Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Quantitative CT Imaging in Chronic Obstructive Pulmonary Disease: Review of Current Status and Future Challenges

CT를 이용한 만성폐쇄성폐질환의 정량적 평가: 현 상태와 미래 과제에 대한 리뷰

  • Cho, Young Hoon (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seo, Joon Beom (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang Min (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang Min (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choe, Jooae (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Dabee (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Namkug (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine)
  • 조영훈 (울산대학교 의과대학 서울아산병원 영상의학과, 영상의학연구소) ;
  • 서준범 (울산대학교 의과대학 서울아산병원 영상의학과, 영상의학연구소) ;
  • 이상민 (울산대학교 의과대학 서울아산병원 영상의학과, 영상의학연구소) ;
  • 이상민 (울산대학교 의과대학 서울아산병원 영상의학과, 영상의학연구소) ;
  • 최주애 (울산대학교 의과대학 서울아산병원 영상의학과, 영상의학연구소) ;
  • 이다비 (울산대학교 의과대학 서울아산병원 영상의학과, 영상의학연구소) ;
  • 김남국 (울산대학교 의과대학 서울아산병원 영상의학과, 영상의학연구소)
  • Received : 2017.09.21
  • Accepted : 2017.11.07
  • Published : 2018.01.01
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Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a complex heterogeneous condition with various clinical and pathologic features. In recent years, technical advances in quantitative CT imaging have generated considerable interest because they can provide a more precise and objective assessment of COPD. Emphysema and small-airway disease, the two major components of COPD, and other comorbidities, including pulmonary vessel alterations, atherosclerosis, cachexia, and osteoporosis, can all be assessed by means of quantitative imaging parameters. Increasing numbers of studies provide promising reports indicating that such parameters are associated with clinical measures of disease severity, respiratory symptoms, COPD exacerbations, and mortality. Despite such optimistic results, there are still many obstacles to using this quantitative technology in everyday practice to manage COPD patients. In this article, we review the current technical status of quantitative CT assessment, emphasizing its clinical implications and limitations. We also discuss present challenges and the potential future role of quantitative CT imaging in assessing COPD.

만성폐쇄성폐질환은 다양한 임상적, 병리학적 특징을 가지고 있는 복합적인 질병이다. CT는 만성폐쇄성폐질환을 평가하는 데 가장 널리 사용되는 영상도구이나, 지금까지의 주관적 평가 방법으로는 임상적으로 의미 있는 일관되고 객관적인 영상 지표를 얻는 데 한계점이 있었다. 이러한 문제점을 극복하기 위하여 만성폐쇄성폐질환 환자에게서 얻은 CT 정보를 정량적으로 분석하는 방법이 많은 연구자들의 주목을 받았고, 이러한 분야의 기술적 진보를 바탕으로 폐기종과 소기도 질환이라는 만성폐쇄성폐질환의 두 주요 요소뿐만 아니라 폐혈관의 변화, 심혈관 질환, 체 성분 변화, 그리고 골다공증을 포함하는 다양한 변화를 정량적으로 분석하고 측정할 수 있게 되었다. 그리고 이렇게 측정된 정량적인 수치들은 만성폐쇄성폐질환 환자의 폐 기능 검사 수치와 연관성이 보고되었으며, 더 나아가 질병의 실제 임상적 경과와 환자의 예후와도 연관성이 있는 것으로 나타났다. 하지만 이러한 긍정적인 보고에도 불구하고 아직 CT를 이용한 만성폐쇄성폐질환의 정량적 평가 방법은 실제 진료와 환자의 치료에 널리 적용되고 있지 않다. 이에 저자들은 먼저 현재까지 이루어진 CT를 이용한 만성폐쇄성폐질환의 정량적 평가 방법의 기술적 진보에 대하여 리뷰하고, 이러한 방법이 질병과 환자의 평가에 갖는 임상적 의미에 대하여 서술하고자 한다. 또한, 이러한 기술이 실질적으로 임상적으로 유용한 도구로 자리잡기 위해서 극복해야 하는 한계점과 문제점에 대하여 논의하고, 마지막으로 앞으로 CT를 이용한 만성폐쇄성폐질환의 정량적 평가 방법에 대한 연구가 나아가야 하는 방향에 대하여 제안하고자 한다.

Keywords

Acknowledgement

Supported by : Small and Medium Business Administration (SMBA)

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