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Zhang D, Guan Y, Zhou X, Zhang M, Pu Y, Gu P, Xia Y, Lu Y, Chen J, Tu W, Huang K, Hou J, Yang H, Fu C, Fang Q, He C, Liu S, Fan L. Aerodynamic Simulation of Small Airway Resistance: A New Imaging Biomarker for Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:1167-1175. [PMID: 38826698 PMCID: PMC11141759 DOI: 10.2147/copd.s456878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024] Open
Abstract
Purpose To develop a novel method for calculating small airway resistance using computational fluid dynamics (CFD) based on CT data and evaluate its value to identify COPD. Patients and Methods 24 subjects who underwent chest CT scans and pulmonary function tests between August 2020 and December 2020 were enrolled retrospectively. Subjects were divided into three groups: normal (10), high-risk (6), and COPD (8). The airway from the trachea down to the sixth generation of bronchioles was reconstructed by a 3D slicer. The small airway resistance (RSA) and RSA as a percentage of total airway resistance (RSA%) were calculated by CFD combined with airway resistance and FEV1 measured by pulmonary function test. A correlation analysis was conducted between RSA and pulmonary function parameters, including FEV1/FVC, FEV1% predicted, MEF50% predicted, MEF75% predicted and MMEF75/25% predicted. Results The RSA and RSA% were significantly different among the three groups (p<0.05) and related to FEV1/FVC (r = -0.70, p < 0.001; r = -0.67, p < 0.001), FEV1% predicted (r = -0.60, p = 0.002; r = -0.57, p = 0.004), MEF50% predicted (r = -0.64, p = 0.001; r = -0.64, p = 0.001), MEF75% predicted (r = -0.71, p < 0.001; r = -0.60, p = 0.002) and MMEF 75/25% predicted (r = -0.64, p = 0.001; r = -0.64, p = 0.001). Conclusion Airway CFD is a valuable method for estimating the small airway resistance, where the derived RSA will aid in the early diagnosis of COPD.
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Affiliation(s)
- Di Zhang
- Department of Radiology, Second Affiliated Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Yu Guan
- Department of Radiology, Second Affiliated Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Xiuxiu Zhou
- Department of Radiology, Second Affiliated Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Mingzi Zhang
- Scientific Research Department, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Yu Pu
- Department of Radiology, Second Affiliated Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Pengchen Gu
- Scientific Research Department, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Yi Xia
- Department of Radiology, Second Affiliated Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Yang Lu
- Scientific Research Department, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Jia Chen
- Scientific Research Department, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Wenting Tu
- Department of Radiology, Second Affiliated Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Kunyao Huang
- Scientific Research Department, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Jixin Hou
- Scientific Research Department, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Hua Yang
- Scientific Research Department, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Chicheng Fu
- Scientific Research Department, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Qu Fang
- Scientific Research Department, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Chuan He
- Scientific Research Department, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Shiyuan Liu
- Department of Radiology, Second Affiliated Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Li Fan
- Department of Radiology, Second Affiliated Hospital, Naval Medical University, Shanghai, People’s Republic of China
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2
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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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Saha PK, Nadeem SA, Comellas AP. A Survey on Artificial Intelligence in Pulmonary Imaging. WILEY INTERDISCIPLINARY REVIEWS. DATA MINING AND KNOWLEDGE DISCOVERY 2023; 13:e1510. [PMID: 38249785 PMCID: PMC10796150 DOI: 10.1002/widm.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/21/2023] [Indexed: 01/23/2024]
Abstract
Over the last decade, deep learning (DL) has contributed a paradigm shift in computer vision and image recognition creating widespread opportunities of using artificial intelligence in research as well as industrial applications. DL has been extensively studied in medical imaging applications, including those related to pulmonary diseases. Chronic obstructive pulmonary disease, asthma, lung cancer, pneumonia, and, more recently, COVID-19 are common lung diseases affecting nearly 7.4% of world population. Pulmonary imaging has been widely investigated toward improving our understanding of disease etiologies and early diagnosis and assessment of disease progression and clinical outcomes. DL has been broadly applied to solve various pulmonary image processing challenges including classification, recognition, registration, and segmentation. This paper presents a survey of pulmonary diseases, roles of imaging in translational and clinical pulmonary research, and applications of different DL architectures and methods in pulmonary imaging with emphasis on DL-based segmentation of major pulmonary anatomies such as lung volumes, lung lobes, pulmonary vessels, and airways as well as thoracic musculoskeletal anatomies related to pulmonary diseases.
