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Elbehairy AF, Marshall H, Naish JH, Wild JM, Parraga G, Horsley A, Vestbo J. Advances in COPD imaging using CT and MRI: linkage with lung physiology and clinical outcomes. Eur Respir J 2024; 63:2301010. [PMID: 38548292 DOI: 10.1183/13993003.01010-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/16/2024] [Indexed: 05/04/2024]
Abstract
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.
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Affiliation(s)
- Amany F Elbehairy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Helen Marshall
- POLARIS, Imaging, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Josephine H Naish
- MCMR, Manchester University NHS Foundation Trust, Manchester, UK
- Bioxydyn Limited, Manchester, UK
| | - Jim M Wild
- POLARIS, Imaging, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for in silico Medicine, Sheffield, UK
| | - Grace Parraga
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Division of Respirology, Western University, London, ON, Canada
| | - Alexander Horsley
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Wang JM, Bell AJ, Ram S, Labaki WW, Hoff BA, Murray S, Kazerooni EA, Galban S, Hatt CR, Han MK, Galban CJ. Topologic Parametric Response Mapping Identifies Tissue Subtypes Associated with Emphysema Progression. Acad Radiol 2024; 31:1148-1159. [PMID: 37661554 PMCID: PMC11098545 DOI: 10.1016/j.acra.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023]
Abstract
RATIONALE AND OBJECTIVES Small airways disease (SAD) and emphysema are significant components of chronic obstructive pulmonary disease (COPD), a heterogenous disease where predicting progression is difficult. SAD, a principal cause of airflow obstruction in mild COPD, has been identified as a precursor to emphysema. Parametric Response Mapping (PRM) of chest computed tomography (CT) can help distinguish SAD from emphysema. Specifically, topologic PRM can define local patterns of both diseases to characterize how and in whom COPD progresses. We aimed to determine if distribution of CT-based PRM of functional SAD (fSAD) is associated with emphysema progression. MATERIALS AND METHODS We analyzed paired inspiratory-expiratory chest CT scans at baseline and 5-year follow up in 1495 COPDGene subjects using topological analyses of PRM classifications. By spatially aligning temporal scans, we mapped local emphysema at year five to baseline lobar PRM-derived topological readouts. K-means clustering was applied to all observations. Subjects were subtyped based on predominant PRM cluster assignments and assessed using non-parametric statistical tests to determine differences in PRM values, pulmonary function metrics, and clinical measures. RESULTS We identified distinct lobar imaging patterns and classified subjects into three radiologic subtypes: emphysema-dominant (ED), fSAD-dominant (FD), and fSAD-transition (FT: transition from healthy lung to fSAD). Relative to year five emphysema, FT showed rapid local emphysema progression (-57.5% ± 1.1) compared to FD (-49.9% ± 0.5) and ED (-33.1% ± 0.4). FT consisted primarily of at-risk subjects (roughly 60%) with normal spirometry. CONCLUSION The FT subtype of COPD may allow earlier identification of individuals without spirometrically-defined COPD at-risk for developing emphysema.
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Affiliation(s)
- Jennifer M Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan (J.M.W., W.W.L., M.K.H.)
| | - Alexander J Bell
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.)
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.); Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan (S.R.)
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan (J.M.W., W.W.L., M.K.H.)
| | - Benjamin A Hoff
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.)
| | - Susan Murray
- School of Public Health, University of Michigan, Ann Arbor, Michigan (S.M.)
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.)
| | - Stefanie Galban
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.)
| | - Charles R Hatt
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.); Imbio, LLC, Minneapolis, Minnesota (C.R.H.)
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan (J.M.W., W.W.L., M.K.H.)
| | - Craig J Galban
- Department of Radiology, University of Michigan, Ann Arbor, Michigan (A.J.B., S.R., B.A.H., E.A.K., S.G., C.R.H., C.J.G.).
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Bell AJ, Pal R, Labaki WW, Hoff BA, Wang JM, Murray S, Kazerooni EA, Galban S, Lynch DA, Humphries SM, Martinez FJ, Hatt CR, Han MK, Ram S, Galban CJ. Local heterogeneity of normal lung parenchyma and small airways disease are associated with COPD severity and progression. Respir Res 2024; 25:106. [PMID: 38419014 PMCID: PMC10903150 DOI: 10.1186/s12931-024-02729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Small airways disease (SAD) is a major cause of airflow obstruction in COPD patients and has been identified as a precursor to emphysema. Although the amount of SAD in the lungs can be quantified using our Parametric Response Mapping (PRM) approach, the full breadth of this readout as a measure of emphysema and COPD progression has yet to be explored. We evaluated topological features of PRM-derived normal parenchyma and SAD as surrogates of emphysema and predictors of spirometric decline. METHODS PRM metrics of normal lung (PRMNorm) and functional SAD (PRMfSAD) were generated from CT scans collected as part of the COPDGene study (n = 8956). Volume density (V) and Euler-Poincaré Characteristic (χ) image maps, measures of the extent and coalescence of pocket formations (i.e., topologies), respectively, were determined for both PRMNorm and PRMfSAD. Association with COPD severity, emphysema, and spirometric measures were assessed via multivariable regression models. Readouts were evaluated as inputs for predicting FEV1 decline using a machine learning model. RESULTS Multivariable cross-sectional analysis of COPD subjects showed that V and χ measures for PRMfSAD and PRMNorm were independently associated with the amount of emphysema. Readouts χfSAD (β of 0.106, p < 0.001) and VfSAD (β of 0.065, p = 0.004) were also independently associated with FEV1% predicted. The machine learning model using PRM topologies as inputs predicted FEV1 decline over five years with an AUC of 0.69. CONCLUSIONS We demonstrated that V and χ of fSAD and Norm have independent value when associated with lung function and emphysema. In addition, we demonstrated that these readouts are predictive of spirometric decline when used as inputs in a ML model. Our topological PRM approach using PRMfSAD and PRMNorm may show promise as an early indicator of emphysema onset and COPD progression.
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Affiliation(s)
- Alexander J Bell
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - Ravi Pal
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - Wassim W Labaki
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin A Hoff
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - Jennifer M Wang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Susan Murray
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stefanie Galban
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | | | | | | | - MeiLan K Han
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Craig J Galban
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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Nakamura H, Hirai T, Kurosawa H, Hamada K, Matsunaga K, Shimizu K, Konno S, Muro S, Fukunaga K, Nakano Y, Kuwahira I, Hanaoka M. Current advances in pulmonary functional imaging. Respir Investig 2024; 62:49-65. [PMID: 37948969 DOI: 10.1016/j.resinv.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 11/12/2023]
Abstract
Recent advances in imaging analysis have enabled evaluation of ventilation and perfusion in specific regions by chest computed tomography (CT) and magnetic resonance imaging (MRI), in addition to modalities including dynamic chest radiography, scintigraphy, positron emission tomography (PET), ultrasound, and electrical impedance tomography (EIT). In this review, an overview of current functional imaging techniques is provided for each modality. Advances in chest CT have allowed for the analysis of local volume changes and small airway disease in addition to emphysema, using the Jacobian determinant and parametric response mapping with inspiratory and expiratory images. Airway analysis can reveal characteristics of airway lesions in chronic obstructive pulmonary disease (COPD) and bronchial asthma, and the contribution of dysanapsis to obstructive diseases. Chest CT is also employed to measure pulmonary blood vessels, interstitial lung abnormalities, and mediastinal and chest wall components including skeletal muscle and bone. Dynamic CT can visualize lung deformation in respective portions. Pulmonary MRI has been developed for the estimation of lung ventilation and perfusion, mainly using hyperpolarized 129Xe. Oxygen-enhanced and proton-based MRI, without a polarizer, has potential clinical applications. Dynamic chest radiography is gaining traction in Japan for ventilation and perfusion analysis. Single photon emission CT can be used to assess ventilation-perfusion (V˙/Q˙) mismatch in pulmonary vascular diseases and COPD. PET/CT V˙/Q˙ imaging has also been demonstrated using "Galligas". Both ultrasound and EIT can detect pulmonary edema caused by acute respiratory distress syndrome. Familiarity with these functional imaging techniques will enable clinicians to utilize these systems in clinical practice.
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Affiliation(s)
- Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Kurosawa
- Center for Environmental Conservation and Research Safety and Department of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuki Hamada
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Ichiro Kuwahira
- Division of Pulmonary Medicine, Department of Medicine, Tokai University Tokyo Hospital, Tokyo, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Ortiz-Puerta D, Diaz O, Retamal J, Hurtado DE. Morphometric analysis of airways in pre-COPD and mild COPD lungs using continuous surface representations of the bronchial lumen. Front Bioeng Biotechnol 2023; 11:1271760. [PMID: 38192638 PMCID: PMC10773673 DOI: 10.3389/fbioe.2023.1271760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a prevalent respiratory disease that presents a high rate of underdiagnosis during onset and early stages. Studies have shown that in mild COPD patients, remodeling of the small airways occurs concurrently with morphological changes in the proximal airways. Despite this evidence, the geometrical study of the airway tree from computed tomography (CT) lung images remains underexplored due to poor representations and limited tools to characterize the airway structure. Methods: We perform a comprehensive morphometric study of the proximal airways based on geometrical measures associated with the different airway generations. To this end, we leverage the geometric flexibility of the Snakes IsoGeometric Analysis method to accurately represent and characterize the airway luminal surface and volume informed by CT images of the respiratory tree. Based on this framework, we study the airway geometry of smoking pre-COPD and mild COPD individuals. Results: Our results show a significant difference between groups in airway volume, length, luminal eccentricity, minimum radius, and surface-area-to-volume ratio in the most distal airways. Discussion: Our findings suggest a higher degree of airway narrowing and collapse in COPD patients when compared to pre-COPD patients. We envision that our work has the potential to deliver a comprehensive tool for assessing morphological changes in airway geometry that take place in the early stages of COPD.
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Affiliation(s)
- David Ortiz-Puerta
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Orlando Diaz
- Department of Intensive Care Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime Retamal
- Department of Intensive Care Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel E. Hurtado
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
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Bell AJ, Pal R, Labaki WW, Hoff BA, Wang JM, Murray S, Kazerooni EA, Galban S, Lynch DA, Humphries SM, Martinez FJ, Hatt CR, Han MK, Ram S, Galban CJ. Quantitative CT of Normal Lung Parenchyma and Small Airways Disease Topologies are Associated With COPD Severity and Progression. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.26.23290532. [PMID: 37333382 PMCID: PMC10274970 DOI: 10.1101/2023.05.26.23290532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Objectives Small airways disease (SAD) is a major cause of airflow obstruction in COPD patients, and has been identified as a precursor to emphysema. Although the amount of SAD in the lungs can be quantified using our Parametric Response Mapping (PRM) approach, the full breadth of this readout as a measure of emphysema and COPD progression has yet to be explored. We evaluated topological features of PRM-derived normal parenchyma and SAD as surrogates of emphysema and predictors of spirometric decline. Materials and Methods PRM metrics of normal lung (PRMNorm) and functional SAD (PRMfSAD) were generated from CT scans collected as part of the COPDGene study (n=8956). Volume density (V) and Euler-Poincaré Characteristic (χ) image maps, measures of the extent and coalescence of pocket formations (i.e., topologies), respectively, were determined for both PRMNorm and PRMfSAD. Association with COPD severity, emphysema, and spirometric measures were assessed via multivariable regression models. Readouts were evaluated as inputs for predicting FEV1 decline using a machine learning model. Results Multivariable cross-sectional analysis of COPD subjects showed that V and χ measures for PRMfSAD and PRMNorm were independently associated with the amount of emphysema. Readouts χfSAD (β of 0.106, p<0.001) and VfSAD (β of 0.065, p=0.004) were also independently associated with FEV1% predicted. The machine learning model using PRM topologies as inputs predicted FEV1 decline over five years with an AUC of 0.69. Conclusions We demonstrated that V and χ of fSAD and Norm have independent value when associated with lung function and emphysema. In addition, we demonstrated that these readouts are predictive of spirometric decline when used as inputs in a ML model. Our topological PRM approach using PRMfSAD and PRMNorm may show promise as an early indicator of emphysema onset and COPD progression.
