Dirksen Asger, Wille Mathilde M W
1 Copenhagen University, Copenhagen, Denmark; and.
2 Department of Respiratory Medicine, Gentofte Hospital, Hellerup, Denmark.
Ann Am Thorac Soc. 2016 Apr;13 Suppl 2:S114-7. doi: 10.1513/AnnalsATS.201503-178KV.
Computed tomography (CT) is an obvious modality for subclassification of COPD. Traditionally, the pulmonary involvement of chronic obstructive pulmonary disease (COPD) in smokers is understood as a combination of deleterious effects of smoking on small airways (chronic bronchitis and small airways disease) and distal to the airways with destruction and loss of lung parenchyma (emphysema). However, segmentation of airways is still experimental; with contemporary high-resolution CT (HRCT) we can just see the "entrance" of small airways, and until now changes in airway morphology that have been observed in COPD are subtle. Furthermore, recent results indicate that emphysema may also be the essential pathophysiologic mechanism behind the airflow limitation of COPD. The definition of COPD excludes bronchiectasis as a symptomatic subtype of COPD, and CT findings in chronic bronchitis and exacerbations of COPD are rather unspecific. This leaves emphysema as the most obvious candidate for subclassification of COPD. Both chest radiologists and pulmonary physicians are quite familiar with the appearance of various patterns of emphysema on HRCT, such as centrilobular, panlobular, and paraseptal emphysema. However, it has not yet been possible to develop operational definitions of these patterns that can be used by computer software to automatically classify CT scans into distinct patterns. In conclusion, even though various emphysema patterns can be recognized visually, CT has not yet demonstrated a great potential for automated subclassification of COPD, and it is an open question whether it will ever be possible to achieve success equivalent to that obtained by HRCT in the area of interstitial lung diseases.
计算机断层扫描(CT)是慢性阻塞性肺疾病(COPD)亚型分类的一种明显方式。传统上,吸烟者慢性阻塞性肺疾病(COPD)的肺部受累被理解为吸烟对小气道(慢性支气管炎和小气道疾病)以及气道远端肺实质破坏和丧失(肺气肿)的有害影响的组合。然而,气道分割仍处于实验阶段;使用当代高分辨率CT(HRCT)我们只能看到小气道的“入口”,到目前为止,在COPD中观察到的气道形态变化很细微。此外,最近的结果表明,肺气肿也可能是COPD气流受限背后的基本病理生理机制。COPD的定义排除了支气管扩张作为COPD的一种症状性亚型,慢性支气管炎和COPD加重期的CT表现相当不具特异性。这使得肺气肿成为COPD亚型分类最明显的候选者。胸部放射科医生和肺科医生都非常熟悉HRCT上各种肺气肿模式的表现,如小叶中心型、全小叶型和间隔旁型肺气肿。然而,尚未能够制定这些模式的操作定义,以便计算机软件能够将CT扫描自动分类为不同模式。总之,尽管各种肺气肿模式可以通过视觉识别,但CT尚未显示出对COPD进行自动亚型分类的巨大潜力,在间质性肺疾病领域是否能够取得与HRCT相当的成功仍是一个悬而未决的问题。