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Zhou X, Ye C, Okamoto T, Iwao Y, Kawata N, Shimada A, Haneishi H. Multi-modal evaluation of respiratory diaphragm motion in chronic obstructive pulmonary disease using MRI series and CT images. Jpn J Radiol 2024:10.1007/s11604-024-01638-9. [PMID: 39096482 DOI: 10.1007/s11604-024-01638-9] [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: 04/12/2024] [Accepted: 07/27/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD), characterized by airflow limitation and breathing difficulty, is usually caused by prolonged inhalation of toxic substances or long-term smoking habits. Some abnormal features of COPD can be observed using medical imaging methods, such as magnetic resonance imaging (MRI) and computed tomography (CT). This study aimed to conduct a multi-modal analysis of COPD, focusing on assessing respiratory diaphragm motion using MRI series in conjunction with low attenuation volume (LAV) data derived from CT images. MATERIALS AND METHOD This study utilized MRI series from 10 normal subjects and 24 COPD patients, along with thoracic CT images from the same patients. Diaphragm profiles in the sagittal thoracic MRI series were extracted using field segmentation, and diaphragm motion trajectories were generated from estimated diaphragm displacements via registration. Re-sliced sagittal CT images were used to calculate regional LAVs for four distinct lung regions. The similarities among diaphragm motion trajectories at various positions were assessed, and their correlations with regional LAVs were analyzed. RESULTS Compared with the normal subjects, patients with COPD typically exhibited fewer similarities in diaphragm motion, as indicated by the mean normalized correlation coefficient of the vertical motion component (0.96 for normal subjects vs. 0.76 for severity COPD patients). This reduction was significantly correlated with the LAV% in the two lower lung regions with a regression coefficient of 0.81. CONCLUSION Our proposed evaluation method may assist in the diagnosis and therapy planning for patients with COPD.
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Affiliation(s)
- Xingyu Zhou
- Graduate School of Science and Engineering, Chiba University, Chiba, 263-8522, Japan
| | - Chen Ye
- School of Communications and Information Engineering, Nanjing University of Posts and Telecommunications, Nanjing, 210003, China.
- Center for Frontier Medical Engineering, Chiba University, Chiba, 263-8522, Japan.
| | - Takayuki Okamoto
- Center for Frontier Medical Engineering, Chiba University, Chiba, 263-8522, Japan
| | - Yuma Iwao
- Center for Frontier Medical Engineering, Chiba University, Chiba, 263-8522, Japan
- National Institutes for Quantum and Radiological Science and Technology, Chiba, 263-0024, Japan
| | - Naoko Kawata
- Graduate School of Science and Engineering, Chiba University, Chiba, 263-8522, Japan
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, 260-0856, Japan
| | - Ayako Shimada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, 260-0856, Japan
- Department of Respirology, Shin-Yurigaoka General Hospital, Kawasaki, 215-0026, Japan
| | - Hideaki Haneishi
- Center for Frontier Medical Engineering, Chiba University, Chiba, 263-8522, Japan
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Wang Y, Chai L, Chen Y, Liu J, Wang Q, Zhang Q, Qiu Y, Li D, Chen H, Shen N, Shi X, Wang J, Xie X, Li M. Quantitative CT parameters correlate with lung function in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Front Surg 2023; 9:1066031. [PMID: 36684267 PMCID: PMC9845891 DOI: 10.3389/fsurg.2022.1066031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/14/2022] [Indexed: 01/06/2023] Open
Abstract
Objective This study aimed to analyze the correlation between quantitative computed tomography (CT) parameters and airflow obstruction in patients with COPD. Methods PubMed, Embase, Cochrane and Web of Knowledge were searched by two investigators from inception to July 2022, using a combination of pertinent items to discover articles that investigated the relationship between CT measurements and lung function parameters in patients with COPD. Five reviewers independently extracted data, and evaluated it for quality and bias. The correlation coefficient was calculated, and heterogeneity was explored. The following CT measurements were extracted: percentage of lung attenuation area <-950 Hounsfield Units (HU), mean lung density, percentage of airway wall area, air trapping index, and airway wall thickness. Two airflow obstruction parameters were extracted: forced expiratory volume in the first second as a percentage of prediction (FEV1%pred) and FEV1 divided by forced expiratory volume lung capacity. Results A total of 141 studies (25,214 participants) were identified, which 64 (6,341 participants) were suitable for our meta-analysis. Results from our analysis demonstrated that there was a significant correlation between quantitative CT parameters and lung function. The absolute pooled correlation coefficients ranged from 0.26 (95% CI, 0.18 to 0.33) to 0.70 (95% CI, 0.65 to 0.75) for inspiratory CT and 0.56 (95% CI, 0.51 to 0.60) to 0.74 (95% CI, 0.68 to 0.80) for expiratory CT. Conclusions Results from this analysis demonstrated that quantitative CT parameters are significantly correlated with lung function in patients with COPD. With recent advances in chest CT, we can evaluate morphological features in the lungs that cannot be obtained by other clinical indices, such as pulmonary function tests. Therefore, CT can provide a quantitative method to advance the development and testing of new interventions and therapies for patients with COPD.
