European Radiology

, Volume 18, Issue 3, pp 510–521 | Cite as

Morphological and functional imaging in COPD with CT and MRI: present and future

  • Julia Ley-ZaporozhanEmail author
  • Sebastian Ley
  • Hans-Ulrich Kauczor


Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. COPD is defined by irreversible airflow obstruction. It is a heterogeneous disease affecting the airways (i.e. chronic bronchitis, airway collapse), the parenchyma (i.e. hyperinflation, air trapping and emphysematous destruction) as well as the vasculature (i.e. hypoxic vasoconstriction, rarefication and pulmonary arterial hypertension) with different severity during the course of the disease. These different aspects of COPD can be best addressed by imaging using a combination of morphological and functional techniques. Three-dimensional high-resolution computed tomography (3D-HRCT) is the technique of choice for morphological imaging of the lung parenchyma and airways. This morphological information is to be accomplished by functional information about perfusion, regional lung mechanics, and ventilation mainly provided by MRI. The comprehensive diagnostic possibilities of CT complemented by MRI will allow for a more sensitive detection, phenotype-driven characterization and dedicated therapy monitoring of COPD as presented in this review.


COPD CT MRI Perfusion Ventilation 


  1. 1.
    GOLD (2006) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Executive summery, updated
  2. 2.
    Szilasi M, Dolinay T, Nemes Z, Strausz J (2006) Pathology of chronic obstructive pulmonary disease. Pathol Oncol Res 12:52–60PubMedGoogle Scholar
  3. 3.
    Rosenkranz S (2007) Pulmonary hypertension: current diagnosis and treatment. Clin Res Cardiol 96:527–541PubMedCrossRefGoogle Scholar
  4. 4.
    Ley-Zaporozhan J, Ley S, Kauczor HU (2007) Proton MRI in COPD. Copd 4:55–65PubMedCrossRefGoogle Scholar
  5. 5.
    Bankier AA, Madani A, Gevenois PA (2002) CT quantification of pulmonary emphysema: assessment of lung structure and function. Crit Rev Comput Tomogr 43:399–417PubMedCrossRefGoogle Scholar
  6. 6.
    Gevenois PA, De Vuyst P, de Maertelaer V, Zanen J, Jacobovitz D, Cosio MG, Yernault JC (1996) Comparison of computed density and microscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 154:187–192PubMedGoogle Scholar
  7. 7.
    Newell JD Jr, Hogg JC, Snider GL (2004) Report of a workshop: quantitative computed tomography scanning in longitudinal studies of emphysema. Eur Respir J 23:769–775PubMedCrossRefGoogle Scholar
  8. 8.
    Martinez FJ, Foster G, Curtis JL, Criner G, Weinmann G, Fishman A, DeCamp MM, Benditt J, Sciurba F, Make B, Mohsenifar Z, Diaz P, Hoffman E, Wise R (2006) Predictors of mortality in patients with emphysema and severe airflow obstruction. Am J Respir Crit Care Med 173:1326–1334PubMedCrossRefGoogle Scholar
  9. 9.
    Aziz ZA, Wells AU, Desai SR, Ellis SM, Walker AE, MacDonald S, Hansell DM (2005) Functional impairment in emphysema: contribution of airway abnormalities and distribution of parenchymal disease. AJR Am J Roentgenol 185:1509–1515PubMedCrossRefGoogle Scholar
  10. 10.
    Nakano Y, Sakai H, Muro S, Hirai T, Oku Y, Nishimura K, Mishima M (1999) Comparison of low attenuation areas on computed tomographic scans between inner and outer segments of the lung in patients with chronic obstructive pulmonary disease: incidence and contribution to lung function. Thorax 54:384–389PubMedCrossRefGoogle Scholar
  11. 11.
    Bankier AA, De Maertelaer V, Keyzer C, Gevenois PA (1999) Pulmonary emphysema: subjective visual grading versus objective quantification with macroscopic morphometry and thin-section CT densitometry. Radiology 211:851–858PubMedGoogle Scholar
  12. 12.
