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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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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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Ohno Y, Hanamatsu S, Obama Y, Ueda T, Ikeda H, Hattori H, Murayama K, Toyama H. Overview of MRI for pulmonary functional imaging. Br J Radiol 2021; 95:20201053. [PMID: 33529053 DOI: 10.1259/bjr.20201053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Morphological evaluation of the lung is important in the clinical evaluation of pulmonary diseases. However, the disease process, especially in its early phases, may primarily result in changes in pulmonary function without changing the pulmonary structure. In such cases, the traditional imaging approaches to pulmonary morphology may not provide sufficient insight into the underlying pathophysiology. Pulmonary imaging community has therefore tried to assess pulmonary diseases and functions utilizing not only nuclear medicine, but also CT and MR imaging with various technical approaches. In this review, we overview state-of-the art MR methods and the future direction of: (1) ventilation imaging, (2) perfusion imaging and (3) biomechanical evaluation for pulmonary functional imaging.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan.,Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan
| | - Satomu Hanamatsu
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yuki Obama
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hidekazu Hattori
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Kazuhiro Murayama
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
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Dynamic respiratory muscle function in late-onset Pompe disease. Sci Rep 2019; 9:19006. [PMID: 31831753 PMCID: PMC6908708 DOI: 10.1038/s41598-019-54314-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/07/2019] [Indexed: 02/02/2023] Open
Abstract
Maximal inspiratory pressure (PIMAX) reflects inspiratory weakness in late-onset Pompe disease (LOPD). However, static pressure tests may not reveal specific respiratory muscle adaptations to disruptions in breathing. We hypothesized that dynamic respiratory muscle functional tests reflect distinct ventilatory compensations in LOPD. We evaluated LOPD (n = 7) and healthy controls (CON, n = 7) during pulmonary function tests, inspiratory endurance testing, dynamic kinematic MRI of the thorax, and ventilatory adjustments to single-breath inspiratory loads (inspiratory load compensation, ILC). We observed significantly lower static and dynamic respiratory function in LOPD. PIMAX, spirometry, endurance time, and maximal diaphragm descent were significantly correlated. During single-breath inspiratory loads, inspiratory time and airflow acceleration increased to preserve volume, and in LOPD, the response magnitudes correlated to maximal chest wall kinematics. The results indicate that changes in diaphragmatic motor function and strength among LOPD subjects could be detected through dynamic respiratory testing. We concluded that neuromuscular function significantly influenced breathing endurance, timing and loading compensations.
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Mueller J, Karrasch S, Lorbeer R, Ivanovska T, Pomschar A, Kunz WG, von Krüchten R, Peters A, Bamberg F, Schulz H, Schlett CL. Automated MR-based lung volume segmentation in population-based whole-body MR imaging: correlation with clinical characteristics, pulmonary function testing and obstructive lung disease. Eur Radiol 2018; 29:1595-1606. [PMID: 30151641 DOI: 10.1007/s00330-018-5659-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/26/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Whole-body MR imaging is increasingly utilised; although for lung dedicated sequences are often not included, the chest is typically imaged. Our objective was to determine the clinical utility of lung volumes derived from non-dedicated MRI sequences in the population-based KORA-FF4 cohort study. METHODS 400 subjects (56.4 ± 9.2 years, 57.6% males) underwent whole-body MRI including a coronal T1-DIXON-VIBE sequence in inspiration breath-hold, originally acquired for fat quantification. Based on MRI, lung volumes were derived using an automated framework and related to common predictors, pulmonary function tests (PFT; spirometry and pulmonary gas exchange, n = 214) and obstructive lung disease. RESULTS MRI-based lung volume was 4.0 ± 1.1 L, which was 64.8 ± 14.9% of predicted total lung capacity (TLC) and 124.4 ± 27.9% of functional residual capacity. In multivariate analysis, it was positively associated with age, male, current smoking and height. Among PFT indices, MRI-based lung volume correlated best with TLC, alveolar volume and residual volume (RV; r = 0.57 each), while it was negatively correlated to FEV1/FVC (r = 0.36) and transfer factor for carbon monoxide (r = 0.16). Combining the strongest PFT parameters, RV and FEV1/FVC remained independently and incrementally associated with MRI-based lung volume (β = 0.50, p = 0.04 and β = - 0.02, p = 0.02, respectively) explaining 32% of the variability. For the identification of subjects with obstructive lung disease, height-indexed MRI-based lung volume yielded an AUC of 0.673-0.654. CONCLUSION Lung volume derived from non-dedicated whole-body MRI is independently associated with RV and FEV1/FVC. Furthermore, its moderate accuracy for obstructive lung disease indicates that it may be a promising tool to assess pulmonary health in whole-body imaging when PFT is not available. KEY POINTS • Although whole-body MRI often does not include dedicated lung sequences, lung volume can be automatically derived using dedicated segmentation algorithms • Lung volume derived from whole-body MRI correlates with typical predictors and risk factors of respiratory function including smoking and represents about 65% of total lung capacity and 125% of the functional residual capacity • Lung volume derived from whole-body MRI is independently associated with residual volume and the ratio of forced expiratory volume in 1 s to forced vital capacity and may allow detection of obstructive lung disease.
