Pulmonary Biomechanics in COPD: Imaging Techniques and Clinical Applications.

The respiratory system depends on complex biomechanical processes to enable gas exchange. The mechanical properties of the lung parenchyma, airways, vasculature, and surrounding structures play an essential role in overall ventilation efficacy. These complex biomechanical processes, however, are significantly altered in chronic obstructive pulmonary disease (COPD) due to emphysematous destruction of the lung parenchyma, chronic airway inflammation, and small airway obstruction. Recent advancements in computed tomography (CT) and magnetic resonance imaging (MRI) acquisition techniques, combined with advanced image post-processing algorithms and deep neural networks, have enabled comprehensive quantitative assessment of lung structure, tissue deformation, and lung function at the voxel level. These methods have led to better phenotyping, therapeutic strategies, and refined our understanding of pathological processes that compromise pulmonary function in COPD. In this review, we discuss recent developments in imaging and image processing methods for studying pulmonary biomechanics with a specific focus on clinical applications for COPD, including the assessment of regional ventilation, planning of endobronchial valve treatment, prediction of disease onset and progression, sizing of lungs for transplantation, and guiding mechanical ventilation. These advanced image-based biomechanical measurements, when combined with clinical expertise, play a critical role in disease management and personalized therapeutic interventions for patients with COPD.