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Uemura R, Nagatani Y, Hashimoto M, Oshio Y, Sonoda A, Otani H, Hanaoka J, Watanabe Y. Association of Respiratory Functional Indices and Smoking with Pleural Movement and Mean Lung Density Assessed Using Four-Dimensional Dynamic-Ventilation Computed Tomography in Smokers and Patients with COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:327-339. [PMID: 36945706 PMCID: PMC10024907 DOI: 10.2147/copd.s389075] [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: 10/01/2022] [Accepted: 02/02/2023] [Indexed: 03/17/2023] Open
Abstract
Purpose To correlate the ratio of the non-dependent to dependent aspects of the maximal pleural movement vector (MPMVND/D) and gravity-oriented collapse ratio (GCRND/D), and the mean lung field density (MLD) obtained using four-dimensional (4D) dynamic-ventilation computed tomography (DVCT) with airflow limitation parameters and the Brinkman index. Materials and Methods Forty-seven patients, including 22 patients with COPD, 13 non-COPD smokers, and 12 non-smokers, with no/slight pleural adhesion confirmed using a thoracoscope, underwent 4D-DVCT with 16 cm coverage. Coordinates for the lung field center, as well as ventral and dorsal pleural points, set on the central trans-axial levels in the median and para-median sagittal planes at end-inspiration, were automatically measured (13-17 frame images, 0.35 seconds/frame). MPMVND/D and GCRND/D were calculated based on MPMV and GCR values for all the included points and the lung field center. MLD was automatically measured in each of the time frames, and the maximal change ratio of MLD (MLDCR) was calculated. These measured values were compared among COPD patients, non-COPD smokers, and non-smokers, and were correlated with the Brinkman index, FEV1/FVC, FEV1 predicted, RV/TLC, and FEF25-75% using Spearman's rank coefficients. Results MPMVND/D was highest in non-smokers (0.819±0.464), followed by non-COPD smokers (0.405±0.131) and patients with COPD (-0.219±0.900). GCRND/D in non-smokers (1.003±1.384) was higher than that in patients with COPD (-0.164±1.199). MLDCR in non-COPD smokers (0.105±0.028) was higher than that in patients with COPD (0.078±0.027). MPMVND/D showed positive correlations with FEV1 predicted (r=0.397, p=0.006), FEV1/FVC (r=0.501, p<0.001), and FEF25-75% (r=0.368, p=0.012). GCRND/D also demonstrated positive correlations with FEV1 (r=0.397, p=0.006), FEV1/FVC (r=0.445, p=0.002), and FEF25-75% (r=0.371, p=0.011). MPMVND/D showed a negative correlation with the Brinkman index (r=-0.398, p=0.006). Conclusion We demonstrated that reduced MPMVND/D and GCRND/D were associated with respiratory functional indices, in addition to a negative association of MPMVND/D with the Brinkman index, which should be recognized when assessing local pleural adhesion on DVCT, especially for ventral pleural aspects.
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Affiliation(s)
- Ryo Uemura
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
- Correspondence: Ryo Uemura; Yukihiro Nagatani, Department of Radiology, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga, Japan, 520-2192, Tel/Fax +81-77-548-2536, Email ;
| | - Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masayuki Hashimoto
- Department of Thoracic Surgery, Kyoto Medical Center, Kyoto, Kyoto, Japan
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasuhiko Oshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hideji Otani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Wei S, Lu R, Zhang Z, Wang F, Tan H, Wang X, Ma J, Zhang Y, Deng N, Chen J. MRI-assessed diaphragmatic function can predict frequent acute exacerbation of COPD: a prospective observational study based on telehealth-based monitoring system. BMC Pulm Med 2022; 22:438. [PMID: 36424599 PMCID: PMC9685983 DOI: 10.1186/s12890-022-02254-x] [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: 09/01/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have considerably high mortality and re-hospitalisation rate. Diaphragmatic dysfunction (DD) is common in COPD patients. However, whether diaphragmatic dysfunction is related to acute exacerbation is yet to be elucidated. This study aimed to evaluate the diaphragm function by magnetic resonance imaging (MRI) in COPD patients and assess whether the impact of DD may help predict AECOPD. METHODS 20 healthy adult volunteers and 80 COPD patients were enrolled. The diaphragms function parameters were accessed by MRI. Patients were guided to start self-management by the Telehealth-based monitoring system following the enrolment. Events of acute exacerbation of COPD were recorded by the system and confirmed by healthcare providers. Binary univariate and multivariate logistic regression analyses were performed to investigate the factors associated with the frequency of AECOPD. Receiver operating characteristic (ROC) curves were further used to assess the value of prediction indexes. RESULTS Fifty-nine COPD patients completed a one-year follow-up based on the Telehealth-based monitoring system. The clinical outcomes showed that the diaphragm function parameters at the end of maximal breathing were lower in the COPD group than in the healthy control group (P < 0.05). ANOVA showed significant differences among Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages for diaphragm function parameters, including chest wall motion, lung area, upper-lower diameter, and the diaphragm thickening fraction at the end of maximal breathing (P < 0.05). Moreover, significant differences in diaphragm function parameters were observed between patients with infrequent AECOPD (n = 28) and frequent AECOPD (n = 31) based on the frequency of AECOPD (P < 0.05). The diaphragm thickening fraction and the chest wall motion were associated with AECOPD after adjusting for age, sex, BMI, and lung functions, and the combination of predictions showed better accuracy in predicting the frequency of AECOPD. CONCLUSIONS In COPD patients, diaphragm function parameters correlate with the severity of airflow limitation. The diaphragm thickening fraction and the chest wall motion were associated with the frequency of AECOPD and can predict it.
