CT-Definable Subtypes of Chronic Obstructive Pulmonary Disease: A Statement of the Fleischner Society

Published Online:May 11 2015https://doi.org/10.1148/radiol.2015141579

Abstract

Integration of visual characterization of emphysema and airway abnormalities with physiologic and quantitative CT assessment permits categorization of chronic obstructive pulmonary disease into distinct structurally and functionally defined subtypes.

The purpose of this statement is to describe and define the phenotypic abnormalities that can be identified on visual and quantitative evaluation of computed tomographic (CT) images in subjects with chronic obstructive pulmonary disease (COPD), with the goal of contributing to a personalized approach to the treatment of patients with COPD. Quantitative CT is useful for identifying and sequentially evaluating the extent of emphysematous lung destruction, changes in airway walls, and expiratory air trapping. However, visual assessment of CT scans remains important to describe patterns of altered lung structure in COPD. The classification system proposed and illustrated in this article provides a structured approach to visual and quantitative assessment of COPD. Emphysema is classified as centrilobular (subclassified as trace, mild, moderate, confluent, and advanced destructive emphysema), panlobular, and paraseptal (subclassified as mild or substantial). Additional important visual features include airway wall thickening, inflammatory small airways disease, tracheal abnormalities, interstitial lung abnormalities, pulmonary arterial enlargement, and bronchiectasis.

^© RSNA, 2015

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Article History

Received July 16, 2014; revision requested September 2; revision received October 28; accepted November 24; final version accepted February 16, 2015.
Published online: May 11 2015
Published in print: Oct 2015

Vol. 277, No. 1

Abbreviations

Abbreviations:
CLE	centrilobular emphysema
COPD	chronic obstructive pulmonary disease\
FEV₁	forced expiratory volume in 1 second
FVC	forced vital capacity
GOLD	Global Obstructive Lung Disease
PLE	panlobular emphysema
PSE	paraseptal emphysema

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