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肺气肿的形态特征是肺的终末细支气管远端异常持久的扩张,伴肺泡壁和细支气管破坏,导致肺泡空间扩大[1]。按病变发生的位置可分为小叶中心型、全小叶型和间隔旁型肺气肿。小叶中心型最常见,以上肺分布为主,与吸烟有关;全小叶型多见于α1-抗胰蛋白酶缺乏症者,多分布于下肺,致死率高,不同的类型与不同的危险因素及临床表现有关。该病多见于慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者,通常早期肺气肿不伴肺纤维化,而晚期肺气肿患者呼吸功能下降,同时由于肺破坏区反复修复和炎症反应,最终会导致间质纤维化发生。多项荟萃分析结果显示,肺气肿增加了患者发生肺癌的风险和不良预后[2-3],因此,通过影像学检查定量评估肺气肿严重程度对早期肺癌风险管理及COPD早期诊断、病情判断、预后评估具有重要意义。
肺气肿可以通过影像学检查或肺功能测试来评价,但肺功能测试通常不能反映肺功能局部损害的程度,也不能显示肺气肿空间分布,同时对轻度肺气肿检测缺乏灵敏度和特异度,影像学检查中CT具有较高的空间分辨率,可区分肺气肿的类型,并评估其分布(如下叶优势、上叶优势),同时可实现肺气肿分布的可视化和定量化,因而CT是评价肺气肿的首选影像检查方法[4]。在肺气肿外科治疗领域,肺气肿CT定量评估在肺减容治疗或支气管内瓣膜置入术的决策中也起着重要作用。
肺气肿定量评估的影像学研究进展
Research progress in imaging on quantitative evaluation of emphysema
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摘要: 肺气肿是肺部各种疾病中常见的伴随病变之一,通过影像学检查客观定量评估其分布类型和严重程度对肺部病变的发生发展、预后判断及个体化治疗具有重要意义。笔者将从现有影像学评估手段、机器学习与人工智能的应用、低剂量CT评估以及新技术应用进展等方面进行综述,以期为肺气肿定量评估提供依据。Abstract: Emphysema is one of the frequent co-morbidities in many lung diseases, and the occurrence, progression, prognosis, and individual therapy of pulmonary diseases all greatly depend on the objective quantitative evaluation of its distribution type and severity by imaging examination. The authors review the existing imaging evaluation methods, the application of machine learning and artificial intelligence, low-dose CT evaluation, and the application progress of new technologies in order to provide a basis for the quantitative evaluation of emphysema.
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Key words:
- Pulmonary emphysema /
- Quantitative evaluation /
- Imaging /
- Artificial intelligence
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[1] Celli B, Fabbri L, Criner G, et al. Definition and nomenclature of chronic obstructive pulmonary disease: time for its revision[J]. Am J Respir Crit Care Med, 2022, 206(11): 1317−1325. DOI: 10.1164/rccm.202204-0671PP. [2] Chen QQ, Liu P, Zhou H, et al. An increased risk of lung cancer in combined pulmonary fibrosis and emphysema patients with usual interstitial pneumonia compared with patients with idiopathic pulmonary fibrosis alone: a systematic review and meta-analysis[J]. Ther Adv Respir Dis, 2021, 15: 17534666211017050. DOI: 10.1177/17534666211017050. [3] Yang XF, Wisselink HJ, Vliegenthart R, et al. Association between chest CT-defined emphysema and lung cancer: a systematic review and meta-analysis[J]. Radiology, 2022, 304(2): 322−330. DOI: 10.1148/radiol.212904. [4] Tanabe N, Hirai T. Recent advances in airway imaging using micro-computed tomography and computed tomography for chronic obstructive pulmonary disease[J]. Korean J Intern Med, 2021, 36(6): 1294−1304. DOI: 10.3904/kjim.2021.124. [5] Wille MMW, Thomsen LH, Dirksen A, et al. Emphysema progression is visually detectable in low-dose CT in continuous but not in former smokers[J]. Eur Radiol, 2014, 24(11): 2692−2699. DOI: 10.1007/s00330-014-3294-7. [6] Stoel BC, Putter H, Bakker ME, et al. Volume correction in computed tomography densitometry for follow-up studies on pulmonary emphysema[J]. Proc Am Thorac Soc, 2008, 5(9): 919−924. DOI: 10.1513/pats.200804-040QC. [7] 王强, 罗勇, 李君. 慢性阻塞性肺疾病患者胸部高分辨率计算机断层成像肺气肿定量指标、气道管壁定量指标与肺功能的相关性研究[J]. 上海医学, 2020, 43(12): 734−739. DOI: 10.19842/j.cnki.issn.0253-9934.2020.12.006.
Wang Q, Luo Y, Li J. Correlation between chest high-resolution computed tomography quantitative indicators of emphysema, measurements of airway wall and pulmonary function test results in patients with chronic obstructive pulmonary disease[J]. Shanghai Med J, 2020, 43(12): 734−739. DOI: 10.19842/j.cnki.issn.0253-9934.2020.12.006.[8] 刘阿茹, 魏华, 邓永红. HRCT肺气肿定量分析与COPD患者疾病相关性分析[J]. 中国CT和MRI杂志, 2021, 19(8): 74−76. DOI: 10.3969/j.issn.1672-5131.2021.08.024.
