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Hirama N, Yamamoto M, Nagaoka S, Segawa W, Sugimoto C, Nagayama H, Hiro S, Kajita Y, Maeda C, Kubo S, Seki K, Nagahara Y, Teranishi S, Tashiro K, Hara Y, Kobayashi N, Watanabe S, Kudo M, Kaneko T. Predictors of lung injury during durvalumab maintenance therapy following concurrent chemoradiotherapy in unresectable locally advanced non-small cell lung carcinoma. Thorac Cancer 2023; 14:2601-2607. [PMID: 37533115 PMCID: PMC10481134 DOI: 10.1111/1759-7714.15042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Based on the results of the PACIFIC trial, maintenance with durvalumab has emerged as the standard treatment following concurrent chemoradiotherapy in patients with unresectable locally advanced non-small cell lung carcinoma (NSCLC). However, adverse events attributed to durvalumab, especially lung injuries, including immune-related adverse events, and radiation pneumonitis, are concerning. This study retrospectively investigated the factors related to lung injury in patients receiving the PACIFIC regimen. METHODS Patients with unresectable locally advanced NSCLC who received durvalumab maintenance therapy following concurrent chemoradiotherapy at Yokohama City University Medical Centre between July 2018 and March 2022 were included. Clinical data, volume of normal lung receiving 20 or 5 Gy or more (V20 or V5), planning target volume (PTV), and relative lung parenchyma volume in emphysematous lung receiving 20 or 5 Gy or more (RLPV20 or 5; V20 or V5/100-percentage of low-attenuation volume) were evaluated. RESULTS Performance status (PS), V20, V5, PTV, RLPV20, and RLPV5 were significantly higher in the lung injury group in the univariate analysis. Furthermore, RLPV20 was the most significant factor in the lung injury group in the multivariate analysis comprising PS, PTV, V20, and RLPV20. CONCLUSION RLPV20 and RLPV5 are useful in estimating lung inflammation. RLPV20 could be considered the most reliable risk factor for maintenance therapy with durvalumab following concurrent chemoradiotherapy in patients with unresectable locally advanced NSCLC.
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Affiliation(s)
- Nobuyuki Hirama
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Masaki Yamamoto
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Satoshi Nagaoka
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Wataru Segawa
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Chihiro Sugimoto
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Hirokazu Nagayama
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Shuntaro Hiro
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Yukihito Kajita
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Chihiro Maeda
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Sousuke Kubo
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Kenichi Seki
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Yoshinori Nagahara
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Shuhei Teranishi
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Ken Tashiro
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Yu Hara
- Department of PulmonologyYokohama City University Graduate School of MedicineYokohamaJapan
| | - Nobuaki Kobayashi
- Department of PulmonologyYokohama City University Graduate School of MedicineYokohamaJapan
| | | | - Makoto Kudo
- Respiratory Disease CenterYokohama City University Medical CenterYokohamaJapan
| | - Takeshi Kaneko
- Department of PulmonologyYokohama City University Graduate School of MedicineYokohamaJapan
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Wisselink HJ, Steerenberg DJD, Rook M, Pelgrim GJ, Heuvelmans MA, van den Berge M, de Bock GH, Vliegenthart R. Predicted versus CT-derived total lung volume in a general population: The ImaLife study. PLoS One 2023; 18:e0287383. [PMID: 37327210 PMCID: PMC10275439 DOI: 10.1371/journal.pone.0287383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/05/2023] [Indexed: 06/18/2023] Open
Abstract
Predicted lung volumes based on the Global Lung Function Initiative (GLI) model are used in pulmonary disease detection and monitoring. It is unknown how well the predicted lung volume corresponds with computed tomography (CT) derived total lung volume (TLV). The aim of this study was to compare the GLI-2021 model predictions of total lung capacity (TLC) with CT-derived TLV. 151 female and 139 male healthy participants (age 45-65 years) were consecutively selected from a Dutch general population cohort, the Imaging in Lifelines (ImaLife) cohort. In ImaLife, all participants underwent low-dose, inspiratory chest CT. TLV was measured by an automated analysis, and compared to predicted TLC based on the GLI-2021 model. Bland-Altman analysis was performed for analysis of systematic bias and range between limits of agreement. To further mimic the GLI-cohort all analyses were repeated in a subset of never-smokers (51% of the cohort). Mean±SD of TLV was 4.7±0.9 L in women and 6.2±1.2 L in men. TLC overestimated TLV, with systematic bias of 1.0 L in women and 1.6 L in men. Range between limits of agreement was 3.2 L for women and 4.2 L for men, indicating high variability. Performing the analysis with never-smokers yielded similar results. In conclusion, in a healthy cohort, predicted TLC substantially overestimates CT-derived TLV, with low precision and accuracy. In a clinical context where an accurate or precise lung volume is required, measurement of lung volume should be considered.
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Affiliation(s)
- Hendrik J. Wisselink
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Danielle J. D. Steerenberg
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mieneke Rook
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Radiology, Martini Hospital, Groningen, The Netherlands
| | - Gert-Jan Pelgrim
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolein A. Heuvelmans
- Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten van den Berge
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- DataScience in Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Impulse Oscillometry as a Diagnostic Test for Pulmonary Emphysema in a Clinical Setting. J Clin Med 2023; 12:jcm12041547. [PMID: 36836082 PMCID: PMC9967696 DOI: 10.3390/jcm12041547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Body plethysmography (BP) is the standard pulmonary function test (PFT) in pulmonary emphysema diagnosis, but not all patients can cooperate to this procedure. An alternative PFT, impulse oscillometry (IOS), has not been investigated in emphysema diagnosis. We investigated the diagnostic accuracy of IOS in the diagnosis of emphysema. Eighty-eight patients from the pulmonary outpatient clinic at Lillebaelt Hospital, Vejle, Denmark, were included in this cross-sectional study. A BP and an IOS were performed in all patients. Computed tomography scan verified presence of emphysema in 20 patients. The diagnostic accuracy of BP and IOS for emphysema was evaluated with two multivariable logistic regression models: Model 1 (BP variables) and Model 2 (IOS variables). Model 1 had a cross-validated area under the ROC curve (CV-AUC) = 0.892 (95% CI: 0.654-0.943), a positive predictive value (PPV) = 59.3%, and a negative predictive value (NPV) = 95.0%. Model 2 had a CV-AUC = 0.839 (95% CI: 0.688-0.931), a PPV = 55.2%, and an NPV = 93.7%. We found no statistically significant difference between the AUC of the two models. IOS is quick and easy to perform, and it can be used as a reliable rule-out method for emphysema.
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Wang Y, Chai L, Chen Y, Liu J, Wang Q, Zhang Q, Qiu Y, Li D, Chen H, Shen N, Shi X, Wang J, Xie X, Li M. Quantitative CT parameters correlate with lung function in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Front Surg 2023; 9:1066031. [PMID: 36684267 PMCID: PMC9845891 DOI: 10.3389/fsurg.2022.1066031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/14/2022] [Indexed: 01/06/2023] Open
Abstract
Objective This study aimed to analyze the correlation between quantitative computed tomography (CT) parameters and airflow obstruction in patients with COPD. Methods PubMed, Embase, Cochrane and Web of Knowledge were searched by two investigators from inception to July 2022, using a combination of pertinent items to discover articles that investigated the relationship between CT measurements and lung function parameters in patients with COPD. Five reviewers independently extracted data, and evaluated it for quality and bias. The correlation coefficient was calculated, and heterogeneity was explored. The following CT measurements were extracted: percentage of lung attenuation area <-950 Hounsfield Units (HU), mean lung density, percentage of airway wall area, air trapping index, and airway wall thickness. Two airflow obstruction parameters were extracted: forced expiratory volume in the first second as a percentage of prediction (FEV1%pred) and FEV1 divided by forced expiratory volume lung capacity. Results A total of 141 studies (25,214 participants) were identified, which 64 (6,341 participants) were suitable for our meta-analysis. Results from our analysis demonstrated that there was a significant correlation between quantitative CT parameters and lung function. The absolute pooled correlation coefficients ranged from 0.26 (95% CI, 0.18 to 0.33) to 0.70 (95% CI, 0.65 to 0.75) for inspiratory CT and 0.56 (95% CI, 0.51 to 0.60) to 0.74 (95% CI, 0.68 to 0.80) for expiratory CT. Conclusions Results from this analysis demonstrated that quantitative CT parameters are significantly correlated with lung function in patients with COPD. With recent advances in chest CT, we can evaluate morphological features in the lungs that cannot be obtained by other clinical indices, such as pulmonary function tests. Therefore, CT can provide a quantitative method to advance the development and testing of new interventions and therapies for patients with COPD.
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Zac J, Zac S, Pérez-Padilla R, Remigio-Luna A, Guzmán-Boulloud N, Gochicoa-Rangel L, Guzmán-Valderrábano C, Thirión-Romero I. Lung volumes measurement using novel pressure derived method in participants with obstructive, restrictive and healthy lungs. Physiol Meas 2022; 43. [PMID: 36537615 DOI: 10.1088/1361-6579/aca7ac] [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: 06/06/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022]
Abstract
Background.Lung volumes can be measured by body plethysmography (BP), by inert gas dilution during a single-breath or multiple breaths and by radiographic methods based on chest roentgenogram or CT scanning. Our objective was to analyze the concordance between several methods including a new pressure-derived method (PDM) in a variety of pulmonary conditions.Methods. We recruited four groups of adult volunteers at the chronic obstructive pulmonary disease and tobacco clinic of a respiratory referral hospital: patients with lung bullae, with obstructive lung diseases, with restrictive lung diseases and healthy controls; all subjects underwent lung volume measurements according to ATS/ERS standards in random order with each method and then CT scanning. Differences among groups were estimated by Kruskal-Wallis tests. Concordance correlation coefficients (CCC) and Bland-Altman plots were performed.Results. Sixty-two patients were studied including 15 with lung bullae, 14 with obstructive lung diseases, 12 with restrictive lung disease and 21 healthy subjects. Highest concordance was obtained between BP and CT scanning (CCC 0.95, mean difference -0.35 l) and the lowest, with TLC-DLCOsb(CCC 0.65, difference -1.05 l). TLC measured by BP had a moderate concordance with the PDM (CCC = 0.91, mean difference -0.19 l). The PDM on the other hand had the lowest intra-test repeatability (2.7%) of all tested methods.Conclusions. Lung volumes measured by BP and CT had high concordance in the scenario of varied pulmonary conditions including lung bullae, restrictive and obstructive diseases. The new PDM device, had low intra-test variability, and was easy to perform, with a reasonable concordance with BP.
