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Kim T, Lim MN, Kim WJ, Ho TT, Lee CH, Chae KJ, Bak SH, Jin GY, Park EK, Choi S. Structural and functional alterations of subjects with cement dust exposure: A longitudinal quantitative computed tomography-based study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 837:155812. [PMID: 35550893 DOI: 10.1016/j.scitotenv.2022.155812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/13/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Cement dust exposure (CDE) can be a risk factor for pulmonary disease, causing changes in segmental airways and parenchymal lungs. This study investigates longitudinal alterations in quantitative computed tomography (CT)-based metrics due to CDE. We obtained CT-based airway structural and lung functional metrics from CDE subjects with baseline CT and follow-up CT scans performed three years later. From the CT, we extracted wall thickness (WT) and bifurcation angle (θ) at total lung capacity (TLC) and functional residual capacity (FRC), respectively. We also computed air volume (Vair), tissue volume (Vtissue), global lung shape, percentage of emphysema (Emph%), and more. Clinical measures were used to associate with CT-based metrics. Three years after their baseline, the pulmonary function tests of CDE subjects were similar or improved, but there were significant alterations in the CT-based structural and functional metrics. The follow-up CT scans showed changes in θ at most of the central airways; increased WT at the subgroup bronchi; smaller Vair at TLC at all except the right upper and lower lobes; smaller Vtissue at all lobes in TLC and FRC except for the upper lobes in FRC; smaller global lung shape; and greater Emph% at the right upper and lower lobes. CT-based structural and functional variables are more sensitive to the early identification of CDE subjects, while most clinical lung function changes were not noticeable. We speculate that the significant long-term changes in CT are uniquely observed in CDE subjects, different from smoking-induced structural changes.
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Affiliation(s)
- Taewoo Kim
- School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Myoung-Nam Lim
- Biomedical Research Institute, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Thao Thi Ho
- School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Chang Hyun Lee
- Department of Radiology, College of Medicine, Seoul National University, Seoul, Republic of Korea; Department of Radiology, College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Kum Ju Chae
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - So Hyeon Bak
- Department of Radiology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Gong Yong Jin
- Department of Radiology, College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, Republic of Korea
| | - Sanghun Choi
- School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea.
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Sieren JC, Schroeder KE, Guo J, Asosingh K, Erzurum S, Hoffman EA. Menstrual cycle impacts lung structure measures derived from quantitative computed tomography. Eur Radiol 2021; 32:2883-2890. [PMID: 34928413 PMCID: PMC9038622 DOI: 10.1007/s00330-021-08404-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/23/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Quantitative computed tomography (qCT) is being increasingly incorporated in research studies and clinical trials aimed at understanding lung disease risk, progression, exacerbations, and intervention response. Menstrual cycle-based changes in lung function are recognized; however, the impact on qCT measures is currently unknown. We hypothesize that the menstrual cycle impacts qCT-derived measures of lung structure in healthy women and that the degree of measurement change may be mitigated in subjects on cyclic hormonal birth control. METHODS Thirty-one non-smoking, healthy women with regular menstrual cycles (16 of which were on cyclic hormonal birth control) underwent pulmonary function testing and qCT imaging at both menses and early luteal phase time points. Data were evaluated to identify lung measurements which changed significantly across the two key time points and to compare degree of change across metrics for the sub-cohort with versus without birth control. RESULTS The segmental airway measurements were larger and mean lung density was higher at menses compared to the early luteal phase. The sub-cohort with cyclic hormonal birth control did not have less evidence of measurement difference over the menstrual cycle compared to the sub-cohort without hormonal birth control. CONCLUSIONS This study provides evidence that qCT-derived measures from the lung are impacted by the female menstrual cycle. This indicates studies seeking to use qCT as a more sensitive measure of cross-sectional differences or longitudinal changes in these derived lung measurements should consider acquiring data at a consistent time in the menstrual cycle for pre-menopausal women and warrants further exploration. KEY POINTS • Lung measurements from chest computed tomography are used in multicenter studies exploring lung disease progression and treatment response. • The menstrual cycle impacts lung structure measurements. • Cyclic variability should be considered when evaluating longitudinal change with CT in menstruating women.
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Affiliation(s)
- Jessica C Sieren
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA. .,Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA.
| | - Kimberly E Schroeder
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA
| | - Junfeng Guo
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA.,Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Kewal Asosingh
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Flow Cytometry Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serpil Erzurum
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA.,Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
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Influence of acquisition settings and radiation exposure on CT lung densitometry-An anthropomorphic ex vivo phantom study. PLoS One 2020; 15:e0237434. [PMID: 32797096 PMCID: PMC7428081 DOI: 10.1371/journal.pone.0237434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 07/28/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives To systematically evaluate the influence of acquisition settings in conjunction with raw-data based iterative image reconstruction (IR) on lung densitometry based on multi-row detector computed tomography (CT) in an anthropomorphic chest phantom. Materials and methods Ten porcine heart-lung explants were mounted in an ex vivo chest phantom shell, six with highly and four with low attenuating chest wall. CT (Somatom Definition Flash, Siemens Healthineers) was performed at 120kVp and 80kVp, each combined with current-time products of 120, 60, 30, and 12mAs, and was reconstructed with filtered back projection (FBP) and IR (Safire, Siemens Healthineers). Mean lung density (LD), air density (AD) and noise were measured by semi-automated region-of interest (ROI) analysis, with 120kVp/120 mAs serving as the standard of reference. Results Using IR, noise in lung parenchyma was reduced by ~ 31% at high attenuating chest wall and by ~ 22% at low attenuating chest wall compared to FBP, respectively (p<0.05). IR induced changes in the order of ±1 HU to mean absolute LD and AD compared to corresponding FBP reconstructions which were statistically significant (p<0.05). Conclusions Densitometry is influenced by acquisition parameters and reconstruction algorithms to a degree that may be clinically negligible. However, in longitudinal studies and clinical research identical protocols and potentially other measures for calibration may be required.