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Affiliation(s)
- Alexander J. Bell
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Ravi Pal
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Wassim W. Labaki
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Benjamin A. Hoff
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer M. Wang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Susan Murray
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Ella A. Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Stefanie Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, CO, United States
| | | | | | | | - MeiLan K. Han
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Craig J. Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
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Dai Q, Zhu X, Zhang J, Dong Z, Pompeo E, Zheng J, Shi J. The utility of quantitative computed tomography in cohort studies of chronic obstructive pulmonary disease: a narrative review. J Thorac Dis 2023; 15:5784-5800. [PMID: 37969311 PMCID: PMC10636446 DOI: 10.21037/jtd-23-1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
Background and Objective Chronic obstructive pulmonary disease (COPD) is a significant contributor to global morbidity and mortality. Quantitative computed tomography (QCT), a non-invasive imaging modality, offers the potential to assess lung structure and function in COPD patients. Amidst the coronavirus disease 2019 (COVID-19) pandemic, chest computed tomography (CT) scans have emerged as a viable alternative for assessing pulmonary function (e.g., spirometry), minimizing the risk of aerosolized virus transmission. However, the clinical application of QCT measurements is not yet widespread enough, necessitating broader validation to determine its usefulness in COPD management. Methods We conducted a search in the PubMed database in English from January 1, 2013 to April 20, 2023, using keywords and controlled vocabulary related to QCT, COPD, and cohort studies. Key Content and Findings Existing studies have demonstrated the potential of QCT in providing valuable information on lung volume, airway geometry, airway wall thickness, emphysema, and lung tissue density in COPD patients. Moreover, QCT values have shown robust correlations with pulmonary function tests, and can predict exacerbation risk and mortality in patients with COPD. QCT can even discern COPD subtypes based on phenotypic characteristics such as emphysema predominance, supporting targeted management and interventions. Conclusions QCT has shown promise in cohort studies related to COPD, since it can provide critical insights into the pathogenesis and progression of the disease. Further research is necessary to determine the clinical significance of QCT measurements for COPD management.
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Affiliation(s)
- Qi Dai
- School of Medicine, Tongji University, Shanghai, China
- Department of Radiology, Ningbo No.2 Hospitall, Ningbo, China
| | - Xiaoxiao Zhu
- Department of Respiratory and Critical Care Medicine, Ningbo No.2 Hospital, Ningbo, China
| | - Jingfeng Zhang
- Department of Radiology, Ningbo No.2 Hospitall, Ningbo, China
| | - Zhaoxing Dong
- Department of Respiratory and Critical Care Medicine, Ningbo No.2 Hospital, Ningbo, China
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Jianjun Zheng
- Department of Radiology, Ningbo No.2 Hospitall, Ningbo, China
| | - Jingyun Shi
- School of Medicine, Tongji University, Shanghai, China
- Department of Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Gerard SE, Chaudhary MFA, Herrmann J, Christensen GE, Estépar RSJ, Reinhardt JM, Hoffman EA. Direct estimation of regional lung volume change from paired and single CT images using residual regression neural network. Med Phys 2023; 50:5698-5714. [PMID: 36929883 PMCID: PMC10743098 DOI: 10.1002/mp.16365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/11/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Chest computed tomography (CT) enables characterization of pulmonary diseases by producing high-resolution and high-contrast images of the intricate lung structures. Deformable image registration is used to align chest CT scans at different lung volumes, yielding estimates of local tissue expansion and contraction. PURPOSE We investigated the utility of deep generative models for directly predicting local tissue volume change from lung CT images, bypassing computationally expensive iterative image registration and providing a method that can be utilized in scenarios where either one or two CT scans are available. METHODS A residual regression convolutional neural network, called Reg3DNet+, is proposed for directly regressing high-resolution images of local tissue volume change (i.e., Jacobian) from CT images. Image registration was performed between lung volumes at total lung capacity (TLC) and functional residual capacity (FRC) using a tissue mass- and structure-preserving registration algorithm. The Jacobian image was calculated from the registration-derived displacement field and used as the ground truth for local tissue volume change. Four separate Reg3DNet+ models were trained to predict Jacobian images using a multifactorial study design to compare the effects of network input (i.e., single image vs. paired images) and output space (i.e., FRC vs. TLC). The models were trained and evaluated on image datasets from the COPDGene study. Models were evaluated against the registration-derived Jacobian images using local, regional, and global evaluation metrics. RESULTS Statistical analysis revealed that both factors - network input and output space - were significant determinants for change in evaluation metrics. Paired-input models performed better than single-input models, and model performance was better in the output space of FRC rather than TLC. Mean structural similarity index for paired-input models was 0.959 and 0.956 for FRC and TLC output spaces, respectively, and for single-input models was 0.951 and 0.937. Global evaluation metrics demonstrated correlation between registration-derived Jacobian mean and predicted Jacobian mean: coefficient of determination (r2 ) for paired-input models was 0.974 and 0.938 for FRC and TLC output spaces, respectively, and for single-input models was 0.598 and 0.346. After correcting for effort, registration-derived lobar volume change was strongly correlated with the predicted lobar volume change: for paired-input models r2 was 0.899 for both FRC and TLC output spaces, and for single-input models r2 was 0.803 and 0.862, respectively. CONCLUSIONS Convolutional neural networks can be used to directly predict local tissue mechanics, eliminating the need for computationally expensive image registration. Networks that use paired CT images acquired at TLC and FRC allow for more accurate prediction of local tissue expansion compared to networks that use a single image. Networks that only require a single input image still show promising results, particularly after correcting for effort, and allow for local tissue expansion estimation in cases where multiple CT scans are not available. For single-input networks, the FRC image is more predictive of local tissue volume change compared to the TLC image.
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Affiliation(s)
- Sarah E. Gerard
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | | | - Jacob Herrmann
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Gary E. Christensen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | | | - Joseph M. Reinhardt
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Eric A. Hoffman
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
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Zeng S, Luo G, Lynch DA, Bowler RP, Arjomandi M. Lung volumes differentiate the predominance of emphysema versus airway disease phenotype in early COPD: an observational study of the COPDGene cohort. ERJ Open Res 2023; 9:00289-2023. [PMID: 37727675 PMCID: PMC10505951 DOI: 10.1183/23120541.00289-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 09/21/2023] Open
Abstract
Rationale Lung volumes identify the "susceptible smokers" who progress to develop spirometric COPD. However, among susceptible smokers, development of spirometric COPD seems to be heterogeneous, suggesting the presence of different pathological mechanisms during early establishment of spirometric COPD. The objective of the present study was to determine the differential patterns of radiographic pathologies among susceptible smokers. Methods We categorised smokers with preserved spirometry (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0) in the Genetic Epidemiology of COPD (COPDGene) cohort based on tertiles (low, intermediate and high) of lung volumes (either total lung capacity (TLC), functional residual capacity FRC or FRC/TLC) at baseline visit. We then examined the differential patterns of change in spirometry and the associated prevalence of computed tomography measured pathologies of emphysema and airway disease with those categories of lung volumes. Results The pattern of spirometric change differed when participants were categorised by TLC versus FRC/TLC: those in the high TLC tertile showed stable forced expiratory volume in 1 s (FEV1), but enlarging forced vital capacity (FVC), while those in the high FRC/TLC tertile showed decline in both FEV1 and FVC. When participants from the high TLC and high FRC/TLC tertiles were partitioned into mutually exclusive groups, compared to those with high TLC, those with high FRC/TLC had lesser emphysema, but greater air trapping, more self-reported respiratory symptoms and exacerbation episodes and higher likelihood of progressing to more severe spirometric disease (GOLD stages 2-4 versus GOLD stage 1). Conclusions Lung volumes identify distinct physiological and radiographic phenotypes in early disease among susceptible smokers and predict the rate of spirometric disease progression and the severity of symptoms in early COPD.
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Affiliation(s)
- Siyang Zeng
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | | | | | - Mehrdad Arjomandi
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
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10
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Abstract
Whereas COPD is currently defined as the presence of spirometric obstruction, the pathologic changes in individuals at risk including chronic mucus hypersecretion and emphysema have been recognized for centuries. At the same time, we have struggled to define criteria that would help us identify patients at an early stage, prior to the development of pulmonary function abnormality. The concept of GOLD 0 was introduced in the hopes that symptoms would help to identify those at greatest risk for progression. While symptoms are a risk factor, in particular chronic bronchitis, the term was abandoned as the majority of individuals at risk who progress to COPD do not have symptoms. Since then, the related terms pre-COPD and early COPD have been introduced. They are similar in that the term pre-COPD identifies individuals based on symptoms, physiologic, or radiographic abnormality that do not meet criteria for COPD but are clearly at risk. The term early COPD extends that concept further, focusing on individuals who have early physiologic or radiographic abnormality but at the same time are young, thereby excluding those with late mild disease who may be less likely to progress. Whereas individuals with early COPD are now being recruited for observational studies, we are still challenged with determining the best way to identify patients at risk who should undergo additional testing as well as developing specific therapies for patients with early-stage disease.
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Affiliation(s)
- Bo Young Lee
- Division of Allergy and Respiratory Diseases, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - MeiLan K Han
- Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan.
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11
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Curtis JL. Understanding COPD Etiology, Pathophysiology, and Definition. Respir Care 2023; 68:859-870. [PMID: 37353333 PMCID: PMC10289621 DOI: 10.4187/respcare.10873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
COPD, one of the leading worldwide health problems, currently lacks truly disease-modifying medical therapies applicable to most patients. Developing such novel therapies has been hampered by the marked heterogeneity of phenotypes between individuals with COPD. Such heterogeneity suggests that, rather than a single cause (particularly just direct inhalation of tobacco products), development and progression of COPD likely involve both complex gene-by-environment interactions to multiple inhalational exposures and a variety of molecular pathways. However, there has been considerable recent progress toward understanding how specific pathological processes can lead to discrete COPD phenotypes, particularly that of small airways disease. Advances in imaging techniques that correlate to specific types of histological damage, and in the immunological mechanisms of lung damage in COPD, hold promise for development of personalized therapies. At the same time, there is growing recognition that the current diagnostic criteria for COPD, based solely on spirometry, exclude large numbers of individuals with very similar disease manifestations. This concise review summarizes current understanding of the etiology and pathophysiology of COPD and provides background explaining the increasing calls to expand the diagnostic criteria used to diagnose COPD and some challenges in doing so.
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Affiliation(s)
- Jeffrey L Curtis
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Division of Pulmonary and Critical Care Medicine, Michigan Medicine, Ann Arbor, Michigan; and Graduate Program in Immunology, University of Michigan, Ann Arbor, Michigan.
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12
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Wang JM, Labaki WW, Murray S, Martinez FJ, Curtis JL, Hoffman EA, Ram S, Bell AJ, Galban CJ, Han MK, Hatt C. Machine learning for screening of at-risk, mild and moderate COPD patients at risk of FEV 1 decline: results from COPDGene and SPIROMICS. Front Physiol 2023; 14:1144192. [PMID: 37153221 PMCID: PMC10161244 DOI: 10.3389/fphys.2023.1144192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose: The purpose of this study was to train and validate machine learning models for predicting rapid decline of forced expiratory volume in 1 s (FEV1) in individuals with a smoking history at-risk-for chronic obstructive pulmonary disease (COPD), Global Initiative for Chronic Obstructive Lung Disease (GOLD 0), or with mild-to-moderate (GOLD 1-2) COPD. We trained multiple models to predict rapid FEV1 decline using demographic, clinical and radiologic biomarker data. Training and internal validation data were obtained from the COPDGene study and prediction models were validated against the SPIROMICS cohort. Methods: We used GOLD 0-2 participants (n = 3,821) from COPDGene (60.0 ± 8.8 years, 49.9% male) for variable selection and model training. Accelerated lung function decline was defined as a mean drop in FEV1% predicted of > 1.5%/year at 5-year follow-up. We built logistic regression models predicting accelerated decline based on 22 chest CT imaging biomarker, pulmonary function, symptom, and demographic features. Models were validated using n = 885 SPIROMICS subjects (63.6 ± 8.6 years, 47.8% male). Results: The most important variables for predicting FEV1 decline in GOLD 0 participants were bronchodilator responsiveness (BDR), post bronchodilator FEV1% predicted (FEV1.pp.post), and CT-derived expiratory lung volume; among GOLD 1 and 2 subjects, they were BDR, age, and PRMlower lobes fSAD. In the validation cohort, GOLD 0 and GOLD 1-2 full variable models had significant predictive performance with AUCs of 0.620 ± 0.081 (p = 0.041) and 0.640 ± 0.059 (p < 0.001). Subjects with higher model-derived risk scores had significantly greater odds of FEV1 decline than those with lower scores. Conclusion: Predicting FEV1 decline in at-risk patients remains challenging but a combination of clinical, physiologic and imaging variables provided the best performance across two COPD cohorts.
