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Ignatova GL, Blinova EV, Bel'sner MS. Lymphangioleiomyomatosis of the lungs: features of the clinical picture, diagnosis and treatment. Case report. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.3.201504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The article highlights the main issues of etiology, pathogenesis, clinical picture, diagnosis and treatment of patients with lymphangioleiomyomatosis. The clinical observation presents the features of the condition, the rate of progression, diagnostic approaches and management programs for a patient with a rare cystic lung pathology.
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Sirolimus Suppresses Phosphorylation of Cofilin and Reduces Interstitial Septal Thickness in Sporadic Lymphangioleiomyomatosis. Int J Mol Sci 2021; 22:ijms22168564. [PMID: 34445268 PMCID: PMC8395305 DOI: 10.3390/ijms22168564] [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: 06/23/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Sporadic lymphangioleiomyomatosis (S-LAM) is a rare lung disease characterized by the proliferation of smooth muscle-like LAM cells and progressive cystic destruction. Sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, has a proven efficacy in patients with LAM. However, the therapeutic mechanisms of sirolimus in LAM remain unclear. We aimed to evaluate sirolimus-related lung parenchymal changes and the potential effect in LAM cells and modulating pathological cystic destruction. Lung specimens were examined for histopathological changes by HMB45 staining and compared the LAM patients treated with and without sirolimus. We detected the overexpression of mTOR, HMB45, and phosphorylation of cofilin (p-cofilin) in LAM patients. Sirolimus showed efficacy in patients with LAM, who exhibited a reduced expression of mTOR and p-cofilin as well as reduced interstitial septal thickness. In addition, sirolimus suppresses mTOR and p-cofilin, thus suppressing the migration and proliferation of LAM cells isolated from the patient's lung tissue. This study demonstrates that interstitial septal thickness, as determined by histological structural analysis. Sirolimus effectively reduced the expression of p-cofilin and interstitial septal thickness, which may be a novel mechanism by sirolimus. Moreover, we develop a new method to isolate and culture the LAM cell, which can test the possibility of medication in vitro and impact this current study has on the LAM field. The development of approaches to interfere with mTOR-cofilin1-actin signaling may result in an option for S-LAM therapy.
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Ni Z, Ng TSC, Liu J, Huang S, Li X, Xu X, Chen H. Quantitative assessment of pulmonary function in lymphangioleiomyomatosis patients using high-resolution computed tomography and pulmonary function tests. J Thorac Dis 2020; 12:6466-6475. [PMID: 33282349 PMCID: PMC7711362 DOI: 10.21037/jtd-20-1104] [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] [Indexed: 11/13/2022]
Abstract
Background To explore the feasibility of using quantitative high-resolution computed tomography (HRCT) to evaluate pulmonary function in patients with pulmonary lymphangioleiomyomatosis (PLAM). Methods Pulmonary function tests (PFTs) were performed in 30 patients with pathologically confirmed PLAM with the use of HRCT. These results were correlated with quantitative HRCT in 21 patients. Results There were significant correlations between the HRCT parameters for lung function and PFT parameters. Among these parameters, emphysema volume (EV), pulmonary volume with a pixel index less than the trigger threshold (−950 HU) to account for a proportion of total lung volume [PI-950 (%)] and forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC (%)] had the strongest correlations, reaching values between −0.71 and −0.68. HRCT lung function might therefore also be helpful for predicting changes in lung function before and after treatment. Conclusions HRCT is helpful for the assessment of pulmonary function in PLAM patients and can assist in the clinical evaluation of lung function and treatment response in patients with this disease.
