肺癌预后及疗效评价的影像组学研究进展

影像组学通过高通量地提取肺癌影像特征并进行分析,获得可视化的定量参数,已逐步成为评估肺癌病人预后的重要工具。利用影像组学可以预测肺癌病人的生存期、淋巴结转移、远处转移以及经过传统治疗、放化疗、免疫治疗及靶向治疗后病人的预后,为病人进行个性化治疗与评估。就影像组学的概况及其在肺癌预后和疗效评价中的研究进展进行综述。     

双源CT双能量肺灌注成像评估COPD研究进展

慢性阻塞性肺疾病(COPD)是以各种原因引起的肺实质和小气道损伤而导致慢性不可逆的气道阻塞、呼吸阻力增加以及肺功能不全为共同特征的肺疾病。目前肺功能检查、肺核素灌注显像和MR灌注成像评估COPD均不能高分辨力显示肺解剖影像。而双源CT双能量肺实质灌注成像能够显示肺的解剖及灌注功能信息,可对肺气肿的部位与灌注缺损区精确配准,虚拟平扫影像可辨别COPD的类型及肺气肿的数量和大小,这对于COPD早期诊断、治疗及预后评估具有重要意义。就双源CT双能量肺灌注成像技术原理及其在COPD中的研究进展予以综述。     

慢性阻塞性肺疾病右心室功能影像方法研究进展

右心室功能的准确评估对慢性阻塞性肺疾病(COPD)的临床诊断及治疗至关重要。鉴于右心室几何形状复杂,传统影像检查方法对于其功能评价的准确性受到制约。近年来随着超声心动图组织多普勒成像(TDI)及应变率成像(SRI)技术的临床应用,多层螺旋CT时间分辨率提高及对比剂注射方案的优化,CMRI电影及相位对比技术的发展,放射性核素的各种新技术在心脏形态和功能评价中取得突破,使得影像技术客观、准确、定量地评估COPD病人右心室功能成为可能。     

慢性阻塞性肺疾病病人右心室功能改变的影像学研究进展

慢性阻塞性肺疾病（COPD）是临床常见的慢性呼吸系统疾病,常继发右心功能不全,增加病人死亡风险。COPD病人右心室功能改变的精准及多方式影像评价已成为研究的热点。超声心动图、CT、心脏MR成像、放射性核素等成像技术是目前无创性评价COPD右心室功能改变的主要方法。就COPD导致右心室功能改变的机制以及各种影像技术的应用进展及其优劣予以综述。     

慢性阻塞性肺疾病的CT定义的亚型:Fleischner学会的一份声明

<正>这份声明的目的是描述和定义对慢性阻塞性肺疾病(COPD)病人CT影像进行观察与定量评估中确定的表型异常,同时有助于COPD病人治疗的个体化方案的实施。定量     

慢性阻塞性肺疾病右心室功能影像学研究新进展

右心室功能的准确评估对慢性阻塞性肺疾病（COPD）的临床诊断及治疗至关重要。鉴于右心室几何形状复杂，传统影像检查方法对于其功能评价的准确性受到制约。近年来随着超声心动图组织多普勒成像(TDI)及应变率成像（SRI）技术的临床应用，多层螺旋ＣＴ时间分辨率提高及对比剂注射方案的优化，CMRI电影及相位对比技术的发展，放射性核素的各种新技术在心脏形态和功能评价中取得突破，使得影像技术客观、准确、定量地评估COPD病人右心室功能成为可能。     

多层螺旋CT在评估慢性阻塞性肺疾病相关肺动脉高压中的应用进展

在我国慢性阻塞性肺疾病（COPD）多发生在40岁及以上人群中,而肺动脉高压（PAH）是COPD进展的中心环节,可导致右心功能衰竭乃至死亡。COPD病人出现PAH后进行早期相关治疗可显著改善预后,因此对COPD病人出现PAH的早期诊断非常重要。多层螺旋CT作为一种无创性检查,可以运用多种定量及定性指标较好地发现和提示COPD相关PAH,并可以评估预后、监测治疗效果。     

炎性肠病相关骨质疏松的影像学研究进展

骨质疏松症（OP）是炎性肠病（IBD）病人最常见的肠道外表现之一。双能X线吸收测量仪、CT、MRI以及定量超声等影像方法可以评估IBD病人的骨量、骨结构、骨髓脂肪以及骨强度变化,对IBD的诊断治疗及预后评估具有重要意义。就IBD相关OP的发病机制、影像学研究进展及其临床应用予以综述。     

