Kirby Miranda, Pike Damien, McCormack David G, Lam Stephen, Coxson Harvey O, Parraga Grace
Department of Radiology, University of British Columbia, Vancouver, Canada.
University of British Columbia, James Hogg Research Center and The Institute of Heart and Lung Health, St. Paul's Hospital, Vancouver, Canada.
Chronic Obstr Pulm Dis. 2014 Sep 25;1(2):200-211. doi: 10.15326/jcopdf.1.2.2014.0136.
Although the human and societal burden and cost of COPD is staggering, there are few clinical tools that provide earlier diagnoses or a means to regionally monitor disease in a way that might lead to improved therapies and outcomes. In acknowledgement of the current gaps in COPD therapy, the objective of the Thoracic Imaging Network of Canada (TINCan) is to improve COPD patient phenotyping through imaging, to provide methods and imaging-based intermediate endpoints for the development of new treatments, and to evaluate disease progression and patient-based outcomes in COPD patients and those at risk of COPD. Here we summarize and outline the TINCan study protocol and describe our objectives. TINCan is a prospective study that aims to identify and quantify novel COPD phenotypes from thoracic computed tomography (CT) and thoracic hyperpolarized noble gas magnetic resonance imaging (MRI) in 200 ex-smokers, 50 years of age or greater, including asymptomatic ex-smokers with normal pulmonary function and Global initiative for chronic Obstructive Lung Disease (GOLD) Unclassified (U) , and GOLD stages I-IV patients. Baseline and 2-year follow-up measurements will be acquired using spirometry, plethysmography, diffusing capacity of the lung for carbon monoxide (DL), St. George's Respiratory Questionnaire (SGRQ), 6-minute walk test (6MWT), thoracic CT and hyperpolarized helium-3 (He) and xenon 129 (Xe) MRI. TINCan provides a unique opportunity to quantify and compare novel lung structure-function measurements and investigate their relationship with well-established clinical measurements and outcomes. Such intermediate endpoints of COPD may be used to stratify patients for personalized treatments and to develop new treatments to improve outcomes, a long-standing clinical goal.
尽管慢性阻塞性肺疾病（COPD）给人类和社会带来的负担及成本惊人，但几乎没有临床工具能够实现早期诊断，或提供一种区域监测疾病的方法，从而改善治疗效果和预后。认识到COPD治疗目前存在的差距，加拿大胸部成像网络（TINCan）的目标是通过成像改善COPD患者的表型分析，为新治疗方法的开发提供基于成像的方法和中间终点，并评估COPD患者及有COPD风险者的疾病进展和基于患者的预后。在此，我们总结并概述了TINCan研究方案，并描述了我们的目标。TINCan是一项前瞻性研究，旨在从胸部计算机断层扫描（CT）和胸部超极化惰性气体磁共振成像（MRI）中识别和量化200名年龄在50岁及以上的前吸烟者的新型COPD表型，包括肺功能正常的无症状前吸烟者、慢性阻塞性肺疾病全球倡议（GOLD）未分类（U）者以及GOLD I-IV期患者。将使用肺活量测定法、体积描记法、肺一氧化碳弥散量（DL）、圣乔治呼吸问卷（SGRQ）、6分钟步行试验（6MWT）、胸部CT以及超极化氦-3（He）和氙129（Xe）MRI进行基线和2年随访测量。TINCan提供了一个独特的机会，来量化和比较新型肺结构-功能测量指标，并研究它们与成熟的临床测量指标和预后之间的关系。COPD的此类中间终点可用于对患者进行分层以实现个性化治疗，并开发新的治疗方法来改善预后，这是一个长期的临床目标。