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Xia M, Richard Hahn P, Gustafson P. A Bayesian mixture of experts approach to covariate misclassification. CAN J STAT 2020. [DOI: 10.1002/cjs.11560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michelle Xia
- Department of Statistics and Actuarial Science Northern Illinois University Dekalb IL U.S.A
| | - P. Richard Hahn
- School of Mathematical and Statistical Sciences Arizona State University Tempe AZ U.S.A
| | - Paul Gustafson
- Department of Statistics University of British Columbia Vancouver British Columbia Canada
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Oh AS, Strand M, Pratte K, Regan EA, Humphries S, Crapo JD, Lynch DA. Visual Emphysema at Chest CT in GOLD Stage 0 Cigarette Smokers Predicts Disease Progression: Results from the COPDGene Study. Radiology 2020; 296:641-649. [PMID: 32633676 DOI: 10.1148/radiol.2020192429] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The clinical significance of visually evident emphysema on CT images in individuals without spirometric evidence of chronic obstructive pulmonary disease (COPD) by current diagnostic criteria is, to the knowledge of the authors, unknown. Purpose To evaluate whether participants with visually evident emphysema at CT were more likely to have progressive disease and increased mortality at 5 years compared with those without visual emphysema. Materials and Methods This secondary analysis of the prospective Genetic Epidemiology of COPD study evaluated current or former smokers enrolled between 2008 and 2011 who did not meet current criteria for COPD (defined as Global Initiative for Obstructive Lung Disease stage 0). Statistical analysis was performed by using linear mixed models to estimate mean physiologic, imaging, and clinical outcomes for those with and without visual emphysema. Hazard ratios for mortality were calculated by using Cox regression models with emphysema as the main predictor. Results Of the 4095 participants, 48.3% (1979 participants; 1096 men and 883 women; mean age, 57 years ± 8 [standard deviation]) had trace or greater visual emphysema at CT and 51.7% (2116 participants; 1068 men and 1048 women; mean age, 56 years ± 8) had no emphysema at CT. At 5 years, participants with visual emphysema at CT demonstrated progressive airflow obstruction with lower values of ratio of forced expiratory volume in 1 second (FEV1)-to-functional vital capacity (FVC) ratio (-1.7 vs -0.7) and greater progression in quantitative emphysema measured by 15th percentile lung density (-3.3 vs -0.3 HU), adjusted lung density (-3.1 vs -0.2 g/L), and percentage of lung voxels with CT attenuation less than -950 HU (0.17 vs -0.20) than participants without emphysema (P < .001 for each). The rate of quantitative emphysema progression increased with greater grades of emphysema severity within the emphysema group. Conclusion The presence of visual emphysema at CT in current and former Global Initiative for Obstructive Lung Disease stage 0 smokers predicted structural and physiologic disease progression. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Grenier in this issue.
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Affiliation(s)
- Andrea S Oh
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Matthew Strand
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Katherine Pratte
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Elizabeth A Regan
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Stephen Humphries
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - James D Crapo
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - David A Lynch
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
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- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
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Emphysema quantification using low-dose computed tomography with deep learning-based kernel conversion comparison. Eur Radiol 2020; 30:6779-6787. [PMID: 32601950 DOI: 10.1007/s00330-020-07020-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/17/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study determined the effect of dose reduction and kernel selection on quantifying emphysema using low-dose computed tomography (LDCT) and evaluated the efficiency of a deep learning-based kernel conversion technique in normalizing kernels for emphysema quantification. METHODS A sample of 131 participants underwent LDCT and standard-dose computed tomography (SDCT) at 1- to 2-year intervals. LDCT images were reconstructed with B31f and B50f kernels, and SDCT images were reconstructed with B30f kernels. A deep learning model was used to convert the LDCT image from a B50f kernel to a B31f kernel. Emphysema indices (EIs), lung attenuation at 15th percentile (perc15), and mean lung density (MLD) were calculated. Comparisons among the different kernel types for both LDCT and SDCT were performed using Friedman's test and Bland-Altman plots. RESULTS All values of LDCT B50f were significantly different compared with the values of LDCT B31f and SDCT B30f (p < 0.05). Although there was a statistical difference, the variation of the values of LDCT B50f significantly decreased after kernel normalization. The 95% limits of agreement between the SDCT and LDCT kernels (B31f and converted B50f) ranged from - 2.9 to 4.3% and from - 3.2 to 4.4%, respectively. However, there were no significant differences in EIs and perc15 between SDCT and LDCT converted B50f in the non-chronic obstructive pulmonary disease (COPD) participants (p > 0.05). CONCLUSION The deep learning-based CT kernel conversion of sharp kernel in LDCT significantly reduced variation in emphysema quantification, and could be used for emphysema quantification. KEY POINTS • Low-dose computed tomography with smooth kernel showed adequate performance in quantifying emphysema compared with standard-dose CT. • Emphysema quantification is affected by kernel selection and the application of a sharp kernel resulted in a significant overestimation of emphysema. • Deep learning-based kernel normalization of sharp kernel significantly reduced variation in emphysema quantification.
