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Xia Z, Peng C, Fan L, Chen Q, Liu W, Ma T, Chen W, Wen Y, Song Y, Lin H. Investigation of diaphragmatic motion and projected lung area in diaphragm paralysis patients using dynamic chest radiography. Quant Imaging Med Surg 2024; 14:5591-5601. [PMID: 39144031 PMCID: PMC11320492 DOI: 10.21037/qims-24-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/28/2024] [Indexed: 08/16/2024]
Abstract
Background Dynamic chest radiography (DCR) is a novel and supplementary examination in respiratory diseases. The investigation of other chest diseases using DCR has been explored, identifying a certain correlation of the pulmonary function test (PFT). However, there is a lack of research using DCR parameters to quantitatively evaluate chest disease. The purpose of this study was to investigate the diagnostic value of DCR for diaphragm paralysis (DP). Methods This retrospective study recruited 118 participants, which include 18 patients with DP, 48 healthy volunteers, and 52 patients with respiratory disease. Comparison of DCR parameters relationships among 3 groups was performed using one-way analysis of variance (ANOVA) and Kruskal-Wallis test. The receiver operating characteristic (ROC) curve was used to compare the value of the DCR parameters to diagnose DP. Results The differences of excursion of diaphragm (ED) in normal (nb) and forced breathing (fb), ED(fb)-ED(nb), and the parameters of projected lung area (PLA) in inspiratory (ins) and expiratory phase (exp), PLA.exp(fb), PLA.ins(fb)-PLA.ins(nb), and PLA.exp(fb)-PLA.exp(nb) among the 3 groups were statistically significant. The highest area under the curve (AUC) of right-side parameter was the ED(fb)-ED(nb), for which the AUC was 0.8950 [95% confidence interval (CI): 0.7618-1.000], whereas that of the left-side parameter was ED(fb), for which the AUC was 0.9176 [95% confidence interval (CI): 0.8524-0.9829]. Conclusions The parameters of DCR have good diagnostic value for DP. The highest diagnostic efficiency for DP on the right side is the ED(fb)-ED(nb), with a sensitivity of 95% and a specificity of 78.6%, whereas on the left side is ED(fb), with a sensitivity of 80% and a specificity of 88.2%.
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Affiliation(s)
- Ziyang Xia
- Department of Radiology, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chuming Peng
- Department of Radiology, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liyuan Fan
- Department of Radiology, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiongzhu Chen
- Department of Radiology, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wentao Liu
- Department of Radiology, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ting Ma
- Department of Radiology, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weicong Chen
- Department of Radiology, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yaocheng Wen
- Department of Radiology, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuquan Song
- Department of Radiology, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haibo Lin
- Department of Radiology, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Yamamoto S, Sakamaki F, Takahashi G, Kondo Y, Taguchi N, Esashi S, Yuji R, Murakami K, Osaragi K, Tomita K, Kamei S, Matsumoto T, Imai Y, Hasebe T. Retracted: Chest digital dynamic radiography to detect changes in human pulmonary perfusion in response to alveolar hypoxia. J Med Radiat Sci 2023; 70:e1-e11. [PMID: 36101943 PMCID: PMC10715373 DOI: 10.1002/jmrs.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/29/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Hypoxic pulmonary vasoconstriction optimises oxygenation in the lung by matching the local-blood perfusion to local-ventilation ratio upon exposure to alveolar hypoxia. It plays an important role in various pulmonary diseases, but few imaging evaluations of this phenomenon in humans. This study aimed to determine whether chest digital dynamic radiography could detect hypoxic pulmonary vasoconstriction as changes in pulmonary blood flow in healthy individuals. METHODS Five Asian men underwent chest digital dynamic radiography before and after 60 sec breath-holding at the maximal inspiratory level in upright and supine positions. Alveolar partial pressure of oxygen and atmospheric pressure were calculated using the blood gas test and digital dynamic radiography imaging, respectively. To evaluate the blood flow, the correlation rate of temporal change in each pixel value between the lung fields and left cardiac ventricles was analysed. RESULTS Sixty seconds of breath-holding caused a mean reduction of 26.7 ± 6.4 mmHg in alveolar partial pressure of oxygen. The mean correlation rate of blood flow in the whole lung was significantly lower after than before breath-holding (before, upright 51.5%, supine 52.2%; after, upright 45.5%, supine 46.1%; both P < 0.05). The correlation rate significantly differed before and after breath-holding in the lower lung fields (upright, 11.8% difference; supine, 10.7% difference; both P < 0.05). The mean radiation exposure of each scan was 0.98 ± 0.09 mGy. No complications occurred. CONCLUSIONS Chest digital dynamic radiography could detect the rapid decrease in pulmonary perfusion in response to alveolar hypoxia. It may suggest hypoxic pulmonary vasoconstriction in healthy individuals.