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Affiliation(s)
- Jennifer M. Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Susan Murray
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | | | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Alexander J. Bell
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Craig J. Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Charles Hatt
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Imbio Inc., Minneapolis, MN, United States
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13
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Shima H, Tanabe N, Oguma A, Shimizu K, Kaji S, Terada K, Oguma T, Kubo T, Suzuki M, Makita H, Sato A, Nishimura M, Sato S, Konno S, Hirai T. Subtyping emphysematous COPD by respiratory volume change distributions on CT. Thorax 2023; 78:344-353. [PMID: 35768196 DOI: 10.1136/thoraxjnl-2021-218288] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is considerable heterogeneity among patients with emphysematous chronic obstructive pulmonary disease (COPD). We hypothesised that in addition to emphysema severity, ventilation distribution in emphysematous regions would be associated with clinical-physiological impairments in these patients. OBJECTIVE To evaluate whether the discordance between respiratory volume change distributions (from expiration to inspiration) in emphysematous and non-emphysematous regions affects COPD outcomes using two cohorts. METHODS Emphysema was quantified using a low attenuation volume percentage on inspiratory CT (iLAV%). Local respiratory volume changes were calculated using non-rigidly registered expiratory/inspiratory CT. The Ventilation Discordance Index (VDI) represented the log-transformed Wasserstein distance quantifying discordance between respiratory volume change distributions in emphysematous and non-emphysematous regions. RESULTS Patients with COPD in the first cohort (n=221) were classified into minimal emphysema (iLAV% <10%; n=113) and established emphysema with high VDI and low VDI groups (n=46 and 62, respectively). Forced expiratory volume in 1 s (FEV1) was lower in the low VDI group than in the other groups, with no difference between the high VDI and minimal emphysema groups. Higher iLAV%, more severe airway disease and hyperventilated emphysematous regions in the upper-middle lobes were independently associated with lower VDI. The second cohort analyses (n=93) confirmed these findings and showed greater annual FEV1 decline and higher mortality in the low VDI group than in the high VDI group independent of iLAV% and airway disease on CT. CONCLUSION Lower VDI is associated with severe airflow limitation and higher mortality independent of emphysema severity and airway morphological changes in patients with emphysematous COPD.
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Affiliation(s)
- Hiroshi Shima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Oguma
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shizuo Kaji
- Institute of Mathematics for Industry, Kyushu University, Fukuoka, Japan
| | - Kunihiko Terada
- Terada Clinic, Respiratory Medicine and General Practice, Himeji, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hironi Makita
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Hokkaido Medical Research Institute for Respiratory Diseases, Sapporo, Japan
| | - Atsuyasu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaharu Nishimura
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Hokkaido Medical Research Institute for Respiratory Diseases, Sapporo, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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14
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Mahdavi MMB, Arabfard M, Rafati M, Ghanei M. A Computer-based Analysis for Identification and Quantification of Small Airway Disease in Lung Computed Tomography Images: A Comprehensive Review for Radiologists. J Thorac Imaging 2023; 38:W1-W18. [PMID: 36206107 DOI: 10.1097/rti.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Computed tomography (CT) imaging is being increasingly used in clinical practice for detailed characterization of lung diseases. Respiratory diseases involve various components of the lung, including the small airways. Evaluation of small airway disease on CT images is challenging as the airways cannot be visualized directly by a CT scanner. Small airway disease can manifest as pulmonary air trapping (AT). Although AT may be sometimes seen as mosaic attenuation on expiratory CT images, it is difficult to identify diffuse AT visually. Computer technology advances over the past decades have provided methods for objective quantification of small airway disease on CT images. Quantitative CT (QCT) methods are being rapidly developed to quantify underlying lung diseases with greater precision than subjective visual assessment of CT images. A growing body of evidence suggests that QCT methods can be practical tools in the clinical setting to identify and quantify abnormal regions of the lung accurately and reproducibly. This review aimed to describe the available methods for the identification and quantification of small airway disease on CT images and to discuss the challenges of implementing QCT metrics in clinical care for patients with small airway disease.
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Affiliation(s)
- Mohammad Mehdi Baradaran Mahdavi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran
| | - Masoud Arabfard
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran
| | - Mehravar Rafati
- Department of Medical Physics and Radiology, Faculty of paramedicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran
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15
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Walters EH, Shukla S, Ward C. Broadening concepts of core pathobiology in various aspects of COPD development. Eur Respir J 2022; 60:2201531. [PMID: 36202414 DOI: 10.1183/13993003.01531-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/23/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Eugene H Walters
- School of Medicine and Menzies Institute, University of Tasmania, Hobart, Australia
| | - Shakti Shukla
- Graduate School of Pharmacy, University of Technology Sydney, Ultimo, Australia
| | - Chis Ward
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Medical School, Newcastle University, Newcastle Upon Tyne, UK
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16
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Kraemer R, Gardin F, Smith HJ, Baty F, Barandun J, Piecyk A, Minder S, Salomon J, Frey M, Brutsche MH, Matthys H. Functional Predictors Discriminating Asthma-COPD Overlap (ACO) from Chronic Obstructive Pulmonary Disease (COPD). Int J Chron Obstruct Pulmon Dis 2022; 17:2723-2743. [PMID: 36304971 PMCID: PMC9595126 DOI: 10.2147/copd.s382761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background A significant proportion of patients with obstructive lung disease have clinical and functional features of both asthma and chronic obstructive pulmonary disease (COPD), referred to as the asthma–COPD overlap (ACO). The distinction of these phenotypes, however, is not yet well-established due to the lack of defining clinical and/or functional criteria. The aim of our investigations was to assess the discriminating power of various lung function parameters on the assessment of ACO. Methods From databases of 4 pulmonary centers, a total of 540 patients (231 males, 309 females), including 372 patients with asthma, 77 patients with ACO and 91 patients with COPD, were retrospectively collected, and gradients among combinations of explanatory variables of spirometric (FEV1, FEV1/FVC, FEF25-75), plethysmographic (sReff, sGeff, the aerodynamic work of breathing at rest; sWOB), static lung volumes, including trapped gases and measurements of the carbon monoxide transfer (DLCO, KCO) were explored using multiple factor analysis (MFA). The discriminating power of lung function parameters with respect to ACO was assessed using linear discriminant analysis (LDA). Results LDA revealed that parameters of airway dynamics (sWOB, sReff, sGeff) combined with parameters of static lung volumes such as functional residual capacity (FRCpleth) and trapped gas at FRC (VTGFRC) are valuable and potentially important tools discriminating between asthma, ACO and COPD. Moreover, sWOB significantly contributes to the diagnosis of obstructive airway diseases, independent from the state of pulmonary hyperinflation, whilst the diffusion capacity for carbon monoxide (DLCO) significantly differentiates between the 3 diagnostic classes. Conclusion The complexity of COPD with its components of interaction and their heterogeneity, especially in discrimination from ACO, may well be differentiated if patients are explored by a whole set of target parameters evaluating, interactionally, flow limitation, airway dynamics, pulmonary hyperinflation, small airways dysfunction and gas exchange disturbances assessing specific functional deficits.
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Affiliation(s)
- Richard Kraemer
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Salem-Hospital, Bern, Switzerland,Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland,Correspondence: Richard Kraemer, Center of Pulmonary Medicine, Hirslanden Private Hospital Group, Schänzlistrasse 39, Berne, CH-3013, Switzerland, Tel +41 79 300 26 53, Email
| | - Fabian Gardin
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Clinic Hirslanden, Zürich, Switzerland
| | - Hans-Jürgen Smith
- Medical Development, Research in Respiratory Diagnostics, Berlin, Germany
| | - Florent Baty
- Department of Pneumology, Cantonal Hospital St, Gallen, Switzerland
| | - Jürg Barandun
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Clinic Hirslanden, Zürich, Switzerland
| | - Andreas Piecyk
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Clinic Hirslanden, Zürich, Switzerland
| | - Stefan Minder
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Salem-Hospital, Bern, Switzerland
| | - Jörg Salomon
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Salem-Hospital, Bern, Switzerland
| | - Martin Frey
- Department of Pneumology, Barmelweid Hospital, Barmelweid, Switzerland
| | | | - Heinrich Matthys
- Department of Pneumology, University Hospital of Freiburg, Freiburg, Germany
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17
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Davis CW, Lopez CL, Bell AJ, Miller RF, Rabin AS, Murray S, Falvo MJ, Han MK, Galban CJ, Osterholzer JJ. The Severity of Functional Small Airway Disease in Military Personnel with Constrictive Bronchiolitis as Measured by Quantitative Computed Tomography. Am J Respir Crit Care Med 2022; 206:786-789. [PMID: 35608541 DOI: 10.1164/rccm.202201-0153le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | | | | | | | - Alexander S Rabin
- University of Michigan Ann Arbor, Michigan.,VA Ann Arbor Health Care System Ann Arbor, Michigan
| | | | - Michael J Falvo
- Rutgers University Newark, New Jersey.,VA New Jersey Health Care System East Orange, New Jersey
| | | | | | - John J Osterholzer
- University of Michigan Ann Arbor, Michigan.,VA Ann Arbor Health Care System Ann Arbor, Michigan
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18
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Huang X, Yin W, Shen M, Wang X, Ren T, Wang L, Liu M, Guo Y. Contributions of Emphysema and Functional Small Airway Disease on Intrapulmonary Vascular Volume in COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:1951-1961. [PMID: 36045693 PMCID: PMC9423118 DOI: 10.2147/copd.s368974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies have demonstrated that there is a certain correlation between emphysema and changes in pulmonary small blood vessels in patients with chronic obstructive pulmonary disease (COPD), but most of them were limited to the investigation of the inspiratory phase. The emphysema indicators need to be further optimized. Based on the parametric response mapping (PRM) method, this study aimed to investigate the effect of emphysema and functional small airway disease on intrapulmonary vascular volume (IPVV). Methods This retrospective study enrolled 63 healthy subjects and 47 COPD patients, who underwent both inspiratory and expiratory CT scans of the chest and pulmonary function tests (PFTs). Inspiratory and expiratory IPVV were measured by using an automatic pulmonary vessels integration segmentation approach, the ratio of emphysema volume (Emph%), functional small airway disease volume (fsAD%), and normal areas volume (Normal%) were quantified by the PRM method for biphasic CT scans. The participants were grouped according to PFTs. Analysis of variance (ANOVA) and Kruskal–Wallis H-test were used to analyze the differences in indicators between different groups. Then, Spearman’s rank correlation coefficients were used to analyze the correlation between Emph%, fsAD%, Normal%, PFTs, and IPVV. Finally, multiple linear regression was applied to analyze the effects of Emph% and fsAD% on IPVV. Results Differences were found in age, body mass index (BMI), smoking index, FEV1%, FEV1/forced vital capacity (FVC), expiratory IPVV, IPVV relative value, IPVV difference value, Emph%, fsAD%, and Normal% between the groups (P<0.05). A strong correlation was established between the outcomes of PFTs and quantitative CT indexes. Finally, the effect of Emph% was more significant than that of fsAD% on expiratory IPVV, IPVV difference value, and IPVV relative value. Conclusion IPVV may have a potential value in assessing COPD severity and is significantly affected by emphysema.