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Affiliation(s)
- Shuoshuo Wei
- grid.413385.80000 0004 1799 1445Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yongan Lane, Xingqing District, Yinchuan, 750004 Ningxia China ,grid.412194.b0000 0004 1761 9803Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Rong Lu
- grid.413385.80000 0004 1799 1445Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yongan Lane, Xingqing District, Yinchuan, 750004 Ningxia China ,Department of Pulmonary Medicine, People’s Hospital of Wuzhong, Wuzhong, 751100 Ningxia China
| | - Zhengping Zhang
- grid.413385.80000 0004 1799 1445Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Faxuan Wang
- grid.412194.b0000 0004 1761 9803Ningxia Medical University, Yinchuan, 750004 Ningxia China ,grid.412194.b0000 0004 1761 9803School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Hai Tan
- grid.413385.80000 0004 1799 1445Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yongan Lane, Xingqing District, Yinchuan, 750004 Ningxia China
| | - Xiaohong Wang
- grid.413385.80000 0004 1799 1445Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Jinlan Ma
- grid.413385.80000 0004 1799 1445Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Yating Zhang
- grid.413385.80000 0004 1799 1445Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yongan Lane, Xingqing District, Yinchuan, 750004 Ningxia China
| | - Ning Deng
- grid.13402.340000 0004 1759 700XMinistry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, 38 Zheda Road, Hangzhou, 310027 Zhejiang China
| | - Juan Chen
- grid.413385.80000 0004 1799 1445Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yongan Lane, Xingqing District, Yinchuan, 750004 Ningxia China
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Semiautomatic assessment of respiratory dynamics using cine MRI in chronic obstructive pulmonary disease. Eur J Radiol Open 2022; 9:100442. [PMID: 36193450 PMCID: PMC9525813 DOI: 10.1016/j.ejro.2022.100442] [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: 06/04/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The quantitative assessment of impaired lung motions and their association with the clinical characteristics of COPD patients is challenging. The aim of this study was to measure respiratory kinetics, including asynchronous movements, and to analyze the relationship between lung area and other clinical parameters. Materials and methods This study enrolled 10 normal control participants and 21 COPD patients who underwent dynamic MRI and pulmonary function testing (PFT). The imaging program was implemented using MATLAB®. Each lung area was detected semi-automatically on a coronal image (imaging level at the aortic valve) from the inspiratory phase to the expiratory phase. The Dice index of the manual measurements was calculated, with the relationship between lung area ratio and other clinical parameters, including PFTs then evaluated. The asynchronous movements of the diaphragm were also evaluated using a sagittal image. Results The Dice index for the lung region using the manual and semi-automatic extraction methods was high (Dice index = 0.97 ± 0.03). A significant correlation was observed between the time corrected lung area ratio and percentage of forced expiratory volume in 1 s (FEV1%pred) and residual volume percentage (RV%pred) (r = −0.54, p = 0.01, r = 0.50, p = 0.03, respectively). The correlation coefficient between each point of the diaphragm in the group with visible see-saw like movements was significantly lower than that in the group without see-saw like movements (value = −0.36 vs 0.95, p = 0.001). Conclusion Semi-automated extraction of lung area from Cine MRI might be useful for detecting impaired respiratory kinetics in patients with COPD.
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Key Words
- Asynchronous movement
- BMI, body mass index
- CAT, chronic obstructive pulmonary disease assessment test
- COPD, chronic obstructive pulmonary disease
- Chronic obstructive pulmonary disease (COPD)
- DLCO, carbon monoxide diffusing capacity of the lung
- Diaphragm
- FEV1, forced expiratory volume in 1 s
- FEV1/FVC, forced expiratory volume in 1 s per forced vital capacity
- FLASH, fast low angle shot
- FOV, field of view
- FRC, functional residual capacity
- FVC, forced vital capacity
- GOLD, Global Initiative for Chronic Pulmonary Obstructive Lung Disease
- HASTE, Half Fourier Acquisition Single-shot Turbo spin Echo
- ICC, intraclass correlation coefficient
- ICS, inhaled corticosteroid
- LAA, low attenuation area
- LABA, long-acting β-2 agonist
- LAMA, long-acting muscarinic antagonists
- LAV, low attenuation volume
- LV, lung volume
- Lung area
- MDCT, multi-detector row computed tomography
- MRI, magnetic resonance imaging
- Magnetic resonance imaging (MRI)
- PFT, pulmonary function testing
- Pulmonary function
- RV, residual volume
- RV/TLC, residual volume per total lung capacity
- SSFP, steady-state free precession
- TLA, total lung area
- TLC, total lung capacity
- UTE, ultrashort echo time
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Shimada A, Kawata N, Sato H, Ikari J, Suzuki E, Anazawa R, Suzuki M, Masuda Y, Haneishi H, Tatsumi K. Dynamic Quantitative Magnetic Resonance Imaging Assessment of Areas of the Lung During Free-Breathing of Patients with Chronic Obstructive Pulmonary Disease. Acad Radiol 2022; 29 Suppl 2:S215-S225. [PMID: 34144888 DOI: 10.1016/j.acra.2021.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES Changes in the geometry of the chest wall due to lung hyperinflation occur in COPD. However, the quantitative assessment of impaired lung motions and its association with the clinical characteristics of COPD patients are unclear. This study aimed to investigate the respiratory kinetics of COPD patients by dynamic MRI. MATERIALS AND METHODS This study enrolled 22 COPD patients and 10 normal participants who underwent dynamic MRI and pulmonary function testing (PFT). Changes in the areas of the lung and mediastinum during respiration were compared between the COPD patients and the normal controls. Relationships between MRI, CT parameters, and clinical measures that included PFT results also were evaluated. RESULTS Asynchronous movements and decreased diaphragmatic motion were found in COPD patients. COPD patients had a larger ratio of MRI-measured lung areas at expiration to inspiration, a smaller magnitude of the peak area change ratio, and a smaller mediastinal-thoracic area ratio than the normal participants. The lung area ratio was associated with FEV1/FVC, predicted RV%, and CT lung volume/predicted total lung capacity (pTLC). The lung area ratio of the right lower and left lower lungs was significantly correlated with emphysema of each lower lobe. The expiratory mediastinal-thoracic area ratio was associated with FEV1% predicted and RV/TLC. CONCLUSION Changes in the lung areas of COPD patients as shown on MRI reflected the severity of airflow limitation, hyperinflation, and the extent of emphysema. Dynamic MRI provides essential information about respiratory kinetics in COPD.
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Kang JH, Choi J, Chae KJ, Shin KM, Lee CH, Guo J, Lin CL, Hoffman EA, Lee C. CT-derived 3D-diaphragm motion in emphysema and IPF compared to normal subjects. Sci Rep 2021; 11:14923. [PMID: 34290275 PMCID: PMC8295260 DOI: 10.1038/s41598-021-93980-5] [Citation(s) in RCA: 6] [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: 01/13/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Image registration-based local displacement analysis enables evaluation of respiratory motion between two computed tomography-captured lung volumes. The objective of this study was to compare diaphragm movement among emphysema, idiopathic pulmonary fibrosis (IPF) and normal subjects. 29 normal, 50 emphysema, and 51 IPF subjects were included. A mass preserving image registration technique was used to compute displacement vectors of local lung regions at an acinar scale. Movement of the diaphragm was assumed to be equivalent to movement of the basal lung within 5 mm from the diaphragm. Magnitudes and directions of displacement vectors were compared between the groups. Three-dimensional (3D) and apico-basal displacements were smaller in emphysema than normal subjects (P = 0.003, P = 0.002). Low lung attenuation area on expiration scan showed significant correlations with decreased 3D and apico-basal displacements (r = - 0.546, P < 0.0001; r = - 0.521, P < 0.0001) in emphysema patients. Dorsal-ventral displacement was smaller in IPF than normal subjects (P < 0.0001). The standard deviation of the displacement angle was greater in both emphysema and IPF patients than normal subjects (P < 0.0001). In conclusion, apico-basal movement of the diaphragm is reduced in emphysema while dorsal-ventral movement is reduced in IPF. Image registration technique to multi-volume CT scans provides insight into the pathophysiology of limited diaphragmatic motion in emphysema and IPF.
