Imaging in Chronic Obstructive Pulmonary Disease: Ready for Prime Time?

다국어 초록 (Multilingual Abstract)

Chronic obstructive pulmonary disease (COPD) is a major global health burden, affectingover 392 million individuals and causing approximately 3.3 million deaths annually.
Although spirometry remains the cornerstone for diagnosing airflow limitation, it incompletelyreflects the structural and biological heterogeneity of the disease, and manysmokers with preserved spirometry exhibit substantial parenchymal and airway abnormalities.
Advances in imaging—particularly quantitative computed tomography (QCT),magnetic resonance imaging (MRI), and positron emission tomography (PET)—enablecomprehensive assessment of structural, functional, and inflammatory processes inCOPD. QCT-derived emphysema metrics, including the 15th percentile lung density,mean lung density, and low attenuation area percentage, are reproducible, sensitiveto progression, and widely used as outcome measures. Small airway disease can becharacterized using parametric response mapping and complementary voxel-basedindices that detect subclinical gas trapping and regional volume changes. The conceptof mechanically affected lung highlights functionally impaired regions adjacent toemphysema that contribute to disease progression and mortality. Airway remodelingmetrics, such as Pi10, PiSlope, tapering slope, and airway fractal dimension, furtherprovide prognostic information. Mucus plug burden independently predicts mortalityand represents a potential surrogate endpoint in therapeutic trials. Advanced MRI techniquesand 18F-fluorodeoxyglucose PET offer radiation-free or inflammatory insights,respectively. Current evidence supports that imaging is ready to evolve from an adjunctto a core element of COPD research and care.