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Affiliation(s)
- Xiaoqi Huang
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Weiling Yin
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Min Shen
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Xionghui Wang
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Tao Ren
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Lei Wang
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Youmin Guo
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
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19
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Christenson SA, Smith BM, Bafadhel M, Putcha N. Chronic obstructive pulmonary disease. Lancet 2022; 399:2227-2242. [PMID: 35533707 DOI: 10.1016/s0140-6736(22)00470-6] [Citation(s) in RCA: 190] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 12/14/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity, mortality, and health-care use worldwide. COPD is caused by exposure to inhaled noxious particles, notably tobacco smoke and pollutants. However, the broad range of factors that increase the risk of development and progression of COPD throughout the life course are increasingly being recognised. Innovations in omics and imaging techniques have provided greater insight into disease pathobiology, which might result in advances in COPD prevention, diagnosis, and treatment. Although few novel treatments have been approved for COPD in the past 5 years, advances have been made in targeting existing therapies to specific subpopulations using new biomarker-based strategies. Additionally, COVID-19 has undeniably affected individuals with COPD, who are not only at higher risk for severe disease manifestations than healthy individuals but also negatively affected by interruptions in health-care delivery and social isolation. This Seminar reviews COPD with an emphasis on recent advances in epidemiology, pathophysiology, imaging, diagnosis, and treatment.
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Affiliation(s)
- Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin M Smith
- Department of Medicine, Columbia University Medical Center, New York, NY, USA; Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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20
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Radovanovic D, Contoli M, Braido F, Maniscalco M, Micheletto C, Solidoro P, Santus P, Carone M. Future Perspectives of Revaluating Mild COPD. Respiration 2022; 101:688-696. [PMID: 35468602 DOI: 10.1159/000524102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
In 2020, COPD was the third leading cause of death worldwide. Lung function is central for the diagnosis of this disease, and COPD severity is still partially classified based on airflow obstruction, which can range from "mild" (GOLD 1 group, FEV1 ≥80% predicted) to "very severe" (GOLD 4, FEV1 <30% predicted). However, the term "mild COPD" needs to be carefully analyzed. Several studies have shown that even in the presence of a mild obstruction, patients can have significant symptoms, physiological deterioration, evidence of emphysema, and suffer from recurrent exacerbations. Small airways pathology significantly correlates with the presence of symptoms, and it has been demonstrated that the onset of bronchiolitis occurs earlier than that of emphysema. These damages have long been known to not be detectable with conventional tests, and exclusive reliance on spirometry is not enough to adequately study and stage a patient with "mild COPD." Therefore, early identification of COPD is of utmost importance in the light of modifying the natural course of the disease. However, patients with early lung damage are yet to be included and studied in interventional clinical trials.
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Affiliation(s)
- Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Marco Contoli
- Respiratory Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Fulvio Braido
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Department of Internal Medicine (DiMI), University of Genova, Genova, Italy
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri, Pavia. IRCCS di Telese, Telese Terme, Italy
| | - Claudio Micheletto
- UOC di Pneumologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Paolo Solidoro
- Medical Sciences Department, University of Torino, Turin, Italy.,Division of Respiratory Diseases, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy.,Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Mauro Carone
- Istituti Clinici Scientifici Maugeri, Pavia. IRCCS di Bari, Bari, Italy
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21
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Wang JM, Han MK, Labaki WW. Chronic obstructive pulmonary disease risk assessment tools: is one better than the others? Curr Opin Pulm Med 2022; 28:99-108. [PMID: 34652295 PMCID: PMC8799486 DOI: 10.1097/mcp.0000000000000833] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Risk assessment tools are essential in COPD care to help clinicians identify patients at higher risk of accelerated lung function decline, respiratory exacerbations, hospitalizations, and death. RECENT FINDINGS Conventional methods of assessing risk have focused on spirometry, patient-reported symptoms, functional status, and a combination of these tools in composite indices. More recently, qualitatively and quantitatively assessed chest imaging findings, such as emphysema, large and small airways disease, and pulmonary vascular abnormalities have been associated with poor long-term outcomes in COPD patients. Although several blood and sputum biomarkers have been investigated for risk assessment in COPD, most still warrant further validation. Finally, novel remote digital monitoring technologies may be valuable to predict exacerbations but their large-scale performance, ease of implementation, and cost effectiveness remain to be determined. SUMMARY Given the complex heterogeneity of COPD, any single metric is unlikely to fully capture the risk of poor long-term outcomes. Therefore, clinicians should review all available clinical data, including spirometry, symptom severity, functional status, chest imaging, and bloodwork, to guide personalized preventive care of COPD patients. The potential of machine learning tools and remote monitoring technologies to refine COPD risk assessment is promising but remains largely untapped pending further investigation.
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Affiliation(s)
- Jennifer M Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
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22
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Mkorombindo T, Dransfield MT. Pre-chronic obstructive pulmonary disease: a pathophysiologic process or an opinion term? Curr Opin Pulm Med 2022; 28:109-114. [PMID: 34907960 DOI: 10.1097/mcp.0000000000000854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Current guidelines does not include current or former smokers who do not have spirometric airflow limitation in their diagnostic or therapeutic algorithms for chronic obstructive pulmonary disease (COPD). The purpose of this review is to outline the burden of respiratory morbidity in this population and to discuss the potential utility of their classification as pre-COPD. RECENT FINDINGS It is increasingly clear that patients with a history of exposure to cigarette smoke or other environmental pollutants may have substantial lung pathology and respiratory impairment even in the absence of airflow limitation, as detected by spirometry. Not all of these patients will develop airflow limitation, but many will have considerable respiratory morbidity and a comparable prognosis to those with classical, spirometrically defined COPD. The use of the term pre-COPD may allow for the identification of these individuals in order to target preventive and earlier therapeutic strategies. SUMMARY Spirometry is not adequately sensitive to identify many current and former smokers and other exposed populations with significant lung pathology and respiratory symptoms. Though the pathologic processes present in these patients differ, the earlier identification of this pre-COPD population may foster the development of more effective and disease-modifying treatments.
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Affiliation(s)
- Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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23
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Current and emerging artificial intelligence applications in chest imaging: a pediatric perspective. Pediatr Radiol 2022; 52:2120-2130. [PMID: 34471961 PMCID: PMC8409695 DOI: 10.1007/s00247-021-05146-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/22/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022]
Abstract
Artificial intelligence (AI) applications for chest radiography and chest CT are among the most developed applications in radiology. More than 40 certified AI products are available for chest radiography or chest CT. These AI products cover a wide range of abnormalities, including pneumonia, pneumothorax and lung cancer. Most applications are aimed at detecting disease, complemented by products that characterize or quantify tissue. At present, none of the thoracic AI products is specifically designed for the pediatric population. However, some products developed to detect tuberculosis in adults are also applicable to children. Software is under development to detect early changes of cystic fibrosis on chest CT, which could be an interesting application for pediatric radiology. In this review, we give an overview of current AI products in thoracic radiology and cover recent literature about AI in chest radiography, with a focus on pediatric radiology. We also discuss possible pediatric applications.
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24
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Lu J, Ge H, Qi L, Zhang S, Yang Y, Huang X, Li M. Subtyping preserved ratio impaired spirometry (PRISm) by using quantitative HRCT imaging characteristics. Respir Res 2022; 23:309. [PMID: 36369019 PMCID: PMC9652811 DOI: 10.1186/s12931-022-02113-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preserved Ratio Impaired Spirometry (PRISm) is defined as FEV1/FVC ≥ 70% and FEV1 < 80%pred by pulmonary function test (PFT). It has highly prevalence and is associated with increased respiratory symptoms, systemic inflammation, and mortality. However, there are few radiological studies related to PRISm. The purpose of this study was to investigate the quantitative high-resolution computed tomography (HRCT) characteristics of PRISm and to evaluate the correlation between quantitative HRCT parameters and pulmonary function parameters, with the goal of establishing a nomogram model for predicting PRISm based on quantitative HRCT. METHODS A prospective and continuous study was performed in 488 respiratory outpatients from February 2020 to February 2021. All patients underwent both deep inspiratory and expiratory CT examinations, and received pulmonary function test (PFT) within 1 month. According to the exclusion criteria and Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification standard, 94 cases of normal pulmonary function, 51 cases of PRISm and 48 cases of mild to moderate chronic obstructive lung disease (COPD) were included in the study. The lung parenchyma, parametric response mapping (PRM), airway and vessel parameters were measured by automatic segmentation software (Aview). One-way analysis of variance (ANOVA) was used to compare the differences in clinical features, pulmonary function parameters and quantitative CT parameters. Spearman rank correlation analysis was used to evaluate the correlation between CT quantitative index and pulmonary function parameters. The predictors were obtained by binary logistics regression analysis respectively in normal and PRISm as well as PRISm and mild to moderate COPD, and the nomogram model was established. RESULTS There were significant differences in pulmonary function parameters among the three groups (P < 0.001). The differences in pulmonary parenchyma parameters such as emphysema index (EI), pixel indices-1 (PI-1) and PI-15 were mainly between mild to moderate COPD and the other two groups. The differences of airway parameters and pulmonary vascular parameters were mainly between normal and the other two groups, but were not found between PRISm and mild to moderate COPD. Especially there were significant differences in mean lung density (MLD) and the percent of normal in PRM (PRMNormal) among the three groups. Most of the pulmonary quantitative CT parameters had mild to moderate correlation with pulmonary function parameters. The predictors of the nomogram model using binary logistics regression analysis to distinguish normal from PRISm were smoking, MLD, the percent of functional small airways disease (fSAD) in PRM (PRMfSAD) and Lumen area. It had a good goodness of fit (χ2 = 0.31, P < 0.001) with the area under curve (AUC) value of 0.786. The predictor of distinguishing PRISm from mild to moderate COPD were PRMEmph (P < 0.001, AUC = 0.852). CONCLUSIONS PRISm was significantly different from subjects with normal pulmonary function in small airway and vessel lesions, which was more inclined to mild to moderate COPD, but there was no increase in pulmonary parenchymal attenuation. The nomogram based on quantitative HRCT parameters has good predictive value and provide more objective evidence for the early screening of PRISm.
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Affiliation(s)
- Jinjuan Lu
- grid.413597.d0000 0004 1757 8802Department of Radiology, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Jingan District, Shanghai, 200040 China
| | - Haiyan Ge
- grid.413597.d0000 0004 1757 8802Department of Respiratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Lin Qi
- grid.413597.d0000 0004 1757 8802Department of Radiology, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Jingan District, Shanghai, 200040 China
| | - Shaojie Zhang
- grid.413597.d0000 0004 1757 8802Department of Radiology, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Jingan District, Shanghai, 200040 China
| | - Yuling Yang
- grid.413597.d0000 0004 1757 8802Department of Radiology, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Jingan District, Shanghai, 200040 China
| | - Xuemei Huang
- grid.413597.d0000 0004 1757 8802Department of Radiology, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Jingan District, Shanghai, 200040 China
| | - Ming Li
- grid.413597.d0000 0004 1757 8802Department of Radiology, Huadong Hospital Affiliated to Fudan University, 221 West Yanan Road, Jingan District, Shanghai, 200040 China
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25
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Tanabe N, Hirai T. Recent advances in airway imaging using micro-computed tomography and computed tomography for chronic obstructive pulmonary disease. Korean J Intern Med 2021; 36:1294-1304. [PMID: 34607419 PMCID: PMC8588974 DOI: 10.3904/kjim.2021.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex lung disease characterized by a combination of airway disease and emphysema. Emphysema is classified as centrilobular emphysema (CLE), paraseptal emphysema (PSE), or panlobular emphysema (PLE), and airway disease extends from the respiratory, terminal, and preterminal bronchioles to the central segmental airways. Although clinical computed tomography (CT) cannot be used to visualize the small airways, micro-CT has shown that terminal bronchiole disease is more severe in CLE than in PSE and PLE, and micro-CT findings suggest that the loss and luminal narrowing of terminal bronchioles is an early pathological change in CLE. Furthermore, the introduction of ultra-high-resolution CT has enabled direct evaluation of the proximal small (1 to 2-mm diameter) airways, and new CT analytical methods have enabled estimation of small airway disease and prediction of future COPD onset and lung function decline in smokers with and without COPD. This review discusses the literature on micro-CT and the technical advancements in clinical CT analysis for COPD. Hopefully, novel micro-CT findings will improve our understanding of the distinct pathogeneses of the emphysema subtypes to enable exploration of new therapeutic targets, and sophisticated CT imaging methods will be integrated into clinical practice to achieve more personalized management.
