and emphysematous destruction) as well as the vasculature (i.e. hypoxic vasoconstriction, rarefication and pulmonary arterial hypertension) with different severity during the course of the disease. These different aspects of COPD can be best addressed by imaging using a combination of morphological and functional techniques. Three-dimensional high-resolution computed tomography (3D-HRCT) is the technique of choice for morphological imaging of the lung parenchyma and airways. This morphological information is to be accomplished by functional information about perfusion, regional lung mechanics, and ventilation mainly provided by MRI. The comprehensive diagnostic possibilities of CT complemented by MRI will allow for a more sensitive detection, phenotype-driven characterization and dedicated therapy monitoring of COPD as presented in this review.

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References

  1. GOLD (2006) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Executive summery, updated http://www.goldcopd.org

  2. Szilasi M, Dolinay T, Nemes Z, Strausz J (2006) Pathology of chronic obstructive pulmonary disease. Pathol Oncol Res 12:52–60

    PubMed  Google Scholar 

  3. Rosenkranz S (2007) Pulmonary hypertension: current diagnosis and treatment. Clin Res Cardiol 96:527–541

    Article  PubMed  CAS  Google Scholar 

  4. Ley-Zaporozhan J, Ley S, Kauczor HU (2007) Proton MRI in COPD. Copd 4:55–65

    Article  PubMed  Google Scholar 

  5. Bankier AA, Madani A, Gevenois PA (2002) CT quantification of pulmonary emphysema: assessment of lung structure and function. Crit Rev Comput Tomogr 43:399–417

    Article  PubMed  Google Scholar 

  6. Gevenois PA, De Vuyst P, de Maertelaer V, Zanen J, Jacobovitz D, Cosio MG, Yernault JC (1996) Comparison of computed density and microscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 154:187–192

    PubMed  CAS  Google Scholar 

  7. Newell JD Jr, Hogg JC, Snider GL (2004) Report of a workshop: quantitative computed tomography scanning in longitudinal studies of emphysema. Eur Respir J 23:769–775

    Article  PubMed  Google Scholar 

  8. Martinez FJ, Foster G, Curtis JL, Criner G, Weinmann G, Fishman A, DeCamp MM, Benditt J, Sciurba F, Make B, Mohsenifar Z, Diaz P, Hoffman E, Wise R (2006) Predictors of mortality in patients with emphysema and severe airflow obstruction. Am J Respir Crit Care Med 173:1326–1334

    Article  PubMed  Google Scholar 

  9. Aziz ZA, Wells AU, Desai SR, Ellis SM, Walker AE, MacDonald S, Hansell DM (2005) Functional impairment in emphysema: contribution of airway abnormalities and distribution of parenchymal disease. AJR Am J Roentgenol 185:1509–1515

    Article  PubMed  Google Scholar 

  10. Nakano Y, Sakai H, Muro S, Hirai T, Oku Y, Nishimura K, Mishima M (1999) Comparison of low attenuation areas on computed tomographic scans between inner and outer segments of the lung in patients with chronic obstructive pulmonary disease: incidence and contribution to lung function. Thorax 54:384–389

    Article  PubMed  CAS  Google Scholar 

  11. Bankier AA, De Maertelaer V, Keyzer C, Gevenois PA (1999) Pulmonary emphysema: subjective visual grading versus objective quantification with macroscopic morphometry and thin-section CT densitometry. Radiology 211:851–858

    PubMed  CAS  Google Scholar 

  12. Gevenois PA, de Maertelaer V, De Vuyst P, Zanen J, Yernault JC (1995) Comparison of computed density and macroscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 152:653–657

    PubMed  CAS  Google Scholar 

  13. Baldi S, Miniati M, Bellina CR, Battolla L, Catapano G, Begliomini E, Giustini D, Giuntini C (2001) Relationship between extent of pulmonary emphysema by high-resolution computed tomography and lung elastic recoil in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164:585–589

    PubMed  CAS  Google Scholar 

  14. Stoel BC, Stolk J (2004) Optimization and standardization of lung densitometry in the assessment of pulmonary emphysema. Invest Radiol 39:681–688

    Article  PubMed  Google Scholar 

  15. Madani A, Zanen J, de Maertelaer V, Gevenois PA (2006) Pulmonary emphysema: objective quantification at multi-detector row CT–comparison with macroscopic and microscopic morphometry. Radiology 238:1036–1043