    Gevenois PA, de Maertelaer V, De Vuyst P, Zanen J, Yernault JC (1995) Comparison of computed density and macroscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 152:653–657PubMedGoogle Scholar
  13. 13.
    Baldi S, Miniati M, Bellina CR, Battolla L, Catapano G, Begliomini E, Giustini D, Giuntini C (2001) Relationship between extent of pulmonary emphysema by high-resolution computed tomography and lung elastic recoil in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164:585–589PubMedGoogle Scholar
  14. 14.
    Stoel BC, Stolk J (2004) Optimization and standardization of lung densitometry in the assessment of pulmonary emphysema. Invest Radiol 39:681–688PubMedCrossRefGoogle Scholar
  15. 15.
    Madani A, Zanen J, de Maertelaer V, Gevenois PA (2006) Pulmonary emphysema: objective quantification at multi-detector row CT–comparison with macroscopic and microscopic morphometry. Radiology 238:1036–1043PubMedCrossRefGoogle Scholar
  16. 16.
    Kinsella M, Muller NL, Abboud RT, Morrison NJ, DyBuncio A (1990) Quantitation of emphysema by computed tomography using a “density mask” program and correlation with pulmonary function tests. Chest 97:315–321PubMedCrossRefGoogle Scholar
  17. 17.
    Arakawa A, Yamashita Y, Nakayama Y, Kadota M, Korogi H, Kawano O, Matsumoto M, Takahashi M (2001) Assessment of lung volumes in pulmonary emphysema using multidetector helical CT: comparison with pulmonary function tests. Comput Med Imaging Graph 25:399–404PubMedCrossRefGoogle Scholar
  18. 18.
    Zaporozhan J, Ley S, Eberhardt R, Weinheimer O, Iliyushenko S, Herth F, Kauczor HU (2005) Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis: comparison of different quantitative evaluations and pulmonary function test. Chest 128:3212–3220PubMedCrossRefGoogle Scholar
  19. 19.
    Boedeker KL, McNitt-Gray MF, Rogers SR, Truong DA, Brown MS, Gjertson DW, Goldin JG (2004) Emphysema: effect of reconstruction algorithm on CT imaging measures. Radiology 232:295–301PubMedCrossRefGoogle Scholar
  20. 20.
    Ley-Zaporozhan J, Ley S, Weinheimer O, Iliyushenko S, Erdugan S, Eberhardt R, Fuxa A, Mews J, Kauczor HU (2007) Quantitative analysis of emphysema in 3D using MDCT: influence of different reconstruction algorithms. Eur J Radiol DOI  10.1016/j.grad.2007.03.034
  21. 21.
    Madani A, De Maertelaer V, Zanen J, Gevenois PA (2007) Pulmonary emphysema: radiation dose and section thickness at multidetector CT quantification–comparison with macroscopic and microscopic morphometry. Radiology 243:250–257PubMedCrossRefGoogle Scholar
  22. 22.
    Zaporozhan J, Ley S, Weinheimer O, Eberhardt R, Tsakiris I, Noshi Y, Herth F, Kauczor HU (2006) Multi-detector CT of the chest: influence of dose onto quantitative evaluation of severe emphysema: a simulation study. J Comput Assist Tomogr 30:460–468PubMedCrossRefGoogle Scholar
  23. 23.
    Mishima M, Hirai T, Itoh H, Nakano Y, Sakai H, Muro S, Nishimura K, Oku Y, Chin K, Ohi M, Nakamura T, Bates JH, Alencar AM, Suki B (1999) Complexity of terminal airspace geometry assessed by lung computed tomography in normal subjects and patients with chronic obstructive pulmonary disease. Proc Natl Acad Sci USA 96:8829–8834PubMedCrossRefGoogle Scholar
  24. 24.