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Affiliation(s)
- Naoya Tanabe
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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26
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Defining Resilience: A Critical Step to Promote Respiratory Health. Ann Am Thorac Soc 2021; 18:1780-1781. [PMID: 34723763 PMCID: PMC8641827 DOI: 10.1513/annalsats.202106-758ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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27
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Matrosic CK, Owen DR, Polan D, Sun Y, Jolly S, Schonewolf C, Schipper M, Haken RKT, Galban CJ, Matuszak M. Feasibility of function-guided lung treatment planning with parametric response mapping. J Appl Clin Med Phys 2021; 22:80-89. [PMID: 34697884 PMCID: PMC8598143 DOI: 10.1002/acm2.13436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/04/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Recent advancements in functional lung imaging have been developed to improve clinicians’ knowledge of patient pulmonary condition prior to treatment. Ultimately, it may be possible to employ these functional imaging modalities to tailor radiation treatment plans to optimize patient outcome and mitigate pulmonary complications. Parametric response mapping (PRM) is a computed tomography (CT)–based functional lung imaging method that utilizes a voxel‐wise image analysis technique to classify lung abnormality phenotypes, and has previously been shown to be effective at assessing lung complication risk in diagnostic applications. The purpose of this work was to demonstrate the implementation of PRM guidance in radiotherapy treatment planning. Methods and materials A retrospective study was performed with 18 lung cancer patients to test the incorporation of PRM into a radiotherapy planning workflow. Paired inspiration/expiration pretreatment CT scans were acquired and PRM analysis was utilized to classify each voxel as normal, parenchymal disease, small airway disease, and emphysema. Density maps were generated for each PRM classification to contour high density regions of pulmonary abnormalities. Conventional volumetric‐modulated arc therapy and PRM‐guided treatment plans were designed for each patient. Results PRM guidance was successfully implemented into the treatment planning process. The inclusion of PRM priorities resulted in statistically significant (p < 0.05) improvements to the V20Gy within the PRM avoidance contours. On average, reductions of 5.4% in the V20Gy(%) were found. The PRM‐guided treatment plans did not significantly increase the dose to the organs at risk or result in insufficient planning target volume coverage, but did increase plan complexity. Conclusions PRM guidance was successfully implemented into a treatment planning workflow and shown to be effective for dose redistribution within the lung. This work has provided a framework for the potential clinical implementation of PRM‐guided treatment planning.
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Affiliation(s)
- Charles K Matrosic
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - D Rocky Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Polan
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yilun Sun
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Craig J Galban
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
This commentary reviews the contribution of imaging by CT and MRI to functional assessment in chronic obstructive pulmonary disease (COPD). CT can help individualize the assessment of COPD by quantifying emphysema, air trapping and airway wall thickening, potentially leading to more specific treatments for these distinct components of COPD. Longitudinal changes in these metrics can help assess progression or improvement. On hyperpolarized gas MRI, the apparent diffusion coefficient of provides an index of airspace enlargement reflecting emphysema. Perfusion imaging and measurement of pulmonary vascular volume on non-contrast CT provide insight into the contribution of pulmonary vascular disease to pulmonary impairment. Functional imaging is particularly valuable in detecting early lung dysfunction in subjects with inhalational exposures.
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Affiliation(s)
- David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, United States
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29
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Walters EH, Shukla SD, Mahmood MQ, Ward C. Fully integrating pathophysiological insights in COPD: an updated working disease model to broaden therapeutic vision. Eur Respir Rev 2021; 30:200364. [PMID: 34039673 PMCID: PMC9488955 DOI: 10.1183/16000617.0364-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
Our starting point is that relatively new findings into the pathogenesis and pathophysiology of airway disease in smokers that lead to chronic obstructive pulmonary disease (COPD) need to be reassessed as a whole and integrated into "mainstream" thinking along with traditional concepts which have stood the test of time. Such a refining of the accepted disease paradigm is urgently needed as thinking on therapeutic targets is currently under active reconsideration. We feel that generalised airway wall "inflammation" is unduly over-emphasised, and highlight the patchy and variable nature of the pathology (with the core being airway remodelling). In addition, we present evidence for airway wall disease in smokers/COPD as including a hypocellular, hypovascular, destructive, fibrotic pathology, with a likely spectrum of epithelial-mesenchymal transition states as significant drivers of this remodelling. Furthermore, we present data from a number of research modalities and integrate this with the aetiology of lung cancer, the role of chronic airway luminal colonisation/infection by a specific group of "respiratory" bacteria in smokers (which results in luminal inflammation) and the central role for oxidative stress on the epithelium. We suggest translation of these insights into more focus on asymptomatic smokers and early COPD, with the potential for fresh preventive and therapeutic approaches.
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Affiliation(s)
- E Haydn Walters
- School of Medicine and Menzies Institute, University of Tasmania, Hobart, Australia
| | - Shakti D Shukla
- Priority Research Centre for Healthy Lungs and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Malik Q Mahmood
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Chris Ward
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Medical School, Newcastle University, UK
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30
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Amaza IP, O'Shea AMJ, Fortis S, Comellas AP. Discordant Quantitative and Visual CT Assessments in the Diagnosis of Emphysema. Int J Chron Obstruct Pulmon Dis 2021; 16:1231-1242. [PMID: 33976544 PMCID: PMC8106452 DOI: 10.2147/copd.s284477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Visual assessment of computed tomography (CT) of the lung is routinely employed in the diagnosis of emphysema. Quantitative CT (QCT) can complement visual CT but must be well validated. QCT emphysema is defined as ≥5% of lung volume occupied by low attenuation areas ≤-950 Hounsfield units (LAA-950). Discordant visual and QCT assessments are not uncommon. We examined the association between visual and quantitative chest CT evaluation within a large cohort of subjects to identify variables that may explain discordant visual and QCT findings. Materials and Methods Volumetric inspiratory CT scans of 1221 subjects enrolled in phase 1 of the COPDGene study conducted at the University of Iowa were reviewed. Participants included never smokers, smokers with normal spirometry, preserved ratio impaired spirometry, and Global Initiative for Obstructive Lung Disease (GOLD) stages I-IV. CT scans were quantitatively scored and visually interpreted by both the COPDGene Imaging Center and the University of Iowa radiologists. Individual-level visual assessments were compared with QCT measurements. Agreement between the two sets of radiologists was calculated using kappa statistic. We assessed variables associated with discordant results using regression methods. Results There was a fair agreement for the presence or absence of emphysema between our center's radiologists and QCT (61% concordance, kappa 0.22 [0.17-0.28]). Similar comparisons showed a slight agreement between the COPDGene Imaging Center and QCT (56% concordance, kappa 0.16 [0.11-0.21]), and a moderate agreement between both sets of visual assessments (80% concordance, kappa 0.60 [0.54-0.65]). Current smoking and female gender were significantly associated with QCT-negative but visually detectable emphysema. Conclusion The slight-to-fair agreement between visual and quantitative CT assessment of emphysema highlights the need to utilize both modalities for a comprehensive radiologic evaluation. Discordant results may be attributable to one or more factors that warrant further exploration in larger studies. Clinical Trial Registration ClinicalTrials.gov Identifier NCT000608764.
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Affiliation(s)
- Iliya P Amaza
- University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, Iowa City, IA, USA
| | - Amy M J O'Shea
- University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Iowa City, IA, USA.,Iowa City VA Health Care System, Center for Access & Delivery Research and Evaluation, Iowa City, IA, USA
| | - Spyridon Fortis
- University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, Iowa City, IA, USA.,Iowa City VA Health Care System, Center for Access & Delivery Research and Evaluation, Iowa City, IA, USA
| | - Alejandro P Comellas
- University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, Iowa City, IA, USA
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31
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Pompe E, Moore CM, Mohamed Hoesein FA, de Jong PA, Charbonnier JP, Han MK, Humphries SM, Hatt CR, Galbán CJ, Silverman EK, Crapo JD, Washko GR, Regan EA, Make B, Strand M, Lammers JWJ, van Rikxoort EM, Lynch DA. Progression of Emphysema and Small Airways Disease in Cigarette Smokers. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:198-212. [PMID: 33290645 PMCID: PMC8237975 DOI: 10.15326/jcopdf.2020.0140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about factors associated with emphysema progression in cigarette smokers. We evaluated factors associated with change in emphysema and forced expiratory volume in 1 second (FEV1) in participants with and without chronic obstructive pulmonary disease (COPD). METHODS This retrospective study included individuals participating in the COPD Genetic Epidemiology study who completed the 5-year follow-up, including inspiratory and expiratory computed tomography (CT) and spirometry. All paired CT scans were analyzed using micro-mapping, which classifies individual voxels as emphysema or functional small airway disease (fSAD). Presence and progression of emphysema and FEV1 were determined based on comparison to nonsmoker values. Logistic regression analyses were used to identify clinical parameters associated with disease progression. RESULTS A total of 3088 participants were included with a mean ± SD age of 60.7±8.9 years, including 72 nonsmokers. In all Global initiative for chronic Obstructive Lung Disease (GOLD) stages, the presence of emphysema at baseline was associated with emphysema progression (odds ratio [OR]: GOLD 0: 4.32; preserved ratio-impaired spirometry [PRISm]; 5.73; GOLD 1: 5.16; GOLD 2: 5.69; GOLD 3/4: 5.55; all p ≤0.01). If there was no emphysema at baseline, the amount of fSAD at baseline was associated with emphysema progression (OR for 1% increase: GOLD 0: 1.06; PRISm: 1.20; GOLD 1: 1.7; GOLD 3/4: 1.08; all p ≤ 0.03).In 1735 participants without spirometric COPD, progression in emphysema occurred in 105 (6.1%) participants and only 21 (1.2%) had progression in both emphysema and FEV1. CONCLUSIONS The presence of emphysema is an important predictor of emphysema progression. In patients without emphysema, fSAD is associated with the development of emphysema. In participants without spirometric COPD, emphysema progression occurred independently of FEV1 decline.