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Affiliation(s)
- Punam K Saha
- Departments of Radiology and Electrical and Computer Engineering, University of Iowa, Iowa City, IA, 52242
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4
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Kirby M, Smith BM. Quantitative CT Scan Imaging of the Airways for Diagnosis and Management of Lung Disease. Chest 2023; 164:1150-1158. [PMID: 36871841 PMCID: PMC10792293 DOI: 10.1016/j.chest.2023.02.044] [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: 11/16/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
CT scan imaging provides high-resolution images of the lungs in patients with chronic respiratory diseases. Extensive research over the last several decades has focused on developing novel quantitative CT scan airway measurements that reflect abnormal airway structure. Despite many observational studies demonstrating that associations between CT scan airway measurements and clinically important outcomes such as morbidity, mortality, and lung function decline, few quantitative CT scan measurements are applied in clinical practice. This article provides an overview of the relevant methodologic considerations for implementing quantitative CT scan airway analyses and provides a review of the scientific literature involving quantitative CT scan airway measurements used in clinical or randomized trials and observational studies of humans. We also discuss emerging evidence for the clinical usefulness of quantitative CT scan imaging of the airways and discuss what is required to bridge the gap between research and clinical application. CT scan airway measurements continue to improve our understanding of disease pathophysiologic features, diagnosis, and outcomes. However, a literature review revealed a need for studies evaluating clinical benefit when quantitative CT scan imaging is applied in the clinical setting. Technical standards for quantitative CT scan imaging of the airways and high-quality evidence of clinical benefit from management guided by quantitative CT scan imaging of the airways are required.
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Affiliation(s)
- Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada; iBEST, St. Michael's Hospital, Toronto, ON, Canada.
| | - Benjamin M Smith
- Department of Medicine, McGill University, Montreal, QC, Canada; Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
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Fang H, Liu Y, Yang Q, Han S, Zhang H. Prognostic Biomarkers Based on Proteomic Technology in COPD: A Recent Review. Int J Chron Obstruct Pulmon Dis 2023; 18:1353-1365. [PMID: 37408604 PMCID: PMC10319291 DOI: 10.2147/copd.s410387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common heterogeneous respiratory disease which is characterized by persistent and incompletely reversible airflow limitation. Due to the heterogeneity and phenotypic complexity of COPD, traditional diagnostic methods provide limited information and pose a great challenge to clinical management. In recent years, with the development of omics technologies, proteomics, metabolomics, transcriptomics, etc., have been widely used in the study of COPD, providing great help to discover new biomarkers and elucidate the complex mechanisms of COPD. In this review, we summarize the prognostic biomarkers of COPD based on proteomic studies in recent years and evaluate their association with COPD prognosis. Finally, we present the prospects and challenges of COPD prognostic-related studies. This review is expected to provide cutting-edge evidence in prognostic evaluation of clinical patients with COPD and to inform future proteomic studies on prognostic biomarkers of COPD.
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Affiliation(s)
- Hanyu Fang
- Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Ying Liu
- The Second Health and Medical Department, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China
| | - Qiwen Yang
- Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Siyu Han
- Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Hongchun Zhang
- Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
- The Second Health and Medical Department, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China
- Department of Traditional Chinese Medicine for Pulmonary Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China
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6
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Abozid H, Kirby M, Nasir N, Hartl S, Breyer-Kohansal R, Breyer MK, Burghuber OC, Bourbeau J, Wouters EFM, Tan W. CT airway remodelling and chronic cough. BMJ Open Respir Res 2023; 10:10/1/e001462. [PMID: 37173074 DOI: 10.1136/bmjresp-2022-001462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
RATIONALE Structural airway changes related to chronic cough (CC) are described in the literature, but so far reported data are rare and non-conclusive. Furthermore, they derive mainly from cohorts with small sample sizes. Advanced CT imaging not only allows airway abnormalities to be quantified, but also to count the number of visible airways. The current study evaluates these airway abnormalities in CC and assesses the contribution of CC in addition to CT findings on the progression of airflow limitation, defined as a decline in forced expiratory volume in 1 s (FEV1) over time. METHODS A total of 1183 males and females aged ≥40 years with thoracic CT scans and valid spirometry from Canadian Obstructive Lung Disease, a Canadian multicentre, population-based study has been included in this analysis. Participants were stratified into 286 never-smokers, 297 ever-smokers with normal lung function and 600 with chronic obstructive pulmonary disease (COPD) of different severity grades. Imaging parameters analyses included total airway count (TAC), airway wall thickness, emphysema as well as parameters for functional small airway disease quantification. RESULTS Irrespective of COPD presence, CC was not related to specific airway and lung structure features. Independent of TAC and emphysema score, CC was highly associated with FEV1 decline over time in the entire study population, particularly in ever-smokers (p<0.0001). CONCLUSION The absence of specific structural CT features independently from COPD presence indicate that other underlying mechanisms are contributing to the symptomatology of CC. On top of derived CT parameters, CC seems to be independently associated with FEV1 decline. TRIAL REGISTRATION NUMBER NCT00920348.
