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Abstract
PURPOSE OF REVIEW Several lung volume reduction (LVR) techniques have been increasingly evaluated in patients with advanced pulmonary emphysema, especially in the last decade. Radiologist plays a pivotal role in the characterization of parenchymal damage and, thus, assessment of eligibility criteria. This review aims to discuss the most common LVR techniques, namely LVR surgery, endobronchial valves, and coils LVR, with emphasis on the role of computed tomography (CT). RECENT FINDINGS Several trials have recently highlighted the importance of regional quantification of emphysema by computerized CT-based segmentation of hyperlucent parenchyma, which is strongly recommended for candidates to any LVR treatment. In particular, emphysema distribution pattern and fissures integrity are evaluated to tailor the choice of the most appropriate LVR technique. Furthermore, a number of CT measures have been tested for the personalization of treatment, according to imaging detected heterogeneity of parenchymal disease. SUMMARY CT characterization of heterogeneous parenchymal abnormalities provides criteria for selection of the preferable treatment in each patient and improves outcome of LVR as reflected by better quality of life, higher exercise tolerance, and lower mortality.
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Lim HJ, Weinheimer O, Wielpütz MO, Dinkel J, Hielscher T, Gompelmann D, Kauczor HU, Heussel CP. Fully Automated Pulmonary Lobar Segmentation: Influence of Different Prototype Software Programs onto Quantitative Evaluation of Chronic Obstructive Lung Disease. PLoS One 2016; 11:e0151498. [PMID: 27029047 PMCID: PMC4814108 DOI: 10.1371/journal.pone.0151498] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 02/29/2016] [Indexed: 12/19/2022] Open
Abstract
Objectives Surgical or bronchoscopic lung volume reduction (BLVR) techniques can be beneficial for heterogeneous emphysema. Post-processing software tools for lobar emphysema quantification are useful for patient and target lobe selection, treatment planning and post-interventional follow-up. We aimed to evaluate the inter-software variability of emphysema quantification using fully automated lobar segmentation prototypes. Material and Methods 66 patients with moderate to severe COPD who underwent CT for planning of BLVR were included. Emphysema quantification was performed using 2 modified versions of in-house software (without and with prototype advanced lung vessel segmentation; programs 1 [YACTA v.2.3.0.2] and 2 [YACTA v.2.4.3.1]), as well as 1 commercial program 3 [Pulmo3D VA30A_HF2] and 1 pre-commercial prototype 4 [CT COPD ISP ver7.0]). The following parameters were computed for each segmented anatomical lung lobe and the whole lung: lobar volume (LV), mean lobar density (MLD), 15th percentile of lobar density (15th), emphysema volume (EV) and emphysema index (EI). Bland-Altman analysis (limits of agreement, LoA) and linear random effects models were used for comparison between the software. Results Segmentation using programs 1, 3 and 4 was unsuccessful in 1 (1%), 7 (10%) and 5 (7%) patients, respectively. Program 2 could analyze all datasets. The 53 patients with successful segmentation by all 4 programs were included for further analysis. For LV, program 1 and 4 showed the largest mean difference of 72 ml and the widest LoA of [-356, 499 ml] (p<0.05). Program 3 and 4 showed the largest mean difference of 4% and the widest LoA of [-7, 14%] for EI (p<0.001). Conclusions Only a single software program was able to successfully analyze all scheduled data-sets. Although mean bias of LV and EV were relatively low in lobar quantification, ranges of disagreement were substantial in both of them. For longitudinal emphysema monitoring, not only scanning protocol but also quantification software needs to be kept constant.
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Affiliation(s)
- Hyun-ju Lim
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstrasse 5, 69126, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstrasse 5, 69126, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstrasse 5, 69126, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Julien Dinkel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstrasse 5, 69126, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
- Institute for Clinical Radiology, University Hospital, Ludwig-Maximilians University, Munich, Marchioninistr. 15, D-81377, Muenchen, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Daniela Gompelmann
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at University of Heidelberg, Amalienstr. 5, 69126, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstrasse 5, 69126, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
- * E-mail:
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Trotta BM, Stolin AV, Williams MB, Gay SB, Brody AS, Altes TA. Characterization of the relation between CT technical parameters and accuracy of quantification of lung attenuation on quantitative chest CT. AJR Am J Roentgenol 2007; 188:1683-90. [PMID: 17515394 DOI: 10.2214/ajr.06.1153] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the compromise between CT technical parameters and the accuracy of CT quantification of lung attenuation. MATERIALS AND METHODS Materials that simulate water (0 H), healthy lung (-650 H), borderline emphysematous lung (-820 H), and severely emphysematous lung (-1,000 H) were placed at both the base and the apex of the lung of an anthropomorphic phantom and outside the phantom. Transaxial CT images through the samples were obtained while the effective tube current was varied from 440 to 10 mAs, kilovoltage from 140 to 80 kVp, and slice thickness from 0.625 to 10 mm. Mean +/- SD attenuation within the samples and the standard quantitative chest CT measurements, the percentage of pixels with attenuation less than -910 H and 15th percentile of attenuation, were computed. RESULTS Outside the phantom, variations in CT parameters produced less than 2.0% error in all measurements. Within the anthropomorphic phantom at 30 mAs, error in measurements was much larger, ranging from zero to 200%. Below approximately 80 mAs, mean attenuation became increasingly biased. The effects were most pronounced at the apex of the lungs. Mean attenuation of the borderline emphysematous sample of apex decreased 55 H as the tube current was decreased from 300 to 30 mAs. Both the 15th percentile of attenuation and percentage of pixels with less than -910 H attenuation were more sensitive to variations in effective tube current than was mean attenuation. For example, the -820 H sample should have 0% of pixels less than -910 H, which was true at 400 mA. At 30 mA in the lung apex, however, the measurement was highly inaccurate, 51% of pixels being below this value. Decreased kilovoltage and slice thickness had analogous, but lesser, effects. CONCLUSION The accuracy of quantitative chest CT is determined by the CT acquisition parameters. There can be significant decreases in accuracy at less than 80 mAs for thin slices in an anthropomorphic phantom, the most pronounced effects occurring in the lung apex.
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Affiliation(s)
- Brian M Trotta
- Department of Radiology, University of Virginia Medical Center, Charlottesville, VA, USA
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