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Affiliation(s)
- Esther Pompe
- Imaging Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Camille M. Moore
- Division of Biostatistics, Environment and Health, National Jewish Health, Denver, Colorado, United States
| | | | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jean-Paul Charbonnier
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Steven M. Humphries
- Department of Radiology, National Jewish Health, Denver, Colorado, United States
| | | | - Craig J. Galbán
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States
- Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan, United States
| | - Ed K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - James D. Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - George R. Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Elisabeth A. Regan
- Division of Rheumatology, Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Barry Make
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Matthew Strand
- Division of Biostatistics, Environment and Health, National Jewish Health, Denver, Colorado, United States
| | | | - Eva M. van Rikxoort
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, United States
| | - on behalf of the COPDGene® investigators
- Imaging Department, University Medical Center Utrecht, Utrecht, the Netherlands
- Division of Biostatistics, Environment and Health, National Jewish Health, Denver, Colorado, United States
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Michigan, United States
- Department of Radiology, National Jewish Health, Denver, Colorado, United States
- Imbio LLC, Minneapolis, Minnesota, United States
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States
- Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan, United States
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
- Division of Rheumatology, Department of Medicine, National Jewish Health, Denver, Colorado, United States
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32
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Hatt CR, Oh AS, Obuchowski NA, Charbonnier JP, Lynch DA, Humphries SM. Comparison of CT Lung Density Measurements between Standard Full-Dose and Reduced-Dose Protocols. Radiol Cardiothorac Imaging 2021; 3:e200503. [PMID: 33969308 DOI: 10.1148/ryct.2021200503] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the reproducibility and predicted clinical outcomes of CT-based quantitative lung density measurements using standard fixed-dose (FD) and reduced-dose (RD) scans. Materials and Methods In this retrospective analysis of prospectively acquired data, 1205 participants (mean age, 65 years ± 9 [standard deviation]; 618 men) enrolled in the COPDGene study who underwent FD and RD CT image acquisition protocols between November 2014 and July 2017 were included. Of these, the RD scans of 640 participants were also reconstructed using iterative reconstruction (IR). Median filtering was applied to the RD scans (RD-MF) to investigate an alternative noise reduction strategy. CT attenuation at the 15th percentile of the lung CT histogram (Perc15) was computed for all image types (FD, RD, RD-MF, and RD-IR). Reproducibility coefficients were calculated to quantify the measurement differences between FD and RD scans. The ability of Perc15 to predict chronic obstructive pulmonary disease (COPD) diagnosis and exacerbation frequency was investigated using receiver operating characteristic analysis. Results The Perc15 reproducibility coefficients with and without volume adjustment were as follows: RD, 29.43 HU ± 0.62 versus 32.81 HU ± 1.70; RD-MF, 7.42 HU ± 0.42 versus 19.40 HU ± 2.65; and RD-IR, 7.10 HU ± 0.52 versus 22.46 HU ± 3.91. Receiver operating characteristic curve analysis indicated that Perc15 on volume-adjusted FD and RD scans were both predictive for COPD diagnosis (area under the receiver operating characteristic curve [AUC]: FD, 0.724 ± 0.045; RD, 0.739 ± 0.045) and for having one or more exacerbation per year (AUCs: FD, 0.593 ± 0.068; RD, 0.589 ± 0.066). Similar trends were observed when volume adjustment was not applied. Conclusion A combination of volume adjustment and noise reduction filtering improved the reproducibility of lung density measurements computed using serial FD and RD CT scans.Supplemental material is available for this article.© RSNA, 2021.
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Affiliation(s)
- Charles R Hatt
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| | - Andrea S Oh
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| | - Nancy A Obuchowski
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| | - Jean-Paul Charbonnier
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| | - David A Lynch
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| | - Stephen M Humphries
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
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Tanabe N, Shimizu K, Terada K, Sato S, Suzuki M, Shima H, Oguma A, Oguma T, Konno S, Nishimura M, Hirai T. Central airway and peripheral lung structures in airway disease-dominant COPD. ERJ Open Res 2021; 7:00672-2020. [PMID: 33778061 PMCID: PMC7983277 DOI: 10.1183/23120541.00672-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/21/2020] [Indexed: 01/14/2023] Open
Abstract
The concept that the small airway is a primary pathological site for all COPD phenotypes has been challenged by recent findings that the disease starts from the central airways in COPD subgroups and that a smaller central airway tree increases COPD risk. This study aimed to examine whether the computed tomography (CT)-based airway disease-dominant (AD) subtype, defined using the central airway dimension, was less associated with small airway dysfunction (SAD) on CT, compared to the emphysema-dominant (ED) subtype. COPD patients were categorised into mild, AD, ED and mixed groups based on wall area per cent (WA%) of the segmental airways and low attenuation volume per cent in the Kyoto–Himeji (n=189) and Hokkaido COPD cohorts (n=93). The volume per cent of SAD regions (SAD%) was obtained by nonrigidly registering inspiratory and expiratory CT. The AD group had a lower SAD% than the ED group and similar SAD% to the mild group. The AD group had a smaller lumen size of airways proximal to the segmental airways and more frequent asthma history before age 40 years than the ED group. In multivariable analyses, while the AD and ED groups were similarly associated with greater airflow limitation, the ED, but not the AD, group was associated with greater SAD%, whereas the AD, but not the ED, group was associated with a smaller central airway size. The CT-based AD COPD subtype might be associated with a smaller central airway tree and asthma history, but not with peripheral lung pathologies including small airway disease, unlike the ED subtype. This study shows that airway disease-dominant COPD, defined using central airway dimension on CT, is associated with a smaller central airway tree, less small airway dysfunction and slower lung function decline than the emphysema-dominant COPDhttps://bit.ly/3nNwxIC
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Affiliation(s)
- Naoya Tanabe
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,These authors contributed equally
| | - Kaoruko Shimizu
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,These authors contributed equally
| | - Kunihiko Terada
- Terada Clinic, Respiratory Medicine and General Practice, Himeji, Japan
| | - Susumu Sato
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaru Suzuki
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Shima
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Oguma
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Tsuyoshi Oguma
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Konno
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaharu Nishimura
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Hokkaido Institute of Respiratory Diseases, Sapporo, Japan
| | - Toyohiro Hirai
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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34
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3D CNN with Visual Insights for Early Detection of Lung Cancer Using Gradient-Weighted Class Activation. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6695518. [PMID: 33777347 PMCID: PMC7979307 DOI: 10.1155/2021/6695518] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 11/17/2022]
Abstract
The 3D convolutional neural network is able to make use of the full nonlinear 3D context information of lung nodule detection from the DICOM (Digital Imaging and Communications in Medicine) images, and the Gradient Class Activation has shown to be useful for tailoring classification tasks and localization interpretation for fine-grained features and visual explanation for the internal working. Gradient-weighted class activation plays a crucial role for clinicians and radiologists in terms of trusting and adopting the model. Practitioners not only rely on a model that can provide high precision but also really want to gain the respect of radiologists. So, in this paper, we explored the lung nodule classification using the improvised 3D AlexNet with lightweight architecture. Our network employed the full nature of the multiview network strategy. We have conducted the binary classification (benign and malignant) on computed tomography (CT) images from the LUNA 16 database conglomerate and database image resource initiative. The results obtained are through the 10-fold cross-validation. Experimental results have shown that the proposed lightweight architecture achieved a superior classification accuracy of 97.17% on LUNA 16 dataset when compared with existing classification algorithms and low-dose CT scan images as well.
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35
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Han MK, Agusti A, Celli BR, Criner GJ, Halpin DMG, Roche N, Papi A, Stockley RA, Wedzicha J, Vogelmeier CF. From GOLD 0 to Pre-COPD. Am J Respir Crit Care Med 2021; 203:414-423. [PMID: 33211970 PMCID: PMC7885837 DOI: 10.1164/rccm.202008-3328pp] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute, Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain
| | - Bartolome R Celli
- Department of Medicine, Pulmonary, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - David M G Halpin
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, APHP.Centre-University of Paris, Cochin Institute (UMR1016), Paris, France
| | - Alberto Papi
- Respiratory Division, Department of Translational Medicine, School of Medicine, University of Ferrara, Ferrera, Italy
| | - Robert A Stockley
- Lung Investigation Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Jadwiga Wedzicha
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom; and
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, member of the German Center for Lung Research (DZL), Philipps-University, Marburg, Germany
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36
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Lange P, Ahmed E, Lahmar ZM, Martinez FJ, Bourdin A. Natural history and mechanisms of COPD. Respirology 2021; 26:298-321. [PMID: 33506971 DOI: 10.1111/resp.14007] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
The natural history of COPD is complex, and the disease is best understood as a syndrome resulting from numerous interacting factors throughout the life cycle with smoking being the strongest inciting feature. Unfortunately, diagnosis is often delayed with several longitudinal cohort studies shedding light on the long 'preclinical' period of COPD. It is now accepted that individuals presenting with different COPD phenotypes may experience varying natural history of their disease. This includes its inception, early stages and progression to established disease. Several scenarios regarding lung function course are possible, but it may conceptually be helpful to distinguish between individuals with normal maximally attained lung function in their early adulthood who thereafter experience faster than normal FEV1 decline, and those who may achieve a lower than normal maximally attained lung function. This may be the main mechanism behind COPD in the latter group, as the decline in FEV1 during their adult life may be normal or only slightly faster than normal. Regardless of the FEV1 trajectory, continuous smoking is strongly associated with disease progression, development of structural lung disease and poor prognosis. In developing countries, factors such as exposure to biomass and sequelae after tuberculosis may lead to a more airway-centred COPD phenotype than seen in smokers. Mechanistically, COPD is characterized by a combination of structural and inflammatory changes. It is unlikely that all patients share the same individual or combined mechanisms given the heterogeneity of resultant phenotypes. Lung explants, bronchial biopsies and other tissue studies have revealed important features. At the small airway level, progression of COPD is clinically imperceptible, and the pathological course of the disease is poorly described. Asthmatic features can further add confusion. However, the small airway epithelium is likely to represent a key focus of the disease, combining impaired subepithelial crosstalk and structural/inflammatory changes. Insufficient resolution of inflammatory processes may facilitate these changes. Pathologically, epithelial metaplasia, inversion of the goblet to ciliated cell ratio, enlargement of the submucosal glands and neutrophil and CD8-T-cell infiltration can be detected. Evidence of type 2 inflammation is gaining interest in the light of new therapeutic agents. Alarmin biology is a promising area that may permit control of inflammation and partial reversal of structural changes in COPD. Here, we review the latest work describing the development and progression of COPD with a focus on lung function trajectories, exacerbations and survival. We also review mechanisms focusing on epithelial changes associated with COPD and lack of resolution characterizing the underlying inflammatory processes.
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Affiliation(s)
- Peter Lange
- Department of Internal Medicine, Section of Respiratory Medicine, Copenhagen University Hospital - Herlev, Herlev, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Engi Ahmed
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France.,Department of Respiratory Diseases, University of Montpellier, CHU Montpellier, INSERM, Montpellier, France
| | - Zakaria Mohamed Lahmar
- Department of Respiratory Diseases, University of Montpellier, CHU Montpellier, INSERM, Montpellier, France
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Arnaud Bourdin
- Department of Respiratory Diseases, University of Montpellier, CHU Montpellier, INSERM, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
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37
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Ross BD, Chenevert TL, Meyer CR. Retrospective Registration in Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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38
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Dolliver WR, Diaz AA. Advances in Chronic Obstructive Pulmonary Disease Imaging. ACTA ACUST UNITED AC 2020; 6:128-143. [PMID: 33758787 DOI: 10.23866/brnrev:2019-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chest computed tomography (CT) imaging is a useful tool that provides in vivo information regarding lung structure. Imaging has contributed to a better understanding of COPD, allowing for the detection of early structural changes and the quantification of extra-pulmonary structures. Novel CT imaging techniques have provided insight into the progression of the main COPD subtypes, such as emphysema and small airway disease. This article serves as a review of new information relevant to COPD imaging. CT abnormalities, such as emphysema and loss of airways, are present even in smokers who do not meet the criteria for COPD and in those with mild-to-moderate disease. Subjects with mild-to-moderate COPD, with the highest loss of airways, also experience the highest decline in lung function. Extra-pulmonary manifestations of COPD, such as right ventricle enlargement and low muscle mass measured on CT, are associated with increased risk for all-cause mortality. CT longitudinal data has also given insight into the progression of COPD. Mechanically affected areas of lung parenchyma adjacent to emphysematous areas are associated with a greater decline in FEV1. Subjects with the greatest percentage of small airway disease, as measured on matched inspiratory-expiratory CT scan, also present with the greatest decline in lung function.
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Affiliation(s)
- Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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39
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Cheng GS, Selwa KE, Hatt C, Ram S, Fortuna AB, Guerriero M, Himelhoch B, McAree D, Hoffman TC, Brisson J, Nazareno R, Bloye K, Johnson TD, Remberger M, Mattsson J, Vummidi D, Kazerooni EE, Lama VN, Galban S, Boeckh M, Yanik GA, Galban CJ. Multicenter evaluation of parametric response mapping as an indicator of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Am J Transplant 2020; 20:2198-2205. [PMID: 32034974 PMCID: PMC7395854 DOI: 10.1111/ajt.15814] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 01/25/2023]
Abstract
Parametric response mapping (PRM) is a novel computed tomography (CT) technology that has shown potential for assessment of bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation (HCT). The primary aim of this study was to evaluate whether variations in image acquisition under real-world conditions affect the PRM measurements of clinically diagnosed BOS. CT scans were obtained retrospectively from 72 HCT recipients with BOS and graft-versus-host disease from Fred Hutchinson Cancer Research Center, Karolinska Institute, and the University of Michigan. Whole lung volumetric scans were performed at inspiration and expiration using site-specific acquisition and reconstruction protocols. PRM and pulmonary function measurements were assessed. Patients with moderately severe BOS at diagnosis (median forced expiratory volume at 1 second [FEV1] 53.5% predicted) had similar characteristics between sites. Variations in site-specific CT acquisition protocols had a negligible effect on the PRM-derived small airways disease (SAD), that is, BOS measurements. PRM-derived SAD was found to correlate with FEV1% predicted and FEV1/ forced vital capacity (R = -0.236, P = .046; and R = -0.689, P < .0001, respectively), which suggests that elevated levels in the PRM measurements are primarily affected by BOS airflow obstruction and not CT scan acquisition parameters. Based on these results, PRM may be applied broadly for post-HCT diagnosis and monitoring of BOS.