    Hoffman EA, Simon BA, McLennan G (2006) State of the Art. A structural and functional assessment of the lung via multidetector-row computed tomography: phenotyping chronic obstructive pulmonary disease. Proc Am Thorac Soc 3:519–532PubMedCrossRefGoogle Scholar
  25. 25.
    Xu Y, Sonka M, McLennan G, Guo J, Hoffman EA (2006) MDCT-based 3-D texture classification of emphysema and early smoking related lung pathologies. IEEE Trans Med Imaging 25:464–475PubMedCrossRefGoogle Scholar
  26. 26.
    Bankier AA, O’Donnell CR, Mai VM, Storey P, De Maertelaer V, Edelman RR, Chen Q (2004) Impact of lung volume on MR signal intensity changes of the lung parenchyma. J Magn Reson Imaging 20:961–966PubMedCrossRefGoogle Scholar
  27. 27.
    Hatabu H, Chen Q, Stock KW, Gefter WB, Itoh H (1999) Fast magnetic resonance imaging of the lung. Eur J Radiol 29:114–132PubMedCrossRefGoogle Scholar
  28. 28.
    Hogg JC, Chu F, Utokaparch S, Woods R, Elliott WM, Buzatu L, Cherniack RM, Rogers RM, Sciurba FC, Coxson HO, Pare PD (2004) The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med 350:2645–2653PubMedCrossRefGoogle Scholar
  29. 29.
    Hogg JC (2006) State of the art. Bronchiolitis in chronic obstructive pulmonary disease. Proc Am Thorac Soc 3:489–493PubMedCrossRefGoogle Scholar
  30. 30.
    Heussel CP, Ley S, Biedermann A, Rist A, Gast KK, Schreiber WG, Kauczor HU (2004) Respiratory lumenal change of the pharynx and trachea in normal subjects and COPD patients: assessment by cine-MRI. Eur Radiol 14:2188–2197PubMedCrossRefGoogle Scholar
  31. 31.
    Boiselle PM, Ernst A (2006) Tracheal morphology in patients with tracheomalacia: prevalence of inspiratory lunate and expiratory “frown” shapes. J Thorac Imaging 21:190–196PubMedCrossRefGoogle Scholar
  32. 32.
    Goldin JG (2002) Quantitative CT of the lung. Radiol Clin North Am 40:145–162PubMedCrossRefGoogle Scholar
  33. 33.
    Mayer D, Bartz D, Fischer J, Ley S, del Rio A, Thust S, Kauczor HU, Heussel CP (2004) Hybrid segmentation and virtual bronchoscopy based on CT images. Acad Radiol 11:551–565PubMedCrossRefGoogle Scholar
  34. 34.
    Berger P, Laurent F, Begueret H, Perot V, Rouiller R, Raherison C, Molimard M, Marthan R, Tunon-de-Lara JM (2003) Structure and function of small airways in smokers: relationship between air trapping at CT and airway inflammation. Radiology 228:85–94PubMedCrossRefGoogle Scholar
  35. 35.
    Hansell DM (2001) Small airways diseases: detection and insights with computed tomography. Eur Respir J 17:1294–1313PubMedCrossRefGoogle Scholar
  36. 36.
    Park JW, Hong YK, Kim CW, Kim DK, Choe KO, Hong CS (1997) High-resolution computed tomography in patients with bronchial asthma: correlation with clinical features, pulmonary functions and bronchial hyperresponsiveness. J Investig Allergol Clin Immunol 7:186–192PubMedGoogle Scholar
  37. 37.
    Nakano Y, Muller NL, King GG, Niimi A, Kalloger SE, Mishima M, Pare PD (2002) Quantitative assessment of airway remodeling using high-resolution CT. Chest 122:271S–275SPubMedCrossRefGoogle Scholar
  38. 38.
    Hasegawa M, Nasuhara Y, Onodera Y, Makita H, Nagai K, Fuke S, Ito Y, Betsuyaku T, Nishimura M (2006) Airflow limitation and airway dimensions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 173:1309–1315PubMedCrossRefGoogle Scholar
  39. 39.