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Affiliation(s)
- Jacob Zac
- Tobacco and COPD Research Unit, Instituto Nacional de Enfermedades Respiratorias INER, Mexico City, Mexico
| | - Salomon Zac
- Tobacco and COPD Research Unit, Instituto Nacional de Enfermedades Respiratorias INER, Mexico City, Mexico
| | - Rogelio Pérez-Padilla
- Tobacco and COPD Research Unit, Instituto Nacional de Enfermedades Respiratorias INER, Mexico City, Mexico
| | - Arantxa Remigio-Luna
- Tobacco and COPD Research Unit, Instituto Nacional de Enfermedades Respiratorias INER, Mexico City, Mexico
| | | | - Laura Gochicoa-Rangel
- Respiratory Physiology Department, INER Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Carlos Guzmán-Valderrábano
- Respiratory Physiology Department, INER Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Ireri Thirión-Romero
- Tobacco and COPD Research Unit, Instituto Nacional de Enfermedades Respiratorias INER, Mexico City, Mexico
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Lv R, Xie M, Jin H, Shu P, Ouyang M, Wang Y, Yao D, Yang L, Huang X, Wang Y. A Preliminary Study on the Relationship Between High-Resolution Computed Tomography and Pulmonary Function in People at Risk of Developing Chronic Obstructive Pulmonary Disease. Front Med (Lausanne) 2022; 9:855640. [PMID: 35602478 PMCID: PMC9115858 DOI: 10.3389/fmed.2022.855640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Patients with chronic obstructive pulmonary disease (COPD) have high morbidity and mortality, the opportunity to carry out a thoracic high-resolution CT (HRCT) scan may increase the possibility to identify the group at risk of disease. The aim of our study was to explore the differences in HRCT emphysema parameters, air trapping parameters, and lung density parameters between high and low-risk patients of COPD and evaluate their correlation with pulmonary function parameters. Methods In this retrospective, single-center cohort study, we enrolled outpatients from the Physical Examination Center and Respiratory Medicine of The First Affiliated Hospital of Wenzhou Medical University. The patients who were ≥ 40 years-old, had chronic cough or sputum production, and/or had exposure to risk factors for the disease and had not reached the diagnostic criteria is considered people at risk of COPD. They were divided into low-risk group and high-risk group according to FEV1/FVC ≥ 80% and 80%>FEV1/FVC ≥ 70%. Data on clinical characteristics, clinical symptom score, pulmonary function, and HRCT were recorded. Results 72 COPD high-risk patients and 86 COPD low-risk patients were enrolled in the study, and the air trapping index of left, right, and bilateral lungs of the high-risk group were higher than those of the low-risk group. However, the result of mean expiratory lung density was opposite. The emphysema index of left, right, and bilateral lungs were negatively correlated with FEV1/FVC (correlation coefficients were -0.33, -0.22, -0.26). Consistently, the air trapping index of left and right lungs and bilateral lungs were negatively correlated with FEV1/FVC (correlation coefficients were -0.33, -0.23, -0.28). Additionally, the mean expiratory lung density of left and right lungs and bilateral lungs were positively correlated with FEV1/FVC (correlation coefficients were 0.31, 0.25, 0.29). Conclusion The emphysema index, air trapping index and the mean expiratory lung density shows significantly positive correlation with FEV1/FVC which can be used to assess the pulmonary function status of people at risk of COPD and provide a useful supplement for the early and comprehensive assessment of the disease.
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Affiliation(s)
- Rui Lv
- Key Laboratory of Respiratory Circulation, Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.,Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, China
| | - Mengyao Xie
- Key Laboratory of Respiratory Circulation, Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Huaqian Jin
- Key Laboratory of Respiratory Circulation, Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Pingping Shu
- Key Laboratory of Respiratory Circulation, Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Mingli Ouyang
- Key Laboratory of Respiratory Circulation, Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yanmao Wang
- Key Laboratory of Respiratory Circulation, Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Dan Yao
- Key Laboratory of Respiratory Circulation, Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lehe Yang
- Key Laboratory of Respiratory Circulation, Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiaoying Huang
- Key Laboratory of Respiratory Circulation, Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yiran Wang
- Key Laboratory of Respiratory Circulation, Division of Pulmonary Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
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Bakker JT, Klooster K, Bouwman J, Pelgrim GJ, Vliegenthart R, Slebos DJ. Evaluation of spirometry-gated computed tomography to measure lung volumes in emphysema patients. ERJ Open Res 2021; 8:00492-2021. [PMID: 35083322 PMCID: PMC8784891 DOI: 10.1183/23120541.00492-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/30/2021] [Indexed: 11/05/2022] Open
Abstract
IntroductionIn emphysema patient being evaluated for bronchoscopic lung volume reduction (BLVR), accurate measurement of lung volumes is important. Total lung capacity (TLC) and residual volume (RV) are commonly measured by body plethysmography but can also be derived from chest computed tomography (CT). Spirometry-gated CT scanning potentially improves the agreement of CT and body plethysmography. The aim of this study was to compare lung volumes derived from spirometry-gated CT and “breath-hold-coached” CT to the reference standard: body plethysmography.MethodsIn this single-centre retrospective cohort study, emphysema patients being evaluated for BLVR underwent body plethysmography, inspiration (TLC) and expiration (RV) CT scan with spirometer guidance (“gated group”) or with breath-hold-coaching (“non-gated group”). Quantitative analysis was used to calculate lung volumes from the CT.Results200 patients were included in the study (mean±sd age 62±8 years, forced expiratory flow in 1 s 29.2±8.7%, TLC 7.50±1.46 L, RV 4.54±1.07 L). The mean±sd CT-derived TLC was 280±340 mL lower compared to body plethysmography in the gated group (n=100), and 590±430 mL lower for the non-gated group (n=100) (both p<0.001). The mean±sd CT-derived RV was 300±470 mL higher in the gated group and 700±720 mL higher in the non-gated group (both p<0.001). Pearson correlation factors were 0.947 for TLC gated, 0.917 for TLC non-gated, 0.823 for RV gated, 0.693 for RV non-gated, 0.539 for %RV/TLC gated and 0.204 for %RV/TLC non-gated. The differences between the gated and non-gated CT results for TLC and RV were significant for all measurements (p<0.001).ConclusionIn severe COPD patients with emphysema, CT-derived lung volumes are strongly correlated to body plethysmography lung volumes, and especially for RV, more accurate when using spirometry gating.
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Bakker JT, Klooster K, Vliegenthart R, Slebos DJ. Measuring pulmonary function in COPD using quantitative chest computed tomography analysis. Eur Respir Rev 2021; 30:30/161/210031. [PMID: 34261743 PMCID: PMC9518001 DOI: 10.1183/16000617.0031-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/08/2021] [Indexed: 12/25/2022] Open
Abstract
COPD is diagnosed and evaluated by pulmonary function testing (PFT). Chest computed tomography (CT) primarily serves a descriptive role for diagnosis and severity evaluation. CT densitometry-based emphysema quantification and lobar fissure integrity assessment are most commonly used, mainly for lung volume reduction purposes and scientific efforts. A shift towards a more quantitative role for CT to assess pulmonary function is a logical next step, since more, currently underutilised, information is present in CT images. For instance, lung volumes such as residual volume and total lung capacity can be extracted from CT; these are strongly correlated to lung volumes measured by PFT. This review assesses the current evidence for use of quantitative CT as a proxy for PFT in COPD and discusses challenges in the movement towards CT as a more quantitative modality in COPD diagnosis and evaluation. To better understand the relevance of the traditional PFT measurements and the role CT might play in the replacement of these parameters, COPD pathology and traditional PFT measurements are discussed. CT may be used as a proxy for lung function in COPD diagnosis and evaluation, particularly for the hyperinflation markershttps://bit.ly/2RrGAZf
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Affiliation(s)
- Jens T Bakker
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Klooster
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Dept of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Song L, Leppig JA, Hubner RH, Lassen-Schmidt BC, Neumann K, Theilig DC, Feldhaus FW, Fahlenkamp UL, Hamm B, Song W, Jin Z, Doellinger F. Quantitative CT Analysis in Patients with Pulmonary Emphysema: Do Calculated Differences Between Full Inspiration and Expiration Correlate with Lung Function? Int J Chron Obstruct Pulmon Dis 2020; 15:1877-1886. [PMID: 32801683 PMCID: PMC7413697 DOI: 10.2147/copd.s253602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this retrospective study was to evaluate correlations between parameters of quantitative computed tomography (QCT) analysis, especially the 15th percentile of lung attenuation (P15), and parameters of clinical tests in a large group of patients with pulmonary emphysema. Patients and Methods One hundred and seventy-two patients with pulmonary emphysema and chronic obstructive pulmonary disease (COPD) global initiative for chronic obstructive lung disease (GOLD) stage 3 or 4 were assessed by nonenhanced thin-section CT scans in full inspiratory and expiratory breath-hold, pulmonary function test (PFT), a 6-minute walk test (6MWT), and quality of life questionnaires (SGRQ and CAT). QCT parameters included total lung volume (TLV), total emphysema score (TES), and P15, all measured at inspiration (IN) and expiration (EX). Differences between inspiration and expiration were calculated for TLV (TLVDiff), TES (TESDiff), and P15 (P15Diff). Spearman correlation analysis was performed. Results CT-measured lung volume in inspiration (TLVIN) correlated strongly with spirometry-measured total lung capacity (TLC) (r=0.81, p<0.001) and moderately to strongly with residual volume (RV), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1)/FVC (r=0.60, 0.56, and −0.49, each p<0.001). Lung volume in expiration (TLVEX) correlated moderately to strongly with TLC, RV and FEV1/FVC ratio (r=0.75, 0.66, and −0.43, each p<0.001). TES and P15 showed stronger correlations with the carbon monoxide transfer coefficient (KCO%) (r= −0.42, 0.44, both p<0.001), when measured during expiration. P15Diff correlated moderately with KCO% and carbon monoxide diffusing capacity (DLCO%) (r= 0.41, 0.40, both p<0.001). The 6MWT and most QCT parameters showed significant differences between COPD GOLD 3 and 4 groups. Conclusion Our results suggest that QCT can help predict the severity of lung function decrease in patients with pulmonary emphysema and COPD GOLD 3 or 4. Some QCT parameters, including P15EX and P15Diff, correlated moderately to strongly with parameters of pulmonary function tests.
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Affiliation(s)
- Lan Song
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jonas A Leppig
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf H Hubner
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Konrad Neumann
- Institute of Biometrics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dorothea C Theilig
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix W Feldhaus
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ute L Fahlenkamp
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wei Song
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Felix Doellinger
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Cheng T, Li Y, Pang S, Wan H, Shi G, Cheng Q, Li Q, Pan Z, Huang S. Normal lung attenuation distribution and lung volume on computed tomography in a Chinese population. Int J Chron Obstruct Pulmon Dis 2019; 14:1657-1668. [PMID: 31413560 PMCID: PMC6662163 DOI: 10.2147/copd.s187596] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 05/10/2019] [Indexed: 01/17/2023] Open
Abstract
Backgroud and objectives: Although lung attenuation distribution and lung volume on computed tomography (CT) have been widely used in evaluating COPD and interstitial lung disease, there are only a few studies regarding the normal range of these indices, especially in Chinese subjects. We aimed to describe the normal range of lung attenuation distribution and lung volume based on CT. Methods: Subjects with normal lung function and basically normal chest CT findings (derivation group) at Ruijin Hospital, Shanghai (from January 2010 to June 2014) were included according to inclusion and exclusion criteria. The range of the percentage of lung volume occupied by low attenuation areas (LAA%), percentile of the histogram of attenuation values (Perc n), and total lung volume were analyzed. Relationships of these measures with demographic variables were evaluated. Participants who underwent chest CT examination for disease screening and had basically normal CT findings served as an external validation group. Results: The number of subjects in the derivation group and external validation groups were 564 and 1,787, respectively. Mean total lung volumes were 4,468±1,271 mL and 4,668±1,192 mL, and median LAA%(-950 HU) was 0.19 (0.03–0.43) and 0.17 (0.01–0.41), in the derivation and external validation groups, respectively. Reference equations for lung volume and attenuation distribution (LAA% using -1,000–210 HU, Perc 1 to Perc 98) were generated: Lung volume (mL) = -1.015 *10^4+605.3*Sex (1= male, 0= female)+92.61*Height (cm) –12.99*Weight (kg) ±1766; LAA% (-950 HU)=[0.2027+0.05926*Sex (1= male, 0= female) –4.111*10^-3*Weight (kg) +4.924*10^-3*Height (cm) +8.504*10^-4*Age]^7.341–0.05; Upper limit of normal range: [0.2027+0.05926*Sex-4.111*10^-3*Weight+4.924*10^-3*Height+8.504*10^-4*Age+0.1993]^7.341–0.05. Conclusion: This large population-based retrospective study demonstrated the normal range of LAA%, Perc n, and total lung volume measured on CT scans among subjects with normal lung function and CT findings. Reference equations are provided.