    Article  PubMed  Google Scholar 

  16. Kinsella M, Muller NL, Abboud RT, Morrison NJ, DyBuncio A (1990) Quantitation of emphysema by computed tomography using a “density mask” program and correlation with pulmonary function tests. Chest 97:315–321

    Article  PubMed  CAS  Google Scholar 

  17. Arakawa A, Yamashita Y, Nakayama Y, Kadota M, Korogi H, Kawano O, Matsumoto M, Takahashi M (2001) Assessment of lung volumes in pulmonary emphysema using multidetector helical CT: comparison with pulmonary function tests. Comput Med Imaging Graph 25:399–404

    Article  PubMed  CAS  Google Scholar 

  18. Zaporozhan J, Ley S, Eberhardt R, Weinheimer O, Iliyushenko S, Herth F, Kauczor HU (2005) Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis: comparison of different quantitative evaluations and pulmonary function test. Chest 128:3212–3220

    Article  PubMed  Google Scholar 

  19. Boedeker KL, McNitt-Gray MF, Rogers SR, Truong DA, Brown MS, Gjertson DW, Goldin JG (2004) Emphysema: effect of reconstruction algorithm on CT imaging measures. Radiology 232:295–301

    Article  PubMed  Google Scholar 

  20. Ley-Zaporozhan J, Ley S, Weinheimer O, Iliyushenko S, Erdugan S, Eberhardt R, Fuxa A, Mews J, Kauczor HU (2007) Quantitative analysis of emphysema in 3D using MDCT: influence of different reconstruction algorithms. Eur J Radiol DOI 10.1016/j.grad.2007.03.034

  21. Madani A, De Maertelaer V, Zanen J, Gevenois PA (2007) Pulmonary emphysema: radiation dose and section thickness at multidetector CT quantification–comparison with macroscopic and microscopic morphometry. Radiology 243:250–257

    Article  PubMed  Google Scholar 

  22. Zaporozhan J, Ley S, Weinheimer O, Eberhardt R, Tsakiris I, Noshi Y, Herth F, Kauczor HU (2006) Multi-detector CT of the chest: influence of dose onto quantitative evaluation of severe emphysema: a simulation study. J Comput Assist Tomogr 30:460–468

    Article  PubMed  Google Scholar 

  23. Mishima M, Hirai T, Itoh H, Nakano Y, Sakai H, Muro S, Nishimura K, Oku Y, Chin K, Ohi M, Nakamura T, Bates JH, Alencar AM, Suki B (1999) Complexity of terminal airspace geometry assessed by lung computed tomography in normal subjects and patients with chronic obstructive pulmonary disease. Proc Natl Acad Sci USA 96:8829–8834

    Article  PubMed  CAS  Google Scholar 

  24. Hoffman EA, Simon BA, McLennan G (2006) State of the Art. A structural and functional assessment of the lung via multidetector-row computed tomography: phenotyping chronic obstructive pulmonary disease. Proc Am Thorac Soc 3:519–532

    Article  PubMed  Google Scholar 

  25. Xu Y, Sonka M, McLennan G, Guo J, Hoffman EA (2006) MDCT-based 3-D texture classification of emphysema and early smoking related lung pathologies. IEEE Trans Med Imaging 25:464–475

    Article  PubMed  CAS  Google Scholar 

  26. Bankier AA, O’Donnell CR, Mai VM, Storey P, De Maertelaer V, Edelman RR, Chen Q (2004) Impact of lung volume on MR signal intensity changes of the lung parenchyma. J Magn Reson Imaging 20:961–966

    Article  PubMed  Google Scholar 

  27. Hatabu H, Chen Q, Stock KW, Gefter WB, Itoh H (1999) Fast magnetic resonance imaging of the lung. Eur J Radiol 29:114–132

    Article  PubMed  CAS  Google Scholar 

  28. Hogg JC, Chu F, Utokaparch S, Woods R, Elliott WM, Buzatu L, Cherniack RM, Rogers RM, Sciurba FC, Coxson HO, Pare PD (2004) The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med 350:2645–2653

    Article  PubMed  CAS  Google Scholar 

  29. Hogg JC (2006) State of the art. Bronchiolitis in chronic obstructive pulmonary disease. Proc Am Thorac Soc 3:489–493

    Article  PubMed  CAS  Google Scholar 

  30. Heussel CP, Ley S, Biedermann A, Rist A, Gast KK, Schreiber WG, Kauczor HU (2004) Respiratory lumenal change of the pharynx and trachea in normal subjects and COPD patients: assessment by cine-MRI. Eur Radiol 14:2188–2197