    Biederer J, Both M, Graessner J, Liess C, Jakob P, Reuter M, Heller M (2003) Lung morphology: fast MR imaging assessment with a volumetric interpolated breath-hold technique: initial experience with patients. Radiology 226:242–249PubMedCrossRefGoogle Scholar
  40. 40.
    Beckmann N, Cannet C, Zurbruegg S, Rudin M, Tigani B (2004) Proton MRI of lung parenchyma reflects allergen-induced airway remodeling and endotoxin-aroused hyporesponsiveness: a step toward ventilation studies in spontaneously breathing rats. Magn Reson Med 52:258–268PubMedCrossRefGoogle Scholar
  41. 41.
    Euler US, Liljestrand G (1946) Observation on the pulmonary arterial blood pressuer in the cat. Acta Physiol Scand 12:301–320CrossRefGoogle Scholar
  42. 42.
    Cederlund K, Hogberg S, Jorfeldt L, Larsen F, Norman M, Rasmussen E, Tylen U (2003) Lung perfusion scintigraphy prior to lung volume reduction surgery. Acta Radiol 44:246–251PubMedCrossRefGoogle Scholar
  43. 43.
    Thabut G, Dauriat G, Stern JB, Logeart D, Levy A, Marrash-Chahla R, Mal H (2005) Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest 127:1531–1536PubMedCrossRefGoogle Scholar
  44. 44.
    Sandek K, Bratel T, Lagerstrand L, Rosell H (2002) Relationship between lung function, ventilation-perfusion inequality and extent of emphysema as assessed by high-resolution computed tomography. Respir Med 96:934–943PubMedCrossRefGoogle Scholar
  45. 45.
    Ley-Zaporozhan J, Ley S, Eberhardt R, Weinheimer O, Fink C, Puderbach M, Eichinger M, Herth F, Kauczor HU (2007) Assessment of the relationship between lung parenchymal destruction and impaired pulmonary perfusion on a lobar level in patients with emphysema. Eur J Radiol 63:76–83PubMedCrossRefGoogle Scholar
  46. 46.
    Hoffman EA, Chon D (2005) Computed tomography studies of lung ventilation and perfusion. Proc Am Thorac Soc 2:492–498, 506PubMedCrossRefGoogle Scholar
  47. 47.
    Fink C, Puderbach M, Bock M, Lodemann KP, Zuna I, Schmahl A, Delorme S, Kauczor HU (2004) Regional lung perfusion: assessment with partially parallel three-dimensional MR imaging. Radiology 231:175–184PubMedCrossRefGoogle Scholar
  48. 48.
    Fink C, Ley S, Kroeker R, Requardt M, Kauczor HU, Bock M (2005) Time-resolved contrast-enhanced three-dimensional magnetic resonance angiography of the chest: combination of parallel imaging with view sharing (TREAT). Invest Radiol 40:40–48PubMedCrossRefGoogle Scholar
  49. 49.
    Morino S, Toba T, Araki M, Azuma T, Tsutsumi S, Tao H, Nakamura T, Nagayasu T, Tagawa T (2006) Noninvasive assessment of pulmonary emphysema using dynamic contrast-enhanced magnetic resonance imaging. Exp Lung Res 32:55–67PubMedCrossRefGoogle Scholar
  50. 50.
    Ohno Y, Hatabu H, Murase K, Higashino T, Kawamitsu H, Watanabe H, Takenaka D, Fujii M, Sugimura K (2004) Quantitative assessment of regional pulmonary perfusion in the entire lung using three-dimensional ultrafast dynamic contrast-enhanced magnetic resonance imaging: preliminary experience in 40 subjects. J Magn Reson Imaging 20:353–365PubMedCrossRefGoogle Scholar
  51. 51.
