1 UAB Lung Imaging Core and UAB Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
2 Division of Pulmonary and Critical Care Medicine.
Am J Respir Crit Care Med. 2019 Feb 1;199(3):286-301. doi: 10.1164/rccm.201807-1351SO.
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.
慢性阻塞性肺疾病（COPD）基因研究（COPDGene）于 2007 年启动，是一项正在进行的、多中心的、针对 1 万多名现吸烟者和前吸烟者的观察性队列研究。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。除了基因分析外，研究对象还通过临床问卷、肺活量测定、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）进行了广泛的特征描述。本综述的目的是总结 COPDGene 研究中的影像学发现对我们理解 COPD 的主要进展。与不良临床结局相关的影像学特征包括早期间质肺异常、肺气肿的可视存在和模式、肺动脉与升主动脉直径比、肺气肿的定量评估、气道壁厚度和呼气气体潴留。COPD 的特征是小气道的早期受累，呼气扫描的增加使得小气道疾病的测量成为可能。计算方面的进展使非肺气肿性气体潴留的间接测量成为可能。这些指标提供了对 COPD 的发病机制和预后的深入了解，并有助于早期识别疾病。重要的可量化的肺外发现包括冠状动脉钙化、心脏形态、胸内和胸外脂肪以及骨质疏松症。目前的活跃研究包括确定新的定量肺气肿和气道疾病指标、评估剂量减少技术以及使用深度学习对 COPD 进行表型分析。