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Anazawa R, Kawata N, Matsuura Y, Ikari J, Tada Y, Suzuki M, Takayanagi S, Matsuoka S, Matsushita S, Tatsumi K. Longitudinal changes in structural lung abnormalities using MDCT in chronic obstructive pulmonary disease with asthma-like features. PLoS One 2019; 14:e0227141. [PMID: 31887184 PMCID: PMC6936827 DOI: 10.1371/journal.pone.0227141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/12/2019] [Indexed: 11/18/2022] Open
Abstract
Background Some patients with chronic obstructive pulmonary disease (COPD) have asthma-like features. However, there have been few reports on the structural lung abnormalities found in this patient population. Multi-detector computed tomography (MDCT) can detect emphysematous low-attenuation areas (LAA) within the lung, airway thickness (wall area percentage, WA%), and the loss of pulmonary vasculature as the percentage of small pulmonary vessels with cross-sectional area (CSA) less than 5 mm2 (%CSA<5). We analyzed differences in structural lung changes over time between patients with COPD and those with COPD with asthma-like features using these CT parameters. Material and methods We performed pulmonary function tests (PFTs), MDCT, and a COPD assessment test (CAT) in 50 patients with COPD and 29 patients with COPD with asthma-like features at the time of enrollment and two years later. We analyzed changes in clinical parameters and CT indices over time and evaluated differences in structural changes between groups. Results The CAT score and FEV1 did not significantly change during the follow-up period in either group. Emphysematous LAA regions significantly increased in both groups. The %CSA<5 showed a small but significant increase in COPD patients, but a significant decrease in patients with COPD with asthma-like features. The WA% at the distal bronchi was significantly decreased in COPD, but did not significantly change in COPD with asthma -like features. Conclusion Emphysematous LAA increased in patients with COPD with and without asthma-like features. The %CSA<5 and WA% at the distal bronchi did not change in parallel with LAA. Furthermore, changes in %CSA<5 were significantly different between patients with COPD and those with COPD with asthma-like features. Patients with COPD with asthma-like features may have different longitudinal structural changes than those seen in COPD patients.
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Affiliation(s)
- Rie Anazawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
- * E-mail:
| | - Yukiko Matsuura
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Masaki Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Shin Takayanagi
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Shin Matsuoka
- Department of Radiology, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, Japan
| | - Shoichiro Matsushita
- Department of Radiology, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
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Cheng T, Li Y, Pang S, Wan H, Shi G, Cheng Q, Li Q, Pan Z, Huang S. Normal lung attenuation distribution and lung volume on computed tomography in a Chinese population. Int J Chron Obstruct Pulmon Dis 2019; 14:1657-1668. [PMID: 31413560 PMCID: PMC6662163 DOI: 10.2147/copd.s187596] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 05/10/2019] [Indexed: 01/17/2023] Open
Abstract
Backgroud and objectives: Although lung attenuation distribution and lung volume on computed tomography (CT) have been widely used in evaluating COPD and interstitial lung disease, there are only a few studies regarding the normal range of these indices, especially in Chinese subjects. We aimed to describe the normal range of lung attenuation distribution and lung volume based on CT. Methods: Subjects with normal lung function and basically normal chest CT findings (derivation group) at Ruijin Hospital, Shanghai (from January 2010 to June 2014) were included according to inclusion and exclusion criteria. The range of the percentage of lung volume occupied by low attenuation areas (LAA%), percentile of the histogram of attenuation values (Perc n), and total lung volume were analyzed. Relationships of these measures with demographic variables were evaluated. Participants who underwent chest CT examination for disease screening and had basically normal CT findings served as an external validation group. Results: The number of subjects in the derivation group and external validation groups were 564 and 1,787, respectively. Mean total lung volumes were 4,468±1,271 mL and 4,668±1,192 mL, and median LAA%(-950 HU) was 0.19 (0.03–0.43) and 0.17 (0.01–0.41), in the derivation and external validation groups, respectively. Reference equations for lung volume and attenuation distribution (LAA% using -1,000–210 HU, Perc 1 to Perc 98) were generated: Lung volume (mL) = -1.015 *10^4+605.3*Sex (1= male, 0= female)+92.61*Height (cm) –12.99*Weight (kg) ±1766; LAA% (-950 HU)=[0.2027+0.05926*Sex (1= male, 0= female) –4.111*10^-3*Weight (kg) +4.924*10^-3*Height (cm) +8.504*10^-4*Age]^7.341–0.05; Upper limit of normal range: [0.2027+0.05926*Sex-4.111*10^-3*Weight+4.924*10^-3*Height+8.504*10^-4*Age+0.1993]^7.341–0.05. Conclusion: This large population-based retrospective study demonstrated the normal range of LAA%, Perc n, and total lung volume measured on CT scans among subjects with normal lung function and CT findings. Reference equations are provided.
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Affiliation(s)
- Ting Cheng
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Yong Li
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Shuai Pang
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - HuanYing Wan
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - GuoChao Shi
- Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - QiJian Cheng
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - QingYun Li
- Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - ZiLai Pan
- Department of Radiology, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - ShaoGuang Huang
- Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Freedman JN, Bainbridge HE, Nill S, Collins DJ, Kachelrieß M, Leach MO, McDonald F, Oelfke U, Wetscherek A. Synthetic 4D-CT of the thorax for treatment plan adaptation on MR-guided radiotherapy systems. Phys Med Biol 2019; 64:115005. [PMID: 30844775 PMCID: PMC8208601 DOI: 10.1088/1361-6560/ab0dbb] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/04/2019] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
MR-guided radiotherapy treatment planning utilises the high soft-tissue contrast of MRI to reduce uncertainty in delineation of the target and organs at risk. Replacing 4D-CT with MRI-derived synthetic 4D-CT would support treatment plan adaptation on hybrid MR-guided radiotherapy systems for inter- and intrafractional differences in anatomy and respiration, whilst mitigating the risk of CT to MRI registration errors. Three methods were devised to calculate synthetic 4D and midposition (time-weighted mean position of the respiratory cycle) CT from 4D-T1w and Dixon MRI. The first approach employed intensity-based segmentation of Dixon MRI for bulk-density assignment (sCTD). The second step added spine density information using an atlas of CT and Dixon MRI (sCTDS). The third iteration used a polynomial function relating Hounsfield units and normalised T1w image intensity to account for variable lung density (sCTDSL). Motion information in 4D-T1w MRI was applied to generate synthetic CT in midposition and in twenty respiratory phases. For six lung cancer patients, synthetic 4D-CT was validated against 4D-CT in midposition by comparison of Hounsfield units and dose-volume metrics. Dosimetric differences found by comparing sCTD,DS,DSL and CT were evaluated using a Wilcoxon signed-rank test (p = 0.05). Compared to sCTD and sCTDS, planning on sCTDSL significantly reduced absolute dosimetric differences in the planning target volume metrics to less than 98 cGy (1.7% of the prescribed dose) on average. When comparing sCTDSL and CT, average radiodensity differences were within 97 Hounsfield units and dosimetric differences were significant only for the planning target volume D99% metric. All methods produced clinically acceptable results for the organs at risk in accordance with the UK SABR consensus guidelines and the LungTech EORTC phase II trial. The overall good agreement between sCTDSL and CT demonstrates the feasibility of employing synthetic 4D-CT for plan adaptation on hybrid MR-guided radiotherapy systems.
