Assessment of COPD severity by computed tomography: correlation with lung functional testing (original) (raw)
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The Indian journal of radiology & imaging
Both emphysematous destruction of lung parenchyma and airway remodeling is thought to contribute to airflow limitation in cases of chronic obstructive pulmonary disease (COPD). To evaluate the value of quantitative computed tomography (QCT) parameters of emphysema and airway disease with disease severity in patients with COPD. We prospectively studied 50 patients with COPD, which included nonsmokers and patients with different degrees of cumulative smoking exposure. Three QCT parameters namely LAA% (low attenuation area percentage), WA% (Wall area percentage), and pi10 were calculated as per the standard technique. Forced expiratory volume in 1 s (FEV1), BODE score, and MMRC dyspnea scale were used as measures of disease severity. FEV1 was inversely and significantly associated with all three QCT parameters. Receiver operated characteristic curves in prediction of GOLD class 3 COPD yielded cut-off values of 12.2, 61.45, and 3.5 for LAA%, WA%, and pi10, respectively, with high sensit...
International journal of chronic obstructive pulmonary disease, 2016
Computed tomography (CT) phenotypic characterization helps in understanding the clinical diversity of chronic obstructive pulmonary disease (COPD) patients, but its clinical relevance and its relationship with functional features are not clarified. Volumetric capnography (VC) uses the principle of gas washout and analyzes the pattern of CO2 elimination as a function of expired volume. The main variables analyzed were end-tidal concentration of carbon dioxide (ETCO2), Slope of phase 2 (Slp2), and Slope of phase 3 (Slp3) of capnogram, the curve which represents the total amount of CO2 eliminated by the lungs during each breath. To investigate, in a group of patients with severe COPD, if the phenotypic analysis by CT could identify different subsets of patients, and if there was an association of CT findings and functional variables. Sixty-five patients with COPD Gold III-IV were admitted for clinical evaluation, high-resolution CT, and functional evaluation (spirometry, 6-minute walk ...
Respiration, 2012
emphysema score in all patients was 25.6 8 25.4%. There was a weak but significant correlation between the percentage of pulmonary emphysema and numbers of pack/years (R = +0.31, p = 0.024). The percentage of emphysema was inversely correlated with the FEV 1 /FVC ratio before and after bronchodilator use (R = -0.44, p = 0.002, and R = -0.39, p = 0.005), DL CO % (R = -0.64, p = 0.0003) and DL CO /VA% (R = -0.68, p ! 0.0001). A weak positive correlation was also found with TLC% (R = +0.28, p = 0.048). When patients with documented emphysema were considered separately, the best significant correlation observed was between DL CO /VA% and HRCT scan score (p = 0.007). Conclusions: These data suggest that in patients with stable chronic obstructive pulmonary disease of varying severity, the presence of pulmonary emphysema is best represented by the impaired gas exchange capability of the respiratory system.
Annals of Thoracic Medicine, 2008
BACKGROUND: During the last few decades, high-resolution computed tomography (HRCT) has come up as a new diagnostic modality to diagnose emphysematous and chronic bronchitis components of chronic obstructive pulmonary disease (COPD). The present study was undertaken to evaluate for various quantitative and qualitative HRCT features in patients with COPD, and to detect patients' characteristics that correlate with these HRCT features. MATERIALS AND METHODS: Forty male patients with COPD attending the COPD clinic at a tertiary referral hospital and postgraduate medical institute were included in the study. Various HRCT features, including tracheal index, thoracic cage ratio, sterno-aortic distance, thoracic cross-sectional area, vascular attenuation, vascular distortion, mosaic attenuation pattern, and directly visible small airways, were evaluated and correlated with patients' characteristics, including age, duration of illness, quantum of smoking, dyspnea score, quality-of-life index, and various spirometric indices. RESULTS: We found signifi cant correlations of various quantitative and qualitative HRCT features with age, duration of illness, quantum of smoking, quality-of-life index, and the spirometric indices showing the extent of airways obstruction. CONCLUSIONS: Various quantitative and qualitative HRCT features were found to correlate with patients' characteristics, spirometric indices, and health-related quality-of-life score, suggesting that HRCT is useful not only in detecting emphysema and its various subtypes but also in predicting the extent and severity of COPD.
The Role of Chest Computed Tomography in the Evaluation and Management of the Patient with COPD
American journal of respiratory and critical care medicine, 2017
Chronic obstructive pulmonary disease (COPD) exhibits significant heterogeneity in clinical presentation and rate of disease progression, owing at least in part to differing underlying morphologic abnormalities. Symptom assessment and spirometry have traditionally been used to determine disease severity and guide management. However, chest computed tomography (CT) is a widely available and increasingly used imaging modality that can provide additional insight into structural and pathophysiologic pulmonary parameters. While chest CT is not currently recommended as part of the routine evaluation for COPD beyond aiding with advanced therapy decision making in severe disease, the expanding use of CT now demands that clinicians understand how to treat relevant information that becomes available. Emphysema, airway disease, air trapping and pulmonary vascular abnormalities have all been associated with a number of important outcomes, including respiratory symptoms, COPD exacerbations and m...