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Affiliation(s)
- Guang-Shing Cheng
- Clinical Research Division, Fred Hutchinson Cancer Research
Center, Seattle, Washington
| | | | | | - Sundaresh Ram
- Department of Radiology, Michigan Medicine, Ann Arbor,
Michigan
| | | | | | - Ben Himelhoch
- Michigan State University College of Human Medicine,
Lansing, Michigan
| | - Daniel McAree
- Pediatrics, University of Michigan, Ann Arbor,
Michigan
| | | | - Joseph Brisson
- Blood and Marrow Transplant Program, Michigan Medicine, Ann
Arbor, Michigan
| | - Ryan Nazareno
- Blood and Marrow Transplant Program, Michigan Medicine, Ann
Arbor, Michigan
| | - Kiernan Bloye
- Blood and Marrow Transplant Program, Michigan Medicine, Ann
Arbor, Michigan
| | - Timothy D. Johnson
- Department of Biostatistics, University of Michigan School
of Public Health, Ann Arbor, Michigan
| | - Mats Remberger
- Department of Oncology-Pathology, Karolinska University
Hospital, Stockholm, Sweden
| | - Jonas Mattsson
- Department of Oncology-Pathology, Karolinska University
Hospital, Stockholm, Sweden
| | | | | | - Vibha N. Lama
- Division of Pulmonary and Critical Care Medicine,
Michigan Medicine, Ann Arbor, Michigan
| | - Stefanie Galban
- Department of Radiology, Michigan Medicine, Ann Arbor,
Michigan
| | - Michael Boeckh
- Clinical Research Division, Fred Hutchinson Cancer Research
Center, Seattle, Washington
| | - Gregory A. Yanik
- Blood and Marrow Transplant Program, Michigan Medicine, Ann
Arbor, Michigan
| | - Craig J. Galban
- Department of Radiology, Michigan Medicine, Ann Arbor,
Michigan
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40
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Janssen R, Wouters EFM. Loss of Alveolar Attachments as a Pathomechanistic Link between Small Airway Disease and Emphysema. Am J Respir Crit Care Med 2020; 201:878-879. [PMID: 31804849 PMCID: PMC7124717 DOI: 10.1164/rccm.201910-1981le] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rob Janssen
- Canisius-Wilhelmina HospitalNijmegen, the Netherlandsand
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41
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Brandsma C, Van den Berge M, Hackett T, Brusselle G, Timens W. Recent advances in chronic obstructive pulmonary disease pathogenesis: from disease mechanisms to precision medicine. J Pathol 2020; 250:624-635. [PMID: 31691283 PMCID: PMC7216938 DOI: 10.1002/path.5364] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 12/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a devastating lung disease with a high personal and societal burden. Exposure to toxic particles and gases, including cigarette smoke, is the main risk factor for COPD. Together with smoking cessation, current treatment strategies of COPD aim to improve symptoms and prevent exacerbations, but there is no disease-modifying treatment. The biggest drawback of today's COPD treatment regimen is the 'one size fits all' pharmacological intervention, mainly based on disease severity and symptoms and not the individual's disease pathology. To halt the worrying increase in the burden of COPD, disease management needs to be advanced with a focus on personalized treatment. The main pathological feature of COPD includes a chronic and abnormal inflammatory response within the lungs, which results in airway and alveolar changes in the lung as reflected by (small) airways disease and emphysema. Here we discuss recent developments related to the abnormal inflammatory response, ECM and age-related changes, structural changes in the small airways and the role of sex-related differences, which are all relevant to explain the individual differences in the disease pathology of COPD and improve disease endotyping. Furthermore, we will discuss the most recent developments of new treatment strategies using biologicals to target specific pathological features or disease endotypes of COPD. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Corry‐Anke Brandsma
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical BiologyGroningenThe Netherlands
- University of Groningen, University Medical Center GroningenGroningen Research Institute for Asthma and COPD (GRIAC)GroningenThe Netherlands
| | - Maarten Van den Berge
- University of Groningen, University Medical Center GroningenGroningen Research Institute for Asthma and COPD (GRIAC)GroningenThe Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary DiseasesGroningenThe Netherlands
| | - Tillie‐Louise Hackett
- Centre for Heart Lung InnovationUnive rsity of British ColumbiaVancouverCanada
- Department of Anesthesiology, Pharmacology and TherapeuticsUniversity of British ColumbiaVancouverCanada
| | - Guy Brusselle
- Department of Respiratory MedicineGhent University HospitalGhentBelgium
- Department of Epidemiology and Respiratory MedicineErasmus Medical Center RotterdamRotterdamThe Netherlands
| | - Wim Timens
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical BiologyGroningenThe Netherlands
- University of Groningen, University Medical Center GroningenGroningen Research Institute for Asthma and COPD (GRIAC)GroningenThe Netherlands
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43
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Shima H, Tanabe N, Sato S, Oguma T, Kubo T, Kozawa S, Koizumi K, Watanabe A, Sato A, Togashi K, Hirai T. Lobar distribution of non-emphysematous gas trapping and lung hyperinflation in chronic obstructive pulmonary disease. Respir Investig 2020; 58:246-254. [PMID: 32085990 DOI: 10.1016/j.resinv.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/27/2019] [Accepted: 01/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lung hyperinflation in chronic obstructive pulmonary disease (COPD) is closely associated with emphysema and non-emphysematous gas trapping, termed functional small airway disease (fSAD), on inspiratory and expiratory computed tomography (CT). Because the cranial-caudal emphysema distribution affects pulmonary function and fSAD may precede emphysema on CT, we tested the hypothesis that lobar fSAD distribution would affect lung hyperinflation differently in COPD with minimal and established emphysema. METHODS The volume percentages of fSAD and emphysema (fSAD% and Emph%) over the upper and lower lobes were measured using inspiratory and expiratory CT in 70 subjects with COPD. Subjects were divided into those with minimal and established emphysema (n = 36 and 34) using a threshold of 10% Emph% in the whole lung. RESULTS In the minimal emphysema group, fSAD% in the upper and lower lobes was positively correlated with functional residual capacity (FRC) and residual volume to total lung capacity ratio (RV/TLC), and the correlation of fSAD% with RV/TLC was greater in the lower lobes. Conversely, in the established emphysema group, fSAD% in the upper and lower lobes was correlated with RV/TLC, but not with FRC. In multivariate analysis, fSAD% in the lower lobes, but not in the upper lobes, was associated with RV/TLC in subjects with minimal emphysema after adjusting for age, smoking status, and bronchodilator use. CONCLUSION Non-emphysematous gas trapping in the upper and lower lobes has a distinct physiological effect, especially in COPD with minimal emphysema. This local evaluation might allow sensitive detection of changes in lung hyperinflation in COPD.
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Affiliation(s)
- Hiroshi Shima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Satoshi Kozawa
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Koji Koizumi
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Aya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Atsuyasu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
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Pompe E, Strand M, van Rikxoort EM, Hoffman EA, Barr RG, Charbonnier JP, Humphries S, Han MK, Hokanson JE, Make BJ, Regan EA, Silverman EK, Crapo JD, Lynch DA. Five-year Progression of Emphysema and Air Trapping at CT in Smokers with and Those without Chronic Obstructive Pulmonary Disease: Results from the COPDGene Study. Radiology 2020; 295:218-226. [PMID: 32013794 DOI: 10.1148/radiol.2020191429] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background CT is used to quantify abnormal changes in the lung parenchyma of smokers that might overlap chronic obstructive pulmonary disease (COPD), but studies on the progression of expiratory air trapping in smokers are scarce. Purpose To evaluate the relationship between longitudinal changes in forced expiratory volume in 1 second (FEV1) and CT-quantified emphysema and air trapping in smokers. Materials and Methods Cigarette smokers with and those without COPD participating in the multicenter observational COPDGene study were evaluated. Subjects underwent inspiratory and expiratory chest CT and spirometry at baseline and 5-year follow-up. Emphysema was quantified by using adjusted lung density (ALD). Air trapping was quantified by using mean lung density at expiratory CT and CT-measured functional residual capacity-to-total lung volume ratio. Linear models were used to regress quantitative CT measurements taken 5 years apart, and models were fit with and without adding FEV1 as a predictor. Analyses were stratified by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage (GOLD 0, no COPD; GOLD 1, mild COPD; GOLD 2, moderate COPD; GOLD 3, severe COPD; GOLD 4, very severe COPD). Subjects with preserved FEV1-to-forced vital capacity ratio and reduced FEV1 percentage predicted were categorized as having preserved ratio impaired spirometry (PRISm). Results A total of 4211 subjects (503 with PRISm; 2034 with GOLD 0, 388 with GOLD 1, 816 with GOLD 2, 381 with GOLD 3, 89 with GOLD 4) were evaluated. ALD decreased by 1.7 g/L (95% confidence interval [CI]: -2.5, -0.9) in subjects with GOLD 0 at baseline and by 5.3 g/L (95% CI: -6.2, -4.4) in those with GOLD 1-4 (P < .001 for both). When adjusted for changes in FEV1, corresponding numbers were -2.2 (95% CI: -3.0, -1.3) and -4.6 g/L (95% CI: -5.6, -3.4) (P < .001 for both). Progression in air trapping was identified only in GOLD stage 2-4. Approximately 33%-50% of changes in air trapping in GOLD stages 2-4 were accounted for by changes in FEV1. Conclusion CT measures of emphysema and air trapping increased over 5 years in smokers. Forced expiratory volume in one second accounted for less than 10% of emphysema progression and less than 50% of air trapping progression detected at CT. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Esther Pompe
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Matthew Strand
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Eva M van Rikxoort
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Eric A Hoffman
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - R Graham Barr
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Jean Paul Charbonnier
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Stephen Humphries
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - MeiLan K Han
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - John E Hokanson
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Barry J Make
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Elizabeth A Regan
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Edwin K Silverman
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - James D Crapo
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - David A Lynch
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
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- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
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Quantitative CT detects progression in COPD patients with severe emphysema in a 3-month interval. Eur Radiol 2020; 30:2502-2512. [PMID: 31965260 DOI: 10.1007/s00330-019-06577-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/26/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) is characterized by variable contributions of emphysema and airway disease on computed tomography (CT), and still little is known on their temporal evolution. We hypothesized that quantitative CT (QCT) is able to detect short-time changes in a cohort of patients with very severe COPD. METHODS Two paired in- and expiratory CT each from 70 patients with avg. GOLD stage of 3.6 (mean age = 66 ± 7.5, mean FEV1/FVC = 35.28 ± 7.75) were taken 3 months apart and analyzed by fully automatic software computing emphysema (emphysema index (EI), mean lung density (MLD)), air-trapping (ratio expiration to inspiration of mean lung attenuation (E/I MLA), relative volume change between - 856 HU and - 950 HU (RVC856-950)), and parametric response mapping (PRM) parameters for each lobe separately and the whole lung. Airway metrics measured were wall thickness (WT) and lumen area (LA) for each airway generation and the whole lung. RESULTS The average of the emphysema parameters (EI, MLD) increased significantly by 1.5% (p < 0.001) for the whole lung, whereas air-trapping parameters (E/I MLA, RVC856-950) were stable. PRMEmph increased from 34.3 to 35.7% (p < 0.001), whereas PRMNormal decrased from 23.6% to 22.8% (p = 0.012). WT decreased significantly from 1.17 ± 0.18 to 1.14 ± 0.19 mm (p = 0.036) and LA increased significantly from 25.08 ± 4.49 to 25.84 ± 4.87 mm2 (p = 0.041) for the whole lung. The generation-based analysis showed heterogeneous results. CONCLUSION QCT detects short-time progression of emphysema in severe COPD. The changes were partly different among lung lobes and airway generations, indicating that QCT is useful to address the heterogeneity of COPD progression. KEY POINTS • QCT detects short-time progression of emphysema in severe COPD in a 3-month period. • QCT is able to quantify even slight parenchymal changes, which were not detected by spirometry. • QCT is able to address the heterogeneity of COPD, revealing inconsistent changes individual lung lobes and airway generations.