    Weitzenblum E (1994) The pulmonary circulation and the heart in chronic lung disease. Monaldi Arch Chest Dis 49:231–234PubMedGoogle Scholar
  52. 52.
    Bruzzi JF, Remy-Jardin M, Delhaye D, Teisseire A, Khalil C, Remy J (2006) When, why, and how to examine the heart during thoracic CT: Part 2, clinical applications. AJR Am J Roentgenol 186:333–341PubMedCrossRefGoogle Scholar
  53. 53.
    Vonk-Noordegraaf A, Marcus JT, Holverda S, Roseboom B, Postmus PE (2005) Early changes of cardiac structure and function in COPD patients with mild hypoxemia. Chest 127:1898–1903PubMedCrossRefGoogle Scholar
  54. 54.
    Budev MM, Arroliga AC, Wiedemann HP, Matthay RA (2003) Cor pulmonale: an overview. Semin Respir Crit Care Med 24:233–244PubMedCrossRefGoogle Scholar
  55. 55.
    Ohno Y, Sugimura K, Hatabu H (2003) Clinical oxygen-enhanced magnetic resonance imaging of the lung. Top Magn Reson Imaging 14:237–243PubMedCrossRefGoogle Scholar
  56. 56.
    Stadler A, Stiebellehner L, Jakob PM, Arnold JF, Bankier AA (2006) [T1 maps and O(2)-enhanced MRT of the diseased lung. Emphysema, fibrosis, mucoviscidosis.]. Radiologe 46:282, 284–9PubMedCrossRefGoogle Scholar
  57. 57.
    Muller CJ, Schwaiblmair M, Scheidler J, Deimling M, Weber J, Loffler RB, Reiser MF (2002) Pulmonary diffusing capacity: assessment with oxygen-enhanced lung MR imaging preliminary findings. Radiology 222:499–506PubMedCrossRefGoogle Scholar
  58. 58.
    van Beek EJ, Wild JM, Kauczor HU, Schreiber W, Mugler JP 3rd, de Lange EE (2004) Functional MRI of the lung using hyperpolarized 3-helium gas. J Magn Reson Imaging 20:540–554PubMedCrossRefGoogle Scholar
  59. 59.
    Kauczor HU, Hofmann D, Kreitner KF, Nilgens H, Surkau R, Heil W, Potthast A, Knopp MV, Otten EW, Thelen M (1996) Normal and abnormal pulmonary ventilation: visualization at hyperpolarized He-3 MR imaging. Radiology 201:564–568PubMedGoogle Scholar
  60. 60.
    Guenther D, Eberle B, Hast J, Lill J, Markstaller K, Puderbach M, Schreiber WG, Hanisch G, Heussel CP, Surkau R, Grossmann T, Weiler N, Thelen M, Kauczor HU (2000) (3)He MRI in healthy volunteers: preliminary correlation with smoking history and lung volumes. NMR Biomed 13:182–189PubMedCrossRefGoogle Scholar
  61. 61.
    Zaporozhan J, Ley S, Gast KK, Schmiedeskamp J, Biedermann A, Eberle B, Kauczor HU (2004) Functional analysis in single-lung transplant recipients: a comparative study of high-resolution CT, (3)He-MRI, and pulmonary function tests. Chest 125:173–181PubMedCrossRefGoogle Scholar
  62. 62.
    Ray N, Acton ST, Altes T, de Lange EE, Brookeman JR (2003) Merging parametric active contours within homogeneous image regions for MRI-based lung segmentation. IEEE Trans Med Imaging 22:189–199PubMedCrossRefGoogle Scholar
  63. 63.
    Salerno M, Altes TA, Brookeman JR, de Lange EE, Mugler JP 3rd (2001) Dynamic spiral MRI of pulmonary gas flow using hyperpolarized (3)He: preliminary studies in healthy and diseased lungs. Magn Reson Med 46:667–677PubMedCrossRefGoogle Scholar
  64. 64.