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Affiliation(s)
- Ji Hee Kang
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Jiwoong Choi
- Department of Internal Medicine, School of Medicine, University of Kansas, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
- Department of Bioengineering, University of Kansas, Lawrence, KS, USA.
| | - Kum Ju Chae
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Kyung Min Shin
- Department of Radiology, Kyungpook National University, Daegu, Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Junfeng Guo
- Department of Radiology, University of Iowa, Iowa City, IA, USA
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Ching-Long Lin
- Department of Mechanical Engineering, IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, IA, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Changhyun Lee
- Department of Radiology, University of Iowa, Iowa City, IA, USA.
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea.
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Shiraishi M, Higashimoto Y, Sugiya R, Mizusawa H, Takeda Y, Fujita S, Nishiyama O, Kudo S, Kimura T, Chiba Y, Fukuda K, Tohda Y. Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients. ERJ Open Res 2020; 6:00589-2020. [PMID: 33447614 PMCID: PMC7792831 DOI: 10.1183/23120541.00589-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022] Open
Abstract
Background Although the pathophysiological mechanisms involved in the development of dyspnoea and poor exercise tolerance in patients with COPD are complex, dynamic lung hyperinflation (DLH) plays a central role. Diaphragmatic excursions can be measured by ultrasonography (US) with high intra- and interobserver reliability. The objective of this study was to evaluate the effect of diaphragmatic excursions as assessed by US on exercise tolerance and DLH in patients with COPD. Methods Patients with COPD (n=20) and age-matched control subjects (n=20) underwent US, which was used to determine the maximum level of diaphragmatic excursion (DEmax). Ventilation parameters, including the change in inspiratory capacity (ΔIC), were measured in the subjects during cardiopulmonary exercise testing (CPET). We examined the correlations between DEmax and the ventilation parameters. Results The DEmax of patients with COPD was significantly lower than that of the controls (45.0±12.8 mm versus 64.6±6.3 mm, respectively; p<0.01). The perception of peak dyspnoea (Borg scale) was significantly negatively correlated with DEmax in patients with COPD. During CPET, oxygen uptake/weight (V′O2/W) and minute ventilation (V′E) were significantly positively correlated with DEmax, while V′E/V′O2 and V′E/carbon dioxide output (V′CO2) were significantly negatively correlated with DEmax in patients with COPD. DEmax was also significantly positively correlated with ΔIC, reflecting DLH, and with V′O2/W, reflecting exercise capacity. Conclusion Reduced mobility of the diaphragm was related to decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patients. Reduced diaphragmatic excursion, as measured on ultrasound images, might predict decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patientshttps://bit.ly/3jkERxZ
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Affiliation(s)
- Masashi Shiraishi
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan.,Dept of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Yuji Higashimoto
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Ryuji Sugiya
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Hiroki Mizusawa
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Yu Takeda
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Shuhei Fujita
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Osamu Nishiyama
- Dept of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Shintarou Kudo
- Inclusive Medical Science Research Institute, Morinomiya University of Health Sciences, Osaka, Japan
| | - Tamotsu Kimura
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Kindai University School of Medicine, Osaka, Japan
| | - Kanji Fukuda
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Yuji Tohda
- Dept of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
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Alqahtani J, Alghamdi S. Ultrasonography in chronic obstructive pulmonary disease: Fact or fiction? Lung India 2020; 37:84-85. [PMID: 31898634 PMCID: PMC6961087 DOI: 10.4103/lungindia.lungindia_375_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Evrin T, Korkut S, Ozturk Sonmez L, Szarpak L, Katipoglu B, Smereka J, Guven R, Akpinar EE. Evaluating Stable Chronic Obstructive Pulmonary Disease by Ultrasound. Emerg Med Int 2019; 2019:5361620. [PMID: 31637058 PMCID: PMC6766158 DOI: 10.1155/2019/5361620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/12/2019] [Accepted: 08/16/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIM The purpose of the study was to evaluate the relationship between COPD severity and the diaphragmatic function measured by point-of-care US in patients with stable COPD. METHOD A total of 61 patients with COPD and 40 healthy subjects who had been admitted to Ufuk University Hospital between December 2018 and May 2019 were enrolled. Point-of-care US was performed, and lung silhouette and anterior, right, and left hemidiaphragm method in M-mode were used to evaluate the diaphragm. RESULTS The point-of-care US measurements, lung silhouette method right (Lung Sil R), lung silhouette method left (Lung Sil L), right hemidiaphragm US method in B-mode (Ant B-Mode R), and right hemidiaphragm US method in M-mode (Ant M-Mode R), were significantly different among groups (P < 0.001 for each). FEV1 was strongly correlated with Lung Sil R, Lung Sil L, Ant B-Mode R, and Ant M-Mode R (r = 0.963, P < 0.001; r = 0.956, P < 0.001; r = 0.953, P < 0.001; and r = 0.917, and P < 0.001, respectively). Negative correlations were detected between the number of exacerbations per year and Lung Sil R and the number of exacerbations per year and Ant M-Mode R (r = -0.599, P < 0.001 and r = -0.587, and P < 0.001, respectively). CONCLUSION In this study, FEV1 and annual number of exacerbations turned out to be strongly correlated US findings. The use of US in COPD patients could help to support clinical decision, but further clinical studies are necessary to confirm those findings.