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Affiliation(s)
- Shota Yamamoto
- Department of RadiologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Fumio Sakamaki
- Department of Respiratory MedicineTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Genki Takahashi
- Department of Respiratory MedicineTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Yusuke Kondo
- Department of Respiratory MedicineTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Naoya Taguchi
- Department of Radiological TechnologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Shogo Esashi
- Department of Radiological TechnologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Ryotaro Yuji
- Department of Radiological TechnologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Katsuki Murakami
- Department of Radiological TechnologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Kensuke Osaragi
- Department of RadiologyKochi University, Kochi Medical SchoolNankokuKochiJapan
| | - Kosuke Tomita
- Department of RadiologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Shunsuke Kamei
- Department of RadiologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Tomohiro Matsumoto
- Department of RadiologyKochi University, Kochi Medical SchoolNankokuKochiJapan
| | - Yutaka Imai
- Department of RadiologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Terumitsu Hasebe
- Department of RadiologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
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Yamamoto S, Sakamaki F. Potential of dynamic chest radiography for preoperative evaluation of pleural adhesions. J Thorac Dis 2023; 15:5278-5281. [PMID: 37969255 PMCID: PMC10636484 DOI: 10.21037/jtd-23-1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/25/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Shota Yamamoto
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Fumio Sakamaki
- Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
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Fyles F, FitzMaurice TS, Robinson RE, Bedi R, Burhan H, Walshaw MJ. Dynamic chest radiography: a state-of-the-art review. Insights Imaging 2023; 14:107. [PMID: 37332064 DOI: 10.1186/s13244-023-01451-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/14/2023] [Indexed: 06/20/2023] Open
Abstract
Dynamic chest radiography (DCR) is a real-time sequential high-resolution digital X-ray imaging system of the thorax in motion over the respiratory cycle, utilising pulsed image exposure and a larger field of view than fluoroscopy coupled with a low radiation dose, where post-acquisition image processing by computer algorithm automatically characterises the motion of thoracic structures. We conducted a systematic review of the literature and found 29 relevant publications describing its use in humans including the assessment of diaphragm and chest wall motion, measurement of pulmonary ventilation and perfusion, and the assessment of airway narrowing. Work is ongoing in several other areas including assessment of diaphragmatic paralysis. We assess the findings, methodology and limitations of DCR, and we discuss the current and future roles of this promising medical imaging technology.Critical relevance statement Dynamic chest radiography provides a wealth of clinical information, but further research is required to identify its clinical niche.
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Affiliation(s)
- Fred Fyles
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thomas S FitzMaurice
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - Ryan E Robinson
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ram Bedi
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Hassan Burhan
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Martin J Walshaw
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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FitzMaurice TS, McCann C, Nazareth DS, Walshaw MJ. Characterisation of hemidiaphragm dysfunction using dynamic chest radiography: a pilot study. ERJ Open Res 2021; 8:00343-2021. [PMID: 35211619 PMCID: PMC8862633 DOI: 10.1183/23120541.00343-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Dynamic chest radiography (DCR) is a novel real-time digital fluoroscopic imaging system that produces clear, wide field-of-view diagnostic images of the thorax and diaphragm in motion, alongside novel metrics on moving structures within the thoracic cavity. We describe the use of DCR in the measurement of diaphragm motion in a pilot series of cases of suspected diaphragm dysfunction. Methods We studied 21 patients referred for assessment of diaphragm function due to suspicious clinical symptoms or imaging (breathlessness, orthopnoea, reduced exercise tolerance and/or an elevated hemidiaphragm on plain chest radiograph). All underwent DCR with voluntary sniff manoeuvres. Results Paradoxical motion on sniffing was observed in 14 patients, and confirmed in six who also underwent fluoroscopy or ultrasound. In four patients, DCR showed reduced hemidiaphragm excursion, but no paradoxical motion; in three, normal bilateral diaphragm motion was demonstrated. DCR was quick to perform, and well tolerated in all cases and with no adverse events reported. DCR was achieved in ∼5 min per patient, with images available to view by the clinician immediately within the clinical setting. Conclusion DCR is a rapid, well-tolerated and straightforward chest radiography technique that warrants further investigation in the assessment of diaphragm dysfunction. Dynamic chest radiography is a rapid, well-tolerated and straightforward chest radiography technique that warrants further investigation in the assessment of diaphragm dysfunctionhttps://bit.ly/3HFriWk
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Yamamoto S, Sakamaki F, Takahashi G, Yuji R, Matsumoto T, Hasebe T. Novel pulmonary perfusion imaging using chest digital dynamic radiography for pulmonary artery sarcoma. Respirol Case Rep 2021; 9:e00737. [PMID: 33732469 PMCID: PMC7943749 DOI: 10.1002/rcr2.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022] Open
Abstract
Chest digital dynamic radiography (DDR) is a novel method for evaluating pulmonary perfusion and ventilation. It could depict ventilation-perfusion mismatch in a pulmonary artery sarcoma with severe stenosis in the right pulmonary artery. This report is the first demonstration of ventilation-perfusion mismatch in a malignant neoplasm using DDR.
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Affiliation(s)
- Shota Yamamoto
- Department of RadiologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Fumio Sakamaki
- Department of Respiratory MedicineTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Genki Takahashi
- Department of Respiratory MedicineTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Ryotaro Yuji
- Department of Radiological TechnologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Tomohiro Matsumoto
- Department of RadiologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
| | - Terumitsu Hasebe
- Department of RadiologyTokai University Hachioji Hospital, Tokai University School of MedicineTokyoJapan
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