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Affiliation(s)
- Zhiwen Ni
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Thomas S C Ng
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jie Liu
- Department of Respiratory, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Suidan Huang
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoling Li
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoyin Xu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Huai Chen
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Chen A, Karwoski RA, Gierada DS, Bartholmai BJ, Koo CW. Quantitative CT Analysis of Diffuse Lung Disease. Radiographics 2019; 40:28-43. [PMID: 31782933 DOI: 10.1148/rg.2020190099] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Quantitative analysis of thin-section CT of the chest has a growing role in the clinical evaluation and management of diffuse lung diseases. This heterogeneous group includes diseases with markedly different prognoses and treatment options. Quantitative tools can assist in both accurate diagnosis and longitudinal management by improving characterization and quantification of disease and increasing the reproducibility of disease severity assessment. Furthermore, a quantitative index of disease severity may serve as a useful tool or surrogate endpoint in evaluating treatment efficacy. The authors explore the role of quantitative imaging tools in the evaluation and management of diffuse lung diseases. Lung parenchymal features can be classified with threshold, histogram, morphologic, and texture-analysis-based methods. Quantitative CT analysis has been applied in obstructive, infiltrative, and restrictive pulmonary diseases including emphysema, cystic fibrosis, asthma, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, connective tissue-related interstitial lung disease, and combined pulmonary fibrosis and emphysema. Some challenges limiting the development and practical application of current quantitative analysis tools include the quality of training data, lack of standard criteria to validate the accuracy of the results, and lack of real-world assessments of the impact on outcomes. Artifacts such as patient motion or metallic beam hardening, variation in inspiratory effort, differences in image acquisition and reconstruction techniques, or inaccurate preprocessing steps such as segmentation of anatomic structures may lead to inaccurate classification. Despite these challenges, as new techniques emerge, quantitative analysis is developing into a viable tool to supplement the traditional visual assessment of diffuse lung diseases and to provide decision support regarding diagnosis, prognosis, and longitudinal evaluation of disease. ©RSNA, 2019.
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Affiliation(s)
- Alicia Chen
- From the Department of Radiology (A.C., B.J.B., C.W.K.) and Biomedical Medicine Imaging Resource (R.A.K.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.S.G.)
| | - Ronald A Karwoski
- From the Department of Radiology (A.C., B.J.B., C.W.K.) and Biomedical Medicine Imaging Resource (R.A.K.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.S.G.)
| | - David S Gierada
- From the Department of Radiology (A.C., B.J.B., C.W.K.) and Biomedical Medicine Imaging Resource (R.A.K.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.S.G.)
| | - Brian J Bartholmai
- From the Department of Radiology (A.C., B.J.B., C.W.K.) and Biomedical Medicine Imaging Resource (R.A.K.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.S.G.)
| | - Chi Wan Koo
- From the Department of Radiology (A.C., B.J.B., C.W.K.) and Biomedical Medicine Imaging Resource (R.A.K.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.S.G.)
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Role of thoracic imaging in the management of lymphangioleiomyomatosis. Respir Med 2019; 157:14-20. [PMID: 31470185 DOI: 10.1016/j.rmed.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare diffuse lung cystic disease (DLCD) that occurs sporadically or in association with Tuberous Sclerosis Complex (TSC). The diagnostic pathway is tracked on the identification of the disease hallmarks on chest High-Resolution Computed Tomography (HRCT). Aim of this review is to discuss the thoracic HRCT pathognomonic features, essential to rule out other DLCD. It also examines the new evidences emerging from Computed Tomography (CT) quantitative studies that, by demonstrating a specific cysts distribution and a pathological aspect of the parenchyma near the cysts, could improve our understanding of this rare disorder and supply pulmonologists with a new tool for a more appropriate long-term management. Finally, the contribution of other image techniques as low dose chest CT, Magnetic Resonance Imaging (MRI) and Ultrasound (US) is discussed.