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Affiliation(s)
- Ting Cheng
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Yong Li
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Shuai Pang
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - HuanYing Wan
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - GuoChao Shi
- Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - QiJian Cheng
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - QingYun Li
- Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - ZiLai Pan
- Department of Radiology, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - ShaoGuang Huang
- Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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12
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CT Imaging-Based Low-Attenuation Super Clusters in Three Dimensions and the Progression of Emphysema. Chest 2018; 155:79-87. [PMID: 30292758 DOI: 10.1016/j.chest.2018.09.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/31/2018] [Accepted: 09/06/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Distributions of low-attenuation areas in two-dimensional (2-D) CT lung slices are used to quantify parenchymal destruction in patients with COPD. However, these segmental approaches are limited and may not reflect the true three-dimensional (3-D) tissue processes that drive emphysematous changes in the lung. The goal of this study was to instead evaluate distributions of 3-D low-attenuation volumes, which we hypothesized would follow a power law distribution and provide a more complete assessment of the mechanisms underlying disease progression. METHODS CT scans and pulmonary function test results were acquired from an observational database for N = 12 patients with COPD and N = 12 control patients. The data set included baseline and two annual follow-up evaluations in patients with COPD. Three-dimensional representations of the lungs were reconstructed from 2-D axial CT slices, with low-attenuation volumes identified as contiguous voxels < -960 Hounsfield units. RESULTS Low-attenuation sizes generally followed a power law distribution, with the exception of large, individual outliers termed "super clusters," which deviated from the expected distribution. Super cluster volume was correlated with disease severity (% total low attenuation, ρ = 0.950) and clinical measures of lung function including FEV1 (ρ = -0.849) and diffusing capacity of the lung for carbon monoxide Dlco (ρ = -0.874). To interpret these results, we developed a personalized computational model of super cluster emergence. Simulations indicated disease progression was more likely to occur near existing emphysematous regions, giving rise to a biomechanical, force-induced mechanism of super cluster growth. CONCLUSIONS Low-attenuation super clusters are defining, quantitative features of parenchymal destruction that dominate disease progression, particularly in advanced COPD.
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13
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Quantitative Computed Tomography Metrics From the Transplanted Lung can Predict Forced Expiratory Volume in the First Second After Lung Transplantation. J Thorac Imaging 2018; 33:112-123. [DOI: 10.1097/rti.0000000000000307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Šileikienė V, Urbonas M, Matačiūnas M, Norkūnienė J. Relationships between pulmonary function test parameters and quantitative computed tomography measurements of emphysema in subjects with chronic obstructive pulmonary disease. Acta Med Litu 2018; 24:209-218. [PMID: 29487484 PMCID: PMC5818256 DOI: 10.6001/actamedica.v24i4.3616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective. CT is able to precisely define the pathological process in COPD. There are a number of previous articles discussing the distribution of emphysema and its connection with pulmonary function tests. However, the results obtained by the researchers are not identical. Purpose. To assess relationships between emphysema and pulmonary function test parameters in COPD patients. Materials and methods. Fifty-nine patients diagnosed to have COPD underwent chest CT examinations and pulmonary function tests. For the quantitative assessment, percentages of low attenuation volume LAV 950 HU (%) of a both lungs, the right lung, the left lung, and each lobe were obtained. Quantitative CT measurements were compared with forced expiratory volume in 1 s (FEV1), the ratio of FEV1 to forced vital capacity (FEV1/FVC), the diffusing capacity for carbon monoxide (DLco) and total lung capacity (TLC). Results. Except for the right middle lobe and the right upper lobe, respectively, all the quantitative CT measurements showed weak to moderate negative correlations with diffusing capacity (DLco) (r = –0.35 to –0.61, p < 0.05) and weak positive correlations with TLC (r = 0.34 to 0.44, p < 0.05). Group analysis indicated that LAV–950 HU (%) values of both lungs, right lung, left lung, and each lobe, except for right middle lobe, were increased in patients with GOLD stages 3 and 4 of COPD compared to GOLD stages 1 and 2 (p < 0.05). Conclusion. CT measurements of emphysema are significantly related to pulmonary function tests results, particularly DLco.
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Affiliation(s)
- Virginija Šileikienė
- Centre of Pulmonology and Allergology of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Clinic of Infectious and Chest Diseases, Dermatovenerology and Allergology of Vilnius University, Vilnius, Lithuania
| | - Marius Urbonas
- Centre of Radiology and Nuclear Medicine of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Mindaugas Matačiūnas
- Centre of Radiology and Nuclear Medicine of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jolita Norkūnienė
- Department of Mathematical Statistics of Vilnius Gediminas Technical University, Vilnius, Lithuania
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15
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Ley-Zaporozhan J, Ley S, Mews J, Weinheimer O, Kandel S, Rogalla P. Changes of Emphysema Parameters over the Respiratory Cycle During Free Breathing: Preliminary Results Using Respiratory Gated 4D-CT. COPD 2017; 14:597-602. [PMID: 29023143 DOI: 10.1080/15412555.2017.1378630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this research was to evaluate respiratory gated CT of the lung in patients with COPD for analysis of parenchymal characteristics who were potential candidates for volume reduction surgery. Eleven patients with clinically known emphysematous disease underwent a respiratory gated, free-breathing 64-multislice-CT (Aquilion 64, Toshiba). Retrospective image reconstruction was performed similar to cardiac CT at every 10% of the respiratory loop, resulting in 10 complete volumetric datasets at 10 equidistant time points. All images were transferred onto a PC for calculation of the total lung volume, emphysema volume, emphysema index, and mean lung density. Complete datasets could be successfully reconstructed in all patients. The mean lung volume increased from 6.9 L to 7.5 L over the respiratory cycle. Emphysema volume increased from 1.6 L to 2.0 L and emphysema index from 22.6% to 26.5% from expiration to inspiration. In conclusion, respiratory gated chest 4D-CT allows for combined morphologic and functional image analysis, which can provide new insight into functional impairment and individual treatment planning.
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Affiliation(s)
- Julia Ley-Zaporozhan
- a Department of Radiology , Ludwig-Maximilians University Hospital Munich , Munich , Germany
| | - Sebastian Ley
- b Diagnostic and Interventional Radiology , Chirurgisches Klinikum München Süd , Munich , Germany
| | - Jürgen Mews
- c Center for Medical Research & Development Europe , Toshiba Medical Systems Europe BV , Zoetermeer , Netherlands
| | - Oliver Weinheimer
- d Department of Diagnostic and Interventional Radiology , Ruprecht-Karls-University Heidelberg , Heidelberg , Germany
| | - Sonja Kandel
- e Department of Medical Imaging , University of Toronto, University Health Network , Toronto , Ontario , Canada
| | - Patrik Rogalla
- e Department of Medical Imaging , University of Toronto, University Health Network , Toronto , Ontario , Canada.,f Department of Radiology , Charite Universitatsmedizin Berlin , Berlin , Germany
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16
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Comparison of Total Lung Capacity Determined by Plethysmography With Computed Tomographic Segmentation Using CALIPER. J Thorac Imaging 2017; 32:101-106. [PMID: 27870822 DOI: 10.1097/rti.0000000000000249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Traditionally, determination of total lung capacity (TLC) by plethysmography (TLCpleth) has been important in the diagnosis of lung diseases. Alternatively, data acquired from computerized tomography (CT) can be utilized to calculate a measure of TLC (TLCCT). The clinical utility of TLCCT is not certain. We sought to determine, in a clinical setting, whether TLCCT correlates with TLCpleth across a range of lung diseases and scanning techniques. In addition, we determined whether TLCCT affects the interpretation of pulmonary function tests. SUBJECTS AND METHODS Records of 118 of 148 consecutive lung transplant recipients were reviewed and determined to have coinciding pulmonary function tests, including plethysmography as well as volumetric chest CT performed supine during full inspiration. CT images acquired with a wide range of scanning protocols were analyzed using CALIPER, a software program for lung and trachea extraction from a CT volume and volumetric tissue characterization of the lung. Segmentation of the lung was achieved by using completely automated dynamic thresholding and region-growing techniques developed to extract the relatively low-density lung and tracheal anatomy from the CT data set without user intervention. RESULTS TLCpleth and TLCCT were strongly related with a correlation coefficient of 0.88 (P<0.001). The efficacy of the CT-derived measure was not influenced by specific lung diagnoses, age, height, body mass index, or spirometric parameters. TLCCT did not misidentify any diagnosis of restrictive lung disease, nor hyperinflation. CONCLUSIONS In a clinical setting, CT segmentation analysis provides a favorable determination of TLC compared with traditional plethysmography. The technique has general applicability across varying CT data acquisition protocols, lung diseases, and patient characteristics. TLCCT may substitute for TLCpleth in pulmonary function interpretation and may be preferable for some patients in whom plethysmography is difficult to perform, such as transplant subjects with severe pulmonary fibrosis.
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17
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Abstract
Lung densitometry assesses with computed tomography (CT) the X-ray attenuation of the pulmonary tissue which reflects both the degree of inflation and the structural lung abnormalities implying decreased attenuation, as in emphysema and cystic diseases, or increased attenuation, as in fibrosis. Five reasons justify replacement with lung densitometry of semi-quantitative visual scales used to measure extent and severity of diffuse lung diseases: (I) improved reproducibility; (II) complete vs. discrete assessment of the lung tissue; (III) shorter computation times; (IV) better correlation with pathology quantification of pulmonary emphysema; (V) better or equal correlation with pulmonary function tests (PFT). Commercially and open platform software are available for lung densitometry. It requires attention to technical and methodological issues including CT scanner calibration, radiation dose, and selection of thickness and filter to be applied to sections reconstructed from whole-lung CT acquisition. Critical is also the lung volume reached by the subject at scanning that can be measured in post-processing and represent valuable information per se. The measurements of lung density include mean and standard deviation, relative area (RA) at -970, -960 or -950 Hounsfield units (HU) and 1st and 15th percentile for emphysema in inspiratory scans, and RA at -856 HU for air trapping in expiratory scans. Kurtosis and skewness are used for evaluating pulmonary fibrosis in inspiratory scans. The main indication for lung densitometry is assessment of emphysema component in the single patient with chronic obstructive pulmonary diseases (COPD). Additional emerging applications include the evaluation of air trapping in COPD patients and in subjects at risk of emphysema and the staging in patients with lymphangioleiomyomatosis (LAM) and with pulmonary fibrosis. It has also been applied to assess prevalence of smoking-related emphysema and to monitor progression of smoking-related emphysema, alpha1 antitrypsin deficiency emphysema, and pulmonary fibrosis. Finally, it is recommended as end-point in pharmacological trials of emphysema and lung fibrosis.
