Welche Bildgebung ist zur Diagnostik der kleinen Atemwege geeignet?

Diseases affecting the small conducting airways form a range of inflammatory and fibrotic pulmonary pathologies collectively known as small airways diseases. The diagnosis of small airways diseases involves several imaging modalities, including high-resolution computed tomography (HRCT) and X-ray examinations. Alternatively, magnetic resonance imaging (MRI) of the lungs provides a unique combination of morphological and functional information. Additionally, clinical findings and histological analyses play a crucial role in achieving an accurate diagnosis.

This article provides an overview of the imaging modalities relevant for the diagnosis of small airways diseases.

An assessment of the literature on small airways diseases was carried out.

The application of imaging modalities such as HRCT and MRI enables a precise anatomical assessment. Special CT postprocessing techniques, such as minimum intensity projection (MinIP) and maximum intensity projection (MIP) enable the visualization of specific pathologies; however, the repeated and frequent utilization of CT is constrained by the radiation exposure. In contrast, MRI is capable of obtaining morphological and functional information without subjecting individuals to radiation, albeit at the cost of time and reduced spatial resolution. Emerging methodologies, such as MRI employing hyperpolarized 129Xe gas along with non-contrast-enhanced ventilation-weighted and perfusion-weighted MRI derived from temporally resolved acquisitions are presently in the developmental phase and may soon be available for clinical application.

When there is a suspicion of small airways diseases, appropriate diagnostics using HRCT are indispensable. Future developments, new technologies and integrative approaches are necessary to further enhance the accuracy and efficiency of the diagnosis.