    Wild JM, Paley MN, Kasuboski L, Swift A, Fichele S, Woodhouse N, Griffiths PD, van Beek EJ (2003) Dynamic radial projection MRI of inhaled hyperpolarized 3He gas. Magn Reson Med 49:991–997PubMedCrossRefGoogle Scholar
  65. 65.
    Kauczor HU (2003) Hyperpolarized helium-3 gas magnetic resonance imaging of the lung. Top Magn Reson Imaging 14:223–230PubMedCrossRefGoogle Scholar
  66. 66.
    Gast KK, Puderbach MU, Rodriguez I, Eberle B, Markstaller K, Knitz F, Schmiedeskamp J, Weiler N, Schreiber WG, Mayer E, Thelen M, Kauczor HU (2003) Distribution of ventilation in lung transplant recipients: evaluation by dynamic 3He-MRI with lung motion correction. Invest Radiol 38:341–348PubMedCrossRefGoogle Scholar
  67. 67.
    Swift AJ, Wild JM, Fichele S, Woodhouse N, Fleming S, Waterhouse J, Lawson RA, Paley MN, Van Beek EJ (2005) Emphysematous changes and normal variation in smokers and COPD patients using diffusion 3He MRI. Eur J Radiol 54:352–358PubMedCrossRefGoogle Scholar
  68. 68.
    Salerno M, de Lange EE, Altes TA, Truwit JD, Brookeman JR, Mugler JP 3rd (2002) Emphysema: hyperpolarized helium 3 diffusion MR imaging of the lungs compared with spirometric indexes–initial experience. Radiology 222:252–260PubMedCrossRefGoogle Scholar
  69. 69.
    Decramer M (1997) Hyperinflation and respiratory muscle interaction. Eur Respir J 10:934–941PubMedGoogle Scholar
  70. 70.
    Henderson AC, Ingenito EP, Salcedo ES, Moy ML, Reilly JJ, Lutchen KR (2007) Dynamic lung mechanics in late-stage emphysema before and after lung volume reduction surgery. Respir Physiol Neurobiol 155:234–242PubMedCrossRefGoogle Scholar
  71. 71.
    Plathow C, Klopp M, Fink C, Sandner A, Hof H, Puderbach M, Herth F, Schmahl A, Kauczor HU (2005) Quantitative analysis of lung and tumour mobility: comparison of two time-resolved MRI sequences. Br J Radiol 78:836–840PubMedCrossRefGoogle Scholar
  72. 72.
    Suga K, Tsukuda T, Awaya H, Takano K, Koike S, Matsunaga N, Sugi K, Esato K (1999) Impaired respiratory mechanics in pulmonary emphysema: evaluation with dynamic breathing MRI. J Magn Reson Imaging 10:510–520PubMedCrossRefGoogle Scholar
  73. 73.
    Iwasawa T, Yoshiike Y, Saito K, Kagei S, Gotoh T, Matsubara S (2000) Paradoxical motion of the hemidiaphragm in patients with emphysema. J Thorac Imaging 15:191–195PubMedCrossRefGoogle Scholar
  74. 74.
    Iwasawa T, Kagei S, Gotoh T, Yoshiike Y, Matsushita K, Kurihara H, Saito K, Matsubara S (2002) Magnetic resonance analysis of abnormal diaphragmatic motion in patients with emphysema. Eur Respir J 19:225–231PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2007

Authors and Affiliations

  • Julia Ley-Zaporozhan
    • 1
    • 3
    Email author
  • Sebastian Ley
    • 1
    • 2
  • Hans-Ulrich Kauczor
    • 1
  1. 1.Department of Radiology (E010)German Cancer Research CenterHeidelbergGermany
  2. 2.Department of Pediatric RadiologyRuprecht-Karls-UniversityHeidelbergGermany
  3. 3.Department of Diagnostic and Interventional RadiologyJohannes Gutenberg-University Hospital, University of MainzMainzGermany

Personalised recommendations