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Affiliation(s)
- Mario Mascalchi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences
| | - Gianna Camiciottoli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences.,Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
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18
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Multivariate modeling using quantitative CT metrics may improve accuracy of diagnosis of bronchiolitis obliterans syndrome after lung transplantation. Comput Biol Med 2017; 89:275-281. [PMID: 28850899 DOI: 10.1016/j.compbiomed.2017.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND To assess how quantitative CT (qCT) metrics compare to pulmonary function testing (PFT) and semi-quantitative image scores (SQS) to diagnose bronchiolitis obliterans syndrome (BOS), manifestation of chronic lung allograft dysfunction after lung transplantation (LTx), according to the type of LTx (unilateral or bilateral). METHODS Paired inspiratory-expiratory CT scans and PFTs of 176 LTx patients were analyzed retrospectively, and separated into BOS (78) and non-BOS (98) cohorts. SQS were assessed by 2 radiologists and graded (0-3) for features including mosaic attenuation and bronchiectasis. qCT metrics included lung volumes and air trapping volumes. Multivariate logistic regression (MVLR) and support vector machines (SVM) were used for the classification task. RESULTS MVLR and SVM models using PFT metrics demonstrated highest accuracy for bilateral LTx (max AUC 0.771), whereas models using qCT metrics-only outperformed models using SQS or PFTs in unilateral LTx (max AUC 0.817), to diagnose BOS. Adding PC (principal components) from qCT on top of PFT improved model diagnostic accuracy for all transplant types. CONCLUSIONS Combinations of qCT metrics augment the diagnostic performance of PFTs, are superior to SQS to predict BOS status, and outperform PFTs in the unilateral LTx group. This suggests that latent information on paired volumetric CT may allow early diagnosis of BOS in LTx patients, particularly in unilateral LTx.
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19
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Oh SY, Lee M, Seo JB, Kim N, Lee SM, Lee JS, Oh YM. Size variation and collapse of emphysema holes at inspiration and expiration CT scan: evaluation with modified length scale method and image co-registration. Int J Chron Obstruct Pulmon Dis 2017; 12:2043-2057. [PMID: 28761337 PMCID: PMC5516780 DOI: 10.2147/copd.s130081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A novel approach of size-based emphysema clustering has been developed, and the size variation and collapse of holes in emphysema clusters are evaluated at inspiratory and expiratory computed tomography (CT). Thirty patients were visually evaluated for the size-based emphysema clustering technique and a total of 72 patients were evaluated for analyzing collapse of the emphysema hole in this study. A new approach for the size differentiation of emphysema holes was developed using the length scale, Gaussian low-pass filtering, and iteration approach. Then, the volumetric CT results of the emphysema patients were analyzed using the new method, and deformable registration was carried out between inspiratory and expiratory CT. Blind visual evaluations of EI by two readers had significant correlations with the classification using the size-based emphysema clustering method (r-values of reader 1: 0.186, 0.890, 0.915, and 0.941; reader 2: 0.540, 0.667, 0.919, and 0.942). The results of collapse of emphysema holes using deformable registration were compared with the pulmonary function test (PFT) parameters using the Pearson's correlation test. The mean extents of low-attenuation area (LAA), E1 (<1.5 mm), E2 (<7 mm), E3 (<15 mm), and E4 (≥15 mm) were 25.9%, 3.0%, 11.4%, 7.6%, and 3.9%, respectively, at the inspiratory CT, and 15.3%, 1.4%, 6.9%, 4.3%, and 2.6%, respectively at the expiratory CT. The extents of LAA, E2, E3, and E4 were found to be significantly correlated with the PFT parameters (r=-0.53, -0.43, -0.48, and -0.25), with forced expiratory volume in 1 second (FEV1; -0.81, -0.62, -0.75, and -0.40), and with diffusing capacity of the lungs for carbon monoxide (cDLco), respectively. The fraction of emphysema that shifted to the smaller subgroup showed a significant correlation with FEV1, cDLco, forced expiratory flow at 25%-75% of forced vital capacity, and residual volume (RV)/total lung capacity (r=0.56, 0.73, 0.40, and -0.58). A detailed assessment of the size variation and collapse of emphysema holes may be useful for understanding the dynamic collapse of emphysema and its functional relation.
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Affiliation(s)
| | | | | | - Namkug Kim
- Department of Radiology.,Department of Convergence Medicine
| | | | - Jae Seung Lee
- Department of Pulmonology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yeon Mok Oh
- Department of Pulmonology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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20
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Chen S, Wang C, Li B, Shi G, Li H, Zhang J, Gu Y, Zhou J, Song Y, Bai C. Risk factors for FEV 1 decline in mild COPD and high-risk populations. Int J Chron Obstruct Pulmon Dis 2017; 12:435-442. [PMID: 28184155 PMCID: PMC5291456 DOI: 10.2147/copd.s118106] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Early diagnosis of COPD is often not achieved due to limited recognition and limited access to the pulmonary function test. Our hypothesis was that lung function decline may be different between populations with mild COPD and those who are at high risk and do not receive treatment. Patients and methods Subjects with mild COPD and those from a high-risk COPD population were recruited from a community-based COPD epidemiological study after obtaining consent. Baseline clinical characteristics, symptom questionnaire, spirometry, low-dose computed tomography (LDCT) chest scan, and blood plasma biomarker data were collected initially and then 1 year later. Results A total of 617 participants were recruited, and 438 eventually completed the first-year follow-up visit; 72 participants (46 males) were in the mild COPD group, and 225 participants (165 males) were in the high-risk group. The mean forced expiratory volume in the first second of expiration (FEV1) decline in the mild COPD group was 129 mL, which was significantly higher than the 30 mL decline in the high-risk population group (P=0.005). Group category (odds ratio [OR] =0.230) and COPD Assessment Test (CAT) score (OR =9.912) were independent risk factors for an FEV1% predicted decline of >15% for all participants. In the mild COPD group, patients with a higher CAT (OR =5.310) and Emphysema Index (OR =5.681) were associated with a FEV1% predicted decline of >15% at the first-year follow-up. No factor showed a significantly predictive effect on FEV1 decline in the high-risk COPD group. Conclusion Group category was an independent influential factor associated with FEV1 decline.
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Affiliation(s)
- Shujing Chen
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University
| | - Changhui Wang
- Department of Pulmonary Medicine, Shanghai Tenth People's Hospital
| | - Bing Li
- Department of Pulmonary Medicine, Shanghai Changzheng Hospital
| | - Guochao Shi
- Department of Pulmonary Medicine, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Huiping Li
- Department of Pulmonary Medicine, Shanghai Pulmonary Hospital, Shanghai, People's Republic of China
| | - Jing Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University
| | - Yutong Gu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University
| | - Jian Zhou
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University
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21
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Adam RJ, Hisert KB, Dodd JD, Grogan B, Launspach JL, Barnes JK, Gallagher CG, Sieren JP, Gross TJ, Fischer AJ, Cavanaugh JE, Hoffman EA, Singh PK, Welsh MJ, McKone EF, Stoltz DA. Acute administration of ivacaftor to people with cystic fibrosis and a G551D-CFTR mutation reveals smooth muscle abnormalities. JCI Insight 2016; 1:e86183. [PMID: 27158673 DOI: 10.1172/jci.insight.86183] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Airflow obstruction is common in cystic fibrosis (CF), yet the underlying pathogenesis remains incompletely understood. People with CF often exhibit airway hyperresponsiveness, CF transmembrane conductance regulator (CFTR) is present in airway smooth muscle (ASM), and ASM from newborn CF pigs has increased contractile tone, suggesting that loss of CFTR causes a primary defect in ASM function. We hypothesized that restoring CFTR activity would decrease smooth muscle tone in people with CF. METHODS To increase or potentiate CFTR function, we administered ivacaftor to 12 adults with CF with the G551D-CFTR mutation; ivacaftor stimulates G551D-CFTR function. We studied people before and immediately after initiation of ivacaftor (48 hours) to minimize secondary consequences of CFTR restoration. We tested smooth muscle function by investigating spirometry, airway distensibility, and vascular tone. RESULTS Ivacaftor rapidly restored CFTR function, indicated by reduced sweat chloride concentration. Airflow obstruction and air trapping also improved. Airway distensibility increased in airways less than 4.5 mm but not in larger-sized airways. To assess smooth muscle function in a tissue outside the lung, we measured vascular pulse wave velocity (PWV) and augmentation index, which both decreased following CFTR potentiation. Finally, change in distensibility of <4.5-mm airways correlated with changes in PWV. CONCLUSIONS Acute CFTR potentiation provided a unique opportunity to investigate CFTR-dependent mechanisms of CF pathogenesis. The rapid effects of ivacaftor on airway distensibility and vascular tone suggest that CFTR dysfunction may directly cause increased smooth muscle tone in people with CF and that ivacaftor may relax smooth muscle. FUNDING This work was funded in part from an unrestricted grant from the Vertex Investigator-Initiated Studies Program.
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Affiliation(s)
- Ryan J Adam
- Department of Biomedical Engineering.,Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Katherine B Hisert
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Brenda Grogan
- National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - Janice L Launspach
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Charles G Gallagher
- National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | | | - Thomas J Gross
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Eric A Hoffman
- Department of Biomedical Engineering.,Department of Radiology, and
| | - Pradeep K Singh
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Michael J Welsh
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.,Department of Molecular Physiology and Biophysics.,Howard Hughes Medical Institute, and.,Pappajohn Biomedical Institute, University of Iowa, Iowa City, Iowa, USA
| | - Edward F McKone
- National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - David A Stoltz
- Department of Biomedical Engineering.,Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.,Department of Molecular Physiology and Biophysics.,Pappajohn Biomedical Institute, University of Iowa, Iowa City, Iowa, USA
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Comparison of a New Integral-Based Half-Band Method for CT Measurement of Peripheral Airways in COPD With a Conventional Full-Width Half-Maximum Method Using Both Phantom and Clinical CT Images. J Comput Assist Tomogr 2015; 39:428-36. [PMID: 25700223 DOI: 10.1097/rct.0000000000000218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare a new integral-based half-band method (IBHB) and a conventional full-width half-maximum (FWHM) method in measuring peripheral airway dimensions at airway phantoms and thin-section computed tomography of chronic obstructive pulmonary disease (COPD). METHODS The IBHB was validated and compared using airway phantoms and 50 patients with COPD. Airway parameters (wall area percentage [WA%], mean lumen radius, and mean wall thickness) were measured at fourth to sixth generations of the right apical bronchus. Matched results from 2 methods were compared and correlated with forced expiratory volume (FEV) in 1 second (FEV1), FEV1 / forced vital capacity (FVC), and global initiative for chronic obstructive lung disease (GOLD) stage. Linear regression analysis was performed using airway dimensions and emphysema index. RESULTS The IBHB generated more accurate measurements at phantom study. Measured airway parameters by both methods at thin-section computed tomography study were significantly different (all P < 0.05, paired t test). The IBHB method-measured WA% and wall thickness were significantly smaller. Mean WA% with IBHB also showed better correlation than that with FWHM (FEV1, r = -0.52 vs -0.28; FEV1 / FVC, r = -0.41 vs r = -0.20; GOLD, 0.52 vs 0.33, respectively). Linear regression analysis revealed fifth-generation WA% measured by IBHB was an independent variable, and addition to emphysema index increased predictability (FEV1, r = 0.63; FEV1 / FVC, r = 0.61; GOLD, r = 0.70). CONCLUSIONS The new IBHB measured peripheral airway dimensions differently than FWHM and showed better correlations with functional parameters in COPD.