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Hong H, Yang R, Li X, Wang M, Ma Z. Pulmonary lymphangioleimyomatosis and systemic lupus erythematosus in a menopausal woman. BMC Nephrol 2018; 19:90. [PMID: 29669532 PMCID: PMC5907197 DOI: 10.1186/s12882-018-0889-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary lymphangioleimyomatosis (PLAM) is a rare disease involving lung. PLAM primarily affects young women, a characteristic it shares with systemic lupus erythematosus (SLE). Estrogen has long been assumed to play an important role both in PLAM and SLE. We report a menopausal woman, who was found to have PLAM 1 year after she was diagnosed with SLE. Her chest radiograph was normal in the early phase of SLE. Case presentation A 52-year-old Chinese woman was referred to our hospital in August 2014 because of swelling in both legs. She also reported a malar rash and intermittent generalized arthralgia. Laboratory examination showed leukopenia. Her serum albumin level was 23 g/L; 24-h urinary protein excretion was 5.3 g. She tested positive for anti-Smith (Sm) antibody and anti-SS-A antibody. Renal biopsy indicated Class V + IV(G)-A lupus nephritis (LN). The condition of SLE and LN improved on a regime of tapering prednisolone and intermittent intravenous cyclophosphamide therapy until 1 year later when she developed exertional dyspnea accompanied with frequent cough. Thoracic computed tomography revealed numerous well-defined cysts and the diagnosis of PLAM was confirmed by lung biopsy. In the follow-up period, the patient continued to be on prednisolone and mycophenolate mofetil for the treatment of SLE, but only agreed to receive symptomatic treatment for PLAM. One year after the diagnosis of PLAM, during which time the SLE was stable, she died of respiratory failure and cor pulmonale. Conclusion We report a patient with coexisting SLE and PLAM, who was treated with immunosuppressive therapy. SLE was stable but PLAM was not improved. Although the coexistence of SLE and PLAM might be a coincidence, the occurrence of these two diseases in a menopausal woman may warrant further mechanistic exploration.
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Affiliation(s)
- Hong Hong
- Department of Nephrology, Liao Cheng People's Hospital, No. 67 West Dongchang Road, Dongchang District, Liaocheng, Shandong Province, People's Republic of China
| | - Ruiheng Yang
- Department of Nephrology, Liao Cheng People's Hospital, No. 67 West Dongchang Road, Dongchang District, Liaocheng, Shandong Province, People's Republic of China.
| | - Xiuzhen Li
- Department of Nephrology, Liao Cheng People's Hospital, No. 67 West Dongchang Road, Dongchang District, Liaocheng, Shandong Province, People's Republic of China
| | - Mengjun Wang
- Department of Nephrology, Liao Cheng People's Hospital, No. 67 West Dongchang Road, Dongchang District, Liaocheng, Shandong Province, People's Republic of China
| | - Zhongchao Ma
- Department of Nephrology, Liao Cheng People's Hospital, No. 67 West Dongchang Road, Dongchang District, Liaocheng, Shandong Province, People's Republic of China
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Ando K, Okada Y, Akiba M, Kondo T, Kawamura T, Okumura M, Chen F, Date H, Shiraishi T, Iwasaki A, Yamasaki N, Nagayasu T, Chida M, Inoue Y, Hirai T, Seyama K, Mishima M. Lung Transplantation for Lymphangioleiomyomatosis in Japan. PLoS One 2016; 11:e0146749. [PMID: 26771878 PMCID: PMC4714890 DOI: 10.1371/journal.pone.0146749] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/20/2015] [Indexed: 11/18/2022] Open
Abstract
Background Lung transplantation has been established as the definitive treatment option for patients with advanced lymphangioleiomyomatosis (LAM). However, the prognosis after registration and the circumstances of lung transplantation with sirolimus therapy have never been reported. Methods In this national survey, we analyzed data from 98 LAM patients registered for lung transplantation in the Japan Organ Transplantation Network. Results Transplantation was performed in 57 patients as of March 2014. Survival rate was 86.7% at 1 year, 82.5% at 3 years, 73.7% at 5 years, and 73.7% at 10 years. Of the 98 patients, 21 had an inactive status and received sirolimus more frequently than those with an active history (67% vs. 5%, p<0.001). Nine of twelve patients who remained inactive as of March 2014 initiated sirolimus before or while on a waiting list, and remained on sirolimus thereafter. Although the statistical analysis showed no statistically significant difference, the survival rate after registration tended to be better for lung transplant recipients than for those who awaited transplantation (p = 0.053). Conclusions Lung transplantation is a satisfactory therapeutic option for advanced LAM, but the circumstances for pre-transplantation LAM patients are likely to alter with the use of sirolimus.