    Article  PubMed  Google Scholar 

  31. Boiselle PM, Ernst A (2006) Tracheal morphology in patients with tracheomalacia: prevalence of inspiratory lunate and expiratory “frown” shapes. J Thorac Imaging 21:190–196

    Article  PubMed  Google Scholar 

  32. Goldin JG (2002) Quantitative CT of the lung. Radiol Clin North Am 40:145–162

    Article  PubMed  Google Scholar 

  33. Mayer D, Bartz D, Fischer J, Ley S, del Rio A, Thust S, Kauczor HU, Heussel CP (2004) Hybrid segmentation and virtual bronchoscopy based on CT images. Acad Radiol 11:551–565

    Article  PubMed  Google Scholar 

  34. Berger P, Laurent F, Begueret H, Perot V, Rouiller R, Raherison C, Molimard M, Marthan R, Tunon-de-Lara JM (2003) Structure and function of small airways in smokers: relationship between air trapping at CT and airway inflammation. Radiology 228:85–94

    Article  PubMed  Google Scholar 

  35. Hansell DM (2001) Small airways diseases: detection and insights with computed tomography. Eur Respir J 17:1294–1313

    Article  PubMed  CAS  Google Scholar 

  36. Park JW, Hong YK, Kim CW, Kim DK, Choe KO, Hong CS (1997) High-resolution computed tomography in patients with bronchial asthma: correlation with clinical features, pulmonary functions and bronchial hyperresponsiveness. J Investig Allergol Clin Immunol 7:186–192

    PubMed  CAS  Google Scholar 

  37. Nakano Y, Muller NL, King GG, Niimi A, Kalloger SE, Mishima M, Pare PD (2002) Quantitative assessment of airway remodeling using high-resolution CT. Chest 122:271S–275S

    Article  PubMed  Google Scholar 

  38. Hasegawa M, Nasuhara Y, Onodera Y, Makita H, Nagai K, Fuke S, Ito Y, Betsuyaku T, Nishimura M (2006) Airflow limitation and airway dimensions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 173:1309–1315

    Article  PubMed  Google Scholar 

  39. Biederer J, Both M, Graessner J, Liess C, Jakob P, Reuter M, Heller M (2003) Lung morphology: fast MR imaging assessment with a volumetric interpolated breath-hold technique: initial experience with patients. Radiology 226:242–249

    Article  PubMed  Google Scholar 

  40. Beckmann N, Cannet C, Zurbruegg S, Rudin M, Tigani B (2004) Proton MRI of lung parenchyma reflects allergen-induced airway remodeling and endotoxin-aroused hyporesponsiveness: a step toward ventilation studies in spontaneously breathing rats. Magn Reson Med 52:258–268

    Article  PubMed  Google Scholar 

  41. Euler US, Liljestrand G (1946) Observation on the pulmonary arterial blood pressuer in the cat. Acta Physiol Scand 12:301–320

    Article  Google Scholar 

  42. Cederlund K, Hogberg S, Jorfeldt L, Larsen F, Norman M, Rasmussen E, Tylen U (2003) Lung perfusion scintigraphy prior to lung volume reduction surgery. Acta Radiol 44:246–251

    Article  PubMed  CAS  Google Scholar 

  43. Thabut G, Dauriat G, Stern JB, Logeart D, Levy A, Marrash-Chahla R, Mal H (2005) Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest 127:1531–1536

    Article  PubMed  Google Scholar 

  44. Sandek K, Bratel T, Lagerstrand L, Rosell H (2002) Relationship between lung function, ventilation-perfusion inequality and extent of emphysema as assessed by high-resolution computed tomography. Respir Med 96:934–943

    Article  PubMed  CAS  Google Scholar 

  45. Ley-Zaporozhan J, Ley S, Eberhardt R, Weinheimer O, Fink C, Puderbach M, Eichinger M, Herth F, Kauczor HU (2007) Assessment of the relationship between lung parenchymal destruction and impaired pulmonary perfusion on a lobar level in patients with emphysema. Eur J Radiol 63:76–83

    Article  PubMed  Google Scholar 

  46. Hoffman EA, Chon D (2005) Computed tomography studies of lung ventilation and perfusion. Proc Am Thorac Soc 2:492–498, 506