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Affiliation(s)
- Jan Mueller
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Stefan Karrasch
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Roberto Lorbeer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Tatyana Ivanovska
- Department of Computational Neuroscience, Computer Vision, Georg-August-University, Gottingen, Germany
| | - Andreas Pomschar
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Ricarda von Krüchten
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Institute for Cardiovascular Prevention, Ludwig-Maximilian-University-Hospital, Munich, Germany.,German Center for Cardiovascular Disease Research (DZHK e.V.), Partnersite Munich, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - Holger Schulz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. .,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
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7
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Martini K, Caviezel C, Schneiter D, Milanese G, Opitz I, Weder W, Frauenfelder T. Dynamic magnetic resonance imaging as an outcome predictor for lung-volume reduction surgery in patients with severe emphysema†. Eur J Cardiothorac Surg 2018; 55:446-454. [DOI: 10.1093/ejcts/ezy277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/29/2018] [Accepted: 07/08/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katharina Martini
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Gianluca Milanese
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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8
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Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. One of the main findings is pulmonary emphysema in association with chronic bronchitis. Clinical signs, pulmonary function tests and imaging are the current used methods to diagnose and stage emphysema. Lung volume reduction (LVR) and endoscopic lung volume reduction (ELVR) are the current therapeutic options beside lung transplantation in cases of severe emphysema. Nowadays imaging is one of the key factors for the success of these therapies. Especially quantitative computed tomography (CT) with its increasing possibilities has become a viable tool, providing detailed information about distribution and heterogeneity of emphysema. Other imaging techniques like dual-energy CT (DECT) and functional magnetic resonance (MR) have shown to add functional information. These structural and functional information support thoracic surgeons and interventional pulmonologists in selecting patients and optimizing LVR procedures but also enables the development of new endobronchial therapies. Imaging will further improve the individual outcome by supporting the choice of optimal therapy.
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Affiliation(s)
- Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Kinematic Magnetic Resonance Imaging of the Thorax Using 2-Dimensional Balanced Subsecond Steady-state Free Precession Sequence During Forced Breathing in Comparison With Spirometry. J Thorac Imaging 2018; 33:184-190. [DOI: 10.1097/rti.0000000000000314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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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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11
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Abstract
Pulmonary magnetic resonance (MR) imaging has been put forward as a new research and diagnostic tool mainly to overcome the limitations of computed tomography and nuclear medicine studies. However, pulmonary MR imaging has been difficult to use because of inherently low proton density, a multitude of air-tissue interfaces, which create significant magnetic field distortions and are commonly referred to as susceptibility artifacts; diminishing signal in the lung; and respiratory and/or cardiac motion artifacts. To overcome these drawbacks of pulmonary MR imaging, technical advances made during the last decade in sequencing, scanner and coil, adaptation of parallel imaging techniques, and utilization of contrast media have been reported as being useful for functional and morphologic assessment of various pulmonary diseases including airway diseases. This review article covers (1) pulmonary MR techniques for morphologic and functional assessment of airway diseases, and (2) pulmonary MR imaging for cystic fibrosis, asthma, and chronic obstructive pulmonary disease. Pulmonary MR imaging provides not only morphology-related but also pulmonary function-related information. It has the potential to replace nuclear medicine studies for the identification of regional pulmonary function and may perform a complementary role in airway disease assessment instead of nuclear medicine study. We believe that the findings of further basic studies as well as clinical applications of this new technique will validate the real significance of pulmonary MR imaging for the future of airway disease assessment and its usefulness for diagnostic radiology and pulmonary medicine.
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12
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Garfield JL, Marchetti N, Gaughan JP, Steiner RM, Criner GJ. Total lung capacity by plethysmography and high-resolution computed tomography in COPD. Int J Chron Obstruct Pulmon Dis 2012; 7:119-26. [PMID: 22399851 PMCID: PMC3292389 DOI: 10.2147/copd.s26419] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To characterize and compare total lung capacity (TLC) measured by plethysmography with high-resolution computed tomography (HRCT), and to identify variables that predict the difference between the two modalities. METHODS Fifty-nine consecutive patients referred for the evaluation of COPD were retrospectively reviewed. Patients underwent full pulmonary function testing and HRCT within 3 months. TLC was obtained by plethysmography as per American Thoracic Society/European Respiratory Society standards and by HRCT using custom software on 0.75 and 5 mm thick contiguous slices performed at full inspiration (TLC). RESULTS TLC measured by plethysmography correlated with TLC measured by inspiratory HRCT (r = 0.92, P < 0.01). TLC measured by plethysmography was larger than that determined by inspiratory HRCT in most patients (mean of 6.46 ± 1.28 L and 5.34 ± 1.20 L respectively, P < 0.05). TLC measured by both plethysmography and HRCT correlated significantly with indices of airflow obstruction (forced expiratory volume in 1 second/forced vital capacity [FVC] and FVC%), static lung volumes (residual volume, percent predicted [RV%], total lung capacity, percent predicted [TLC%], functional residual capacity, percent predicted [FRC%], and inspiratory capacity, percent predicted), and percent emphysema. TLC by plethysmography and HRCT both demonstrated significant inverse correlations with diffusion impairment. The absolute difference between TLC measured by plethysmography and HRCT increased as RV%, TLC%, and FRC% increased. Gas trapping (RV% and FRC%) independently predicted the difference in TLC between plethysmography and HRCT. CONCLUSION In COPD, TLC by plethysmography can be up to 2 L greater than inspiratory HRCT. Gas trapping independently predicts patients for whom TLC by plethysmography differs significantly from HRCT.