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Affiliation(s)
- Togay Evrin
- Department of Emergency Medicine, Ufuk University Medical Faculty, Dr. Ridvan Ege Education and Research Hospital, Ankara, Turkey
| | - Semih Korkut
- Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Leyla Ozturk Sonmez
- Department of Physiology, Selcuk University Faculty of Medicine, Konya, Turkey
- Department of Emergency Medicine, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | | | - Burak Katipoglu
- Department of Emergency Medicine, Ufuk University Medical Faculty, Dr. Ridvan Ege Education and Research Hospital, Ankara, Turkey
| | - Jacek Smereka
- Department of Emergency Medical Services, Wroclaw Medical University, Wroclaw, Poland
| | - Ramazan Guven
- Department of Emergency Medicine, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Evrim Eylem Akpinar
- Department of Chest Diseases, Ufuk University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey
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Brüggemann AKV, Leal BE, Gonçalves MA, Lisboa L, Tavares MGDS, Paulin E. Mobilidade diafragmática direita e esquerda em indivíduos saudáveis e na doença pulmonar obstrutiva crônica. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/16155925022018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
RESUMO Avaliar o músculo diafragma é importante para verificar suas possíveis alterações ou disfunções. Existem várias formas de avaliar a mobilidade diafragmática, mas poucos estudos que comparam a mobilidade do hemidiafragma direito com o esquerdo. O objetivo deste estudo é avaliar se existem diferenças entre a mobilidade diafragmática das hemicúpulas direita e esquerda em indivíduos saudáveis e em indivíduos com Doença Pulmonar Obstrutiva Crônica (DOCP), bem como comparar a mobilidade diafragmática entre homens e mulheres, e entre pacientes saudáveis e com DPOC. Foram avaliados 40 indivíduos saudáveis e 40 indivíduos com diagnóstico clínico de DPOC. Utilizaram-se os parâmetros antropométricos, cardiopulmonares e avaliação da mobilidade diafragmática pelo método radiográfico. Os dados foram analisados estatisticamente e tratados com análise descritiva (média e desvio-padrão) e análise inferencial. Para comparar a mobilidade das hemicúpulas diafragmáticas direita e esquerda, utilizou-se o teste t pareado. O nível de significância adotado para o tratamento estatístico foi de 5% (p<0,05). Não houve diferença da mobilidade diafragmática tanto do lado direito quanto do lado esquerdo nos indivíduos saudáveis (p=0,45) e nos indivíduos com DPOC (p=0,77), assim como não houve diferenças quando os grupos foram separados por sexo. Foi encontrada uma diferença importante comparando tanto a mobilidade diafragmática do lado direito quanto do lado esquerdo entre indivíduos saudáveis e DPOC (p<0,001). Concluiu-se que a mobilidade diafragmática das hemicúpulas direita e esquerda em indivíduos saudáveis e em indivíduos com DPOC é a mesma. Não há diferença da mobilidade entre homens e mulheres. A mobilidade diafragmática é reduzida em paciente com DPOC.
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12
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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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13
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Yamada Y, Ueyama M, Abe T, Araki T, Abe T, Nishino M, Jinzaki M, Hatabu H, Kudoh S. Time-Resolved Quantitative Analysis of the Diaphragms During Tidal Breathing in a Standing Position Using Dynamic Chest Radiography with a Flat Panel Detector System ("Dynamic X-Ray Phrenicography"): Initial Experience in 172 Volunteers. Acad Radiol 2017; 24:393-400. [PMID: 27989446 DOI: 10.1016/j.acra.2016.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Diaphragmatic motion in a standing position during tidal breathing remains unclear. The purpose of this observational study was to evaluate diaphragmatic motion during tidal breathing in a standing position in a health screening center cohort using dynamic chest radiography in association with participants' demographic characteristics. MATERIALS AND METHODS One hundred seventy-two subjects (103 men; aged 56.3 ± 9.8 years) underwent sequential chest radiographs during tidal breathing using dynamic chest radiography with a flat panel detector system. We evaluated the excursions of and peak motion speeds of the diaphragms. Associations between the excursions and participants' demographics (gender, height, weight, body mass index [BMI], smoking history, tidal volume, vital capacity, and forced expiratory volume) were investigated. RESULTS The average excursion of the left diaphragm (14.9 ± 4.6 mm, 95% CI 14.2-15.5 mm) was significantly larger than that of the right (11.0 ± 4.0 mm, 95% CI 10.4-11.6 mm) (P <0.001). The peak motion speed of the left diaphragm (inspiratory, 16.6 ± 4.2 mm/s; expiratory, 13.7 ± 4.2 mm/s) was significantly faster than that of the right (inspiratory, 12.4 ± 4.4 mm/s; expiratory, 9.4 ± 3.8 mm/s) (both P <0.001). Both simple and multiple regression models demonstrated that higher BMI and higher tidal volume were associated with increased excursions of the bilateral diaphragm (all P <0.05). CONCLUSIONS The average excursions of the diaphragms are 11.0 mm (right) and 14.9 mm (left) during tidal breathing in a standing position. The diaphragmatic motion of the left is significantly larger and faster than that of the right. Higher BMI and tidal volume are associated with increased excursions of the bilateral diaphragm.
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Affiliation(s)
- Yoshitake Yamada
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02215; Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Masako Ueyama
- Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
| | - Takehiko Abe
- Department of Radiology, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
| | - Tetsuro Araki
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02215
| | - Takayuki Abe
- Department of Preventive Medicine and Public Health, Biostatistics Unit at Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Mizuki Nishino
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02215
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroto Hatabu
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02215.