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Affiliation(s)
- Joshua N Freedman
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- CR UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Hannah E Bainbridge
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Simeon Nill
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J Collins
- CR UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Marc Kachelrieß
- Medical Physics in Radiology, The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin O Leach
- CR UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Author to whom any correspondence should be addressed
| | - Fiona McDonald
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Uwe Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Andreas Wetscherek
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Janssen R, Piscaer I, Franssen FME, Wouters EFM. Emphysema: looking beyond alpha-1 antitrypsin deficiency. Expert Rev Respir Med 2019; 13:381-397. [DOI: 10.1080/17476348.2019.1580575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Rob Janssen
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ianthe Piscaer
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M. E. Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F. M. Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
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11
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Jou SS, Yagihashi K, Zach JA, Lynch D, Suh YJ. Relationship between current smoking, visual CT findings and emphysema index in cigarette smokers. Clin Imaging 2019; 53:195-199. [PMID: 30419414 PMCID: PMC6633913 DOI: 10.1016/j.clinimag.2018.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate whether visual CT findings could account for the effect of current smoking. METHODS 500 CT scans were visually evaluated within each lobe. A multivariate model for emphysema index was constructed containing previously described confounders in addition to the visual components associated with smoking status. RESULTS Current smokers displayed 23% less visual emphysema, 19% more airway wall thickening, and 188% more centrilogular nodule than former smokers (all p < 0.001). The effect of current smoking on the emphysema index decreased after adjustment with confounders and visual parameters. CONCLUSIONS Visual CT findings could partially account for the effect of current smoking.
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Affiliation(s)
- Sung Shick Jou
- Department of Radiology, Soonchunhyang University Cheonan Hospital, 31 Soonchunhyang 6-gil, Dongnamgu, Cheonan-si, Chungchengnam-do 311511, Republic of Korea.
| | - Kunihiro Yagihashi
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki 216-8511, Japan
| | | | - David Lynch
- Division of Radiology, National Jewish Health, Denver, CO, United States of America
| | - Young Ju Suh
- Department of Biomedical Sciences College of Medicine, Inha University Incheon, Republic of Korea
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Longitudinal airway remodeling in active and past smokers in a lung cancer screening population. Eur Radiol 2018; 29:2968-2980. [PMID: 30552475 DOI: 10.1007/s00330-018-5890-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/07/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To longitudinally investigate smoking cessation-related changes of quantitative computed tomography (QCT)-based airway metrics in a group of heavy smokers. METHODS CT scans were acquired in a lung cancer screening population over 4 years at 12-month intervals in 284 long-term ex-smokers (ES), 405 continuously active smokers (CS), and 31 subjects who quitted smoking within 2 years after baseline CT (recent quitters, RQ). Total diameter (TD), lumen area (LA), and wall percentage (WP) of 1st-8th generation airways were computed using airway analysis software. Inter-group comparison was performed using Mann-Whitney U test or Student's t test (two groups), and ANOVA or ANOVA on ranks with Dunn's multiple comparison test (more than two groups), while Fisher's exact test or chi-squared test was used for categorical data. Multiple linear regression was used for multivariable analysis. RESULTS At any time, TD and LA were significantly higher in ES than CS, for example, in 5th-8th generation airways at baseline with 6.24 mm vs. 5.93 mm (p < 0.001) and 15.23 mm2 vs. 13.51 mm2 (p < 0.001), respectively. RQ showed higher TD (6.15 mm vs. 5.93 mm, n.s.) and significantly higher LA (14.77 mm2 vs. 13.51 mm2, p < 0.001) than CS after 3 years, and after 4 years. In multivariate analyses, smoking status independently predicted TD, LA, and WP at baseline, at 3 years and 4 years (p < 0.01-0.001), with stronger impact than pack years. CONCLUSIONS Bronchial dimensions depend on the smoking status. Smoking-induced airway remodeling can be partially reversible after smoking cessation even in long-term heavy smokers. Therefore, QCT-based airway metrics in clinical trials should consider the current smoking status besides pack years. KEY POINTS • Airway lumen and diameter are decreased in active smokers compared to ex-smokers, and there is a trend towards increased airway wall thickness in active smokers. • Smoking-related airway changes improve within 2 years after smoking cessation. • Smoking status is an independent predictor of airway dimensions.