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Affiliation(s)
- Jamie L Garfield
- Department of Pulmonary and Critical Care Medicine and Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
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13
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Tetzlaff R, Eichinger M. [Magnetic resonance imaging of respiratory movement and lung function]. Radiologe 2009; 49:712-9. [PMID: 19693620 DOI: 10.1007/s00117-009-1881-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Lung function measurements are the domain of spirometry or plethysmography. These methods have proven their value in clinical practice, nevertheless, being global measurements the functional indices only describe the sum of all functional units of the lung. Impairment of only a single component of the respiratory pump or of a small part of lung parenchyma can be compensated by unaffected lung tissue. Dynamic imaging can help to detect such local changes and lead to earlier adapted therapy. Magnetic resonance imaging (MRI) seems to be perfect for this application as it is not hampered by image distortion as is projection radiography and it does not expose the patient to potentially harmful radiation like computed tomography. Unfortunately, lung parenchyma is not easy to image using MRI due to its low signal intensity. For this reason first applications of MRI in lung function measurements concentrated on the movement of the thoracic wall and the diaphragm. Recent technical advances in MRI however might allow measurements of regional dynamics of the lungs.
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Affiliation(s)
- R Tetzlaff
- Abteilung Radiologie (E010), Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120 Heidelberg.
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Lung motion and volume measurement by dynamic 3D MRI using a 128-channel receiver coil. Acad Radiol 2009; 16:22-7. [PMID: 19064208 DOI: 10.1016/j.acra.2008.07.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 07/01/2008] [Accepted: 07/07/2008] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES The authors present their initial experience using a 3-T whole-body scanner equipped with a 128-channel coil applied to lung motion assessment. Recent improvements in fast magnetic resonance imaging (MRI) technology have enabled several trials of free-breathing three-dimensional (3D) imaging of the lung. A large number of image frames necessarily increases the difficulty of image analysis and therefore warrants automatic image processing. However, the intensity homogeneities of images of prior dynamic 3D lung MRI studies have been insufficient to use such methods. In this study, initial data were obtained at 3 T with a 128-channel coil that demonstrate the feasibility of acquiring multiple sets of 3D pulmonary scans during free breathing and that have sufficient quality to be amenable to automatic segmentation. MATERIALS AND METHODS Dynamic 3D images of the lungs of two volunteers were acquired with acquisition times of 0.62 to 0.76 frames/s and an image matrix of 128 x 128, with 24 to 30 slice encodings. The volunteers were instructed to take shallow and deep breaths during the scans. The variation of lung volume was measured from the segmented images. RESULTS Dynamic 3D images were successfully acquired for both respiratory conditions for each subject. The images showed whole-lung motion, including lifting of the chest wall and the displacement of the diaphragm, with sufficient contrast to distinguish these structures from adjacent tissues. The average time to complete segmentation for one 3D image was 4.8 seconds. The tidal volume measured was consistent with known tidal volumes for healthy subjects performing deep-breathing maneuvers. The temporal resolution was insufficient to measure tidal volumes for shallow breathing. CONCLUSION This initial experience with a 3-T whole-body scanner and a 128-channel coil showed that the scanner and imaging protocol provided dynamic 3D images with spatial and temporal resolution sufficient to delineate the diaphragmatic domes and chest wall during active breathing. In addition, the intensity homogeneities and signal-to-noise ratio were adequate to perform automatic segmentation.
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Eichinger M, Tetzlaff R, Puderbach M, Woodhouse N, Kauczor HU. Proton magnetic resonance imaging for assessment of lung function and respiratory dynamics. Eur J Radiol 2007; 64:329-34. [PMID: 17889475 DOI: 10.1016/j.ejrad.2007.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 07/31/2007] [Accepted: 08/01/2007] [Indexed: 10/22/2022]
Abstract
Since many pulmonary diseases present with a variable regional involvement, modalities for assessment of regional lung function gained increasing attention over the last years. Together with lung perfusion and gas exchange, ventilation, as a result of the interaction of the respiratory pump and the lungs, is an indispensable component of lung function. So far, this complex mechanism is still mainly assessed indirectly and globally. A differentiation between the individual determining factors of ventilation would be crucial for precise diagnostics and adequate treatment. By dynamic imaging of the respiratory pump, the mechanical components of ventilation can be assessed regionally. Amongst imaging modalities applicable to this topic, magnetic resonance imaging (MRI), as a tool not relying on ionising radiation, is the most attractive. Recent advances in MRI technology have made it possible to assess diaphragmatic and chest wall motion, static and dynamic lung volumes, as well as regional lung function. Even though existing studies show large heterogeneity in design and applied methods, it becomes evident that MRI is capable to visualise pulmonary function as well as diaphragmatic and thoracic wall movement, providing new insights into lung physiology. Partly contradictory results and conclusions are most likely caused by technical limitations, limited number of studies and small sample size. Existing studies mainly evaluate possible imaging techniques and concentrate on normal physiology. The few studies in patients with lung cancer and emphysema already give a promising outlook for these techniques from which an increasing impact on improved and quantitative disease characterization as well as better patient management can be expected.