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Affiliation(s)
- Katsutoshi Ando
- Division of Respiratory Medicine, Juntendo University, Faculty of Medicine and Graduate School of Medicine; 2-1-1 Hongo; Bunkyo-Ku; Tokyo, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University; Seiryo-machi 4-1, Aoba-ku Sendai, Miyagi, Japan
| | - Miki Akiba
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University; Seiryo-machi 4-1, Aoba-ku Sendai, Miyagi, Japan
| | - Takashi Kondo
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University; Seiryo-machi 4-1, Aoba-ku Sendai, Miyagi, Japan
| | - Tomohiro Kawamura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine; 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine; 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Fengshi Chen
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Takeshi Shiraishi
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University School of Medicine; 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, Japan
| | - Akinori Iwasaki
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University School of Medicine; 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, Japan
| | - Naoya Yamasaki
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences; 1-7-1 Sakamoto, Nagasaki, Japan
| | - Takeshi Nagayasu
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences; 1-7-1 Sakamoto, Nagasaki, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University; 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center; 1180, Nagasonecho, Kita-Ku, Sakai, Osaka, Japan.,Respiratory Failure Research Group from the Ministry of Health, Labour and Welfare, Japan, (Office) Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan.,Respiratory Failure Research Group from the Ministry of Health, Labour and Welfare, Japan, (Office) Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Kuniaki Seyama
- Division of Respiratory Medicine, Juntendo University, Faculty of Medicine and Graduate School of Medicine; 2-1-1 Hongo; Bunkyo-Ku; Tokyo, Japan.,Respiratory Failure Research Group from the Ministry of Health, Labour and Welfare, Japan, (Office) Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan.,Respiratory Failure Research Group from the Ministry of Health, Labour and Welfare, Japan, (Office) Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University; Kawahara 54, Shogoin, Sakyo-ku, Kyoto, Japan
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Potential Role of CT Metrics in Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension. Lung 2015; 193:911-8. [PMID: 26453478 DOI: 10.1007/s00408-015-9813-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Recent imaging studies demonstrated the usefulness of quantitative computed tomographic (CT) analysis assessing pulmonary hypertension (PH) in patients with chronic obstructive lung disease (COPD-PH). The aim of this study was to investigate whether it would be also valuable for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD-PH. METHODS We analyzed a correlation between the extent of cystic destruction (LAA%) and total cross-sectional areas of small pulmonary vessels less than 5 mm(2) (%CSA <5) in many CT slices from each of four COPD-PH patients before and after the initiation of pulmonary vasodilator. To evaluate those generalized data from patients with COPD, we evaluated multiple slices from 42 patients whose PH was not clinically suspicious. We also selected five PH patients with idiopathic interstitial pneumonia (IIP-PH) and analyzed serial changes of pulmonary artery enlargement (PA:A ratio). RESULTS In 42 COPD patients without PH, LAA% had a statistically significant negative correlation with %CSA <5. However, three of four COPD-PH patients manifested no such correlation. In two patients, clinical findings were dramatically improved after the initiation of pulmonary vasodilator. Notably, LAA% and %CSA <5 in those patients correlated significantly after its treatment. In COPD-PH, the PA:A ratio was significantly decreased after the initiation of pulmonary vasodilator therapy (1.25 ± 0.13 vs. 1.13 ± 0.11, p = 0.019), but not in IIP-PH. CONCLUSIONS Our study demonstrates that the use of quantitative CT analysis is a plausible and beneficial tool for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD-PH.
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Matsuoka S, Yamashiro T, Matsushita S, Kotoku A, Fujikawa A, Yagihashi K, Tomita H, Sakamoto S, Saito Y, Saruya S, Nakajima Y. Usefulness of coronal reconstruction CT images for quantitative evaluation of the cross-sectional area of small pulmonary vessels. Acad Radiol 2014; 21:1411-5. [PMID: 25088831 DOI: 10.1016/j.acra.2014.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 04/20/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES Cross-sectional area <5 mm(2) (CSA<5) is a computed tomography (CT) metric that has been used for the evaluation of pulmonary vessel alterations and perfusion. CSA<5 is calculated from three axial slices; thus, whether CSA<5 represents the small pulmonary vessel alterations in the whole lung remains unclear. The purpose of this study was to compare the measurements of CSA<5 using three axial slices and coronal reconstructed slices in the relationship between the measured CSA<5 and pulmonary perfusion measured using lung perfusion scintigraphy. MATERIALS AND METHODS This study comprised 28 subjects who underwent both noncontrast CT and lung perfusion scintigraphy. The present study measured CSA<5 using both three axial CT images and coronal reconstruction images and then obtained the percentage of the CSA in right lung to that in whole lung (R/W-CSA<5). Using anteroposterior and posteroanterior projections on technetium-99m macroaggregated albumin (MAA) lung perfusion scintigraphy, we obtained right and total lung counts and calculated the percentage of the right to whole lung counts (R/W-MAA). The correlations of the R/W-CSA<5 calculated using three axial slices (R/W-CSA(A)x<5) and coronal reconstructed slices (R/W-CSA(COR)<5) with R/W-MAA were evaluated using Spearman rank correlation analysis. RESULTS Both R/W-CSA(Ax)<5 and R/W-CSA(COR)<5 were significantly correlated with R/W-MAA; however, the correlation coefficient with R/W-CSA(COR)<5 (ρ = 0.842, P < .0001) was greater than that with R/W-CSA(Ax)<5 (ρ = 0.631, P = .0004). CONCLUSIONS Coronal reconstruction images appear suitable for quantitative measurement of CSA of small pulmonary vessels.
