Imaging Advances in Chronic Obstructive Pulmonary Disease Insights from the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) Study
Imaging Advances in Chronic Obstructive Pulmonary Disease Insights from the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) Study
复制标题
慢性阻塞性肺疾病的影像学进展——来自慢性阻塞性肺疾病遗传流行病学（COPDGene）研究的见解
DOI：
10.1164/rccm.201807-1351so
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发表时间：
2019-02-01
影响因子：
24.7
通讯作者：
Lynch, David A.
中科院分区：
文献类型：
--
作者：
Bhatt, Surya P.;Washko, George R.;Lynch, David A.
慢性阻塞性肺疾病遗传流行病学（COPDGene）研究始于2007年，是一项正在进行的多中心观察性队列研究，涉及10，000多名当前和以前的吸烟者。该研究旨在了解慢性阻塞性肺疾病（COPD）的病因、进展和异质性。除了遗传分析，参与者还通过临床问卷调查、肺功能测定、容积吸气和呼气计算机断层扫描以及纵向随访（包括入组后5年的随访计算机断层扫描）进行了广泛的特征分析。这篇最先进的综述的目的是总结我们对COPD的认识的主要进展，这些进展来自于COPD基因研究中的成像结果。与不良临床结局相关的影像学特征包括早期间质性肺异常、肺气肿的视觉表现和模式、肺动脉与升主动脉直径的比值、肺气肿的定量评价、气道壁厚度和呼气气体潴留。慢性阻塞性肺病的特点是早期累及小气道，呼气扫描的增加使小气道疾病的测量成为可能。计算技术的进步使非肺气肿性气体滞留的间接测量成为可能。这些指标为COPD的发病机制和预后提供了见解，并有助于疾病的早期识别。重要的可量化的肺外发现包括冠状动脉钙化、心脏形态、胸内和胸外脂肪和骨质疏松症。目前活跃的研究包括识别肺气肿和气道疾病的新定量指标，评估剂量减少技术，以及使用深度学习对COPD进行表型分析。
The Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study, which began in 2007, is an ongoing multicenter observational cohort study of more than 10,000 current and former smokers. The study is aimed at understanding the etiology, progression, and heterogeneity of chronic obstructive pulmonary disease (COPD). In addition to genetic analysis, the participants have been extensively characterized by clinical questionnaires, spirometry, volumetric inspiratory and expiratory computed tomography, and longitudinal follow-up, including follow-up computed tomography at 5 years after enrollment. The purpose of this state-of-the-art review is to summarize the major advances in our understanding of COPD resulting from the imaging findings in the COPDGene study. Imaging features that are associated with adverse clinical outcomes include early interstitial lung abnormalities, visual presence and pattern of emphysema, the ratio of pulmonary artery to ascending aortic diameter, quantitative evaluation of emphysema, airway wall thickness, and expiratory gas trapping. COPD is characterized by the early involvement of the small conducting airways, and the addition of expiratory scans has enabled measurement of small airway disease. Computational advances have enabled indirect measurement of nonemphysematous gas trapping. These metrics have provided insights into the pathogenesis and prognosis of COPD and have aided early identification of disease. Important quantifiable extrapulmonary findings include coronary artery calcification, cardiac morphology, intrathoracic and extrathoracic fat, and osteoporosis. Current active research includes identification of novel quantitative measures for emphysema and airway disease, evaluation of dose reduction techniques, and use of deep learning for phenotyping COPD.