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Mashimo S, Chubachi S, Tsutsumi A, Kameyama N, Sasaki M, Jinzaki M, Nakamura H, Asano K, Reilly JJ, Betsuyaku T. Relationship between diminution of small pulmonary vessels and emphysema in chronic obstructive pulmonary disease. Clin Imaging 2017; 46:85-90. [DOI: 10.1016/j.clinimag.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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14
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Jobst BJ, Weinheimer O, Trauth M, Becker N, Motsch E, Groß ML, Tremper J, Delorme S, Eigentopf A, Eichinger M, Kauczor HU, Wielpütz MO. Effect of smoking cessation on quantitative computed tomography in smokers at risk in a lung cancer screening population. Eur Radiol 2017; 28:807-815. [DOI: 10.1007/s00330-017-5030-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 05/10/2017] [Accepted: 08/10/2017] [Indexed: 01/17/2023]
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15
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Kim SS, Jin GY, Li YZ, Lee JE, Shin HS. CT Quantification of Lungs and Airways in Normal Korean Subjects. Korean J Radiol 2017; 18:739-748. [PMID: 28670169 PMCID: PMC5447650 DOI: 10.3348/kjr.2017.18.4.739] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/05/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To measure and compare the quantitative parameters of the lungs and airways in Korean never-smokers and current or former smokers (“ever-smokers”). Materials and Methods Never-smokers (n = 119) and ever-smokers (n = 45) who had normal spirometry and visually normal chest computed tomography (CT) results were retrospectively enrolled in this study. For quantitative CT analyses, the low attenuation area (LAA) of LAAI-950, LAAE-856, CT attenuation value at the 15th percentile, mean lung attenuation (MLA), bronchial wall thickness of inner perimeter of a 10 mm diameter airway (Pi10), total lung capacity (TLCCT), and functional residual capacity (FRCCT) were calculated based on inspiratory and expiratory CT images. To compare the results between groups according to age, sex, and smoking history, independent t test, one way ANOVA, correlation test, and simple and multiple regression analyses were performed. Results The values of attenuation parameters and volume on inspiratory and expiratory quantitative computed tomography (QCT) were significantly different between males and females (p < 0.001). The MLA and the 15th percentile value on inspiratory QCT were significantly lower in the ever-smoker group than in the never-smoker group (p < 0.05). On expiratory QCT, all lung attenuation parameters were significantly different according to the age range (p < 0.05). Pi10 in ever-smokers was significantly correlated with forced expiratory volume in 1 second/forced vital capacity (r = −0.455, p = 0.003). In simple and multivariate regression analyses, TLCCT, FRCCT, and age showed significant associations with lung attenuation (p < 0.05), and only TLCCT was significantly associated with inspiratory Pi10. Conclusion In Korean subjects with normal spirometry and visually normal chest CT, there may be significant differences in QCT parameters according to sex, age, and smoking history.
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Affiliation(s)
- Song Soo Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon 35015, Korea
| | - Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Institute of Medical Science, Jeonju 54907, Korea
| | - Yuan Zhe Li
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
| | - Jeong Eun Lee
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon 35015, Korea
| | - Hye Soo Shin
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon 35015, Korea
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Takayanagi S, Kawata N, Tada Y, Ikari J, Matsuura Y, Matsuoka S, Matsushita S, Yanagawa N, Kasahara Y, Tatsumi K. Longitudinal changes in structural abnormalities using MDCT in COPD: do the CT measurements of airway wall thickness and small pulmonary vessels change in parallel with emphysematous progression? Int J Chron Obstruct Pulmon Dis 2017; 12:551-560. [PMID: 28243075 PMCID: PMC5315203 DOI: 10.2147/copd.s121405] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Recent advances in multidetector computed tomography (MDCT) facilitate acquiring important clinical information for managing patients with COPD. MDCT can detect the loss of lung tissue associated with emphysema as a low-attenuation area (LAA) and the thickness of airways as the wall area percentage (WA%). The percentage of small pulmonary vessels <5 mm2 (% cross-sectional area [CSA] <5) has been recently recognized as a parameter for expressing pulmonary perfusion. We aimed to analyze the longitudinal changes in structural abnormalities using these CT parameters and analyze the effect of exacerbation and smoking cessation on structural changes in COPD patients. Methods We performed pulmonary function tests (PFTs), an MDCT, and a COPD assessment test (CAT) in 58 patients with COPD at the time of their enrollment at the hospital and 2 years later. We analyzed the change in clinical parameters including CT indices and examined the effect of exacerbations and smoking cessation on the structural changes. Results The CAT score and forced expiratory volume in 1 second (FEV1) did not significantly change during the follow-up period. The parameters of emphysematous changes significantly increased. On the other hand, the WA% at the distal airways significantly decreased or tended to decrease, and the %CSA <5 slightly but significantly increased over the same period, especially in ex-smokers. The parameters of emphysematous change were greater in patients with exacerbations and continued to progress even after smoking cessation. In contrast, the WA% and %CSA <5 did not change in proportion to emphysema progression. Conclusion The WA% at the distal bronchi and the %CSA <5 did not change in parallel with parameters of LAA over the same period. We propose that airway disease and vascular remodeling may be reversible to some extent by smoking cessation and appropriate treatment. Optimal management may have a greater effect on pulmonary vascularity and airway disease than parenchymal deconstruction in the early stage of COPD.
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Affiliation(s)
- Shin Takayanagi
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Yukiko Matsuura
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Shin Matsuoka
- Department of Radiology, St Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, Japan
| | - Shoichiro Matsushita
- Department of Radiology, St Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, Japan
| | - Noriyuki Yanagawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Yasunori Kasahara
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba
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Magnetic resonance imaging-guided attenuation correction in whole-body PET/MRI using a sorted atlas approach. Med Image Anal 2016; 31:1-15. [PMID: 26948109 DOI: 10.1016/j.media.2016.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 12/21/2022]
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19
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Yablonskiy DA, Sukstanskii AL, Quirk JD, Woods JC, Conradi MS. Probing lung microstructure with hyperpolarized noble gas diffusion MRI: theoretical models and experimental results. Magn Reson Med 2016; 71:486-505. [PMID: 23554008 DOI: 10.1002/mrm.24729] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The introduction of hyperpolarized gases ((3)He and (129)Xe) has opened the door to applications for which gaseous agents are uniquely suited-lung MRI. One of the pulmonary applications, diffusion MRI, relies on measuring Brownian motion of inhaled hyperpolarized gas atoms diffusing in lung airspaces. In this article we provide an overview of the theoretical ideas behind hyperpolarized gas diffusion MRI and the results obtained over the decade-long research. We describe a simple technique based on measuring gas apparent diffusion coefficient (ADC) and an advanced technique, in vivo lung morphometry, that quantifies lung microstructure both in terms of Weibel parameters (acinar airways radii and alveolar depth) and standard metrics (mean linear intercept, surface-to-volume ratio, and alveolar density) that are widely used by lung researchers but were previously available only from invasive lung biopsy. This technique has the ability to provide unique three-dimensional tomographic information on lung microstructure from a less than 15 s MRI scan with results that are in good agreement with direct histological measurements. These safe and sensitive diffusion measurements improve our understanding of lung structure and functioning in health and disease, providing a platform for monitoring the efficacy of therapeutic interventions in clinical trials.