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Xia Y, Guan Y, Fan L, Liu SY, Yu H, Zhao LM, Li B. Dynamic contrast enhanced magnetic resonance perfusion imaging in high-risk smokers and smoking-related COPD: correlations with pulmonary function tests and quantitative computed tomography. COPD 2015; 11:510-20. [PMID: 25211632 DOI: 10.3109/15412555.2014.948990] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study aimed to prospectively evaluate correlations between dynamic contrast-enhanced (DCE) MR perfusion imaging, pulmonary function tests (PFT) and volume quantitative CT in smokers with or without chronic obstructive pulmonary disease (COPD) and to determine the value of DCE-MR perfusion imaging and CT volumetric imaging on the assessment of smokers. According to the ATS/ERS guidelines, 51 male smokers were categorized into five groups: At risk for COPD (n = 8), mild COPD (n = 9), moderate COPD (n = 12), severe COPD (n = 10), and very severe COPD (n = 12). Maximum slope of increase (MSI), positive enhancement integral (PEI), etc. were obtained from MR perfusion data. The signal intensity ratio (RSI) of the PDs and normal lung was calculated (RSI = SIPD/SInormal). Total lung volume (TLV), total emphysema volume (TEV) and emphysema index (EI) were obtained from volumetric CT data. For "at risk for COPD," the positive rate of PDs on MR perfusion images was higher than that of abnormal changes on non-enhanced CT images (p < 0.05). Moderate-to-strong positive correlations were found between all the PFT parameters and SIPD, or RSI (r range 0.445∼0.683, p ≤ 0.001). TEV and EI were negatively correlated better with FEV1/FVC than other PFT parameters (r range -0.48 --0.63, p < 0.001). There were significant differences in RSI and SIPD between "at risk for COPD" and "very severe COPD," and between "mild COPD" and "very severe COPD". Thus, MR perfusion imaging may be a good approach to identify early evidence of COPD and may have potential to assist in classification of COPD.
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Affiliation(s)
- Yi Xia
- 1Department of Radiology, Changzheng Hospital of the Second Military Medical University , Shanghai , China
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Quantitative emphysema assessment of pulmonary function impairment by computed tomography in chronic obstructive pulmonary disease. J Comput Assist Tomogr 2015; 39:171-5. [PMID: 25474145 DOI: 10.1097/rct.0000000000000187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to determine the capability of quantitative emphysema by computed tomography (CT) to assess pulmonary function impairment in a population of current smokers with and without airflow limitation. METHODS Seventy-six subjects (30 normal smokers; 8 with mild obstruction; 17 with moderate obstruction; 13 with severe obstruction; 8 with very severe obstruction) underwent CT examinations and pulmonary function tests. For the quantitative assessment, percentages of low attenuation volume (%LAVs) of whole lung, right lung, left lung, and each lobe were obtained. Computed tomography measurements were related to lung function (forced expiratory volume in 1 second [FEV1], ratio of FEV1 to forced vital capacity, diffusing capacity for carbon monoxide [DLCO], ratio of residual volume to total lung capacity [RV/TLC]) by multivariate linear regression analysis. RESULTS Quantitative CT measurements of emphysema were moderately, negatively correlated to airflow limitation (FEV1 and ratio of FEV1 to forced vital capacity) (r = -0.68 to -0.52, P < 0.001). Except for right middle and lower lobes, all the quantitative CT measurements showed moderate, negative correlations with diffusing capacity (DLCO) (r = -0.63 to -0.54, P ≤ 0.001) and weak to moderate correlations with RV (RV/TLC) (r = 0.36-0.41, P < 0.01). As compared with control samples, the %LAV of whole lung, right lung, left lung, and each lobe was increased in patients with GOLD stages 2, 3, and 4 disease (P < 0.05), and the % LAV of whole lung, right lung and right upper lobe was increased in patients with GOLD stage 1 (P < 0.05). CONCLUSIONS Pulmonary function results, particularly DLCO and RV/TLC, were primarily affected by the % LAV of the upper lobes. Quantitative CT measurements of emphysema provides a morphological method to investigate lung function impairment in patients with chronic obstructive pulmonary disease.
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Guan Y, Xia Y, Fan L, Liu SY, Yu H, Li B, Zhao LM, Li B. Quantitative assessment of pulmonary perfusion using dynamic contrast-enhanced CT in patients with chronic obstructive pulmonary disease: correlations with pulmonary function test and CT volumetric parameters. Acta Radiol 2015; 56:573-80. [PMID: 24917608 DOI: 10.1177/0284185114535208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 04/18/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pulmonary function test (PFT) is commonly used to help diagnose chronic obstructive pulmonary disease (COPD) and other lung diseases. However, it cannot be used to evaluate regional function and morphological abnormalities. PURPOSE To quantitatively evaluate pulmonary perfusion imaging using dynamic contrast-enhanced (DCE) computed tomography (CT) and observe its correlations with PFT and CT volumetric parameters in COPD patients. MATERIAL AND METHODS PFT and CT pulmonary perfusion examination were performed in 63 COPD patients. Perfusion defects were quantitated by calculating the CT value ratio (RHU) between perfusion defects (HUdefect) and normal lung (HUnormal). Volumetric CT data were used to calculate emphysema index (EI), total lung volume (TLV), and total emphysema volume (TEV). Emphysematous parenchyma was defined as the threshold of lung area lower than -950 HU. Correlations between RHU and TLV, TEV, EI, and PFT were assessed using Spearman correlation analysis. RESULTS The positive rate of perfusion defects on CT perfusion images was higher than that of emphysema on CT mask images (χ(2) = 17.027, P < 0.001). The Spearman correlation test showed that RHU was positively correlated with FEV1 (R = 0.59, P < 0.001), FEV1% Predicted (R = 0.61, P < 0.001), FVC (R = 0.47, P = 0.002), and FEV1/FVC (R = 0.65, P < 0.001), and negatively correlated with EI (R = -0.67, P < 0.001). CONCLUSION CT perfusion imaging is more sensitive in detecting emphysema that is inconspicuous on CT images. RHU is correlated with PFT and CT volumetric parameters, suggesting that it is more sensitive in detecting early COPD changes and may prove to be a potential predictor of focal lung function.
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Affiliation(s)
- Yu Guan
- Department of Radiology, Changzheng Hospital of the Second Military Medical University, Shanghai, PR China
| | - Yi Xia
- Department of Radiology, Changzheng Hospital of the Second Military Medical University, Shanghai, PR China
| | - Li Fan
- Department of Radiology, Changzheng Hospital of the Second Military Medical University, Shanghai, PR China
| | - Shi-yuan Liu
- Department of Radiology, Changzheng Hospital of the Second Military Medical University, Shanghai, PR China
| | - Hong Yu
- Department of Radiology, Changzheng Hospital of the Second Military Medical University, Shanghai, PR China
| | - Bin Li
- Department of Radiology, Changzheng Hospital of the Second Military Medical University, Shanghai, PR China
| | - Li-ming Zhao
- Department of Respiration Medicine, Changzheng Hospital of the Second Military Medical University, Shanghai, PR China
| | - Bing Li
- Department of Respiration Medicine, Changzheng Hospital of the Second Military Medical University, Shanghai, PR China
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Yanagawa N, Kawata N, Matsuura Y, Sugiura T, Suzuki T, Kasai H, Irie R, Iesato K, Tada Y, Tanabe N, Suzuki Y, Tatsumi K. Effect of threshold on the correlation between airflow obstruction and low attenuation volume in smokers assessed by inspiratory and expiratory MDCT. Acta Radiol 2015; 56:438-46. [PMID: 24633696 DOI: 10.1177/0284185114528489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The estimation of emphysematous changes is very sensitive to computed tomography (CT) threshold level. In clinical practice, the predetermined threshold is usually set at -950 Hounsfield units (HU) for the detection of low attenuation volume (LAV). However, threshold levels that are tightly connected to pulmonary function abnormalities have not been determined. PURPOSE To determine the threshold level for calculating an LAV that closely reflects airflow limitation in patients with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS Seventy-six consecutive non-COPD smokers and COPD patients underwent paired inspiratory and expiratory multidetector CT (MDCT). LAV% was segmented every 10 HU between -1000 and -750 HU to examine the correlation between LAV% and indexes of obstructive impairment. RESULTS LAV% gradually increased as the threshold level increased on both inspiratory and expiratory images. LAV% on inspiratory images was higher than that on expiratory images at all threshold levels between -1000 and -750 HU. The threshold level that correlated with obstructive impairment differed between the two images: -930 HU on inspiratory and -870 or -880 HU on expiratory images. CONCLUSION LAV% dramatically changed according to the threshold level on both inspiratory and expiratory images, indicating that LAV% is dependent on the attenuation threshold level in patients with COPD. The threshold linking LAV% to airflow limitation was higher on expiratory than on inspiratory images.
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Affiliation(s)
- Noriyuki Yanagawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yukiko Matsuura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshio Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryosuke Irie
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ken Iesato
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoichi Suzuki
- Department of public Health, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Abstract
High-resolution chest computed tomography (CT) is one of the most useful techniques available for imaging bronchiolitis because it shows highly specific direct and indirect imaging signs. The distribution and combination of these various signs can further classify bronchiolitis as either cellular/inflammatory or fibrotic/constrictive. Emphysema is characterized by destruction of the airspaces, and a brief discussion of imaging findings of this class of disease is also included. Typical CT findings include destruction of airspace, attenuated vasculatures, and hyperlucent as well as hyperinflated lungs.