    Article  PubMed  Google Scholar 

  47. Fink C, Puderbach M, Bock M, Lodemann KP, Zuna I, Schmahl A, Delorme S, Kauczor HU (2004) Regional lung perfusion: assessment with partially parallel three-dimensional MR imaging. Radiology 231:175–184

    Article  PubMed  Google Scholar 

  48. Fink C, Ley S, Kroeker R, Requardt M, Kauczor HU, Bock M (2005) Time-resolved contrast-enhanced three-dimensional magnetic resonance angiography of the chest: combination of parallel imaging with view sharing (TREAT). Invest Radiol 40:40–48

    Article  PubMed  Google Scholar 

  49. Morino S, Toba T, Araki M, Azuma T, Tsutsumi S, Tao H, Nakamura T, Nagayasu T, Tagawa T (2006) Noninvasive assessment of pulmonary emphysema using dynamic contrast-enhanced magnetic resonance imaging. Exp Lung Res 32:55–67

    Article  PubMed  Google Scholar 

  50. Ohno Y, Hatabu H, Murase K, Higashino T, Kawamitsu H, Watanabe H, Takenaka D, Fujii M, Sugimura K (2004) Quantitative assessment of regional pulmonary perfusion in the entire lung using three-dimensional ultrafast dynamic contrast-enhanced magnetic resonance imaging: preliminary experience in 40 subjects. J Magn Reson Imaging 20:353–365

    Article  PubMed  Google Scholar 

  51. Weitzenblum E (1994) The pulmonary circulation and the heart in chronic lung disease. Monaldi Arch Chest Dis 49:231–234

    PubMed  CAS  Google Scholar 

  52. Bruzzi JF, Remy-Jardin M, Delhaye D, Teisseire A, Khalil C, Remy J (2006) When, why, and how to examine the heart during thoracic CT: Part 2, clinical applications. AJR Am J Roentgenol 186:333–341

    Article  PubMed  Google Scholar 

  53. Vonk-Noordegraaf A, Marcus JT, Holverda S, Roseboom B, Postmus PE (2005) Early changes of cardiac structure and function in COPD patients with mild hypoxemia. Chest 127:1898–1903

    Article  PubMed  Google Scholar 

  54. Budev MM, Arroliga AC, Wiedemann HP, Matthay RA (2003) Cor pulmonale: an overview. Semin Respir Crit Care Med 24:233–244

    Article  PubMed  Google Scholar 

  55. Ohno Y, Sugimura K, Hatabu H (2003) Clinical oxygen-enhanced magnetic resonance imaging of the lung. Top Magn Reson Imaging 14:237–243

    Article  PubMed  Google Scholar 

  56. Stadler A, Stiebellehner L, Jakob PM, Arnold JF, Bankier AA (2006) [T1 maps and O(2)-enhanced MRT of the diseased lung. Emphysema, fibrosis, mucoviscidosis.]. Radiologe 46:282, 284–9

    Article  PubMed  CAS  Google Scholar 

  57. Muller CJ, Schwaiblmair M, Scheidler J, Deimling M, Weber J, Loffler RB, Reiser MF (2002) Pulmonary diffusing capacity: assessment with oxygen-enhanced lung MR imaging preliminary findings. Radiology 222:499–506

    Article  PubMed  Google Scholar 

  58. van Beek EJ, Wild JM, Kauczor HU, Schreiber W, Mugler JP 3rd, de Lange EE (2004) Functional MRI of the lung using hyperpolarized 3-helium gas. J Magn Reson Imaging 20:540–554

    Article  PubMed  Google Scholar 

  59. Kauczor HU, Hofmann D, Kreitner KF, Nilgens H, Surkau R, Heil W, Potthast A, Knopp MV, Otten EW, Thelen M (1996) Normal and abnormal pulmonary ventilation: visualization at hyperpolarized He-3 MR imaging. Radiology 201:564–568

    PubMed  CAS  Google Scholar 

  60. Guenther D, Eberle B, Hast J, Lill J, Markstaller K, Puderbach M, Schreiber WG, Hanisch G, Heussel CP, Surkau R, Grossmann T, Weiler N, Thelen M, Kauczor HU (2000) (3)He MRI in healthy volunteers: preliminary correlation with smoking history and lung volumes. NMR Biomed 13:182–189