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Dubé BP, Guerder A, Morelot-Panzini C, Laveneziana P. The clinical relevance of the emphysema-hyperinflated phenotype in COPD. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40749-015-0017-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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21
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Kervancioglu S, Bayram N, Gelebek Yilmaz F, Sanli M, Sirikci A. Radiological findings and outcomes of bronchial artery embolization in cryptogenic hemoptysis. J Korean Med Sci 2015; 30:591-7. [PMID: 25931790 PMCID: PMC4414643 DOI: 10.3346/jkms.2015.30.5.591] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 01/06/2015] [Indexed: 11/29/2022] Open
Abstract
Management of cryptogenic massive hemoptysis is difficult, and conservative treatment may be inadequate to stop the hemorrhage. Surgery is not a reasonable option because there is no underlying identifiable pathology. This study aimed to investigate the radiologic findings and bronchial artery embolization outcomes in cryptogenic hemoptysis, and to compare the results with non-cryptogenic hemoptysis. We evaluated 26 patients with cryptogenic hemoptysis and 152 patients with non-cryptogenic hemoptysis. A comparison of the bronchial artery abnormalities between the cryptogenic and non-cryptogenic hemoptysis groups showed that only extravasation was more statistically significant in the cryptogenic hemoptysis group than in the non-cryptogenic hemoptysis group, while the other bronchial artery abnormalities, such as bronchial artery dilatation, hypervascularity, and bronchial-to-pulmonary shunting, showed no significant difference between groups. Involvement of the non-bronchial systemic artery was significantly greater in the non-cryptogenic hemoptysis group than in the cryptogenic hemoptysis group. While 69.2% of patients with cryptogenic hemoptysis also had hypervascularity in the contralateral bronchial arteries and/or ipsilateral bronchial artery branches other than the bleeding lobar branches, this finding was not detected in non-cryptogenic hemoptysis. Embolization was performed on all patients using polyvinyl alcohol particles of 355-500 µm. Hemoptysis ceased in all patients immediately after embolization. While recurrence of hemoptysis showed no statistically significant difference between the cryptogenic and non-cryptogenic hemoptysis groups, it was mild in cryptogenic hemoptysis in contrast to mostly severe in non-cryptogenic hemoptysis. Transarterial embolization is a safe and effective technique to manage cryptogenic hemoptysis.
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Affiliation(s)
- Selim Kervancioglu
- Department of Radiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Nazan Bayram
- Department of Pulmonology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Feyza Gelebek Yilmaz
- Department of Radiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Maruf Sanli
- Department of Thoracic Surgery, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Akif Sirikci
- Department of Radiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Yamasawa W, Tasaka S, Betsuyaku T, Yamaguchi K. Correlation of a decline in aerobic capacity with development of emphysema in patients with chronic obstructive pulmonary disease: a prospective observational study. PLoS One 2015; 10:e0125053. [PMID: 25909949 PMCID: PMC4409313 DOI: 10.1371/journal.pone.0125053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 03/16/2015] [Indexed: 02/07/2023] Open
Abstract
In patients with COPD, CT assessment of emphysema and airway disease is known to be associated with lung function and 6-minute walk distance. However, it remains to be determined whether low attenuation area (LAA) on CT is associated with aerobic capacity assessed using cardiopulmonary exercise testing (CPET). In this prospective observational study, we repeatedly conducted high-resolution CT and CPET using a treadmill in 81 COPD patients over a median interval of 3.5 years. Two investigators independently scored LAA on images obtained at the aortic arch level, tracheal bifurcation level, and supradiaphragmatic level. Grades for the images of each lung were added to yield the total LAA score. Total LAA score was negatively correlated with peak aerobic capacity ([Formula: see text]) (p<0.001, r = -0.485). LAA scores of the upper (aortic arch level) and the lower (supradiaphragmatic level) lungs were both significantly associated with peak [Formula: see text]. There was a significant correlation between total LAA score and peak CO2 output ([Formula: see text]) (p<0.001, r = -0.433). Total LAA score was correlated with oxygen saturation at peak exercise (p<0.001, r = -0.634) and the estimated dead space fraction (p<0.001, r = 0.416). The mean annual change in total LAA score was significantly correlated with those in peak [Formula: see text] (p<0.001, r = -0.546) and peak [Formula: see text] (p<0.001, r = -0.488). The extent of emphysema measured by CT was associated with the results of CPET. The time-dependent changes in CPET data were also correlated with that in total LAA score. CT assessment could be a non-invasive tool to predict aerobic capacity in patients with COPD.
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Affiliation(s)
- Wakako Yamasawa
- Division of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Sadatomo Tasaka
- Division of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Tomoko Betsuyaku
- Division of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Yamaguchi
- Comprehensive and Internal Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Abstract
COPD is characterized by airflow limitation that is not fully reversible. The morphological basis for airflow obstruction results from a varying combination of obstructive changes in peripheral conducting airways and destructive changes in respiratory bronchioles, alveolar ducts, and alveoli. A reduction of vascularity within the alveolar septa has been reported in emphysema. Typical physiological changes reflect these structural abnormalities. Spirometry documents airflow obstruction when the FEV1/FVC ratio is reduced below the lower limit of normality, although in early disease stages FEV1 and airway conductance are not affected. Current guidelines recommend testing for bronchoreversibility at least once and the postbronchodilator FEV1/FVC be used for COPD diagnosis; the nature of bronchodilator response remains controversial, however. One major functional consequence of altered lung mechanics is lung hyperinflation. FRC may increase as a result of static or dynamic mechanisms, or both. The link between dynamic lung hyperinflation and expiratory flow limitation during tidal breathing has been demonstrated. Hyperinflation may increase the load on inspiratory muscles, with resulting length adaptation of diaphragm. Reduction of exercise tolerance is frequently noted, with compelling evidence that breathlessness and altered lung mechanics play a major role. Lung function measurements have been traditionally used as prognostic indices and to monitor disease progression; FEV1 has been most widely used. An increase in FVC is also considered as proof of bronchodilatation. Decades of work has provided insight into the histological, functional, and biological features of COPD. This has provided a clearer understanding of important pathobiological processes and has provided additional therapeutic options.
