Quantitative CT measurement of cross-sectional area of small pulmonary vessel in COPD: correlations with emphysema and airflow limitation - PubMed (original) (raw)

Clinical Trial

Quantitative CT measurement of cross-sectional area of small pulmonary vessel in COPD: correlations with emphysema and airflow limitation

Shin Matsuoka et al. Acad Radiol. 2010 Jan.

Abstract

Rationale and objectives: Pulmonary vascular alteration is one of the characteristic features of chronic obstructive pulmonary disease (COPD). Recent studies suggest that vascular alteration is closely related to endothelial dysfunction and may be further influenced by emphysema. However, the relationship between morphological alteration of small pulmonary vessels and the extent of emphysema has not been assessed in vivo. The objectives of this study are: to evaluate the correlation of total cross-sectional area (CSA) of small pulmonary vessels with the extent of emphysema and airflow obstruction using CT scans and to assess the difference of total CSA between COPD phenotypes.

Materials and methods: We measured CSA less than 5 mm(2) and 5-10 mm(2), and calculated the percentage of the total CSA for the lung area (%CSA < 5, and %CSA5-10, respectively) using CT scans in 191 subjects. The extent of emphysema (%LAA-950) was calculated, and the correlations of %CSA < 5 and %CSA5-10 with %LAA-950 and results of pulmonary function tests (PFTs) were evaluated. The differences in %CSA between COPD phenotypes were also assessed.

Results: The %CSA < 5 had significant negative correlations with %LAA-950 (r = -0.83, P < .0001). There was a weak but statistically significant correlation of %CSA < 5 with forced expiratory volume in 1 second (FEV1)% predicted (r = 0.29, P < .0001) and FEV1/forced vital capacity (r = 0.45, P < .0001). A %CSA 5-10 had weak correlations with %LAA-950 and results of PFTs. %CSA < 5 was significantly higher in bronchitis phenotype than in the emphysema phenotype (P < .0001).

Conclusions: Total CSA of small pulmonary vessels at sub-subsegmental levels strongly correlates with the extent of emphysema (%LAA-950) and reflects differences between COPD phenotypes.

Trial registration: ClinicalTrials.gov NCT00047385.

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Figures

Figure 1

Figure 1

The method of measuring the cross sectional area of small pulmonary vessels using ImageJ software. A, CT image of lung field segmented within the threshold values from −500 HU to −1024 HU. B, Binary image converted from segmented image (A) with window level of −720 HU. Pulmonary vessels are displayed in black. C, Mask image for the particle analysis after setting vessel size within 0 – 5 mm2, and circularity within 0.9 – 1.0.

Figure 2

Figure 2

The relationship between the percentage cross sectional area of pulmonary vessels less than 5 mm2 (%CSA<5) and (A) the percentage area of emphysema (%LAA-950) estimated by CT, (B) FEV1 % predicted, and (C) FEV1/FVC. The %CSA<5 had significant negative correlation with the %LAA-950 (r = −0.83, p < 0.0001), and relatively weak correlation with FEV1 % predicted (r = 0.29, p < 0.0001) or FEV1/FVC (r = 0.45, p < 0.0001).

Figure 3

Figure 3

Individual data of the percentage cross sectional area of pulmonary vessels less than 5 mm2 (%CSA<5) of COPD phenotypes as defined by the percentage of emphysema (bronchitis type, %LAA-950 < 5% and emphysema type, %LAA-950 > 5%) in each GOLD stage: stage 1 (A), stage 2 (B), and stage 3 and 4 (C). In each GOLD stage, %CSA<5 in the bronchitis type is significantly higher than that in the emphysema type.

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