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Affiliation(s)
- Hazim Abozid
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST), Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Neha Nasir
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Otto C Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty for Medicine, Sigmund Freud University, Vienna, Austria
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University, Montreal, Québec, Canada
| | - Emiel F M Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wan Tan
- Centre for Heart Lung Innovation, University of British Columbia, St Pauls's Hospital, Vancouver, British Columbia, Canada
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7
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Papazoglou AS, Karagiannidis E, Liatsos A, Bompoti A, Moysidis DV, Arvanitidis C, Tsolaki F, Tsagkaropoulos S, Theocharis S, Tagarakis G, Michaelson JS, Herrmann MD. Volumetric Tissue Imaging of Surgical Tissue Specimens Using Micro-Computed Tomography: An Emerging Digital Pathology Modality for Nondestructive, Slide-Free Microscopy-Clinical Applications of Digital Pathology in 3 Dimensions. Am J Clin Pathol 2023; 159:242-254. [PMID: 36478204 DOI: 10.1093/ajcp/aqac143] [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: 08/16/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Micro-computed tomography (micro-CT) is a novel, nondestructive, slide-free digital imaging modality that enables the acquisition of high-resolution, volumetric images of intact surgical tissue specimens. The aim of this systematic mapping review is to provide a comprehensive overview of the available literature on clinical applications of micro-CT tissue imaging and to assess its relevance and readiness for pathology practice. METHODS A computerized literature search was performed in the PubMed, Scopus, Web of Science, and CENTRAL databases. To gain insight into regulatory and financial considerations for performing and examining micro-CT imaging procedures in a clinical setting, additional searches were performed in medical device databases. RESULTS Our search identified 141 scientific articles published between 2000 and 2021 that described clinical applications of micro-CT tissue imaging. The number of relevant publications is progressively increasing, with the specialties of pulmonology, cardiology, otolaryngology, and oncology being most commonly concerned. The included studies were mostly performed in pathology departments. Current micro-CT devices have already been cleared for clinical use, and a Current Procedural Terminology (CPT) code exists for reimbursement of micro-CT imaging procedures. CONCLUSIONS Micro-CT tissue imaging enables accurate volumetric measurements and evaluations of entire surgical specimens at microscopic resolution across a wide range of clinical applications.
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Affiliation(s)
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Liatsos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreana Bompoti
- Diagnostic Imaging, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Arvanitidis
- Institute of Marine Biology, Biotechnology and Aquaculture, Hellenic Centre for Marine Research, Heraklion, Crete, Greece.,LifeWatch ERIC, Sector II-II, Seville, Spain
| | - Fani Tsolaki
- Department of Cardiothoracic Surgery, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Stamatios Theocharis
- First Department of Pathology, National and Kapoditrian University of Athens, Athens, Greece
| | - Georgios Tagarakis
- Department of Cardiothoracic Surgery, AHEPA University Hospital, Thessaloniki, Greece
| | - James S Michaelson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Markus D Herrmann
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Maetani T, Tanabe N, Terada S, Shiraishi Y, Shima H, Kaji S, Sakamoto R, Oguma T, Sato S, Masuda I, Hirai T. Physiological impacts of computed tomography airway dysanapsis, fractal dimension, and branch count in asymptomatic never smokers. J Appl Physiol (1985) 2023; 134:20-27. [PMID: 36269294 DOI: 10.1152/japplphysiol.00385.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dysanapsis, a mismatch between airway tree caliber and lung size, contributes to a large variation in lung function on spirometry in healthy subjects. However, it remains unclear whether other morphological features of the airway tree could be associated with the variation in lung function independent of dysanapsis. This study used lung cancer screening chest computed tomography (CT) and spirometry data from asymptomatic never smokers. Dysanapsis and the complexity of airway tree geometry were quantified on CT by measuring airway to lung ratio (ALR) and airway fractal dimension (AFD). Moreover, total airway count (TAC), ratio of airway luminal surface area to volume (SA/V), longitudinal tapering and irregularity of the radius of the internal lumen from the central to peripheral airways (Tapering index and Irregularity index) were quantified. In 431 asymptomatic never smokers without a history of lung diseases, lower ALR was associated with lower forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FEV1/FVC). The associations of ALR with AFD and TAC (r = 0.41 and 0.13) were weaker than the association between TAC and AFD (r = 0.64). In multivariable models adjusted for age, sex, height, and mean lung density, lower AFD and TAC were associated with lower FEV1 and FEV1/FVC independent of ALR, whereas SA/V and Tapering index were not. These results suggest that the smaller airway tree relative to a given lung size and the lower complexity of airway tree shape, including lower branch count, are independently associated with lower lung function in healthy subjects.NEW & NOTEWORTHY This study showed that fractal dimension and total airway count of the airway tree on computed tomography are associated with lung function on spirometry independent of a smaller airway for a given lung size (dysanapsis) in asymptomatic never smokers without a history of lung diseases. In addition to dysanapsis, the morphometric complexity of the airway tree and the airway branch count may cause a substantial variation of lung function in these subjects.