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Variation of densitometry on computed tomography in COPD--influence of different software tools. PLoS One 2014; 9:e112898. [PMID: 25386874 PMCID: PMC4227864 DOI: 10.1371/journal.pone.0112898] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/16/2014] [Indexed: 02/03/2023] Open
Abstract
Objectives Quantitative multidetector computed tomography (MDCT) as a potential biomarker is increasingly used for severity assessment of emphysema in chronic obstructive pulmonary disease (COPD). Aim of this study was to evaluate the user-independent measurement variability between five different fully-automatic densitometry software tools. Material and Methods MDCT and full-body plethysmography incl. forced expiratory volume in 1s and total lung capacity were available for 49 patients with advanced COPD (age = 64±9 years, forced expiratory volume in 1s = 31±6% predicted). Measurement variation regarding lung volume, emphysema volume, emphysema index, and mean lung density was evaluated for two scientific and three commercially available lung densitometry software tools designed to analyze MDCT from different scanner types. Results One scientific tool and one commercial tool failed to process most or all datasets, respectively, and were excluded. One scientific and another commercial tool analyzed 49, the remaining commercial tool 30 datasets. Lung volume, emphysema volume, emphysema index and mean lung density were significantly different amongst these three tools (p<0.001). Limits of agreement for lung volume were [−0.195, −0.052l], [−0.305, −0.131l], and [−0.123, −0.052l] with correlation coefficients of r = 1.00 each. Limits of agreement for emphysema index were [−6.2, 2.9%], [−27.0, 16.9%], and [−25.5, 18.8%], with r = 0.79 to 0.98. Correlation of lung volume with total lung capacity was good to excellent (r = 0.77 to 0.91, p<0.001), but segmented lung volume (6.7±1.3 – 6.8±1.3l) were significantly lower than total lung capacity (7.7±1.7l, p<0.001). Conclusions Technical incompatibilities hindered evaluation of two of five tools. The remaining three showed significant measurement variation for emphysema, hampering quantitative MDCT as a biomarker in COPD. Follow-up studies should currently use identical software, and standardization efforts should encompass software as well.
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Clinical Assessment of MR-Guided 3-Class and 4-Class Attenuation Correction in PET/MR. Mol Imaging Biol 2014; 17:264-76. [DOI: 10.1007/s11307-014-0777-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Lung density on high resolution computer tomography (HRCT) reflects degree of inflammation in smokers. Respir Res 2014; 15:23. [PMID: 24564813 PMCID: PMC3944780 DOI: 10.1186/1465-9921-15-23] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/16/2014] [Indexed: 01/11/2023] Open
Abstract
Background Smokers have increased cell concentration in the lower respiratory tract indicating a chronic inflammatory state, which in some individuals may lead to development of chronic obstructive pulmonary disease (COPD). Computer tomography (CT) imaging provides means of quantifying pulmonary structure and early signs of disease. We investigated whether lung density on high resolution CT differs between smokers and never-smokers and if this were associated to intensity of inflammation. Methods Forty smoking volunteers with normal pulmonary function, 40 healthy never-smokers and 40 patients with COPD of GOLD stage I-II, were included. Mean lung attenuation and percentage of pixels in the lung with attenuation between −750 and −900 HU (percentage higher density spectrum (%HDS)) were calculated on inspiratory CT-scans. Markers of systemic inflammation in blood and cell counts in bronchoalveolar lavage (BAL) fluid were recorded. Results Lung density expressed as %HDS was increased in smokers (44.0 ± 5.8%) compared to both never-smokers (38.3 ± 5.8%) and patients with COPD (39.1 ± 5.8%), (p < 0.001, for both). Females had denser lungs than males, which was dependent on body height. Cell concentration in BAL were correlated to lung density in smokers (r = 0.50, p < 0.001). Conclusions Lung density on CT is associated with cell concentration in BAL in smokers and may mirror an inflammatory response in the lung. Gender difference in lung density is dependent on height. In COPD with emphysema, loss of lung tissue may counterbalance the expected increase in density due to inflammation. The findings may help to interpret high resolution CT in the context of smoking and gender and highlight the heterogeneity of structural changes in COPD.
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Iyer KS, Grout RW, Zamba GK, Hoffman EA. Repeatability and Sample Size Assessment Associated with Computed Tomography-Based Lung Density Metrics. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2014; 1:97-104. [PMID: 25553338 PMCID: PMC4278434 DOI: 10.15326/jcopdf.1.1.2014.0111#sthash.nxtderi7.dpuf] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES Density-based metrics assess severity of lung disease but vary with lung inflation and method of scanning. The aim of this study was to evaluate the repeatability of single center, CT-based density metrics of the lung in a normal population and assess study sample sizes needed to detect meaningful changes in lung density metrics when scan parameters and volumes are tightly controlled. MATERIALS AND METHODS Thirty-seven subjects (normal smokers and non-smokers) gave consent to have randomly assigned repeated, breath-held scans at either inspiration (90% vital capacity: TLC) or expiration (20% vital capacity: FRC). Repeated scans were analyzed for: mean lung density (MLD), 15th percentile point of the density histogram (P15), low attenuation areas (LAA) and alpha (fractal measure of hole size distribution). Using inter-subject differences and previously reported bias, sample size was estimated from month or yearly change in density metrics obtained from published literature (i.e. meaningful change). RESULTS Inter-scan difference measurements were small for density metrics (ICC > 0.80) and average ICCs for whole lung alpha-910 and alpha-950 were 0.57 and 0.64, respectively. Power analyses demonstrated that, under the control conditions with minimal extrinsic variation, population sizes needed to detect meaningful changes in density measures for TLC or FRC repeated scans ranged from a few (20-40) to a few hundred subjects, respectively. CONCLUSION A meaningful sample size was predicted from this study using volume-controlled normal subjects in a controlled imaging environment. Under proper breath-hold conditions, high repeatability was obtained in cohorts of normal smokers and non-smokers.