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Affiliation(s)
- Monika Eichinger
- Department of Radiology (E010), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
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Chu WC, Ng BK, Li AM, Lam TP, Lam WW, Cheng JC. Dynamic magnetic resonance imaging in assessing lung function in adolescent idiopathic scoliosis: a pilot study of comparison before and after posterior spinal fusion. J Orthop Surg Res 2007; 2:20. [PMID: 18021435 PMCID: PMC2203977 DOI: 10.1186/1749-799x-2-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Accepted: 11/19/2007] [Indexed: 11/10/2022] Open
Abstract
Background Restrictive impairment is the commonest reported pulmonary deficit in AIS, which improves following surgical operation. However, exact mechanism of how improvement is brought about is unknown. Dynamic fast breath-hold (BH)-MR imaging is a recent advance which provides direct quantitative visual assessment of pulmonary function. By using above technique, change in lung volume, chest wall and diaphragmatic motion in AIS patients before and six months after posterior spinal fusion surgery were measured. Methods 16 patients with severe right-sided predominant thoracic scoliosis (standing Cobb's angle 50° -82°, mean 60°) received posterior spinal fusion without thoracoplasty were recruited into this study. BH-MR sequences were used to obtain coronal images of the whole chest during full inspiration and expiration. The following measurements were assessed: (1) inspiratory, expiratory and change in lung volume; (2) change in anteroposterior (AP) and transverse (TS) diameter of the chest wall at two levels: carina and apex (3) change in diaphragmatic heights. The changes in parameters before and after operation were compared using Wilcoxon signed ranks test. Patients were also asked to score their breathing effort before and after operation using a scale of 1–9 with ascending order of effort. The degree of spinal surgical correction at three planes was also assessed by reformatted MR images and correction rate of Cobb's angle was calculated. Results The individual or total inspiratory and expiratory volume showed slight but insignificant increase after operation. There was significantly increase in bilateral TS chest wall movement at carina level and increase in bilateral diaphragmatic movements between inspiration and expiration. The AP chest wall movements, however, did not significantly change. The median breathing effort after operation was lower than that before operation (p < 0.05). There was significant reduction in coronal Cobb's angle after operation but the change in sagittal and axial angle at scoliosis apex was not significant. Conclusion There is improvement of lateral chest wall and diaphragmatic motions in AIS patients six months after posterior spinal fusion, associated with subjective symptomatic improvement. Lung volumes however, do not significantly change after operation. BH-MR is novel non-invasive method for long term post operative assessment of pulmonary function in AIS patients.
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Affiliation(s)
- Winnie Cw Chu
- Departments of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
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Chu WCW, Li AM, Ng BKW, Chan DFY, Lam TP, Lam WWM, Cheng JCY. Dynamic magnetic resonance imaging in assessing lung volumes, chest wall, and diaphragm motions in adolescent idiopathic scoliosis versus normal controls. Spine (Phila Pa 1976) 2006; 31:2243-9. [PMID: 16946662 DOI: 10.1097/01.brs.0000232822.74349.32] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Dynamic breath-hold (BH)- magnetic resonance (MR) imaging was used to evaluate lung function in adolescent idiopathic scoliosis (AIS). OBJECTIVES Changes in lung volume, chest wall, and diaphragmatic motions were evaluated in AIS patients and compared with normal controls. SUMMARY OF BACKGROUND DATA Little is known about whether pulmonary function impairment in AIS is related to restriction of lung volume, poor chest wall expansibility, or impaired diaphragmatic motion. This is a study on the underlying pathophysiology of the abnormal pulmonary function in AIS using the ultrafast BH-MR imaging technique. METHODS Forty-two patients with moderate to severe right thoracic scoliosis (Cobb angle, 40 degrees -98 degrees), 22 patients with mild right thoracic scoliosis (Cobb angle 10 degrees -30 degrees), and 12 healthy subjects (age ranged, 11-18 years; all girls) were recruited for the following assessments: 1) inspiratory, expiratory, and change in lung volume; 2) change in anteroposterior (AP) and transverse (TS) diameter of the chest wall at two levels: carina and apical vertebra level; and 3) change in diaphragmatic heights. RESULTS Inspiratory, expiratory lung volume and diaphragmatic heights were significantly reduced in the severe scoliosis group (P < 0.05), but the change in lung volume was not affected. There was no significant difference in the change of AP or TS diameter of the chest wall as well as diaphragmatic motions among groups. CONCLUSION Impairment in lung function in AIS patients is predominantly due to restriction of lung volume.
