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Review
.2020 Nov;8(21):1467.
doi: 10.21037/atm.2020.04.44.

Advances in imaging for lung emphysema

Affiliations
Review

Advances in imaging for lung emphysema

Katharina Martini et al. Ann Transl Med.2020 Nov.

Abstract

Lung emphysema represents a major public health burden and still accounts for five percent of all deaths worldwide. Hence, it is essential to further understand this disease in order to develop effective diagnostic and therapeutic strategies. Lung emphysema is an irreversible enlargement of the airways distal to the terminal bronchi (i.e., the alveoli) due to the destruction of the alveolar walls. The two most important causes of emphysema are (I) smoking and (II) α1-antitrypsin-deficiency. In the former lung emphysema is predominant in the upper lung parts, the latter is characterized by a predominance in the basal areas of the lungs. Since quantification and evaluation of the distribution of lung emphysema is crucial in treatment planning, imaging plays a central role. Imaging modalities in lung emphysema are manifold: computed tomography (CT) imaging is nowadays the gold standard. However, emerging imaging techniques like dynamic or functional magnetic resonance imaging (MRI), scintigraphy and lately also the implementation of radiomics and artificial intelligence are more and more diffused in the evaluation, diagnosis and quantification of lung emphysema. The aim of this review is to shortly present the different subtypes of lung emphysema, to give an overview on prediction and risk assessment in emphysematous disease and to discuss not only the traditional, but also the new imaging techniques for diagnosis, quantification and evaluation of lung emphysema.

Keywords: Emphysema; chronic obstructive pulmonary disease (COPD); imaging.

2020 Annals of Translational Medicine. All rights reserved.

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Conflict of interest statement

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm.2020.04.44). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Different types of emphysema in axial (upper row) and coronal (lower row) reconstructions. (A,D) mild form of centrilobular emphysema, (B,E) paraseptal emphysema, and (C,F) panlobular emphysema.
Figure 2
Figure 2
Conventional chest radiography of a 38-year-old female patient with α1-antitrypsin deficiency showing typical signs of emphysema: (I) the barrel shaped thoracic cage with flattening of the hemi-diaphragmatic domes, (II) hyperlucency of the lung tissue due to overinflation and rarefication of vessels, (III) enlargement of the retrosternal clear space >2.5 cm; and (V) narrow configuration of the cardiac silhouette.
Figure 3
Figure 3
Lung scintigraphy in a 43-year-old female patient with COPD GOLD IV showing perfusion maps in (A) anteroposterior, (B) right oblique and (C) left oblique perfusion maps. Emphysematous lung areas in CT lung windows (D,E,F) correspond to areas on scintigraphy with reduced or no tracer uptake.
Figure 4
Figure 4
Showing the distribution of emphysema in a 64-year-old male patient with COPD on (A,B) computed tomography images in axial and coronal slices as well as (C,D) dual-energy CT (DECT) maps superimposed to CT lung window images.
Figure 5
Figure 5
Subtraction maps of oxygen enhanced MRI in a patient with chronic obstructive pulmonary disease showing areas of emphysema in the upper lobes and middle lobe with lower mean ΔO2 pressure uptake of oxygen compared to the less emphysematous lung parts in the lower lobes.
Figure 6
Figure 6
Images of 67-year-old male patients before (A) and after (B) undergoing lung volume reduction surgery. (A) resembles typical findings of emphysema such as flattening of the hemidiaphragmatic dome; postoperative image (B) shows a different configuration of the hemidiaphragmatic dome with a convex shape and lower lung volumes.
Figure 7
Figure 7
A 43-year-old female patient with upper lobe predominant centrilobular emphysema (A) reconstructed with filtered back projection (FBP) and (B) reconstructed with advanced modeled iterative reconstruction (ADMIRE) strength level 5.
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