    Article  PubMed  CAS  Google Scholar 

  61. Zaporozhan J, Ley S, Gast KK, Schmiedeskamp J, Biedermann A, Eberle B, Kauczor HU (2004) Functional analysis in single-lung transplant recipients: a comparative study of high-resolution CT, (3)He-MRI, and pulmonary function tests. Chest 125:173–181

    Article  PubMed  Google Scholar 

  62. Ray N, Acton ST, Altes T, de Lange EE, Brookeman JR (2003) Merging parametric active contours within homogeneous image regions for MRI-based lung segmentation. IEEE Trans Med Imaging 22:189–199

    Article  PubMed  Google Scholar 

  63. Salerno M, Altes TA, Brookeman JR, de Lange EE, Mugler JP 3rd (2001) Dynamic spiral MRI of pulmonary gas flow using hyperpolarized (3)He: preliminary studies in healthy and diseased lungs. Magn Reson Med 46:667–677

    Article  PubMed  CAS  Google Scholar 

  64. Wild JM, Paley MN, Kasuboski L, Swift A, Fichele S, Woodhouse N, Griffiths PD, van Beek EJ (2003) Dynamic radial projection MRI of inhaled hyperpolarized 3He gas. Magn Reson Med 49:991–997

    Article  PubMed  Google Scholar 

  65. Kauczor HU (2003) Hyperpolarized helium-3 gas magnetic resonance imaging of the lung. Top Magn Reson Imaging 14:223–230

    Article  PubMed  Google Scholar 

  66. Gast KK, Puderbach MU, Rodriguez I, Eberle B, Markstaller K, Knitz F, Schmiedeskamp J, Weiler N, Schreiber WG, Mayer E, Thelen M, Kauczor HU (2003) Distribution of ventilation in lung transplant recipients: evaluation by dynamic 3He-MRI with lung motion correction. Invest Radiol 38:341–348

    Article  PubMed  Google Scholar 

  67. Swift AJ, Wild JM, Fichele S, Woodhouse N, Fleming S, Waterhouse J, Lawson RA, Paley MN, Van Beek EJ (2005) Emphysematous changes and normal variation in smokers and COPD patients using diffusion 3He MRI. Eur J Radiol 54:352–358

    Article  PubMed  Google Scholar 

  68. Salerno M, de Lange EE, Altes TA, Truwit JD, Brookeman JR, Mugler JP 3rd (2002) Emphysema: hyperpolarized helium 3 diffusion MR imaging of the lungs compared with spirometric indexes–initial experience. Radiology 222:252–260

    Article  PubMed  Google Scholar 

  69. Decramer M (1997) Hyperinflation and respiratory muscle interaction. Eur Respir J 10:934–941

    PubMed  CAS  Google Scholar 

  70. Henderson AC, Ingenito EP, Salcedo ES, Moy ML, Reilly JJ, Lutchen KR (2007) Dynamic lung mechanics in late-stage emphysema before and after lung volume reduction surgery. Respir Physiol Neurobiol 155:234–242

    Article  PubMed  Google Scholar 

  71. Plathow C, Klopp M, Fink C, Sandner A, Hof H, Puderbach M, Herth F, Schmahl A, Kauczor HU (2005) Quantitative analysis of lung and tumour mobility: comparison of two time-resolved MRI sequences. Br J Radiol 78:836–840

    Article  PubMed  CAS  Google Scholar 

  72. Suga K, Tsukuda T, Awaya H, Takano K, Koike S, Matsunaga N, Sugi K, Esato K (1999) Impaired respiratory mechanics in pulmonary emphysema: evaluation with dynamic breathing MRI. J Magn Reson Imaging 10:510–520

    Article  PubMed  CAS  Google Scholar 

  73. Iwasawa T, Yoshiike Y, Saito K, Kagei S, Gotoh T, Matsubara S (2000) Paradoxical motion of the hemidiaphragm in patients with emphysema. J Thorac Imaging 15:191–195

    Article  PubMed  CAS  Google Scholar 

  74. Iwasawa T, Kagei S, Gotoh T, Yoshiike Y, Matsushita K, Kurihara H, Saito K, Matsubara S (2002) Magnetic resonance analysis of abnormal diaphragmatic motion in patients with emphysema. Eur Respir J 19:225–231

    Article  PubMed  CAS  Google Scholar 

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Ley-Zaporozhan, J., Ley, S. & Kauczor, HU. Morphological and functional imaging in COPD with CT and MRI: present and future. Eur Radiol 18, 510–521 (2008). https://doi.org/10.1007/s00330-007-0772-1

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