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Affiliation(s)
- Tomoki Maetani
- 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
| | - Satoru Terada
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Shiraishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Shima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shizuo Kaji
- Institute of Mathematics for Industry, Kyushu University, Fukuoka, Japan
| | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Izuru Masuda
- Medical Examination Center, Takeda Hospital, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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9
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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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10
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Moslemi A, Makimoto K, Tan WC, Bourbeau J, Hogg JC, Coxson HO, Kirby M. Quantitative CT Lung Imaging and Machine Learning Improves Prediction of Emergency Room Visits and Hospitalizations in COPD. Acad Radiol 2022; 30:707-716. [PMID: 35690537 DOI: 10.1016/j.acra.2022.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/03/2022] [Accepted: 05/15/2022] [Indexed: 12/12/2022]
Abstract
RATIONALE Predicting increased risk of future healthcare utilization in chronic obstructive pulmonary disease (COPD) patients is an important goal for improving patient management. OBJECTIVE Our objective was to determine the importance of computed tomography (CT) lung imaging measurements relative to other demographic and clinical measurements for predicting future health services use with machine learning in COPD. MATERIALS AND METHODS In this retrospective study, lung function measurements and chest CT images were acquired from Canadian Cohort of Obstructive Lung Disease study participants from 2010 to 2017 (https://clinicaltrials.gov, NCT00920348). Up to two follow-up visits (1.5- and 3-year follow-up) were performed and participants were asked for details related to healthcare utilization. Healthcare utilization was defined as any COPD hospitalization or emergency room visit due to respiratory problems in the 12 months prior to the follow-up visits. CT analysis was performed (VIDA Diagnostics Inc.); a total of 108 CT quantitative emphysema, airway and vascular measurements were investigated. A hybrid feature selection method with support vector machine classifier was used to predict healthcare utilization. Performance was determined using accuracy, F1-measure and area under the receiver operating characteristic curve (AUC) and Matthews's correlation coefficient (MC). RESULTS Of the 527 COPD participants evaluated, 179 (35%) used healthcare services at follow-up. There were no significant differences between the participants with or without healthcare utilization at follow-up for age (p = 0.50), sex (p = 0.44), BMI (p = 0.05) or pack-years (p = 0.76). The accuracy for predicting subsequent healthcare utilization was 80% ± 3% (F1-measure = 74%, AUC = 0.80, MC = 0.6) when all measurements were considered, 76% ± 6% (F1-measure = 72%, AUC = 0.77, MC = 0.55) for CT measurements alone and 65% ± 5% (F1-measure = 60%, AUC = 0.67, MC = 0.34) for demographic and lung function measurements alone. CONCLUSION The combination of CT lung imaging and conventional measurements leads to greater prediction accuracy of subsequent health services use than conventional measurements alone, and may provide needed prognostic information for patients suffering from COPD.
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Affiliation(s)
- Amir Moslemi
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Kalysta Makimoto
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
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11
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Methods of Sputum and Mucus Assessment for Muco-Obstructive Lung Diseases in 2022: Time to “Unplug” from Our Daily Routine! Cells 2022; 11:cells11050812. [PMID: 35269434 PMCID: PMC8909676 DOI: 10.3390/cells11050812] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 01/27/2023] Open
Abstract
Obstructive lung diseases, such as chronic obstructive pulmonary disease, asthma, or non-cystic fibrosis bronchiectasis, share some major pathophysiological features: small airway involvement, dysregulation of adaptive and innate pulmonary immune homeostasis, mucus hyperproduction, and/or hyperconcentration. Mucus regulation is particularly valuable from a therapeutic perspective given it contributes to airflow obstruction, symptom intensity, disease severity, and to some extent, disease prognosis in these diseases. It is therefore crucial to understand the mucus constitution of our patients, its behavior in a stable state and during exacerbation, and its regulatory mechanisms. These are all elements representing potential therapeutic targets, especially in the era of biologics. Here, we first briefly discuss the composition and characteristics of sputum. We focus on mucus and mucins, and then elaborate on the different sample collection procedures and how their quality is ensured. We then give an overview of the different direct analytical techniques available in both clinical routine and more experimental settings, giving their advantages and limitations. We also report on indirect mucus assessment procedures (questionnaires, high-resolution computed tomography scanning of the chest, lung function tests). Finally, we consider ways of integrating these techniques with current and future therapeutic options. Cystic fibrosis will not be discussed given its monogenic nature.