Liu AR, Wei H, Deng YH. Analysis of relationship between quantitative analysis of HRCT emphysema and severity of COPD patients[J]. Chin J CT MRI, 2021, 19(8): 74−76. DOI: 10.3969/j.issn.1672-5131.2021.08.024.[9] Moon DH, Park CH, Kang DY, et al. Significance of the lobe-specific emphysema index to predict prolonged air leak after anatomical segmentectomy[J/OL]. PLoS One, 2019, 14(11): e0224519[2022-10-10]. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224519. DOI: 10.1371/journal.pone.0224519. [10] Ronit A, Kristensen T, Çolak Y, et al. Validation of lung density indices by cardiac CT for quantification of lung emphysema[J]. Int J Chron Obstruct Pulmon Dis, 2018, 13: 3321−3330. DOI: 10.2147/COPD.S172695. [11] Erickson BJ, Korfiatis P, Akkus Z, et al. Machine learning for medical imaging[J]. Radiographics, 2017, 37(2): 505−515. DOI: 10.1148/rg.2017160130. [12] Sørensen L, Shaker SB, de Bruijne M. Quantitative analysis of pulmonary emphysema using local binary patterns[J]. IEEE Trans Med Imaging, 2010, 29(2): 559−569. DOI: 10.1109/TMI.2009.2038575. [13] Mendoza CS, Washko GR, Ross JC, et al. Emphysema quantification in a multi-scanner HRCT cohort using local intensity distributions[C]//Proceedings of the 9th IEEE International Symposium on Biomedical Imaging (ISBI). Barcelona, Spain: IEEE, 2012: 474−477. DOI: 10.1109/ISBI.2012.6235587. [14] Yang J, Angelini ED, Balte PP, et al. Novel subtypes of pulmonary emphysema based on spatially-informed lung texture learning: the multi-ethnic study of atherosclerosis (MESA) COPD study[J]. IEEE Trans Med Imaging, 2021, 40(12): 3652−3662. DOI: 10.1109/TMI.2021.3094660. [15] Peng LY, Lin LF, Hu HJ, et al. Classification and quantification of emphysema using a multi-scale residual network[J]. IEEE J Biomed Health Inform, 2019, 23(6): 2526−2536. DOI: 10.1109/JBHI.2018.2890045. [16] Nishio M, Tanaka Y. Heterogeneity in pulmonary emphysema: analysis of CT attenuation using gaussian mixture model[J/OL]. PLoS One, 2018, 13(2): e0192892[2022-10-10]. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192892. DOI: 10.1371/journal.pone.0192892. [17] Peng LY, Lin LF, Hu HJ, et al. Semi-supervised learning for semantic segmentation of emphysema with partial annotations[J]. IEEE J Biomed Health Inform, 2020, 24(8): 2327−2336. DOI: 10.1109/JBHI.2019.2963195. [18] Diciotti S, Nobis A, Ciulli S, et al. Development of digital phantoms based on a finite element model to simulate low-attenuation areas in CT imaging for pulmonary emphysema quantification[J]. Int J Comput Assist Radiol Surg, 2017, 12(9): 1561−1570. DOI: 10.1007/s11548-016-1500-6. [19] Fischer AM, Varga-Szemes A, Martin SS, et al. Artificial intelligence-based fully automated per lobe segmentation and emphysema-quantification based on chest computed tomography compared with global initiative for chronic obstructive lung disease severity of smokers[J]. J Thorac Imaging, 2020, 35 Suppl 1: S28−34. DOI: 10.1097/RTI.0000000000000500. [20] Ebrahimian S, Digumarthy SR, Bizzo B, et al. Artificial intelligence has similar performance to subjective assessment of emphysema severity on chest CT[J]. Acad Radiol, 2022, 29(8): 1189−1195. DOI: 10.1016/j.acra.2021.09.007. [21] Hasenstab KA, Yuan N, Retson T, et al. Automated CT staging of chronic obstructive pulmonary disease severity for predicting disease progression and mortality with a deep learning convolutional neural network[J/OL]. Radiol Cardiothorac Imaging, 2021, 3(2): e200477[2022-10-10]. https://pubs.rsna.org/doi/10.1148/ryct.2021200477. DOI: 10.1148/ryct.2021200477. [22] de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial[J]. N Engl J Med, 2020, 382(6): 503−513. DOI: 10.1056/NEJMoa1911793. [23] Cao XX, Jin CW, Tan T, et al. Optimal threshold in low-dose CT quantification of emphysema[J]. Eur J Radiol, 2020, 129: 109094. DOI: 10.1016/j.ejrad.2020.109094. [24] den Harder AM, de Boer E, Lagerweij SJ, et al. Emphysema quantification using chest CT: influence of radiation dose reduction and reconstruction technique[J/OL]. Eur Radiol Exp, 2018, 2(1): 30[2022-10-10]. https://eurradiolexp.springeropen.com/articles/10.1186/s41747-018-0064-3. DOI: 10.1186/s41747-018-0064-3. [25] 黄晓旗, 祁鑫华, 王雷, 等. 基于KARL迭代算法对COPD低剂量CT扫描条件下肺气肿定量测量的影响[J]. 西安交通大学学报: 医学版, 2020, 41(3): 410−414, 467. DOI: 10.7652/jdyxb202003017.
