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Thoracic Imaging at Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review

Authors Rangelov BA, Young AL, Jacob J, Cahn AP, Lee S, Wilson FJ, Hawkes DJ, Hurst JR

Received 22 February 2020

Accepted for publication 3 May 2020

Published 22 July 2020 Volume 2020:15 Pages 1751—1787


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Bojidar A Rangelov,1 Alexandra L Young,1– 3 Joseph Jacob,1,4 Anthony P Cahn,5 Sarah Lee,6 Frederick J Wilson,5 David J Hawkes,1 John R Hurst4

1Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK; 2Department of Computer Science, University College London, London, UK; 3Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; 4UCL Respiratory, University College London, London, UK; 5GlaxoSmithKline Research and Development, Stevenage, UK; 6Amallis Consulting LTD, London, UK

Correspondence: John R Hurst Email

Abstract: Exacerbations of chronic obstructive pulmonary disease (COPD) are currently diagnosed based on changes in respiratory symptoms. Characterizing the imaging manifestation of exacerbations could be useful for objective diagnosis of exacerbations in the clinic and clinical trials, as well as provide a mechanism for monitoring exacerbation treatment and recovery. In this systematic review, we employed a comprehensive search across three databases (Medline, EMBASE, Web of Science) to identify studies that performed imaging of the thorax at COPD exacerbation. We included 51 from a total of 5,047 articles which met all our inclusion criteria. We used an adapted version of the Modified Newcastle-Ottawa Quality Assessment Scale for cohort studies to assess the quality of the included studies. Conclusions were weighted towards higher-quality articles. We identified a total of 36 thoracic imaging features studied at exacerbation of COPD. Studies were generally heterogeneous in their measurements and focus. Nevertheless, considering studies which performed consecutive imaging at stable state and exacerbation, which scored highest for quality, we identified salient imaging biomarkers of exacerbations. An exacerbation is characterized by airway wall and airway calibre changes, hyperinflation, pulmonary vasoconstriction and imaging features suggestive of pulmonary arterial hypertension. Most information was gained from CT studies. We present the first ever composite imaging signature of COPD exacerbations. While imaging during an exacerbation is comparatively new and not comprehensively studied, it may uncover important insights into the acute pathophysiologic changes in the cardiorespiratory system during exacerbations of COPD, providing objective confirmation of events and a biomarker of recovery and treatment response.

Keywords: COPD, radiology and other imaging, emphysema

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