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Martinez FJ, Agusti A, Celli BR, Han MK, Allinson JP, Bhatt SP, Calverley P, Chotirmall SH, Chowdhury B, Darken P, Da Silva CA, Donaldson G, Dorinsky P, Dransfield M, Faner R, Halpin DM, Jones P, Krishnan JA, Locantore N, Martinez FD, Mullerova H, Price D, Rabe KF, Reisner C, Singh D, Vestbo J, Vogelmeier CF, Wise RA, Tal-Singer R, Wedzicha JA. Treatment Trials in Young Patients with Chronic Obstructive Pulmonary Disease and Pre-Chronic Obstructive Pulmonary Disease Patients: Time to Move Forward. Am J Respir Crit Care Med 2022; 205:275-287. [PMID: 34672872 PMCID: PMC8886994 DOI: 10.1164/rccm.202107-1663so] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the end result of a series of dynamic and cumulative gene-environment interactions over a lifetime. The evolving understanding of COPD biology provides novel opportunities for prevention, early diagnosis, and intervention. To advance these concepts, we propose therapeutic trials in two major groups of subjects: "young" individuals with COPD and those with pre-COPD. Given that lungs grow to about 20 years of age and begin to age at approximately 50 years, we consider "young" patients with COPD those patients in the age range of 20-50 years. Pre-COPD relates to individuals of any age who have respiratory symptoms with or without structural and/or functional abnormalities, in the absence of airflow limitation, and who may develop persistent airflow limitation over time. We exclude from the current discussion infants and adolescents because of their unique physiological context and COPD in older adults given their representation in prior randomized controlled trials (RCTs). We highlight the need of RCTs focused on COPD in young patients or pre-COPD to reduce disease progression, providing innovative approaches to identifying and engaging potential study subjects. We detail approaches to RCT design, including potential outcomes such as lung function, patient-reported outcomes, exacerbations, lung imaging, mortality, and composite endpoints. We critically review study design components such as statistical powering and analysis, duration of study treatment, and formats to trial structure, including platform, basket, and umbrella trials. We provide a call to action for treatment RCTs in 1) young adults with COPD and 2) those with pre-COPD at any age.
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Affiliation(s)
| | - Alvar Agusti
- Catedra Salut Respiratoria and,Institut Respiratorio, Hospital Clinic, Barcelona, Spain;,Institut d’investigacions biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain;,Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Bartolome R. Celli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - MeiLan K. Han
- University of Michigan Health System, Ann Arbor, Michigan
| | - James P. Allinson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Surya P. Bhatt
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Peter Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Carla A. Da Silva
- Clinical Development, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Gavin Donaldson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Mark Dransfield
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rosa Faner
- Department of Biomedical Sciences, University of Barcelona, Barcelona, Spain
| | | | - Paul Jones
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | - David Price
- Observational and Pragmatic Research Institute, Singapore;,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Klaus F. Rabe
- LungenClinic Grosshansdorf, Member of the German Center for Lung Research, Grosshansdorf, Germany;,Department of Medicine, Christian Albrechts University Kiel, Member of the German Center for Lung Research Kiel, Germany
| | | | | | - Jørgen Vestbo
- Manchester University NHS Trust, Manchester, United Kingdom
| | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Member of the German Center for Lung Research, Marburg, Germany
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13
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Kooner HK, McIntosh MJ, Desaigoudar V, Rayment JH, Eddy RL, Driehuys B, Parraga G. Pulmonary functional MRI: Detecting the structure-function pathologies that drive asthma symptoms and quality of life. Respirology 2022; 27:114-133. [PMID: 35008127 PMCID: PMC10025897 DOI: 10.1111/resp.14197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/09/2021] [Accepted: 12/12/2021] [Indexed: 12/21/2022]
Abstract
