Reviews and feature articleUsing imaging as a biomarker for asthma
Section snippets
Use of imaging in the clinical evaluation of asthma
Imaging of the lungs in asthmatic patients has evolved dramatically over the last decade; however, the clinical diagnosis of asthma is still based on a compatible history, examination findings, and evidence of variable airflow obstruction. Chest imaging is most helpful in evaluating complications from asthma and ruling out alternative diagnoses. The chest radiographic findings are nonspecific and often can be normal. The most common abnormal finding is bronchial wall thickening, which is
Assessing lung structure and function with CT, OCT, EBUS, PET, and MRI
With the drive to more broadly use CT for its newfound roles in clinical assessment of the lung, screening, phenotyping, and drug and device discovery and outcomes assessment, there have been rapid advances, bringing highly evolved CT technologies into the clinical environment. CT imaging can provide comprehensive evaluation of the lung by allowing for detailed descriptions of not only the airway tree and lung parenchyma but also regional ventilation.2 Multidetector row CT allows for faster
Relating structure and function to clinical parameters
Airway remodeling is a term used to describe increased airway WT in asthmatic patients. This condition encompasses a range of processes, including mucous gland hyperplasia, smooth muscle hypertrophy, inflammatory cell infiltration, and collagen deposition.73 CT has been used to evaluate the extent of airway wall thickening.74, 75 WA% and WT percentage (WT%) measured by using CT were increased in patients with severe asthma and correlated with airway epithelial thickness on endobronchial biopsy
Imaging as a biomarker
The effect of inhaled corticosteroid use on air trapping in patients with mild-to-moderate asthma with uncontrolled symptoms has been assessed by using CT. After completing 3 months of therapy with an inhaled corticosteroid, patients exhibited a decrease in air trapping, as measured by using CT.80 Thus air trapping can serve as a potential outcome related to disease control. Recently, biologic therapy with anti–IL-5 mAb has shown promise to reverse the airway remodeling process. In 26 patients
Conclusion
Current use of chest CT in asthmatic patients has been used to identify alternative diagnosis or complicating conditions that might be contributing to uncontrolled disease. Recent studies have now demonstrated that quantitative CT of the chest and hyperpolarized gas MRI can be used as a biomarker of airway remodeling. Prospective longitudinal trials of targeted biologics (anti-IgE, IL-5, IL-4α, and IL-13) and nonpharmacologic (bronchial thermoplasty) treatments using these quantitative imaging
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2022, Immunology and Allergy Clinics of North AmericaCitation Excerpt :The past decade has seen the development of chest imaging techniques and biomarkers that offer a comprehensive and quantitative assessment of parenchymal, airway, and vascular pathology (Fig. 2). Although modern functional imaging approaches, including xenon-enhanced dual-energy CT and hyperpolarized gas magnetic resonance imaging (MRI), can be applied to regionally visualize and quantify ventilation abnormalities in patients with asthma17 and COPD18 alone, CT is the most well-validated imaging approach to evaluate airways disease and emphysema. CT imaging biomarkers relevant to asthma and COPD have been the focus of recent reviews,17,19 and those that the authors consider applicable to the discussion of their overlap are defined in Table 1.
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