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Affiliation(s)
- Matthew Gillott
- Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC
| | - Brian Flemming
- Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC
| | - James G Ravenel
- Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC.
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Ando K, Sekiya M, Tobino K, Takahashi K. Relationship between quantitative CT metrics and pulmonary function in combined pulmonary fibrosis and emphysema. Lung 2013; 191:585-91. [PMID: 24085320 DOI: 10.1007/s00408-013-9513-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/13/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Combined pulmonary fibrosis and emphysema (CPFE) is increasingly recognized, as current reports of its clinical features show. To determine CPFE's physiologic and radiologic features, we conducted quantitative assessment of computed tomography scans to compare with those of chronic obstructive pulmonary disease (COPD). METHODS In 23 patients with CPFE and 42 patients with COPD, we measured the extent of emphysema (LAA %), parenchymal density, and total cross-sectional areas of pulmonary vessels smaller than 5 mm(2) (%CSA <5) and 5-10 mm(2) (%CSA 5-10). RESULTS For CPFE, airflow was better, but diffusing capacity for carbon monoxide (DLCO) was worse than for COPD, whereas LAA % was similar for both groups. The %CSA <5 was greater but %CSA5-10 was less in CPFE than COPD. COPD involved a negative correlation between DLCO and LAA % at all lung sites; those factors correlated for CPFE only in the upper lobe (r = -0.535). In contrast, CPFE had a negative correlation between DLCO and parenchymal density in lower lobes (r = -0.453), but COPD showed no correlation in any such sections. In CPFE, no correlation was apparent between LAA in upper lobes and parenchymal density in lower lobes. The annual rate of FVC decline (-169.26 ml/year) in CPFE patients correlated with parenchymal density (r = -0.714). CONCLUSIONS In CPFE, fibrosis and emphysema apparently existed independently, but both correlate with and likely contribute to the disproportionate reduction in gas exchange. Our study also suggested that pulmonary fibrotic changes may be more important contributors than emphysema for disease progression.
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Affiliation(s)
- Katsutoshi Ando
- Division of Respiratory Medicine, Department of Internal Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan,
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Mavroudi M, Zarogoulidis P, Katsikogiannis N, Tsakiridis K, Huang H, Sakkas A, Kallianos A, Rapti A, Sarika E, Karapantzos I, Zarogoulidis K. Lymphangioleiomyomatosis: current and future. J Thorac Dis 2013; 5:74-9. [PMID: 23372952 DOI: 10.3978/j.issn.2072-1439.2013.01.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 01/08/2013] [Indexed: 01/30/2023]
Abstract
Lymphangioleiomyomatosis is a rare slowly progressive lung disease that affects almost exclusively young women of reproductive age. It occurs sporadically or in association with Tuberous Sclerosis Complex. LAM is characterized by cystic remodeling of the lung parenchyma, due to proliferation of abnormal smooth muscle-like LAM cells and presence of extra pulmonary manifestations such as lymphadenopathy, angiomyolipomas and abdominal lymphangioleiomyomas. The most common clinical manifestations are progressive dyspnea on exertion, pneumothorax and chylous effusions. Currently there is no curative treatment for the disease, but the ongoing study of the genetic and molecular pathways implicated in the pathogenesis of the disease could lead to targeted therapy.
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Affiliation(s)
- Maria Mavroudi
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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