Pulmonary functional MRI (PfMRI) using inhaled hyperpolarized, radiation-free gases (such as 3 He and 129 Xe) provides a way to directly visualize inhaled gas distribution and ventilation defects (or ventilation heterogeneity) in real time with high spatial (~mm3 ) resolution. Both gases enable quantitative measurement of terminal airway morphology, while 129 Xe uniquely enables imaging the transfer of inhaled gas across the alveolar-capillary tissue barrier to the red blood cells. In patients with asthma, PfMRI abnormalities have been shown to reflect airway smooth muscle dysfunction, airway inflammation and remodelling, luminal occlusions and airway pruning. The method is rapid (8-15 s), cost-effective (~$300/scan) and very well tolerated in patients, even in those who are very young or very ill, because unlike computed tomography (CT), positron emission tomography and single-photon emission CT, there is no ionizing radiation and the examination takes only a few seconds. However, PfMRI is not without limitations, which include the requirement of complex image analysis, specialized equipment and additional training and quality control. We provide an overview of the three main applications of hyperpolarized noble gas MRI in asthma research including: (1) inhaled gas distribution or ventilation imaging, (2) alveolar microstructure and finally (3) gas transfer into the alveolar-capillary tissue space and from the tissue barrier into red blood cells in the pulmonary microvasculature. We highlight the evidence that supports a deeper understanding of the mechanisms of asthma worsening over time and the pathologies responsible for symptoms and disease control. We conclude with a summary of approaches that have the potential for integration into clinical workflows and that may be used to guide personalized treatment planning.
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Affiliation(s)
- Harkiran K Kooner
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Marrissa J McIntosh
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Vedanth Desaigoudar
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jonathan H Rayment
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel L Eddy
- Centre of Heart Lung Innovation, Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Centre, Durham, North Carolina, USA
| | - Grace Parraga
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
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14
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Wu F, Jiang C, Zhou Y, Zheng Y, Tian H, Li H, Deng Z, Zhao N, Chen H, Ran P. Association of Total Airway Count on Computed Tomography with Pulmonary Function Decline in Early-Stage COPD: A Population-Based Prospective Cohort Study. Int J Chron Obstruct Pulmon Dis 2022; 16:3437-3448. [PMID: 34984001 PMCID: PMC8702985 DOI: 10.2147/copd.s339029] [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: 09/15/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background It has been found that the degree of terminal bronchiole destruction is associated with the severity of COPD. However, total airway count (TAC) of CT-visible and its relationship with COPD lung function severity and pulmonary function decline remains controversial. The present study aimed to determine whether TAC is significantly reduced in early-stage COPD (GOLD stage I–II) compared with healthy control subjects and whether TAC is associated with annual decline in pulmonary function in Chinese patients with early-stage COPD. Methods A total of 176 participants were enrolled in this study, of which 139 participants had undergone at least two spirometry measurements within 7 years (average 5.5 [standard deviation 0.8] years) after baseline data acquisition. CT-visible TAC was measured by summing all airway segments using semi-automated software. Average lumen diameter, average inner area, emphysema index, air trapping, and inspiratory Pi10 were also measured. Multivariable linear analysis was performed to evaluate variables that were significantly related to pulmonary function parameters and to evaluate the correlation between TAC and annual decline in longitudinal pulmonary function. Results Compared with healthy control subjects, CT-visible TAC was significantly reduced by 51% in GOLD II and by 31% in GOLD I after adjustment. TAC had the greatest impact on pre-bronchodilator FEV1, pre-bronchodilator FVC, post-bronchodilator FEV1, and post-bronchodilator FEV1/FVC (both p<0.001) among all CT indicators measured. TAC has the best correlation with inspiratory Pi10 (ρ=−0.751, p<0.001), an evaluation indicator of the degree of airway remodeling. TAC was independently associated with annual decline in pre-bronchodilator FEV1 (p=0.023), post-bronchodilator FEV1 (p=0.018), and post-bronchodilator FEV1/FVC (p<0.001). Conclusion This finding suggests that CT-visible TAC may be an evaluation indicator of the degree of airway remodeling, and was diminished in greater COPD lung function severity, and independently associated with disease progression. Early-stage COPD patients have already occurred lung structural changes and early intervention may be needed to ameliorate the progression of disease. Clinical Trial Registration ChiCTR-OO-14004264.