| | - Shoji Kudoh
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
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Rocha FR, Brüggemann AKV, Francisco DDS, de Medeiros CS, Rosal D, Paulin E. Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea, and physical activity in daily life in patients with COPD. J Bras Pneumol 2017; 43:32-37. [PMID: 28380186 PMCID: PMC5790674 DOI: 10.1590/s1806-37562016000000097] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 10/31/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: To evaluate diaphragmatic mobility in relation to lung function, respiratory muscle strength, dyspnea, and physical activity in daily life (PADL) in patients with COPD. METHODS: We included 25 patients with COPD, classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria, and 25 healthy individuals. For all of the participants, the following were evaluated: anthropometric variables, spirometric parameters, respiratory muscle strength, diaphragmatic mobility (by X-ray), PADL, and the perception of dyspnea. RESULTS: In the COPD group, diaphragmatic mobility was found to correlate with lung function variables, inspiratory muscle strength, and the perception of dyspnea, whereas it did not correlate with expiratory muscle strength or PADL. CONCLUSIONS: In patients with COPD, diaphragmatic mobility seems to be associated with airway obstruction and lung hyperinflation, as well as with ventilatory capacity and the perception of dyspnea, although not with PADL. OBJETIVO: Avaliar a relação da mobilidade diafragmática com a função pulmonar, força muscular respiratória, dispneia e atividade física de vida diária (AFVD) em pacientes com DPOC. MÉTODOS: Foram avaliados 25 pacientes com diagnóstico de DPOC, classificados de acordo com critérios da Global Initiative for Chronic Obstructive Lung Disease, e 25 indivíduos saudáveis. Todos foram submetidos às seguintes avaliações: mensuração antropométrica, espirometria, força muscular respiratória, mobilidade diafragmática (por radiografia), AFVD e percepção de dispneia. RESULTADOS: No grupo DPOC, houve correlações da mobilidade diafragmática com variáveis de função pulmonar, força muscular inspiratória e percepção de dispneia. Não houve correlações da mobilidade diafragmática com força muscular expiratória e AFVD. CONCLUSÕES: A mobilidade diafragmática parece estar associada tanto com a obstrução das vias aéreas quanto com a hiperinsuflação pulmonar em pacientes com DPOC, assim como com a capacidade ventilatória e percepção de dispneia, mas não com AFVD.
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Affiliation(s)
- Flávia Roberta Rocha
- . Curso de Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
| | | | - Davi de Souza Francisco
- . Curso de Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
| | | | - Danielle Rosal
- . Fundação Universidade Regional de Blumenau - FURB - Blumenau (SC) Brasil
| | - Elaine Paulin
- . Curso de Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
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15
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Yamashiro T, Moriya H, Tsubakimoto M, Matsuoka S, Murayama S. Continuous quantitative measurement of the proximal airway dimensions and lung density on four-dimensional dynamic-ventilation CT in smokers. Int J Chron Obstruct Pulmon Dis 2016; 11:755-64. [PMID: 27110108 PMCID: PMC4835141 DOI: 10.2147/copd.s100658] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Four-dimensional dynamic-ventilation computed tomography (CT) imaging demonstrates continuous movement of the airways and lungs, which cannot be depicted with conventional CT. We aimed to investigate continuous changes in lung density and airway dimensions and to assess the correlation with spirometric values in smokers. Materials and methods This retrospective study was approved by the Institutional Review Board, and informed consent was waived. Twenty-one smokers including six patients with COPD underwent four-dimensional dynamic-ventilation CT during free breathing (160 mm in length). The mean lung density (MLD) of the scanned lung and luminal areas (Ai) of fixed points in the trachea and the right proximal bronchi (main bronchus, upper bronchus, bronchus intermedius, and lower bronchus) were continuously measured. Concordance between the time curve of the MLD and that of the airway Ai values was expressed by cross-correlation coefficients. The associations between these quantitative measurements and the forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) values were assessed by Spearman’s rank correlation analysis. Results On the time curve for the MLD, the Δ-MLD1.05 values between the peak inspiratory frame to the later third frame (1.05 seconds later) were strongly correlated with the FEV1/FVC (ρ=0.76, P<0.0001). The cross-correlation coefficients between the airway Ai and MLD values were significantly correlated with the FEV1/FVC (ρ=−0.56 to −0.66, P<0.01), except for the right upper bronchus. This suggested that the synchrony between the airway and lung movement was lost in patients with severe airflow limitation. Conclusion Respiratory changes in the MLD and synchrony between the airway Ai and the MLD measured with dynamic-ventilation CT were correlated with patient’s spirometric values.
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Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima-shi, Fukushima, Japan
| | - Maho Tsubakimoto
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Shin Matsuoka
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
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16
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Koyama H, Ohno Y, Fujisawa Y, Seki S, Negi N, Murakami T, Yoshikawa T, Sugihara N, Nishimura Y, Sugimura K. 3D lung motion assessments on inspiratory/expiratory thin-section CT: Capability for pulmonary functional loss of smoking-related COPD in comparison with lung destruction and air trapping. Eur J Radiol 2015; 85:352-9. [PMID: 26781140 DOI: 10.1016/j.ejrad.2015.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/14/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the utility of three-dimensional (3D) lung motion on inspiratory and expiratory CT for pulmonary functional loss in smoking-related COPD in comparison with lung destruction and air trapping assessments. METHOD AND MATERIALS Forty-four consecutive smokers and COPD patients prospectively underwent inspiratory and expiratory CT. A 3D motion vector map was generated from these CTs, and regional motion magnitudes were measured at the horizontal axis (X-axis), the ventrodorsal axis (Y-axis), and the craniocaudal axis (Z-axis). All mean magnitudes within the entire lung (MMLX, MMLY, and MMLZ) were normalized by expiratory CT lung volume. Moreover, CT-based functional lung volume (FLV) on inspiratory CT and air trapping lung volume (ATLV) on expiratory CT were assessed quantitatively. To evaluate the capability for pulmonary function loss assessment, all MMLs were correlated with pulmonary function tests. Then, discrimination analysis was performed to determine the concordance capability for clinical stage, and correct classification capabilities were compared by means of McNemar's test. RESULTS Multiple regression analysis showed MMLY (β=0.657, p<0.001) and FLV (β=0.375, p=0.019) were correlated with percentage of predicted forced expiratory volume in 1 second. Correct classification capabilities using patient characteristics and MMLs (68.2 (30/44)%) were significantly higher than those obtained by patient characteristics, FLV, and ATLV (54.5 (24/44)%), p=0.031). CONCLUSION 3D lung motion parameter assessment is useful for smoking-related COPD assessment as well as lung parenchymal destruction and/or air trapping evaluations.