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Affiliation(s)
- Winnie C W Chu
- Department of Diagnostic Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Plathow C, Schoebinger M, Fink C, Ley S, Puderbach M, Eichinger M, Bock M, Meinzer HP, Kauczor HU. Evaluation of lung volumetry using dynamic three-dimensional magnetic resonance imaging. Invest Radiol 2006; 40:173-9. [PMID: 15714092 DOI: 10.1097/00004424-200503000-00007] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES We sought to investigate lung volume and surface measurements during the breathing cycle using dynamic three-dimensional magnetic resonance imaging (3D MRI). MATERIALS AND METHODS Breathing cycles of 20 healthy volunteers were examined using a 2D trueFISP sequence (3 images/second) in combination with a model and segmented 3D FLASH sequence (1 image/second) MR images using view sharing. Segmentation was performed semiautomatically using an interactive region growing technique. Vital capacity (VC) was calculated from MRI using the model (2D) and counting the voxels (3D) and was compared with spirometry. RESULTS VC from spirometry was 4.9+/-0.9 L, 4.4+/-1.2 L from 2D MRI measurement, and 4.7+/-0.9 L for 3D MRI. Using the 3D technique, correlation to spirometry was higher than using the 2D technique (r>0.95 vs. r>0.83). Using the 3D technique, split lung volumes and lung surface could be calculated. There was a significant difference between the left and right lung volume in expiration (P<0.05). CONCLUSIONS Dynamic 3D MRI is a noninvasive tool to evaluate split lung volumes and lung surfaces during the breathing cycle with a high correlation to spirometry.
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Affiliation(s)
- Christian Plathow
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
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Plathow C, Fink C, Sandner A, Ley S, Puderbach M, Eichinger M, Schmähl A, Kauczor HU. Comparison of relative forced expiratory volume of one second with dynamic magnetic resonance imaging parameters in healthy subjects and patients with lung cancer. J Magn Reson Imaging 2005; 21:212-8. [PMID: 15723381 DOI: 10.1002/jmri.20255] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To assess relative forced expiratory volume in one second (FEV1/vital capacity (VC)) in healthy subjects and patients with a lung tumor using dynamic magnetic resonance imaging (dMRI) parameters. MATERIALS AND METHODS In 15 healthy volunteers and 31 patients with a non-small-cell lung carcinoma stage I (NSCLC I), diaphragmatic length change (LE1) and craniocaudal (CC) intrathoracic distance change within one second from maximal inspiration (DE1) were divided by total length change (LE(total), DE(total)) as a surrogate of spirometric FEV1/VC using a true fast imaging with steady-state precession (trueFISP) sequence (TE/TR = 1.7/37.3 msec, temporal resolution = 3 images/second). Influence of tumor localization was examined. RESULTS In healthy volunteers FEV1/VC showed a highly significant correlation with LE1/LE(total) and DE1/DE(total) (r > 0.9, P < 0.01). In stage IB tumor patients, comparing tumor-bearing with the non-tumor-bearing hemithorax, there was a significant difference in tumors of the middle (LE1/LE(total) = 0.63 +/- 0.05 vs. 0.73 +/- 0.04, DE1/DE(total) = 0.66 +/- 0.05 vs. 0.72 +/- 0.04; P < 0.05) and lower (P < 0.05) lung region. Stage IA tumor patients showed no significant differences with regard to healthy subjects. CONCLUSION dMRI is a simple noninvasive method to locally determine LE1/LE(total) and DE1/DE(total) as a surrogate of FEV1/VC in volunteers and patients. Tumors of the middle and lower lung regions have a significant influence on these MRI parameters.
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Affiliation(s)
- Christian Plathow
- Department of Radiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany.
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Awai K, Utsunomiya D, Imuta M, Shiraishi S, Yamashita Y, Nishimura Y, Sato N, Kudo M. Retrospective Respiration-Gated MDCT: Initial Results in Canine Models. AJR Am J Roentgenol 2004; 183:79-81. [PMID: 15208114 DOI: 10.2214/ajr.183.1.1830079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto 860-8556, Japan
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Plathow C, Ley S, Fink C, Puderbach M, Heilmann M, Zuna I, Kauczor HU. Evaluation of Chest Motion and Volumetry During the Breathing Cycle by Dynamic MRI in Healthy Subjects. Invest Radiol 2004; 39:202-9. [PMID: 15021323 DOI: 10.1097/01.rli.0000113795.93565.c3] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate diaphragm and chest wall motion during the whole breathing cycle using magnetic resonance imaging (MRI) and a volumetric model in correlation with spirometry. MATERIALS AND METHODS Breathing cycles of 15 healthy volunteers were examined using a trueFISP sequence (5 slices in 3 planes, 3 images per second). Time-distance curves were calculated and correlated to spirometry. A model for vital capacity (VC), continuous time-dependent vital capacity (tVC), and investigating the influence of horizontal and vertical parameters on tVC was introduced. RESULTS Time-distance curves of the breathing cycle using MRI correlated highly significant with spirometry (P < 0.0001). VC calculated by the model was similar to VC measured in spirometry (5.00 L vs. 5.15 L). tVC correlated highly significantly with spirometry (P < 0.0001). Vertical parameters had a more profound influence on tVC change than horizontal parameters. CONCLUSIONS Dynamic MRI is a simple noninvasive method to evaluate local chest wall motion and respiratory mechanics. It widens the repertoire of tools for lung examination with a high temporal resolution.
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Affiliation(s)
- Christian Plathow
- Department of Radiology, Therapy, German Cancer Research Center Heidelberg, Heidelberg, Germany.