肝硬化胆囊改变的影像学评估

胆囊改变是肝硬化较为常见的肝外影像征象,近年来研究表明其与肝硬化临床Child-Pugh分级、肝纤维化等存在相关性,对于肝硬化的临床诊断、指导治疗、疗效评估及预后有着一定的价值。从肝硬化病人胆囊的位置、形态、功能及结石形成等多方面综述述其发病机制、影像学评估及其临床意义。     

COPD病人的MR肺功能成像进展

慢性阻塞性肺疾病（COPD）是以气道受阻及肺实质破坏导致的气流不可逆性受限为特征的疾病。掌握COPD病人局部肺组织的通气和灌注异常及其与肺结构的关系,是理解其病理生理改变的关键。目前,CT薄层容积扫描是首选的无创性评估方法,但其仅能反映形态学的变化。随着MR功能成像的发展,其在肺实质成像中应用已取得重要进展。就MRI肺灌注及通气成像在COPD病人的应用进展作一综述。     

慢性阻塞性肺疾病各中医证型的CT肺功能评估及临床肺功能检查参数分析

目的:对慢性阻塞性肺疾病(COPD)患者行CT肺功能评估,探究其与肺功能检查的相关性,并分析比较COPD各中医证型的肺功能参数与CT肺功能评估结果,为COPD中医辨证提供参考依据。方法:根据COPD中医诊断标准对其进行分型,完成肺功能、CT检查,并对CT图像进行三维重建,计算肺气肿指数(LAA%)。结果:痰浊壅肺证、痰热蕴肺证、痰瘀阻肺证、肺肾气虚证之间第1秒用力呼气容积占预计值百分比(FEV1占预计值%)及第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC%)比较差异均有统计学意义(均P<0.01),FEV1占预计值%、FEV1/FVC%由痰浊壅肺证→痰热蕴肺证→痰瘀阻肺证→肺肾气虚证逐渐变小;LAA%由痰浊壅肺证→痰热蕴肺证→痰瘀阻肺证→肺肾气虚证逐渐增大。LAA%与FEV1占预计值%呈负相关(r=-0.775,P=0.001);LAA%与FEV1/FVC%呈负相关(r=-0.458,P=0.001)。结论:CT肺功能评估与临床肺功能检查之间呈负相关,随着肺通气功能的降低,COPD患者的LAA%随之升高,说明CT评估肺功能是可行的。COPD各中医证型之间LAA%、肺功能参数存在差异,可为COPD辨证分型提供一定的参考价值。     

Pulmonary CT and MRI phenotypes that help explain chronic pulmonary obstruction disease pathophysiology and outcomes

Pulmonary x‐ray computed tomographic (CT) and magnetic resonance imaging (MRI) research and development has been motivated, in part, by the quest to subphenotype common chronic lung diseases such as chronic obstructive pulmonary disease (COPD). For thoracic CT and MRI, the main COPD research tools, disease biomarkers are being validated that go beyond anatomy and structure to include pulmonary functional measurements such as regional ventilation, perfusion, and inflammation. In addition, there has also been a drive to improve spatial and contrast resolution while at the same time reducing or eliminating radiation exposure. Therefore, this review focuses on our evolving understanding of patient‐relevant and clinically important COPD endpoints and how current and emerging MRI and CT tools and measurements may be exploited for their identification, quantification, and utilization. Since reviews of the imaging physics of pulmonary CT and MRI and reviews of other COPD imaging methods were previously published and well‐summarized, we focus on the current clinical challenges in COPD and the potential of newly emerging MR and CT imaging measurements to address them. Here we summarize MRI and CT imaging methods and their clinical translation for generating reproducible and sensitive measurements of COPD related to pulmonary ventilation and perfusion as well as parenchyma morphology. The key clinical problems in COPD provide an important framework in which pulmonary imaging needs to rapidly move in order to address the staggering burden, costs, as well as the mortality and morbidity associated with COPD. J. MAGN. RESON. IMAGING 2016;43:544–557.     