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Affiliation(s)
- Hisanobu Koyama
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yoshiharu Ohno
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuko Fujisawa
- Toshiba Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Shinichiro Seki
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Negi
- Center for Radiology and Radiation Oncology, Kobe University Hospital, Japan
| | - Tohru Murakami
- Center for Radiology and Radiation Oncology, Kobe University Hospital, Japan
| | - Takeshi Yoshikawa
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Sugihara
- Toshiba Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuro Sugimura
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
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Scheibe N, Sosnowski N, Pinkhasik A, Vonderbank S, Bastian A. Sonographic evaluation of diaphragmatic dysfunction in COPD patients. Int J Chron Obstruct Pulmon Dis 2015; 10:1925-30. [PMID: 26392767 PMCID: PMC4574853 DOI: 10.2147/copd.s85659] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Diaphragmatic dysfunction is an important reason for dyspnea in COPD patients. But diaphragmatic dysfunction is difficult to evaluate. Ultrasound is an option. We measure sonographically the up- and downward movement of the lung silhouette on both hemidiaphragms. The aim of this prospective investigation was to compare this method with another sonographic method that visualizes the right hemidiaphragm directly and to compare the sonographic results with lung function parameters. Methods and patients Eighty participants – 20 healthy persons and 60 COPD patients – three groups each with 20 patients with COPD GOLD II, III, and IV – were investigated. The sonographic measurements of the diaphragms were performed. Lung function parameters, blood gases, and 6-minute walk test were also collected and compared to the sonographic results. Results The sonographic measurement of the lung silhouette was easy to perform in all study participants. The correlation between the sonographic methods measuring the right hemidiaphragmatic movement was strong (r=0.85). There was also a strong correlation between the demonstrated sonographic measurement of the up- and downward movement of the lung silhouette and the forced expiratory volume in the first second (r=0.83). Conclusion We demonstrated that the sonographic measurement of the movement of the lung silhouette is an easy way to establish diaphragmatic dysfunction in COPD patients; it can be done in all patients with reliable results for the right and the left hemidiaphragm.
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Affiliation(s)
- Nadine Scheibe
- Department of Pneumonology, Marienkrankenhaus Kassel, Kassel, Germany
| | - Natalia Sosnowski
- Department of Pneumonology, Marienkrankenhaus Kassel, Kassel, Germany
| | - Alina Pinkhasik
- Department of Pneumonology, Marienkrankenhaus Kassel, Kassel, Germany
| | - Sandy Vonderbank
- Department of Pneumonology, Marienkrankenhaus Kassel, Kassel, Germany
| | - Andreas Bastian
- Department of Pneumonology, Marienkrankenhaus Kassel, Kassel, Germany
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Baria MR, Shahgholi L, Sorenson EJ, Harper CJ, Lim KG, Strommen JA, Mottram CD, Boon AJ. B-mode ultrasound assessment of diaphragm structure and function in patients with COPD. Chest 2015; 146:680-685. [PMID: 24700122 DOI: 10.1378/chest.13-2306] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Electromyographic evaluation of diaphragmatic neuromuscular disease in patients with COPD is technically difficult and potentially high risk. Defining standard values for diaphragm thickness and thickening ratio using B-mode ultrasound may provide a simpler, safer means of evaluating these patients. METHODS Fifty patients with a diagnosis of COPD and FEV₁ < 70% underwent B-mode ultrasound. Three images were captured both at end expiration (Tmin) and at maximal inspiration (Tmax). The thickening ratio was calculated as (Tmax/Tmin), and each set of values was averaged. Findings were compared with a database of 150 healthy control subjects. RESULTS There was no significant difference in diaphragm thickness or thickening ratio between sides within groups (control subjects or patients with COPD) or between groups, with the exception of the subgroup with severe air trapping (residual volume > 200%), in which the only difference was that the thickening ratio was higher on the left (P = .0045). CONCLUSIONS In patients with COPD presenting for evaluation of coexisting neuromuscular respiratory weakness, the same values established for healthy control subjects serve as the baseline for comparison. This knowledge expands the role of ultrasound in evaluating neuromuscular disease in patients with COPD.
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Affiliation(s)
- Michael R Baria
- Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN
| | - Leili Shahgholi
- Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN
| | - Eric J Sorenson
- Division of Clinical Neurophysiology, Mayo Clinic and Foundation, Rochester, MN
| | - Caitlin J Harper
- Department of Neurology, Mayo Medical School, Mayo Clinic and Foundation, Rochester, MN
| | - Kaiser G Lim
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN; Division of Allergic Diseases, Mayo Clinic and Foundation, Rochester, MN
| | - Jeffrey A Strommen
- Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN; Division of Clinical Neurophysiology, Mayo Clinic and Foundation, Rochester, MN
| | - Carl D Mottram
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN; Division of Clinical Neurophysiology, Mayo Clinic and Foundation, Rochester, MN.
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Smargiassi A, Inchingolo R, Tagliaboschi L, Di Marco Berardino A, Valente S, Corbo GM. Ultrasonographic assessment of the diaphragm in chronic obstructive pulmonary disease patients: relationships with pulmonary function and the influence of body composition - a pilot study. Respiration 2014; 87:364-71. [PMID: 24732295 DOI: 10.1159/000358564] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 01/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Skeletal muscle weakness with loss of fat-free mass (FFM) is one of the main systemic effects of chronic obstructive pulmonary disease (COPD). The diaphragm is also involved, leading to disadvantageous conditions and poor contractile capacities. OBJECTIVES We measured the thickness of the diaphragm (TD) by ultrasonography to evaluate the relationships between echographic measurements, parameters of respiratory function and body composition data. METHODS Thirty-two patients (23 males) underwent (1) pulmonary function tests, (2) echographic assessment of TD in the zone of apposition at various lung volumes, i.e. TD at residual volume (TDRV), TD at functional residual capacity (TDFRC) and TD at total lung capacity (TDTLC), and (3) bioelectrical body impedance analysis. The BMI and the BODE (BMI-Obstruction-Dyspnea-Exercise) index values were reported. RESULTS TDRV, TDFRC and TDTLC measured 3.3, 3.6 and 6 mm, respectively, with good intraobserver reproducibility (0.97, 0.97 and 0.96, respectively). All the TDs were found to be related to FFM, with the relationship being greater for TDFRC (r(2) = 0.39 and p = 0.0002). With regard to lung volumes, inspiratory capacity (IC) was found to be closely related to TDTLC (r(2) = 0.42 and p = 0.0001). The difference between TDTLC and TDRV, as a thickening value (TDTLCRV), was closely related to FVC (r(2) = 0.34 and p = 0.0004) and to air-trapping indices (RV/TLC, FRC/TLC and IC/TLC): the degree of lung hyperinflation was greater and the TDTLCRV was less. Finally, we found a progressive reduction of both thicknesses and thickenings as the severity of IC/TLC increased, with a significant p value for the trend in both analyses (p = 0.02). CONCLUSIONS Ultrasonographic assessment of the diaphragm could be a useful tool for studying disease progression in COPD patients, in terms of lung hyperinflation and the loss of FFM. © 2014 S. Karger AG, Basel.