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Gierada DS. Radiologic assessment of emphysema for lung volume reduction surgery. Semin Thorac Cardiovasc Surg 2002; 14:381-90. [PMID: 12652443 DOI: 10.1053/stcs.2002.35304] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Radiologic imaging is vital to determining whether lung volume reduction surgery (LVRS) is a potential therapeutic option for patients with severe chronic obstructive pulmonary disease. The importance of imaging in patient selection for LVRS has been emphasized by numerous studies relating preoperative imaging features to postoperative outcomes. This article reviews the radiologic features assessed in the LVRS evaluation, summarizes the relationships between preoperative radiologic features and postoperative outcomes, and addresses the limitations of imaging in guiding patient selection.
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Affiliation(s)
- David S Gierada
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110, USA
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Quint LE, Bland PH, Walker JM, Kazerooni EA, Martinez FJ, Iannettoni MD, Bookstein FL. Diaphragmatic shape change after lung volume reduction surgery. J Thorac Imaging 2001; 16:149-55. [PMID: 11428413 DOI: 10.1097/00005382-200107000-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diaphragmatic shape in normal patients was significantly different from shape in emphysema patients. Postoperative diaphragmatic shape in patients with good clinical outcome differed from preoperative shape and was similar to shape in normal patients. In patients with poor clinical outcome, surgery appeared to have little effect on diaphragm shape.
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Affiliation(s)
- L E Quint
- Department of Radiology, University of Michigan Health Systems, Ann Arbor 48109-0030, USA.
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Kauczor HU, Chen XJ, van Beek EJ, Schreiber WG. Pulmonary ventilation imaged by magnetic resonance: at the doorstep of clinical application. Eur Respir J 2001; 17:1008-23. [PMID: 11488304 DOI: 10.1183/09031936.01.17510080] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Over the past few years, magnetic resonance imaging (MRI) has emerged as an important instrument for functional ventilation imaging. The aim of this review is to summarize established clinical methods and emerging techniques for research and clinical arenas. Before the advent of MRI, chest radiography and computed tomography (CT) dominated morphological lung imaging, while functional ventilation imaging was accomplished with scintigraphy. Initially, MRI was not used for morphological lung imaging often, due to technical and physical limitations. However, recent developments have considerably improved anatomical MRI, as well as advanced new techniques in functional ventilation imaging, such as inhaled contrast aerosols, oxygen, hyperpolarized noble gases (Helium-3, Xenon-129), and fluorinated gases (sulphur-hexafluoride). Straightforward images demonstrating homogeneity of ventilation and determining ventilated lung volumes can be obtained. Furthermore, new image-derived functional parameters are measurable, such as airspace size, regional oxygen partial pressure, and analysis of ventilation distribution and ventilation/perfusion ratios. There are several advantages to using MRI: lack of radiation, high spatial and temporal resolution and a broad range of functional information. The MRI technique applied in patients with chronic obstructive pulmonary disease, emphysema, cystic fibrosis, asthma, and bronchiolitis obliterans, may yield a higher sensitivity in the detection of ventilation defects than ventilation scintigraphy, CT or standard pulmonary function tests. The next step will be to define the threshold between physiological variation and pathological defects. Using complementary strategies, radiologists will have the tools to characterize the impairment of lung function and to improve specificity.
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Affiliation(s)
- H U Kauczor
- Dept of Radiology, Johannes Gutenberg-Universitaet Mainz, Germany
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Kauczor HU, Markstaller K, Puderbach M, Lill J, Eberle B, Hanisch G, Grossmann T, Heussel CP, Schreiber W, Thelen M. Volumetry of ventilated airspaces by 3He MRI: preliminary results. Invest Radiol 2001; 36:110-4. [PMID: 11224759 DOI: 10.1097/00004424-200102000-00007] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES To develop a validated post-processing routine for volumetry of the ventilated airspaces by 3He MRI. METHODS 3Helium MRI and pulmonary function tests were performed in seven healthy volunteers. After segmentation of ventilated airspaces, their volumes were calculated. Functional residual capacity (FRC) was used as a reference. For comparison of absolute volumes, correction factors were evaluated. RESULTS Mean lung volume (+/- standard deviation) calculated from 3He MRI was 4,082 +/- 908 mL and mean FRC was 3,696 +/- 1166 mL, with a mean difference of 386 mL (r = 0.88). After correction for the relative pulmonary air content (factor 0.82), posture (0.72), and the individual tidal volume, 3He MRI volume was 3,348 +/- 744 mL and mean FRC was 3,422 +/- 817 mL, with the mean difference down to -74 mL (r = 0.9). Comparison on an individual basis confirmed an improvement in the estimation of absolute lung volume. CONCLUSIONS Volumetry of ventilated lung from 3He MRI shows high correlation and good agreement with the results of pulmonary function tests.
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Affiliation(s)
- H U Kauczor
- Department of Radiology, Johannes Gutenberg University, Mainz, Germany.
