Recent years have witnessed major advances in lung imaging in patients with COPD. These include significant refinements in images obtained by computed tomography (CT) scans together with the introduction of new techniques and software that aim for obtaining the best image whilst using the lowest possible radiation dose. Magnetic resonance imaging (MRI) has also emerged as a useful radiation-free tool in assessing structural and more importantly functional derangements in patients with well-established COPD and smokers without COPD, even before the existence of overt changes in resting physiological lung function tests. Together, CT and MRI now allow objective quantification and assessment of structural changes within the airways, lung parenchyma and pulmonary vessels. Furthermore, CT and MRI can now provide objective assessments of regional lung ventilation and perfusion, and multinuclear MRI provides further insight into gas exchange; this can help in structured decisions regarding treatment plans. These advances in chest imaging techniques have brought new insights into our understanding of disease pathophysiology and characterising different disease phenotypes. The present review discusses, in detail, the advances in lung imaging in patients with COPD and how structural and functional imaging are linked with common resting physiological tests and important clinical outcomes.

近年来，慢性阻塞性肺病患者的肺部影像学取得了重大进展。其中包括对计算机断层扫描 (CT) 扫描获得的图像进行重大改进，并引入新技术和软件，旨在使用尽可能低的辐射剂量获得最佳图像。磁共振成像 (MRI) 也已成为一种有用的无辐射工具，用于评估患有慢性阻塞性肺病的患者和无慢性阻塞性肺病的吸烟者的结构紊乱，更重要的是功能紊乱，甚至在静息生理肺功能测试出现明显变化之前。 CT 和 MRI 结合在一起，现在可以客观量化和评估气道、肺实质和肺血管内的结构变化。此外，CT 和 MRI 现在可以提供局部肺通气和灌注的客观评估，多核 MRI 可以进一步了解气体交换；这有助于做出有关治疗计划的结构化决策。胸部成像技术的这些进步为我们理解疾病病理生理学和表征不同疾病表型带来了新的见解。本综述详细讨论了慢性阻塞性肺病患者肺部成像的进展，以及结构和功能成像如何与常见的静息生理测试和重要的临床结果联系起来。