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Affiliation(s)
- Rachael M Edwards
- Department of Radiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
| | - Gregory Kicska
- Department of Radiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Rodney Schmidt
- Department of Pathology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Sudhakar N J Pipavath
- Department of Radiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
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Paired maximum inspiratory and expiratory plain chest radiographs for assessment of airflow limitation in chronic obstructive pulmonary disease. Eur J Radiol 2015; 84:726-31. [DOI: 10.1016/j.ejrad.2014.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/07/2014] [Accepted: 12/15/2014] [Indexed: 11/21/2022]
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A new quantitative index of lobar air trapping in chronic obstructive pulmonary disease (COPD): comparison with conventional methods. Eur J Radiol 2015; 84:963-74. [PMID: 25681134 DOI: 10.1016/j.ejrad.2014.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the usefulness of newly-proposed index (attenuation-volume index, AVI: increase in mean value of lung attenuation (MVLA) divided by volume decrease ratio (VDR)) for quantitative assessment of lobar air trapping (LAT) using expiratory/inspiratory (E/I) computed tomography (CT) by minimizing influence of respiratory level. MATERIALS AND METHODS Institutional review board approved study protocol. Twenty-one moderate or severe COPD (group A), 16 mild COPD (group B) and 26 normal volunteers (group C) underwent both E/I scans via 320-row CT and pulmonary functional test (PFT). Volume image data were automatically segmented into six lung lobes with minimal manual intervention. AVI, pixel index (PI), air trapping ratio (ATR) and relative volume change (RVC860-950) were calculated in total lung (TL) and each lobe. Four indices in TL were correlated with both PFT result and VDR and those in TL and each lobe were compared between three groups. RESULTS Similar to ATR, AVI correlated with both FEV1/FVC (r=0.772, p<0.01) and RV/TLC (r=-0.726, p<0.01) and demonstrated a significant difference between three groups in both TL (group A: 1.69±0.45, group B: 2.21±0.45 and group C: 2.80±0.44) and five lobes except for left lingular segment. In a lobe-based analysis regarding relationship with VDR, AVI was much less dependent than ATR, although regression lines of groups A and C were separated for AVI as well as ATR. Coefficient of variation of either PI or RVC860-950 was significantly larger than that of AVI. CONCLUSION AVI can be a more suitable CT index for quantitative evaluation of LAT, minimizing influence of respiratory level.
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Rutty GN, Biggs MJP, Brough A, Robinson C, Mistry R, Amoroso J, Deshpande A, Morgan B. Ventilated post-mortem computed tomography through the use of a definitive airway. Int J Legal Med 2014; 129:325-34. [PMID: 25524761 DOI: 10.1007/s00414-014-1135-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/08/2014] [Indexed: 11/30/2022]
Abstract
Ventilated post-mortem computed tomography (VPMCT) has been shown to achieve lung expansion in cadavers and has been proposed to enhance the diagnosis of lung pathology. Two key problems of the method of ventilation have been identified: firstly, the presence of head and neck rigor making airway insertion challenging and, secondly, air leak, if there is not a good seal around the airway, which diminishes lung expansion and causes inflation of the stomach. Simple procedures to insert a 'definitive' cuffed airway, which has a balloon inflated within the trachea, are therefore desirable. This study aims to test different procedures for inserting cuffed airways in cadavers and compare their ventilation efficacy and to propose a decision algorithm to select the most appropriate method. We prospectively tested variations on two ways of inserting a cuffed airway into the trachea: firstly, using an endotracheal tube (ET) approach, either blind or by direct visualisation, and, secondly, using a tracheostomy incision, either using a standard tracheostomy tube or shortened ET tube. We compare these approaches with a retrospective analysis of a previously reported series using supraglottic airways. All techniques, except 'blind' insertion of ET tubes, were possible with adequate placement of the airway in most cases. However, achieving both adequate insertion and a complete tracheal seal was better for definitive airways with 56 successful cases from 59 (95 %), compared with 9 cases from 18 (50 %) using supraglottic airways (p < 0.0001). Good lung expansion was achieved using all techniques if the airway was adequately positioned and achieved a good seal, and there was no significant chest pathology. We prefer inserting a shortened ET tube via a tracheostomy incision, as we find this the easiest technique to perform and train. Based on our experience, we have developed a decision algorithm to select the most appropriate method for VPMCT.
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Affiliation(s)
- Guy N Rutty
- East Midlands Forensic Pathology Unit, University of Leicester, Robert Kilpatrick Building, Leicester, LE2 7LX, UK,
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31
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Kitano M, Iwano S, Hashimoto N, Matsuo K, Hasegawa Y, Naganawa S. Lobar analysis of collapsibility indices to assess functional lung volumes in COPD patients. Int J Chron Obstruct Pulmon Dis 2014; 9:1347-56. [PMID: 25525352 PMCID: PMC4266257 DOI: 10.2147/copd.s72616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background We investigated correlations between lung volume collapsibility indices and pulmonary function test (PFT) results and assessed lobar differences in chronic obstructive pulmonary disease (COPD) patients, using paired inspiratory and expiratory three dimensional (3D) computed tomography (CT) images. Methods We retrospectively assessed 28 COPD patients who underwent paired inspiratory and expiratory CT and PFT exams on the same day. A computer-aided diagnostic system calculated total lobar volume and emphysematous lobar volume (ELV). Normal lobar volume (NLV) was determined by subtracting ELV from total lobar volume, both for inspiratory phase (NLVI) and for expiratory phase (NLVE). We also determined lobar collapsibility indices: NLV collapsibility ratio (NLVCR) (%) = (1 − NLVE/NLVI) × 100%. Associations between lobar volumes and PFT results, and collapsibility indices and PFT results were determined by Pearson correlation analysis. Results NLVCR values were significantly correlated with PFT results. Forced expiratory volume in 1 second, measured as percent of predicted results (FEV1%P) was significantly correlated with NLVCR values for the lower lobes (P<0.01), whereas this correlation was not significant for the upper lobes (P=0.05). FEV1%P results were also moderately correlated with inspiratory, expiratory ELV (ELVI,E) for the lower lobes (P<0.05). In contrast, the ratio of the diffusion capacity for carbon monoxide to alveolar gas volume, measured as percent of predicted (DLCO/VA%P) results were strongly correlated with ELVI for the upper lobes (P<0.001), whereas this correlation with NLVCR values was weaker for upper lobes (P<0.01) and was not significant for the lower lobes (P=0.26). Conclusion FEV1%P results were correlated with NLV collapsibility indices for lower lobes, whereas DLCO/VA%P results were correlated with NLV collapsibility indices and ELV for upper lobes. Thus, evaluating lobar NLV collapsibility might be useful for estimating pulmonary function in COPD patients.
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Affiliation(s)
- Mariko Kitano
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Keiji Matsuo
- Department of Radiology, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
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Morgan B, Adlam D, Robinson C, Pakkal M, Rutty GN. Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging. Br J Radiol 2014; 87:20130662. [PMID: 24338941 DOI: 10.1259/bjr.20130662] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The use of post-mortem imaging is expanding throughout the world with increasing use of advanced imaging techniques, such as contrast-enhanced CT and MRI. The questions asked of post-mortem imaging are complex and can be very different, for example for natural sudden death investigation will focus on the cause, whereas for trauma the cause of death is often clear, but injury patterns may be very revealing in investigating the background to the incident. Post-mortem imaging is different to clinical imaging regarding both the appearance of pathology and the information required, but there is much to learn from many years of clinical research in the use of these techniques. Furthermore, it is possible that post-mortem imaging research could be used not only for investigating the cause of death but also as a model to conduct clinically relevant research. This article reviews challenges to the development of post-mortem imaging for trauma, identification and cardiorespiratory death, and how they may be influenced by current clinical thinking and practice.
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Affiliation(s)
- B Morgan
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
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Lee JH, McDonald MLN, Cho MH, Wan ES, Castaldi PJ, Hunninghake GM, Marchetti N, Lynch DA, Crapo JD, Lomas DA, Coxson HO, Bakke PS, Silverman EK, Hersh CP. DNAH5 is associated with total lung capacity in chronic obstructive pulmonary disease. Respir Res 2014; 15:97. [PMID: 25134640 PMCID: PMC4169636 DOI: 10.1186/s12931-014-0097-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/07/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterized by expiratory flow limitation, causing air trapping and lung hyperinflation. Hyperinflation leads to reduced exercise tolerance and poor quality of life in COPD patients. Total lung capacity (TLC) is an indicator of hyperinflation particularly in subjects with moderate-to-severe airflow obstruction. The aim of our study was to identify genetic variants associated with TLC in COPD. METHODS We performed genome-wide association studies (GWASs) in white subjects from three cohorts: the COPDGene Study; the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE); and GenKOLS (Bergen, Norway). All subjects were current or ex-smokers with at least moderate airflow obstruction, defined by a ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) <0.7 and FEV1 < 80% predicted on post-bronchodilator spirometry. TLC was calculated by using volumetric computed tomography scans at full inspiration (TLCCT). Genotyping in each cohort was completed, with statistical imputation of additional markers. To find genetic variants associated with TLCCT, linear regression models were used, with adjustment for age, sex, pack-years of smoking, height, and principal components for genetic ancestry. Results were summarized using fixed-effect meta-analysis. RESULTS Analysis of a total of 4,543 COPD subjects identified one genome-wide significant locus on chromosome 5p15.2 (rs114929486, β = 0.42L, P = 4.66 × 10-8). CONCLUSIONS In COPD, TLCCT was associated with a SNP in dynein, axonemal, heavy chain 5 (DNAH5), a gene in which genetic variants can cause primary ciliary dyskinesia. DNAH5 could have an effect on hyperinflation in COPD.
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Affiliation(s)
- Jin Hwa Lee
- />Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
- />Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Merry-Lynn N McDonald
- />Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
| | - Michael H Cho
- />Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
- />Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA USA
| | - Emily S Wan
- />Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
- />Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA USA
| | - Peter J Castaldi
- />Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
| | - Gary M Hunninghake
- />Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA USA
| | - Nathaniel Marchetti
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, PA USA
| | | | | | - David A Lomas
- />Wolfson Institute for Biomedical Research, University College London, London, UK
| | - Harvey O Coxson
- />Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Per S Bakke
- />Department of Clinical Science, University of Bergen, Bergen, Norway
- />Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Edwin K Silverman
- />Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
- />Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA USA
| | - Craig P Hersh
- />Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
- />Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA USA
| | - the COPDGene and ECLIPSE Investigators
- />Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 USA
- />Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
- />Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, PA USA
- />National Jewish Health, Denver, CO USA
- />Wolfson Institute for Biomedical Research, University College London, London, UK
- />Department of Radiology, University of British Columbia, Vancouver, Canada
- />Department of Clinical Science, University of Bergen, Bergen, Norway
- />Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Correlation of pulmonary function indexes determined by low-dose MDCT with spirometric pulmonary function tests in patients with chronic obstructive pulmonary disease. AJR Am J Roentgenol 2014; 202:711-8. [PMID: 24660696 DOI: 10.2214/ajr.12.10501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the correlation between pulmonary function indexes determined by low-dose MDCT and those obtained from routine spirometric pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS Lung function of patients with COPD stages 0-III was evaluated by both MDCT and spirometric PFTs. Scanning was performed at maximum end-inspiration and maximum end-expiration. RESULTS A very strong correlation was found between extrapolated expiratory lung volume (LVex) and COPD stage (r = 0.802, p < 0.001) and between extrapolated LVex and the ratio of forced expiratory volume in 1 second and percentage forced vital capacity (FEV1/FVC%) (r = -0.831, p < 0.001). Moreover, strong positive correlations were found between inspiratory lung volume (LVin) and total lung capacity (TLC) (r = 0.658, p < 0.001), LVex and residual volume (RV) (r = 0.683, p < 0.001), extrapolated LVex and RV (r = 0.640, p < 0.001), LVex and RV/TLC (r = 0.602, p < 0.001), LVex/LVin and RV/TLC (r = 0.622, p < 0.001), extrapolated LVex and RV/TLC (r = 0.663, p < 0.001), and LVex and COPD stage (r = 0.697, p < 0.001). CONCLUSION Low-dose MDCT lung function indexes correlate well with spirometric PFT results, and the highest correlation is at end-expiration. Low-dose MDCT may be useful for evaluating lung function in patients with COPD.