Functional imaging of COPD by CT and MRI

This commentary reviews the contribution of imaging by CT and MRI to functional assessment in chronic obstructive pulmonary disease (COPD). CT can help individualize the assessment of COPD by quantifying emphysema, air trapping and airway wall thickening, potentially leading to more specific treatments for these distinct components of COPD. Longitudinal changes in these metrics can help assess progression or improvement. On hyperpolarized gas MRI, the apparent diffusion coefficient of provides an index of airspace enlargement reflecting emphysema. Perfusion imaging and measurement of pulmonary vascular volume on non-contrast CT provide insight into the contribution of pulmonary vascular disease to pulmonary impairment. Functional imaging is particularly valuable in detecting early lung dysfunction in subjects with inhalational exposures.     

慢性阻塞性肺疾病的人工智能研究进展

人工智能（AI）已广泛应用于慢性阻塞性肺疾病（COPD）的研究,在COPD的临床筛查、预诊分级、风险评估、医学成像和远程监护等方面均取得一定进展。AI不仅可以对未患病人群进行早筛、早诊及早治,也可为COPD病人的治疗和管控提供众多的可行方案。重点就AI在肺气肿量化、CT纹理分析、解剖结构分割等影像诊断应用进展予以综述。     

慢性阻塞性肺病肺部感染36例临床分析

目的：探讨慢性阻塞性肺病（COPD）肺部感染的临床特点、诊断及治疗方法。方法：收集我院36例慢性阻塞性肺病（COPD）肺部感染患者,观察其临床特点,并对对治疗前后情况进行比较分析。结果：对COPD进行分级治疗后,效果显著。同时慢性阻塞性肺病并发肺部感染后能使病情迅速恶化,死亡率高。结论：COPD是多发性呼吸系统疾病,肺部感染后其死亡率高,准确诊断并给予积极治疗,可以延缓症状发作。     

Functional lung imaging using hyperpolarized gas MRI

The noninvasive assessment of lung function using imaging is increasingly of interest for the study of lung diseases, including chronic obstructive pulmonary disease (COPD) and asthma. Hyperpolarized gas MRI (HP MRI) has demonstrated the ability to detect changes in ventilation, perfusion, and lung microstructure that appear to be associated with both normal lung development and disease progression. The physical characteristics of HP gases and their application to MRI are presented with an emphasis on current applications. Clinical investigations using HP MRI to study asthma, COPD, cystic fibrosis, pediatric chronic lung disease, and lung transplant are reviewed. Recent advances in polarization, pulse sequence development for imaging with Xe-129, and prototype low magnetic field systems dedicated to lung imaging are highlighted as areas of future development for this rapidly evolving technology.     

定量CT评估慢性阻塞性肺疾病的研究进展

慢性阻塞性肺疾病（COPD）的病理改变主要包括慢性支气管炎和肺气肿。定量CT（QCT）能够直接观察和量化肺实质的细微变化,有助于推测COPD的病理生理过程,对COPD的诊断和疗效评价具有重要价值。就QCT在评估肺气肿、气道病变、血管损伤及COPD表型上的应用研究进展予以综述。     

COPD-bronchiectasis overlap syndrome: Are there clinical,physiological and radiological synergistic effects?

Introduction: The coexistence of chronic obstructive pulmonary disease (COPD) and bronchiectasis is increasingly diagnosed in clinical practice; however this overlap is not well studied. Aim: To study the impact of overlap between of COPD and bronchiectasis on patient clinical, physiological and radiological indices as well as health related quality of life (HRQOL). Patients and methods: One hundred eighty-four patients were included; 68 patients had COPD, 68 had bronchiectasis, and 48 had overlapping COPD and bronchiectasis. Clinical assessment, arterial blood gas (ABG) analysis, pulmonary function tests, and high resolution computed tomography (HRCT) chest with Bhalla scoring were done. HRQOL were assessed using the arabic version of St. George Respiratory Questionnaire (SGRQ). Results: Dyspnea scale significantly increased in COPD, and overlapping COPD and bronchiectasis groups compared to bronchiectasis group. There was no significant difference between the three groups regarding ABG values, spirometeric parameters, diffusing capacity for carbon monoxide (DL_CO) and SGRQ score. Bronchiectasis group had a significantly higher total Bhalla score with significant deterioration of spirometeric parameters and ABG values with increasing radiological extent and severity of bronchiectasis. Conclusion: The overlap between COPD and bronchiectasis did not significantly impair physiological parameters or HRQOL in comparison to either disease alone.