Huang XQ, Qi XH, Wang L, et al. Effect of KARL iterative reconstruction on quantitative measurement of emphysema under low-dose CT scan of COPD[J]. J Xi'an Jiaotong Univ (Med Sci), 2020, 41(3): 410−414, 467. DOI: 10.7652/jdyxb202003017.[26] 高燕莉, 翟晓力, 李坤, 等. 超低剂量CT能谱纯化技术定量肺气肿[J]. 中国医学影像技术, 2021, 37(3): 375−379. DOI: 10.13929/j.issn.1003-3289.2021.03.015.
Gao YL, Zhai XL, Li K, et al. Feasibility of ultra low-dose CT with selective photon shield in quantification of emphysema[J]. Chin J Med Imaging Technol, 2021, 37(3): 375−379. DOI: 10.13929/j.issn.1003-3289.2021.03.015.[27] Messerli M, Ottilinger T, Warschkow R, et al. Emphysema quantification and lung volumetry in chest X-ray equivalent ultralow dose CT-Intra-individual comparison with standard dose CT[J]. Eur J Radiol, 2017, 91: 1−9. DOI: 10.1016/j.ejrad.2017.03.003. [28] Greffier J, Hamard A, Pereira F, et al. Image quality and dose reduction opportunity of deep learning image reconstruction algorithm for CT: a phantom study[J]. Eur Radiol, 2020, 30(7): 3951−3959. DOI: 10.1007/s00330-020-06724-w. [29] Bak SH, Kim JH, Jin H, et al. Emphysema quantification using low-dose computed tomography with deep learning-based kernel conversion comparison[J]. Eur Radiol, 2020, 30(12): 6779−6787. DOI: 10.1007/s00330-020-07020-3. [30] Ferri F, Bouzerar R, Auquier M, et al. Pulmonary emphysema quantification at low dose chest CT using Deep Learning image reconstruction[J]. Eur J Radiol, 2022, 152: 110338. DOI: 10.1016/j.ejrad.2022.110338. [31] Pfeiffer F, Bech M, Bunk O, et al. Hard-x-ray dark-field imaging using a grating interferometer[J]. Nat Mater, 2008, 7(2): 134−137. DOI: 10.1038/nmat2096. [32] Kottler C, Pfeiffer F, Bunk O, et al. Grating interferometer based scanning setup for hard x-ray phase contrast imaging[J]. Rev Sci Instrum, 2007, 78(4): 043710. DOI: 10.1063/1.2723064. [33] Hellbach K, Beller E, Schindler A, et al. Improved detection of foreign bodies on radiographs using x-ray dark-field and phase-contrast imaging[J]. Invest Radiol, 2018, 53(6): 352−356. DOI: 10.1097/RLI.0000000000000450. [34] Gromann LB, De Marco F, Willer K, et al. In-vivo x-ray dark-field chest radiography of a pig[J/OL]. Sci Rep, 2017, 7(1): 4807[2022-10-10]. https://www.nature.com/articles/s41598-017-05101-w. DOI: 10.1038/s41598-017-05101-w. [35] Urban T, Gassert FT, Frank M, et al. Qualitative and quantitative assessment of emphysema using dark-field chest radiography[J]. Radiology, 2022, 303(1): 119−127. DOI: 10.1148/radiol.212025. [36] Willer K, Fingerle AA, Noichl W, et al. X-ray dark-field chest imaging for detection and quantification of emphysema in patients with chronic obstructive pulmonary disease: a diagnostic accuracy study[J/OL]. Lancet Digit Health, 2021, 3(11): e733−e744[2022-10-10]. https://linkinghub.elsevier.com/retrieve/pii/S2589-7500(21)00146-1. DOI: 10.1016/S2589-7500(21)00146-1. [37] Benlala I, Berger P, Girodet PO, et al. Automated volumetric quantification of emphysema severity by using ultrashort echo time MRI: validation in participants with chronic obstructive pulmonary disease[J]. Radiology, 2019, 292(1): 216−225. DOI: 10.1148/radiol.2019190052. [38] 陈海燕, 杨永波, 刘璐璐, 等. 光子计数探测器CT初步临床应用的研究进展[J]. 中华放射学杂志, 2022, 56(2): 213−216. DOI: 10.3760/cma.j.cn112149-20210608-00543.
Chen HY, Yang YB, Liu LL et al. Research progress of clinical application of spectrum CT based on photon-counting detector[J]. Chin J Radiol, 2022, 56(2): 213−216. DOI: 10.3760/cma.j.cn112149-20210608-00543.[39] Jungblut L, Sartoretti T, Kronenberg D, et al. Performance of virtual non-contrast images generated on clinical photon-counting detector CT for emphysema quantification: proof of concept[J]. Br J Radiol, 2022, 95(1135): 20211367. DOI: 10.1259/bjr.20211367.
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