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Cleverley JR, Müller NL. Advances in radiologic assessment of chronic obstructive pulmonary disease. Clin Chest Med 2000; 21:653-63. [PMID: 11194777 DOI: 10.1016/s0272-5231(05)70175-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Chest radiography allows detection of moderate and severe emphysema but does not allow quantitation of severity of disease or detection of mild emphysema. Chest radiography is helpful in assessing complications of emphysema such as pneumothorax or secondary infection of a bulla. HRCT provides a detailed image of emphysematous lung disease comparable to that of macroscopic pathologic appearance. The main role of HRCT in patients with COPD is in the preoperative assessment of patients being considered for bullectomy or LVRS.
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Affiliation(s)
- J R Cleverley
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Over the past decades, extensive literature has been published regarding surgical therapies for advanced COPD. Lung-volume reduction surgery would be an option for a significantly larger number of patients than classic bullectomy or lung transplantation. Unfortunately, the initial enthusiasm has been tempered by major questions regarding the optimal surgical approach, safety, firm selection criteria, and confirmation of long-term benefits. In fact, the long-term follow-up reported in patients undergoing classical bullectomy should serve to caution against unbridled enthusiasm for the indiscriminate application of LVRS. Those with the worst long-term outcome despite favourable short-term improvements after bullectomy have consistently been those with the lowest pulmonary function and significant emphysema in the remaining lung who appear remarkably similar to those being evaluated for LVRS. With this in mind, the National Heart, Lung and Blood Institute partnered with the Health Care Finance Administration to establish a multicenter, prospective, randomized study of intensive medical management, including pulmonary rehabilitation versus the same plus bilateral (by MS or VATS), known as the National Emphysema Treatment Trial. The primary objectives are to determine whether LVRS improves survival and exercise capacity. The secondary objectives will examine effects on pulmonary function and HRQL, compare surgical techniques, examine selection criteria for optimal response, identify criteria to determine those who are at prohibitive surgical risk, and examine long-term cost effectiveness. It is hoped that data collected from this novel, multicenter collaboration will place the role of LVRS in a clearer perspective for the physician caring for patients with advanced emphysema.
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Affiliation(s)
- K R Flaherty
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
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Baldwin JC, Miller CC, Prince RA, Espada R. Chest radiograph heterogeneity predicts functional improvement with volume reduction surgery. Ann Thorac Surg 2000; 70:1208-11. [PMID: 11081872 DOI: 10.1016/s0003-4975(00)01583-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Using a historical cohort study model, we tested the hypothesis that heterogeneity of emphysematous changes on the preoperative chest radiograph correlated with favorable outcome of lung volume reduction surgery. METHODS The test population consisted of 21 patients with severe emphysema who were being treated at a 1,000-bed university-affiliated tertiary teaching hospital. A simple but quantitative index of heterogeneity has been devised, whereby the preoperative posteroanterior chest radiographic lung fields are divided into four geometric quadrants. Each quadrant is scored (0 to 4) for emphysematous changes by two radiologists blinded as to subsequent patient management and outcome. Criteria for determining presence of emphysema were hyperlucency, decreased vascular markings, and parenchymal crowding indicating compressed lung. Heterogeneity index is the sum of the two highest scores minus the two lowest, with a maximum index of 8 and a minimum of 0. Preoperative chest radiographs and postoperative changes in forced expiratory volume in 1 second were examined. RESULTS The heterogeneity index was positively correlated with change in forced expiratory volume in 1 second after operation with an r2 of 0.31 and an average increase of 117 mL per unit increase in heterogeneity index (p < 0.009). CONCLUSIONS This simple index of heterogeneity may be useful as a predictor of improved pulmonary function after lung volume reduction surgery.
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Affiliation(s)
- J C Baldwin
- Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA
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Cluzel P, Similowski T, Chartrand-Lefebvre C, Zelter M, Derenne JP, Grenier PA. Diaphragm and chest wall: assessment of the inspiratory pump with MR imaging-preliminary observations. Radiology 2000; 215:574-83. [PMID: 10796942 DOI: 10.1148/radiology.215.2.r00ma28574] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Magnetic resonance (MR) imaging of the thorax with three-dimensional (3D) reconstruction and functional quantification was evaluated as a tool for structure-function evaluation of chest-wall mechanics. Good agreement was found between the corresponding spirometric and MR imaging values of lung volumes. Fast MR imaging of the thorax with 3D reconstruction should improve the ability to evaluate the inspiratory pump in clinical and research investigations.
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Affiliation(s)
- P Cluzel
- Department of Diagnostic and Interventional Radiology, Pulmonary Function Test Laboratory, Hôpital Pitié-Salpêtrière, 43-87 boulevard de l'Hôpital, 75651 Paris 13, France
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Abstract
Three patients with Wegener's granulomatosis (WG) established by clinical, serological and histological criteria were noted to have marked asymmetrical hemithorax volume loss on thoracic CT. Lung dimensions were analysed from the CT in each case. Evidence of airways disease, parenchymal abnormalities and pleural changes was evaluated on CT, in order to establish the aetiology of the volume loss. Previous pulmonary infection and thoracic intervention were excluded by the clinical data. The three patients had chronic treated thoracic WG for 1-9 years. There was severe asymmetrical pleural disease in one case and parenchymal disease with evidence of fibrotic healing but no evidence of bronchial disease in two cases. Marked asymmetrical volume loss of a hemithorax is a previously unreported finding and should be added to the features of primary chronic thoracic WG. This finding does not require investigation for additional pathology.