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Iyer KS, Grout RW, Zamba GK, Hoffman EA. Repeatability and Sample Size Assessment Associated with Computed Tomography-Based Lung Density Metrics. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2014; 1:97-104. [PMID: 25553338 PMCID: PMC4278434 DOI: 10.15326/jcopdf.1.1.2014.0111#sthash.nxtderi7.dpuf] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES Density-based metrics assess severity of lung disease but vary with lung inflation and method of scanning. The aim of this study was to evaluate the repeatability of single center, CT-based density metrics of the lung in a normal population and assess study sample sizes needed to detect meaningful changes in lung density metrics when scan parameters and volumes are tightly controlled. MATERIALS AND METHODS Thirty-seven subjects (normal smokers and non-smokers) gave consent to have randomly assigned repeated, breath-held scans at either inspiration (90% vital capacity: TLC) or expiration (20% vital capacity: FRC). Repeated scans were analyzed for: mean lung density (MLD), 15th percentile point of the density histogram (P15), low attenuation areas (LAA) and alpha (fractal measure of hole size distribution). Using inter-subject differences and previously reported bias, sample size was estimated from month or yearly change in density metrics obtained from published literature (i.e. meaningful change). RESULTS Inter-scan difference measurements were small for density metrics (ICC > 0.80) and average ICCs for whole lung alpha-910 and alpha-950 were 0.57 and 0.64, respectively. Power analyses demonstrated that, under the control conditions with minimal extrinsic variation, population sizes needed to detect meaningful changes in density measures for TLC or FRC repeated scans ranged from a few (20-40) to a few hundred subjects, respectively. CONCLUSION A meaningful sample size was predicted from this study using volume-controlled normal subjects in a controlled imaging environment. Under proper breath-hold conditions, high repeatability was obtained in cohorts of normal smokers and non-smokers.
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Affiliation(s)
- Krishna S. Iyer
- Department of Radiology, University of Iowa, College of Medicine, Iowa City
- Department of Biomedical Engineering, University of Iowa, Iowa City
| | - Randall W. Grout
- Department of Radiology, University of Iowa, College of Medicine, Iowa City
| | | | - Eric A. Hoffman
- Department of Radiology, University of Iowa, College of Medicine, Iowa City
- Department of Biomedical Engineering, University of Iowa, Iowa City
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Lee JS, Lee SM, Seo JB, Lee SW, Huh JW, Oh YM, Lee SD. Clinical utility of computed tomographic lung volumes in patients with chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2013; 87:196-203. [PMID: 24334816 DOI: 10.1159/000355097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Published data concerning the utility of computed tomography (CT)-based lung volumes are limited to correlation with lung function. OBJECTIVES The aim of this study was to evaluate the clinical utility of the CT expiratory-to-inspiratory lung volume ratio (CT Vratio) by assessing the relationship with clinically relevant outcomes. METHODS A total of 75 stable chronic obstructive pulmonary disease (COPD) patients having pulmonary function testing and volumetric CT at full inspiration and expiration were retrospectively evaluated. Inspiratory and expiratory CT lung volumes were measured using in-house software. Correlation of the CT Vratio with patient-centered outcomes, including the modified Medical Research Council (MMRC) dyspnea score, the 6-min walk distance (6MWD), the St. George's Respiratory Questionnaire (SGRQ) score, and multidimensional COPD severity indices, such as the BMI, airflow obstruction, dyspnea, and exercise capacity index (BODE) and age, dyspnea, and airflow obstruction (ADO), were analyzed. RESULTS The CT Vratio correlated significantly with BMI (r = -0.528, p < 0.001). The CT Vratio was also significantly associated with MMRC dyspnea (r = 0.387, p = 0.001), 6MWD (r = -0.459, p < 0.001), and SGRQ (r = 0.369, p = 0.001) scores. Finally, the CT Vratio had significant correlations with the BODE and ADO multidimensional COPD severity indices (r = 0.605, p < 0.001; r = 0.411, p < 0.001). CONCLUSION The CT Vratio had significant correlations with patient-centered outcomes and multidimensional COPD severity indices.
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Affiliation(s)
- Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asthma Center and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Robinson C, Biggs MJ, Amoroso J, Pakkal M, Morgan B, Rutty GN. Post-mortem computed tomography ventilation; simulating breath holding. Int J Legal Med 2013; 128:139-46. [PMID: 24276489 DOI: 10.1007/s00414-013-0943-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/08/2013] [Indexed: 11/29/2022]
Abstract
Whilst the literature continues to report on advances in the use of post-mortem computed tomography (PMCT), particularly in relation to post-mortem angiography, there are few papers published that address the diagnostic problems related to post-mortem changes in the lungs and ventilation. We present a development of previous methods to achieve ventilated PMCT (VPMCT). We successfully introduced a supraglottic airway in 17/18 cases without causing overt damage, despite rigor mortis. Using a clinical portable ventilator, we delivered continuous positive airway pressure to mimic clinical breath-hold inspiratory scans. This caused significant lung expansion and a reduction in lung density and visible normal post-mortem changes. All thoracic pathology identified at autopsy, including pneumonia, was diagnosed on VPMCT in this small series. This technique provides a rapid form of VPMCT, which can be used in both permanent and temporary mortuaries, allowing for the post-mortem radiological comparison of pre-ventilation and post-ventilation images mimicking expiratory and inspiratory phases. We believe that it will enhance the diagnostic ability of PMCT in relation to lung pathology.
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Affiliation(s)
- C Robinson
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE2 7LX, UK
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Ohno Y, Nishio M, Koyama H, Yoshikawa T, Matsumoto S, Seki S, Obara M, van Cauteren M, Takahashi M, Sugimura K. Pulmonary 3 T MRI with ultrashort TEs: Influence of ultrashort echo time interval on pulmonary functional and clinical stage assessments of smokers. J Magn Reson Imaging 2013; 39:988-97. [DOI: 10.1002/jmri.24232] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/30/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yoshiharu Ohno
- Advanced Biomedical Imaging Research Center; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
- Division of Functional and Diagnostic Imaging Research, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
| | - Mizuho Nishio
- Division of Functional and Diagnostic Imaging Research, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
| | - Hisanobu Koyama
- Division of Radiology, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
| | - Takeshi Yoshikawa
- Advanced Biomedical Imaging Research Center; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
- Division of Functional and Diagnostic Imaging Research, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
| | - Sumiaki Matsumoto
- Advanced Biomedical Imaging Research Center; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
- Division of Functional and Diagnostic Imaging Research, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
| | - Shinichiro Seki
- Division of Radiology, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
| | | | | | - Masaya Takahashi
- Advanced Imaging Research Center; University of Texas Southwestern Medical Center; Houston Texas USA
| | - Kazuro Sugimura
- Division of Radiology, Department of Radiology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
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Makara M, Dennler M, Schnyder M, Bektas R, Kircher P, Hall E, Glaus T. Effect of ventilation technique and airway diameter on bronchial lumen to pulmonary artery diameter ratios in clinically normal beagle dogs. Vet Radiol Ultrasound 2013; 54:605-9. [PMID: 23815744 DOI: 10.1111/vru.12073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 05/18/2013] [Indexed: 01/17/2023] Open
Abstract
In dogs, a mean broncho-arterial ratio of 1.45 ± 0.21 has been previously defined as normal. These values were obtained in dogs under general inhalational anesthesia using a single breath-hold technique. The purpose of the study was to determine whether ventilation technique and bronchial diameter have an effect on broncho-arterial ratios. Four healthy Beagle dogs were scanned twice, each time with positive-pressure inspiration and end expiration. For each ventilation technique, broncho-arterial ratios were grouped into those obtained from small or large bronchi using the median diameter of the bronchi as the cutoff value. Mean broncho-arterial ratios obtained using positive-pressure inspiration (1.24 ± 0.23) were statistically greater than those obtained at end expiration (1.11 ± 0.20) P = 0.005. There was a strong positive correlation between bronchial diameter and broncho-arterial ratios for both ventilation techniques (positive-pressure inspiration rs = .786, P < 0.0005 and end expiration rs = .709, P < 0.0005). Mean broncho-arterial ratio for the large bronchi obtained applying positive-pressure inspiration was 1.39 cm ± 0.20 and during end expiration was 1.22 cm ± 0.20. Mean broncho-arterial ratio for the small bronchi obtained during positive-pressure inspiration was 1.08 cm ± 0.13 and during end expiration was 1.01 cm ± 0.13. There was a statistically significant difference between these groups (F = 248.60, P = 0.005). Findings indicated that reference values obtained using positive-pressure inspiration or from the larger bronchi may not be applicable to dogs scanned during end expiration or to the smaller bronchi.
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Affiliation(s)
- Mariano Makara
- Division of Diagnostic Imaging, Vetsuisse Faculty University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
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Matsuura Y, Kawata N, Yanagawa N, Sugiura T, Sakurai Y, Sato M, Iesato K, Terada J, Sakao S, Tada Y, Tanabe N, Suzuki Y, Tatsumi K. Quantitative assessment of cross-sectional area of small pulmonary vessels in patients with COPD using inspiratory and expiratory MDCT. Eur J Radiol 2013; 82:1804-10. [PMID: 23769190 DOI: 10.1016/j.ejrad.2013.05.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 03/01/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Structural and functional changes in pulmonary vessels are prevalent at the initial stages of chronic obstructive pulmonary disease (COPD). These vascular alterations can be assessed using cross-sectional area (CSA) of small pulmonary vessels. However, neither in non-COPD smokers nor in COPD patients it has been defined whether the structural changes of pulmonary vessels detected by paired inspiratory and expiratory CT scans are associated with emphysematous changes. We quantified the CSA and low attenuation area (LAA) and evaluated the changes in these parameters in the inspiratory and expiratory phases. MATERIALS AND METHODS Fifty consecutive non-COPD smokers and COPD patients were subjected to multi detector-row CT and the percentage of vessels with a CSA less than 5 mm(2) as well as the percentage LAA for total lung area (%CSA<5, %LAA, respectively) were calculated. RESULTS The %CSA<5 correlated negatively with %LAA. The %CSA<5 was lower in COPD patients with emphysema as compared with non-COPD smokers and COPD patients with or without mild emphysema. In addition, the %CSA<5 was lower in the no/mild emphysema subgroup as compared with non-COPD smokers. The respiratory phase change of %CSA<5 in COPD patients was greater than that in non-COPD smokers. CONCLUSION The percentage of small pulmonary vessels decreased as emphysematous changes increase, and this decrease was observed even in patients with no/mild emphysema. Furthermore, respiratory phase changes in CSA were higher in COPD patients than in non-COPD smokers.
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Affiliation(s)
- Yukiko Matsuura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan.