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Affiliation(s)
- Andrea Smargiassi
- Pulmonary Medicine Department, Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
Pulmonary emphysema is a pathologic condition characterized by permanently enlarged airspaces distal to the terminal bronchiole with destruction of the alveolar walls. Functional information of the lungs is important to understand the pathophysiology of emphysema and that of chronic obstructive pulmonary disease. With the recent developments in magnetic resonance imaging (MRI) techniques, functional MRI with variable MR sequences can be used for the evaluation of different physiological and anatomic changes seen in cases of pulmonary emphysema. In this review article, we will focus on a brief description of each method, results of some of the most recent work, and the clinical application of such knowledge.
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Xie X, de Jong PA, Oudkerk M, Wang Y, Ten Hacken NHT, Miao J, Zhang G, de Bock GH, Vliegenthart R. Morphological measurements in computed tomography correlate with airflow obstruction in chronic obstructive pulmonary disease: systematic review and meta-analysis. Eur Radiol 2012; 22:2085-93. [PMID: 22699870 PMCID: PMC3431473 DOI: 10.1007/s00330-012-2480-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/20/2012] [Accepted: 03/26/2012] [Indexed: 01/08/2023]
Abstract
Objectives To determine the correlation between CT measurements of emphysema or peripheral airways and airflow obstruction in chronic obstructive pulmonary disease (COPD). Methods PubMed, Embase and Web of Knowledge were searched from 1976 to 2011. Two reviewers independently screened 1,763 citations to identify articles that correlated CT measurements to airflow obstruction parameters of the pulmonary function test in COPD patients, rated study quality and extracted information. Three CT measurements were accessed: lung attenuation area percentage < -950 Hounsfield units, mean lung density and airway wall area percentage. Two airflow obstruction parameters were accessed: forced expiratory volume in the first second as percentage from predicted (FEV1 %pred) and FEV1 divided by the forced volume vital capacity. Results Seventy-nine articles (9,559 participants) were included in the systematic review, demonstrating different methodologies, measurements and CT airflow obstruction correlations. There were 15 high-quality articles (2,095 participants) in the meta-analysis. The absolute pooled correlation coefficients ranged from 0.48 (95 % CI, 0.40 to 0.54) to 0.65 (0.58 to 0.71) for inspiratory CT and 0.64 (0.53 to 0.72) to 0.73 (0.63 to 0.80) for expiratory CT. Conclusions CT measurements of emphysema or peripheral airways are significantly related to airflow obstruction in COPD patients. CT provides a morphological method to investigate airway obstruction in COPD. Key Points • Computed tomography is widely performed in patients with chronic obstructive pulmonary disease (COPD) • CT provides quantitative morphological methods to investigate airflow obstruction in COPD • CT measurements correlate significantly with the degree of airflow obstruction in COPD • Expiratory CT measurements correlate more strongly with airflow obstruction than inspiratory CT • Low-dose CT decreases the radiation dose for diagnosis and quantitative emphysema evaluation Electronic supplementary material The online version of this article (doi:10.1007/s00330-012-2480-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xueqian Xie
- Center for Medical Imaging-North East Netherlands (CMI-NEN), Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700, RB, Groningen, The Netherlands
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Vivier E, Mekontso Dessap A, Dimassi S, Vargas F, Lyazidi A, Thille AW, Brochard L. Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. Intensive Care Med 2012; 38:796-803. [PMID: 22476448 DOI: 10.1007/s00134-012-2547-7] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 01/12/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE Ultrasonography allows the direct observation of the diaphragm. Its thickness variation measured in the zone of apposition has been previously used to diagnose diaphragm paralysis. We assessed the feasibility and accuracy of this method to assess diaphragmatic function and its contribution to respiratory workload in critically ill patients under non-invasive ventilation. METHODS This was a preliminary physiological study in the intensive care unit of a university hospital. Twelve patients requiring planned non-invasive ventilation after extubation were studied while spontaneously breathing and during non-invasive ventilation at three levels of pressure support (5, 10 and 15 cmH(2)O). Diaphragm thickness was measured in the zone of apposition during tidal ventilation and the thickening fraction (TF) was calculated as (thickness at inspiration - thickness at expiration)/thickness at expiration. Diaphragmatic pressure-time product per breath (PTP(di)) was measured from oesophageal and gastric pressure recordings. RESULTS PTP(di) and TF both decreased as the level of pressure support increased. A significant correlation was found between PTP(di) and TF (ρ = 0.74, p < 0.001). The overall reproducibility of TF assessment was good but the coefficient of repeatability reached 18% for inter-observer reproducibility. CONCLUSIONS Ultrasonographic assessment of the diaphragm TF is a non-invasive method that may prove useful in evaluating diaphragmatic function and its contribution to respiratory workload in intensive care unit patients.
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Affiliation(s)
- Emmanuel Vivier
- AP-HP, Service de Réanimation Médicale, Centre Hospitalo-Universitaire Henri Mondor, 51, avenue du Mal de Lattre de Tassigny, 94 010, Créteil Cedex, France
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