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Hadzic S, Wu CY, Avdeev S, Weissmann N, Schermuly RT, Kosanovic D. Lung epithelium damage in COPD - An unstoppable pathological event? Cell Signal 2020; 68:109540. [PMID: 31953012 DOI: 10.1016/j.cellsig.2020.109540] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/11/2020] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common term for alveolar septal wall destruction resulting in emphysema, and chronic bronchitis accompanied by conductive airway remodelling. In general, this disease is characterized by a disbalance of proteolytic/anti-proteolytic activity, augmented inflammatory response, increased oxidative/nitrosative stress, rise in number of apoptotic cells and decreased proliferation. As the first responder to the various environmental stimuli, epithelium occupies an important position in different lung pathologies, including COPD. Epithelium sequentially transitions from the upper airways in the direction of the gas exchange surface in the alveoli, and every cell type possesses a distinct role in the maintenance of the homeostasis. Basically, a thick ciliated structure of the airway epithelium has a major function in mucus secretion, whereas, alveolar epithelium which forms a thin barrier covered by surfactant has a function in gas exchange. Following this line, we will try to reveal whether or not the chronic bronchitis and emphysema, being two pathological phenotypes in COPD, could originate in two different types of epithelium. In addition, this review focuses on the role of lung epithelium in COPD pathology, and summarises underlying mechanisms and potential therapeutics.
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Affiliation(s)
- Stefan Hadzic
- Department of Internal Medicine, Cardio-Pulmonary Institute (CPI), German Center for Lung Research (DZL), Justus-Liebig University, Giessen, Germany
| | - Cheng-Yu Wu
- Department of Internal Medicine, Cardio-Pulmonary Institute (CPI), German Center for Lung Research (DZL), Justus-Liebig University, Giessen, Germany
| | - Sergey Avdeev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Norbert Weissmann
- Department of Internal Medicine, Cardio-Pulmonary Institute (CPI), German Center for Lung Research (DZL), Justus-Liebig University, Giessen, Germany
| | - Ralph Theo Schermuly
- Department of Internal Medicine, Cardio-Pulmonary Institute (CPI), German Center for Lung Research (DZL), Justus-Liebig University, Giessen, Germany
| | - Djuro Kosanovic
- Department of Internal Medicine, Cardio-Pulmonary Institute (CPI), German Center for Lung Research (DZL), Justus-Liebig University, Giessen, Germany; Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
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Tanabe N, Sato S, Muro S, Shima H, Oguma T, Tanimura K, Sato A, Hirai T. Regional lung deflation with increased airway volume underlies the functional response to bronchodilators in chronic obstructive pulmonary disease. Physiol Rep 2019; 7:e14330. [PMID: 31880096 PMCID: PMC6933023 DOI: 10.14814/phy2.14330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Bronchodilators, including long-acting muscarinic antagonists (LAMAs), improve airflow limitation and lung hyperinflation in patients with chronic obstructive pulmonary disease (COPD). While bronchodilators increase airway caliber and deflate the lungs, little is known about the effects of the local interaction between airway dilation and lung deflation on functional improvements resulting from bronchodilator therapy. This study aimed to explore whether lung deflation with increased airway volume in the upper and lower lung regions would produce different physiological responses to LAMA therapy. Using the clinical data of 41 patients with COPD who underwent spirometry and inspiratory computed tomography (CT) before and 1 year after LAMA treatment, we measured the 1-year change in the airway tree to lung volume percentage ratio (AWV%) for the right upper, middle, and lower lobes (RUL, RML, and RLL) and the left upper and lower lobes (LUL and LLL), and total airway count (TAC) identifiable on CT in relation to the forced expiratory volume in 1 s (FEV1 ). The results showed that LAMA treatment significantly increased the FEV1 and AWV% of the RUL, RML, RLL, LUL, and LLL. Increased AWV% in the RLL and LLL, but not in the RUL and LUL, was correlated with increased FEV1 . In the multivariate analysis, the increased AWV% in the RLL was associated with the increased FEV1 independent of the change in TAC in the RLL after treatment. This is the first study to show that the physiological improvements after bronchodilator treatment in COPD could be mainly due to the combination of regional deflation and increased airway volume of the lower lobes.
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Affiliation(s)
- Naoya Tanabe
- Department of Respiratory MedicineGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Susumu Sato
- Department of Respiratory MedicineGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Shigeo Muro
- Department of Respiratory MedicineGraduate School of MedicineKyoto UniversityKyotoJapan
- Department of Respiratory MedicineNara Medical UniversityNaraJapan
| | - Hiroshi Shima
- Department of Respiratory MedicineGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Tsuyoshi Oguma
- Department of Respiratory MedicineGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Kazuya Tanimura
- Department of Respiratory MedicineGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Atsuyasu Sato
- Department of Respiratory MedicineGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Toyohiro Hirai
- Department of Respiratory MedicineGraduate School of MedicineKyoto UniversityKyotoJapan
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48
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Arjomandi M, Zeng S, Barjaktarevic I, Barr RG, Bleecker ER, Bowler RP, Buhr RG, Criner GJ, Comellas AP, Cooper CB, Couper DJ, Curtis JL, Dransfield MT, Han MK, Hansel NN, Hoffman EA, Kaner RJ, Kanner RE, Krishnan JA, Paine R, Peters SP, Rennard SI, Woodruff PG. Radiographic lung volumes predict progression to COPD in smokers with preserved spirometry in SPIROMICS. Eur Respir J 2019; 54:13993003.02214-2018. [PMID: 31439683 DOI: 10.1183/13993003.02214-2018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 07/17/2019] [Indexed: 11/05/2022]
Abstract
The characteristics that predict progression to overt chronic obstructive pulmonary disease (COPD) in smokers without spirometric airflow obstruction are not clearly defined.We conducted a post hoc analysis of 849 current and former smokers (≥20 pack-years) with preserved spirometry from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) cohort who had baseline computed tomography (CT) scans of lungs and serial spirometry. We examined whether CT-derived lung volumes representing air trapping could predict adverse respiratory outcomes and more rapid decline in spirometry to overt COPD using mixed-effect linear modelling.Among these subjects with normal forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio, CT-measured residual volume (RVCT) to total lung capacity (TLCCT) ratio varied widely, from 21% to 59%. Over 2.5±0.7 years of follow-up, subjects with higher RVCT/TLCCT had a greater differential rate of decline in FEV1/FVC; those in the upper RVCT/TLCCT tertile had a 0.66% (95% CI 0.06%-1.27%) faster rate of decline per year compared with those in the lower tertile (p=0.015) regardless of demographics, baseline spirometry, respiratory symptoms score, smoking status (former versus current) or smoking burden (pack-years). Accordingly, subjects with higher RVCT/TLCCT were more likely to develop spirometric COPD (OR 5.7 (95% CI 2.4-13.2) in upper versus lower RVCT/TLCCT tertile; p<0.001). Other CT indices of air trapping showed similar patterns of association with lung function decline; however, when all CT indices of air trapping, emphysema, and airway disease were included in the same model, only RVCT/TLCCT retained its significance.Increased air trapping based on radiographic lung volumes predicts accelerated spirometry decline and progression to COPD in smokers without obstruction.
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Affiliation(s)
- Mehrdad Arjomandi
- San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA .,Dept of Medicine, University of California, San Francisco, CA, USA
| | - Siyang Zeng
- San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Dept of Medicine, University of California, San Francisco, CA, USA
| | - Igor Barjaktarevic
- Dept of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - R Graham Barr
- Columbia-Presbyterian Medical Center, New York, NY, USA
| | | | | | - Russell G Buhr
- Dept of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | | | | | - Christopher B Cooper
- Dept of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Dept of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Jeffrey L Curtis
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - MeiLan K Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Eric A Hoffman
- Dept of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Robert J Kaner
- Weill Cornell Weill Cornell Medical Center, New York, NY, USA
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49
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Aaron CP, Washko GR. Validation of Imaging Measures in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 200:524-525. [PMID: 30836008 PMCID: PMC6727160 DOI: 10.1164/rccm.201902-0395ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - George R. Washko
- Department of MedicineBrigham and Women’s HospitalBoston, Massachusetts
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50
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Vasilescu DM, Martinez FJ, Marchetti N, Galbán CJ, Hatt C, Meldrum CA, Dass C, Tanabe N, Reddy RM, Lagstein A, Ross BD, Labaki WW, Murray S, Meng X, Curtis JL, Hackett TL, Kazerooni EA, Criner GJ, Hogg JC, Han MK. Noninvasive Imaging Biomarker Identifies Small Airway Damage in Severe Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 200:575-581. [PMID: 30794432 PMCID: PMC6727153 DOI: 10.1164/rccm.201811-2083oc] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/21/2019] [Indexed: 02/02/2023] Open
Abstract
Rationale: Evidence suggests damage to small airways is a key pathologic lesion in chronic obstructive pulmonary disease (COPD). Computed tomography densitometry has been demonstrated to identify emphysema, but no such studies have been performed linking an imaging metric to small airway abnormality.Objectives: To correlate ex vivo parametric response mapping (PRM) analysis to in vivo lung tissue measurements of patients with severe COPD treated by lung transplantation and control subjects.Methods: Resected lungs were inflated, frozen, and systematically sampled, generating 33 COPD (n = 11 subjects) and 22 control tissue samples (n = 3 subjects) for micro-computed tomography analysis of terminal bronchioles (TBs; last generation of conducting airways) and emphysema.Measurements and Main Results: PRM analysis was conducted to differentiate functional small airways disease (PRMfSAD) from emphysema (PRMEmph). In COPD lungs, TB numbers were reduced (P = 0.01); surviving TBs had increased wall area percentage (P < 0.001), decreased circularity (P < 0.001), reduced cross-sectional luminal area (P < 0.001), and greater airway obstruction (P = 0.008). COPD lungs had increased airspace size (P < 0.001) and decreased alveolar surface area (P < 0.001). Regression analyses demonstrated unique correlations between PRMfSAD and TBs, with decreased circularity (P < 0.001), decreased luminal area (P < 0.001), and complete obstruction (P = 0.008). PRMEmph correlated with increased airspace size (P < 0.001), decreased alveolar surface area (P = 0.003), and fewer alveolar attachments per TB (P = 0.01).Conclusions: PRMfSAD identifies areas of lung tissue with TB loss, luminal narrowing, and obstruction. This is the first confirmation that an imaging biomarker can identify terminal bronchial pathology in established COPD and provides a noninvasive imaging methodology to identify small airway damage in COPD.
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Affiliation(s)
| | | | - Nathaniel Marchetti
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | - Charles Hatt
- University of Michigan, Ann Arbor, Michigan
- Imbio, Minneapolis, Minnesota
| | | | - Chandra Dass
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | - Xia Meng
- University of British Columbia, Vancouver, British Columbia, Canada
- Weill Cornell Medical College, New York, New York
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- University of Michigan, Ann Arbor, Michigan
- Imbio, Minneapolis, Minnesota
- Kyoto University, Kyoto, Japan; and
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Jeffrey L. Curtis
- University of Michigan, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | | | | | - Gerard J. Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - James C. Hogg
- University of British Columbia, Vancouver, British Columbia, Canada
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