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Castillo R, Castillo E, Fuentes D, Ahmad M, Wood AM, Ludwig MS, Guerrero T. A reference dataset for deformable image registration spatial accuracy evaluation using the COPDgene study archive. Phys Med Biol 2013; 58:2861-77. [PMID: 23571679 DOI: 10.1088/0031-9155/58/9/2861] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Landmark point-pairs provide a strategy to assess deformable image registration (DIR) accuracy in terms of the spatial registration of the underlying anatomy depicted in medical images. In this study, we propose to augment a publicly available database (www.dir-lab.com) of medical images with large sets of manually identified anatomic feature pairs between breath-hold computed tomography (BH-CT) images for DIR spatial accuracy evaluation. Ten BH-CT image pairs were randomly selected from the COPDgene study cases. Each patient had received CT imaging of the entire thorax in the supine position at one-fourth dose normal expiration and maximum effort full dose inspiration. Using dedicated in-house software, an imaging expert manually identified large sets of anatomic feature pairs between images. Estimates of inter- and intra-observer spatial variation in feature localization were determined by repeat measurements of multiple observers over subsets of randomly selected features. 7298 anatomic landmark features were manually paired between the 10 sets of images. Quantity of feature pairs per case ranged from 447 to 1172. Average 3D Euclidean landmark displacements varied substantially among cases, ranging from 12.29 (SD: 6.39) to 30.90 (SD: 14.05) mm. Repeat registration of uniformly sampled subsets of 150 landmarks for each case yielded estimates of observer localization error, which ranged in average from 0.58 (SD: 0.87) to 1.06 (SD: 2.38) mm for each case. The additions to the online web database (www.dir-lab.com) described in this work will broaden the applicability of the reference data, providing a freely available common dataset for targeted critical evaluation of DIR spatial accuracy performance in multiple clinical settings. Estimates of observer variance in feature localization suggest consistent spatial accuracy for all observers across both four-dimensional CT and COPDgene patient cohorts.
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Affiliation(s)
- Richard Castillo
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Hackx M, Bankier AA, Gevenois PA. Chronic obstructive pulmonary disease: CT quantification of airways disease. Radiology 2012; 265:34-48. [PMID: 22993219 DOI: 10.1148/radiol.12111270] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide and results in substantial social and economic burdens. COPD is a heterogeneous disease with both extrapulmonary and pulmonary components. The pulmonary component is characterized by an airflow limitation that is not fully reversible. In the authors' opinion, none of the currently available classifications combining airflow limitation measurements with clinical parameters is sufficient to determine the prognosis and treatment of a particular patient with COPD. With regard to the causes of airflow limitation, CT can be used to quantify the two main contributions to COPD: emphysema, and small airways disease (a narrowing of the airways). CT quantification--with subsequent COPD phenotyping--can contribute to improved patient care, assessment of COPD progression, and identification of severe COPD with increasing risk of mortality. Small airways disease can be quantified through measurements reflecting morphology, quantification of obstruction, and changes in airways walls. This article details these three approaches and concludes with perspectives and directions for further research.
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Affiliation(s)
- Maxime Hackx
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
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Emphysema quantification by low-dose CT: potential impact of adaptive iterative dose reduction using 3D processing. AJR Am J Roentgenol 2012; 199:595-601. [PMID: 22915399 DOI: 10.2214/ajr.11.8174] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the effect of a novel reconstruction algorithm, adaptive iterative dose reduction using 3D processing, on emphysema quantification by low-dose CT. MATERIALS AND METHODS Twenty-six patients who had undergone standard-dose (150 mAs) and low-dose (25 mAs) CT scans were included in this retrospective study. Emphysema was quantified by several quantitative measures, including emphysema index given by the percentage of lung region with low attenuation (lower than -950 HU), the 15th percentile of lung density, and size distribution of low-attenuation lung regions, on standard-dose CT images reconstructed without adaptive iterative dose reduction using 3D processing and on low-dose CT images reconstructed both without and with adaptive iterative dose reduction using 3D processing. The Bland-Altman analysis was used to assess whether the agreement between emphysema quantifications on low-dose CT and on standard-dose CT was improved by the use of adaptive iterative dose reduction using 3D processing. RESULTS For the emphysema index, the mean differences between measurements on low-dose CT and on standard-dose CT were 1.98% without and -0.946% with the use of adaptive iterative dose reduction using 3D processing. For 15th percentile of lung density, the mean differences without and with adaptive iterative dose reduction using 3D processing were -6.67 and 1.28 HU, respectively. For the size distribution of low-attenuation lung regions, the ranges of the mean relative differences without and with adaptive iterative dose reduction using 3D processing were 21.4-85.5% and -14.1% to 11.2%, respectively. For 15th percentile of lung density and the size distribution of low-attenuation lung regions, the agreement was thus improved by the use of adaptive iterative dose reduction using 3D processing. CONCLUSION The use of adaptive iterative dose reduction using 3D processing resulted in greater consistency of emphysema quantification by low-dose CT, with quantification by standard-dose CT.
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Okada M, Kunihiro Y, Nakashima Y, Matsunaga N, Sano Y, Yuasa Y, Narazaki A, Kudomi S, Koike M, Kido S. The low attenuation area on dual-energy perfusion CT: Correlation with the pulmonary function tests and quantitative CT measurements. Eur J Radiol 2012; 81:2892-9. [DOI: 10.1016/j.ejrad.2011.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 11/01/2011] [Accepted: 11/02/2011] [Indexed: 10/14/2022]
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Van Tho N, Wada H, Ogawa E, Nakano Y. Recent findings in chronic obstructive pulmonary disease by using quantitative computed tomography. Respir Investig 2012; 50:78-87. [PMID: 23021766 DOI: 10.1016/j.resinv.2012.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 07/27/2012] [Accepted: 08/08/2012] [Indexed: 11/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible airflow limitation that results from a combination of airway wall remodeling and emphysematous lung destruction. Forced expiratory volume in 1s (FEV(1)) has been considered the gold standard for diagnosis, classification, and follow-up in patients with COPD, but it has certain limitations and it is still necessary to find other noninvasive modalities to complement FEV(1) to evaluate the effect of therapeutic interventions and the pathogenesis of COPD. Quantitative computed tomography (CT) has partly met this demand. The extent of emphysema and airway dimensions measured using quantitative CT are associated with morphological and functional changes and clinical symptoms in patients with COPD. Phenotyping COPD based on quantitative CT has facilitated interventional and genotypic studies. Recent advances in COPD findings with quantitative CT are discussed in this review.
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Affiliation(s)
- Nguyen Van Tho
- Division of Respiratory Medicine, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
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Song G, Mortani Barbosa E, Tustison N, Gefter WB, Kreider M, Gee JC, Torigian DA. A comparative study of HRCT image metrics and PFT values for characterization of ILD and COPD. Acad Radiol 2012; 19:857-64. [PMID: 22516670 DOI: 10.1016/j.acra.2012.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 01/23/2012] [Accepted: 03/02/2012] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to compare the performance of various image-based metrics computed from thoracic high-resolution computed tomography (HRCT) with data from pulmonary function testing (PFT) in characterizing interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS Fourteen patients with ILD and 11 with COPD had undergone both PFT and HRCT within 3 days. For each patient, 93 image-based metrics were computed, and their relationships with the 21 clinically used PFT parameters were analyzed using a minimal-redundancy-maximal-relevance statistical framework. The first 20 features were selected among the total of 114 mixed image metrics and PFT values in the characterization of ILD and COPD. RESULTS Among the best-performing 20 features, 14 were image metrics, derived from attenuation histograms and texture descriptions. The highest relevance value computed from PFT parameters was 0.47, and the highest from image metrics was 0.52, given the theoretical bound as [0, 0.69]. The ILD or COPD classifier using the first four features achieved a 1.92% error rate. CONCLUSIONS Some image metrics are not only as good discriminators as PFT for the characterization of ILD and COPD but are also not redundant when PFT values are provided. Image metrics of attenuation histogram statistics and texture descriptions may be valuable for further investigation in computer-assisted diagnosis.
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Xie X, de Jong PA, Oudkerk M, Wang Y, Ten Hacken NHT, Miao J, Zhang G, de Bock GH, Vliegenthart R. Morphological measurements in computed tomography correlate with airflow obstruction in chronic obstructive pulmonary disease: systematic review and meta-analysis. Eur Radiol 2012; 22:2085-93. [PMID: 22699870 PMCID: PMC3431473 DOI: 10.1007/s00330-012-2480-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/20/2012] [Accepted: 03/26/2012] [Indexed: 01/08/2023]
Abstract
Objectives To determine the correlation between CT measurements of emphysema or peripheral airways and airflow obstruction in chronic obstructive pulmonary disease (COPD). Methods PubMed, Embase and Web of Knowledge were searched from 1976 to 2011. Two reviewers independently screened 1,763 citations to identify articles that correlated CT measurements to airflow obstruction parameters of the pulmonary function test in COPD patients, rated study quality and extracted information. Three CT measurements were accessed: lung attenuation area percentage < -950 Hounsfield units, mean lung density and airway wall area percentage. Two airflow obstruction parameters were accessed: forced expiratory volume in the first second as percentage from predicted (FEV1 %pred) and FEV1 divided by the forced volume vital capacity. Results Seventy-nine articles (9,559 participants) were included in the systematic review, demonstrating different methodologies, measurements and CT airflow obstruction correlations. There were 15 high-quality articles (2,095 participants) in the meta-analysis. The absolute pooled correlation coefficients ranged from 0.48 (95 % CI, 0.40 to 0.54) to 0.65 (0.58 to 0.71) for inspiratory CT and 0.64 (0.53 to 0.72) to 0.73 (0.63 to 0.80) for expiratory CT. Conclusions CT measurements of emphysema or peripheral airways are significantly related to airflow obstruction in COPD patients. CT provides a morphological method to investigate airway obstruction in COPD. Key Points • Computed tomography is widely performed in patients with chronic obstructive pulmonary disease (COPD) • CT provides quantitative morphological methods to investigate airflow obstruction in COPD • CT measurements correlate significantly with the degree of airflow obstruction in COPD • Expiratory CT measurements correlate more strongly with airflow obstruction than inspiratory CT • Low-dose CT decreases the radiation dose for diagnosis and quantitative emphysema evaluation Electronic supplementary material The online version of this article (doi:10.1007/s00330-012-2480-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xueqian Xie
- Center for Medical Imaging-North East Netherlands (CMI-NEN), Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700, RB, Groningen, The Netherlands
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Henao-Guerrero N, Ricco C, Jones JC, Buechner-Maxwell V, Daniel GB. Comparison of four ventilatory protocols for computed tomography of the thorax in healthy cats. Am J Vet Res 2012; 73:646-53. [DOI: 10.2460/ajvr.73.5.646] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kimura T, Nishibuchi I, Murakami Y, Kenjo M, Kaneyasu Y, Nagata Y. Functional Image-Guided Radiotherapy Planning in Respiratory-Gated Intensity-Modulated Radiotherapy for Lung Cancer Patients With Chronic Obstructive Pulmonary Disease. Int J Radiat Oncol Biol Phys 2012; 82:e663-70. [DOI: 10.1016/j.ijrobp.2011.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 06/27/2011] [Accepted: 08/05/2011] [Indexed: 11/28/2022]
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Murphy K, Pluim JPW, van Rikxoort EM, de Jong PA, de Hoop B, Gietema HA, Mets O, de Bruijne M, Lo P, Prokop M, Ginneken BV. Toward automatic regional analysis of pulmonary function using inspiration and expiration thoracic CT. Med Phys 2012; 39:1650-62. [DOI: 10.1118/1.3687891] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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