Coxson Harvey O, Lam Stephen
Department of Radiology, Vancouver General Hospital, and Department of Medicine, University of British Columbia, 855 West 12th Ave, Room 3350 JPN, Vancouver, BC, V5Z 1M9 Canada.
Proc Am Thorac Soc. 2009 Aug 15;6(5):439-43. doi: 10.1513/pats.200904-015AW.
Ever since the site and nature of airflow obstruction in chronic obstructive pulmonary disease was described by Hogg, Thurlbeck, and Macklem, investigators have been looking for methods to noninvasively measure the airway wall dimensions. Recent advances in computed tomography technology and new computer algorithms have made it possible to visualize and measure the airway wall and lumen without the need for tissue. However, while there is great hope for computed tomographic assessment of airways, it is well known that the spatial resolution does not allow small airways to be visualized and there are still concerns about the sensitivity of these measurements obtained from these airways. Optical coherence tomography is a new bronchoscopic imaging technique that has generated considerable interest because the spatial resolution is much higher than computed tomography. While relatively more invasive than computed tomography, it has the advantage of not exposing the patient to ionizing radiation. This review discusses some of the data surrounding these two imaging techniques in patients with chronic obstructive pulmonary disease. These imaging techniques are extremely important in the assessment of patients with chronic obstructive pulmonary disease because therapy that is designed to modulate the inflammation in airways may be contraindicated in subjects with the emphysema phenotype and visa versa. Therefore, these new imaging techniques are very likely to play a front-line role in the study of chronic obstructive pulmonary disease and will, hopefully, allow clinicians to phenotype individuals, thereby personalizing their treatment.
自从霍格、瑟尔贝克和麦克勒姆描述了慢性阻塞性肺疾病气流阻塞的部位和性质以来，研究人员一直在寻找非侵入性测量气道壁尺寸的方法。计算机断层扫描技术的最新进展和新的计算机算法使得无需组织就能可视化和测量气道壁及管腔成为可能。然而，尽管对气道的计算机断层扫描评估充满希望，但众所周知，空间分辨率不允许可视化小气道，而且从这些气道获得的测量结果的敏感性仍存在问题。光学相干断层扫描是一种新的支气管镜成像技术，因其空间分辨率远高于计算机断层扫描而引起了相当大的关注。虽然它比计算机断层扫描相对更具侵入性，但它的优点是不会让患者暴露于电离辐射。这篇综述讨论了慢性阻塞性肺疾病患者中围绕这两种成像技术的一些数据。这些成像技术在慢性阻塞性肺疾病患者的评估中极其重要，因为旨在调节气道炎症的治疗可能在具有肺气肿表型的受试者中是禁忌的，反之亦然。因此，这些新的成像技术很可能在慢性阻塞性肺疾病的研究中发挥一线作用，并有望使临床医生能够对个体进行表型分析，从而实现个性化治疗。