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Affiliation(s)
- Fan Wu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.,Guangzhou Laboratory, Bio-island, Guangzhou, People's Republic of China
| | - Changbin Jiang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yumin Zhou
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.,Guangzhou Laboratory, Bio-island, Guangzhou, People's Republic of China
| | - Youlan Zheng
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Heshen Tian
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Haiqing Li
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Zhishan Deng
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Ningning Zhao
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Huai Chen
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Pixin Ran
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.,Guangzhou Laboratory, Bio-island, Guangzhou, People's Republic of China
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15
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Bompoti A, Papazoglou AS, Moysidis DV, Otountzidis N, Karagiannidis E, Stalikas N, Panteris E, Ganesh V, Sanctuary T, Arvanitidis C, Sianos G, Michaelson JS, Herrmann MD. Volumetric Imaging of Lung Tissue at Micrometer Resolution: Clinical Applications of Micro-CT for the Diagnosis of Pulmonary Diseases. Diagnostics (Basel) 2021; 11:diagnostics11112075. [PMID: 34829422 PMCID: PMC8625264 DOI: 10.3390/diagnostics11112075] [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: 09/17/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Micro-computed tomography (micro-CT) is a promising novel medical imaging modality that allows for non-destructive volumetric imaging of surgical tissue specimens at high spatial resolution. The aim of this study is to provide a comprehensive assessment of the clinical applications of micro-CT for the tissue-based diagnosis of lung diseases. This scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews, aiming to include every clinical study reporting on micro-CT imaging of human lung tissues. A literature search yielded 570 candidate articles, out of which 37 were finally included in the review. Of the selected studies, 9 studies explored via micro-CT imaging the morphology and anatomy of normal human lung tissue; 21 studies investigated microanatomic pulmonary alterations due to obstructive or restrictive lung diseases, such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and cystic fibrosis; and 7 studies examined the utility of micro-CT imaging in assessing lung cancer lesions (n = 4) or in transplantation-related pulmonary alterations (n = 3). The selected studies reported that micro-CT could successfully detect several lung diseases providing three-dimensional images of greater detail and resolution than routine optical slide microscopy, and could additionally provide valuable volumetric insight in both restrictive and obstructive lung diseases. In conclusion, micro-CT-based volumetric measurements and qualitative evaluations of pulmonary tissue structures can be utilized for the clinical management of a variety of lung diseases. With micro-CT devices becoming more accessible, the technology has the potential to establish itself as a core diagnostic imaging modality in pathology and to enable integrated histopathologic and radiologic assessment of lung cancer and other lung diseases.
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Affiliation(s)
- Andreana Bompoti
- Department of Radiology, Peterborough City Hospital, Northwest Anglia NHS Foundation Trust, Peterborough PE3 9GZ, UK;
| | - Andreas S. Papazoglou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - Dimitrios V. Moysidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - Nikolaos Otountzidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - Nikolaos Stalikas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - Eleftherios Panteris
- Biomic_AUTh, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center B1.4, 10th km Thessaloniki-Thermi Rd., P.O. Box 8318, GR 57001 Thessaloniki, Greece;
| | | | - Thomas Sanctuary
- Respiratory Department, Medway NHS Foundation Trust, Kent ME7 5NY, UK;
| | - Christos Arvanitidis
- Hellenic Centre for Marine Research (HCMR), Institute of Marine Biology, Biotechnology and Aquaculture (IMBBC), 70013 Heraklion, Greece;
- LifeWatch ERIC, Sector II-II, Plaza de España, 41071 Seville, Spain
| | - Georgios Sianos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloniki, Greece; (A.S.P.); (D.V.M.); (N.O.); (E.K.); (N.S.); (G.S.)