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Affiliation(s)
- S E Connor
- Department of Clinical Radiology, Queen Elizabeth Hospital, Birmingham, West Midlands, UK
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Cleverley JR, Desai SR, Wells AU, Koyama H, Eastick S, Schmidt MA, Charrier CL, Gatehouse PD, Goldstraw P, Pepper JR, Geddes DM, Hansell DM. Evaluation of patients undergoing lung volume reduction surgery: ancillary information available from computed tomography. Clin Radiol 2000; 55:45-50. [PMID: 10650110 DOI: 10.1053/crad.1999.0326] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM A number of imaging techniques have been used for the pre-operative assessment of patients for lung volume reduction surgery (LVRS). We evaluated whether data currently acquired from perfusion scintigrams and cine MR of the diaphragm are obtainable from high resolution CT (HRCT) of the thorax. MATERIALS AND METHODS Thirty patients taking part in a randomized controlled trial of LVRS against maximal medical therapy were evaluated. HRCT examinations (n= 30) were scored for (i) the extent and distribution of emphysema; (ii) the extent of normal pulmonary vasculature; and (iii) diaphragmatic contour, apparent defects and herniation. On scintigraphy, (n= 28), perfusion of the lower thirds of both lungs, as a proportion of total lung perfusion (LZ/T(PERF)), was expressed as a percentage of predicted values (derived from 10 normal control subjects). On cine MR (n= 25) hemidiaphragmatic excursion and coordination were recorded. RESULTS Extensive emphysema was present on HRCT (60% +/- 13.2%). There was strong correlation between the extent of normal pulmonary vasculature on HRCT and on perfusion scanning (r(s)= 0.85, P< 0.00005). Hemidiaphragmatic incoordination on MR was weakly associated with hemidiaphragmatic eventration on HRCT (P= 0.04). CONCLUSION The strong correlation between lung perfusion assessed by HRCT and lung perfusion on scintigraphy suggests that perfusion scintigraphy is superfluous in the pre-operative evaluation of patients with emphysema for LVRS.
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Affiliation(s)
- J R Cleverley
- Department of Radiology, The Royal Brompton Hospital, London, UK
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Abstract
Lung volume reduction surgery has created an opportunity for the advanced imaging of emphysema. Patients with CT or perfusion scintigraphy demonstrating an upper- or lower-lobe-predominant pattern of emphysema have better patient outcomes after LVRS than patients with emphysema diffusely or homogeneously distributed throughout the lungs. Some patients with diffuse or homogeneous emphysema may demonstrate improvement in function or dyspnea after surgery, but the magnitude of the improvement seen is less than in patients with heterogeneous emphysema, and the duration of benefit is not known. An ongoing, multicenter National Heart, Lung, and Blood Institute (NHLBI)/Health Care Financing Association (HCFA) sponsored trial of LVRS aims to determine whether LVRS together with maximal medical therapy and pulmonary rehabilitation improves patient outcomes compared with maximal medical therapy and pulmonary rehabilitation alone. This study will address the duration of clinical benefit and the cost-effectiveness of LVRS.
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Affiliation(s)
- E A Kazerooni
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, USA.
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Maki DD, Miller WT, Aronchick JM, Gefter WB, Miller WT, Kotloff RM, Tino G. Advanced emphysema: preoperative chest radiographic findings as predictors of outcome following lung volume reduction surgery. Radiology 1999; 212:49-55. [PMID: 10405719 DOI: 10.1148/radiology.212.1.r99jl4849] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether preoperative chest radiographic findings alone can reliably predict which patients will achieve the best functional outcome of lung volume reduction surgery. MATERIALS AND METHODS The preoperative chest radiographs obtained in 57 patients who had undergone lung volume reduction surgery were retrospectively scored by five blinded readers for severity and distribution of emphysema, evidence of lung compression, disease heterogeneity, and other features. Comparisons were made with the 3-6-month postoperative functional outcome for each patient. RESULTS High disease heterogeneity (score > 2) and unequivocal lung compression (score 1) both were 100% predictive of a favorable outcome (FEV1 increase, > or = 30%). Low heterogeneity (score < 1) was 94% predictive of an unfavorable outcome (FEV1 increase < 30%), as was a lack of lung compression, which was 92% predictive of an unfavorable outcome. These two features also correlated with an improved 6-minute walk test result, although this correlation was weaker. CONCLUSION Chest radiography alone may be sufficient for initial screening. High disease heterogeneity and lung compression on chest radiographs are highly predictive of a favorable functional outcome.
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Affiliation(s)
- D D Maki
- Department of Radiology, Hospital of University of Pennsylvania, Philadelphia 19104, USA
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Cleverley JR, Hansell DM. Imaging of patients with severe emphysema considered for lung volume reduction surgery. Br J Radiol 1999; 72:227-35. [PMID: 10396211 DOI: 10.1259/bjr.72.855.10396211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lung volume reduction surgery has recently been reintroduced as a palliative treatment for patients with severe emphysema. Selection criteria vary between centres and imaging is extensively used, but the exact role of individual techniques in the selection process is still emerging.
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