Utility of Chest Computed Tomography for Chronic Obstructive Pulmonary Disease Patients
The Indian Journal of Chest Diseases and Allied Sciences
Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development. 1 Currently, the diagnosis of COPD is based on the clinical history of the patient along with a post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV 1 /FVC) ratio lower than 0.70 on spirometry. Even though spirometry is considered the most valuable tool in diagnosing COPD, it lacks in certain aspects such as covering the morphological analysis of the disease and correlating between the lesions and lung function. Also, spirometry usually becomes abnormal pretty late in the disease evolution, and hence, is unable to identify early and pre-COPD patients leading to delayed diagnosis. Chest computed tomography (CT) scan provides in vivo assessment of organ structure and can prove itself to be a useful tool to provide additional information about parenchymal remodeling, airway dilation, and vascular calcification. This, in turn, can be useful to not only detect and stratify the severity of the disease but can also to predict its clinical course. We must consider the utility of CT scan to offer impactful therapy for what is found in those images. However, does this additional information really makes a difference in the management of COPD patients? Can this information be obtained using inexpensive and easy methods (such as spirometry and questionnaires)? Does this additional information really justify the expense of radiation exposure? This article highlights the utility, limitations, and future prospects of adding a chest CT scan as a routine investigation in patients with COPD.
CT metrics of airway disease and emphysema in severe COPD
Chest, 2009
Background: CT scan measures of emphysema and airway disease have been correlated with lung function in cohorts of subjects with a range of COPD severity. The contribution of CT scan-assessed airway disease to objective measures of lung function and respiratory symptoms such as dyspnea in severe emphysema is less clear. Methods: Using data from 338 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study, densitometric measures of emphysema using a threshold of ؊950 Hounsfield units (%LAA-950) and airway wall phenotypes of the wall thickness (WT) and the square root of wall area (SRWA) of a 10-mm luminal perimeter airway were calculated for each subject. Linear regression analysis was performed for outcome variables FEV 1 and percent predicted value of FEV 1 with CT scan measures of emphysema and airway disease. Results: In univariate analysis, there were significant negative correlations between %LAA-950 and both the WT (r ؍ ؊0.28, p ؍ 0.0001) and SRWA (r ؍ ؊0.19, p ؍ 0.0008). Airway wall thickness was weakly but significantly correlated with postbronchodilator FEV 1 % predicted (R ؍ ؊0.12, p ؍ 0.02). Multivariate analysis showed significant associations between either WT or SRWA ( ؍ ؊5.2, p ؍ 0.009;  ؍ ؊2.6, p ؍ 0.008, respectively) and %LAA-950 ( ؍ ؊10.6, p ؍ 0.03) with the postbronchodilator FEV 1 % predicted. Male subjects exhibited significantly thicker airway wall phenotypes (p ؍ 0.007 for WT and p ؍ 0.0006 for SRWA). Conclusions: Airway disease and emphysema detected by CT scanning are inversely related in patients with severe COPD. Airway wall phenotypes were influenced by gender and associated with lung function in subjects with severe emphysema. (CHEST 2009; 136:396 -404) Abbreviations: BMI ϭ body mass index; %LAA ϭ percent emphysema; %LAA-950 ϭ percent emphysema at a threshold of 950 Hounsfield units; NETT ϭ National Emphysema Treatment Trial; Pi10-mm ϭ 10-mm luminal perimeter; SRWA ϭ square root wall area; UCSD SOBQ ϭ University of California, San Diego Shortness of Breath Questionnaire; WT ϭ wall thickness Manuscript
Recent Advances in Computed Tomography Imaging in Chronic Obstructive Pulmonary Disease
Annals of the American Thoracic Society, 2017
Lung imaging is increasingly being used to diagnose, quantify, and phenotype chronic obstructive pulmonary disease (COPD). Although spirometry is the gold standard for the diagnosis of COPD and for severity staging, the role of computed tomography (CT) imaging has expanded in both clinical practice and research. COPD is a heterogeneous disease with considerable variability in clinical features, radiographic disease, progression, and outcomes. Recent studies have examined the utility of CT imaging in enhancing diagnostic certainty, improving phenotyping, predicting disease progression and prognostication, selecting patients for intervention, and also in furthering our understanding of the complex pathophysiology of this disease. Multiple CT metrics show promise for use as imaging biomarkers in COPD.
Value of chest radiography in phenotyping chronic obstructive pulmonary disease
European Respiratory Journal, 2008
The objectives of the present study were to reappraise chest radiography for the diagnosis of emphysema, using computed tomography (CT) as the reference standard, and to establish whether or not chest radiography is useful for phenotyping chronic obstructive pulmonary disease (COPD).