| | - James S. Michaelson
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Markus D. Herrmann
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Correspondence: ; Tel.: +6-17-724-1896
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16
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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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17
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Kirby M, Smith BM, Tanabe N, Hogg JC, Coxson HO, Sin DD, Bourbeau J, Tan WC. Computed tomography total airway count predicts progression to COPD in at-risk smokers. ERJ Open Res 2021; 7:00307-2021. [PMID: 34708120 PMCID: PMC8542990 DOI: 10.1183/23120541.00307-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
There is limited understanding of how to identify people at high risk of developing COPD. Our objective was to investigate the association between computed tomography (CT) total airway count (TAC) and incident COPD over 3 years among ever-smokers from the population-based Canadian Cohort Obstructive Lung Disease (CanCOLD) study. CT and spirometry were acquired in ever-smokers at baseline; spirometry was repeated at 3-year follow-up. CT TAC was generated by summing all airway segments in the segmented airway tree (VIDA Diagnostics, Inc.). CT airway wall area, wall thickness for a theoretical airway with 10 mm perimeter (Pi10), and low attenuation areas below −856 HU (LAA856) were also measured. Logistic and mixed effects regression models were constructed to determine the association for CT measurements with development of COPD and forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) decline, respectively. Among 316 at-risk participants evaluated at baseline (65±9 years, 40% female, 18±19 pack-years), incident COPD was detected in 56 participants (18%) over a median 3.1±0.6 years of follow-up. Among CT measurements, only TAC was associated with incident COPD (p=0.03), where a 1-sd decrement in TAC increased the odds ratio for incident COPD by a factor of two. In a multivariable linear regression model, reduced TAC was significantly associated with greater longitudinal FEV1/FVC decline (p=0.03), but no other measurements were significant. CT TAC predicts incident COPD in at-risk smokers, indicating that smokers exhibit early structural changes associated with COPD prior to abnormal spirometry. Computed tomography (CT) total airway count (TAC) predicts incident COPD in at-risk smokers, indicating that smokers exhibit early airway remodelling prior to abnormal spirometry and that CT TAC is a potential tool to help identify smokers at increased risk of COPDhttps://bit.ly/2UTw3I4
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Affiliation(s)
- Miranda Kirby
- Dept of Physics, Ryerson University, Toronto, ON, Canada.,UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Benjamin M Smith
- Dept of Medicine, McGill University, Montreal, QC, Canada.,Dept of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Dept of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Naoya Tanabe
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - James C Hogg
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Harvey O Coxson
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Don D Sin
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Wan C Tan
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
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18
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Wouters EFM, Breyer MK, Breyer-Kohansal R, Hartl S. COPD Diagnosis: Time for Disruption. J Clin Med 2021; 10:jcm10204660. [PMID: 34682780 PMCID: PMC8539379 DOI: 10.3390/jcm10204660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Articulating a satisfactory definition of a disease is surprisingly difficult. Despite the alarming individual, societal and economic burden of chronic obstructive pulmonary disease (COPD), diagnosis is still largely based on a physiologically dominated disease conception, with spirometrically determined airflow limitation as a cardinal feature of the disease. The diagnostic inaccuracy and insensitivity of this physiological disease definition is reviewed considering scientific developments of imaging of the respiratory system in particular. Disease must be approached as a fluid concept in response to new scientific and medical discoveries, but labelling as well as mislabelling someone as diseased, will have enormous individual, social and financial implications. Nosology of COPD urgently needs to dynamically integrate more sensitive diagnostic procedures to detect the breadth of abnormalities early in the disease process. Integration of broader information for the identification of abnormalities in the respiratory system is a cornerstone for research models of underlying pathomechanisms to create a breakthrough in research.
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Affiliation(s)
- Emiel F. M. Wouters
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria; (M.K.B.); (R.B.-K.); (S.H.)
- Department of Respiratory Medicine, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
- Correspondence:
| | - Marie K. Breyer
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria; (M.K.B.); (R.B.-K.); (S.H.)
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria; (M.K.B.); (R.B.-K.); (S.H.)
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria; (M.K.B.); (R.B.-K.); (S.H.)
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19
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Ritchie AI, Baker JR, Parekh TM, Allinson JP, Bhatt SP, Donnelly LE, Donaldson GC. Update in Chronic Obstructive Pulmonary Disease 2020. Am J Respir Crit Care Med 2021; 204:14-22. [PMID: 33856972 DOI: 10.1164/rccm.202102-0253up] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andy I Ritchie
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jonathon R Baker
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Trisha M Parekh
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - James P Allinson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Louise E Donnelly
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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20
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Vameghestahbanati M, Kirby M, Tanabe N, Vasilescu DM, Janssens W, Everaerts S, Vanaudenaerde BM, Benedetti A, Hogg JC, Smith BM. Central Airway Tree Dysanapsis Extends to the Peripheral Airways. Am J Respir Crit Care Med 2021; 203:378-381. [PMID: 33137261 PMCID: PMC7874305 DOI: 10.1164/rccm.202007-3025le] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Bart M. Vanaudenaerde
- Katholieke Universiteit Leuven
- Universitair Ziekenhuis GasthuisbergLeuven, Belgiumand
| | | | - James C. Hogg
- Univeristy of British ColumbiaVancouver, British Columbia, Canada
| | - Benjamin M. Smith
- McGill UniversityMontreal, Quebec, Canada
- Columbia University Medical CenterNew York, New York
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21
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Lynch DA, Oh AS. High-Spatial-Resolution CT Offers New Opportunities for Discovery in the Lung. Radiology 2020; 297:472-473. [DOI: 10.1148/radiol.2020203473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David A. Lynch
- From the Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206
| | - Andrea S. Oh
- From the Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206
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22
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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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23
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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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