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Affiliation(s)
- Krishna S. Iyer
- Department of Radiology, University of Iowa, College of Medicine, Iowa City
- Department of Biomedical Engineering, University of Iowa, Iowa City
| | - Randall W. Grout
- Department of Radiology, University of Iowa, College of Medicine, Iowa City
| | | | - Eric A. Hoffman
- Department of Radiology, University of Iowa, College of Medicine, Iowa City
- Department of Biomedical Engineering, University of Iowa, Iowa City
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Multidetector Computed Tomographic Imaging in Chronic Obstructive Pulmonary Disease. Radiol Clin North Am 2014; 52:137-54. [DOI: 10.1016/j.rcl.2013.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Samaha HMS, Ali AM. Radiologic and physiologic correlation in apparently healthy smoker. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Quantitative computed tomography (QCT) can provide reliable and valid measures of lung structure and volumes. Similar to lung function measured by spirometry, lung measures obtained by QCT vary by demographic and anthropomorphic factors including sex, race/ethnicity, and height in asymptomatic nonsmokers. Hence, accounting for these factors is necessary to define abnormal from normal QCT values. Prediction equations for QCT may be derived from a sample of asymptomatic individuals to estimate reference values. This review article describes the methodology of reference equation development using, as an example, quantitative densitometry to detect pulmonary emphysema. The process described is generalizable to other QCT measures, including lung volumes, airway dimensions, and gas-trapping. Pulmonary emphysema is defined morphologically by airspace enlargement with alveolar wall destruction and has been shown to correlate with low lung attenuation estimated by QCT. Deriving reference values for a normal quantity of low lung attenuation requires 3 steps. First, criteria that define normal must be established. Second, variables for inclusion must be selected on the basis of an understanding of subject-specific, scanner-specific, and protocol-specific factors that influence lung attenuation. Finally, a reference sample of normal individuals must be selected that is representative of the population in which QCT will be used to detect pulmonary emphysema. Sources of bias and confounding inherent to reference values are also discussed. Reference equation development is a multistep process that can define normal values for QCT measures such as lung attenuation. Normative reference values will increase the utility of QCT in both research and clinical practice.
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Affiliation(s)
- Benjamin M. Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Medicine, McGill University Health Center, Montreal, Canada
| | - R. Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Mohamed Hoesein FAA, Zanen P, de Jong PA, van Ginneken B, Boezen HM, Groen HJM, Oudkerk M, de Koning HJ, Postma DS, Lammers JWJ. Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study. Respir Res 2013; 14:55. [PMID: 23688060 PMCID: PMC3669040 DOI: 10.1186/1465-9921-14-55] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/02/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Little is known about the factors associated with CT-quantified emphysema progression in heavy smokers. The objective of this study was to investigate the effect of length of smoking cessation and clinical / demographical factors on the rate of emphysema progression and FEV1-decline in male heavy smokers. METHODS 3,670 male smokers with mean (SD) 40.8 (17.9) packyears underwent chest CT scans and pulmonary function tests at baseline and after 1 and 3 years follow-up. Smoking status (quitted ≥5, ≥1-<5, <1 years or current smoker) was noted. Rate of progression of emphysema and FEV1-decline after follow-up were assessed by analysis of variance adjusting for age, height, baseline pulmonary function and emphysema severity, packyears, years in study and respiratory symptoms. The quitted ≥5 group was used as reference. RESULTS Median (Q1-Q3) emphysema severity,<-950 HU, was 8.8 (5.1 - 14.1) and mean (SD) FEV1 was 3.4 (0.73) L or 98.5 (18.5) % of predicted. The group quitted '>5 years' showed significantly lower rates of progression of emphysema compared to current smokers, 1.07% and 1.12% per year, respectively (p<0.001). Current smokers had a yearly FEV1-decline of 69 ml, while subjects quit smoking >5 years had a yearly decline of 57.5 ml (p<0.001). CONCLUSION Quit smoking >5 years significantly slows the rate of emphysema progression and lung function decline. TRIAL REGISTRATION Registered at http://www.trialregister.nl with trial number ISRCTN63545820.
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Affiliation(s)
- Firdaus A A Mohamed Hoesein
- Department of Respiratory Medicine, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, the Netherlands.
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Copley SJ, Giannarou S, Schmid VJ, Hansell DM, Wells AU, Yang GZ. Effect of aging on lung structure in vivo: assessment with densitometric and fractal analysis of high-resolution computed tomography data. J Thorac Imaging 2013; 27:366-71. [PMID: 22487994 DOI: 10.1097/rti.0b013e31825148c9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To test the hypothesis that there is a difference between the lung computed tomography (CT) microstructure of asymptomatic older individuals and that of young individuals as evaluated by objective indices of complexity and density. MATERIALS AND METHODS Two study groups of nonsmoking urban-dwelling individuals over 75 years and under 55 years were prospectively identified. Thirty-three consecutive volunteers (21 older than 75 y and 12 less than 55 y) were included, and CTs were performed with concurrent pulmonary function testing. Pulmonary regions of interest (ROIs) were evaluated with fractal dimension (FD) analysis (an index of complexity), mean lung density (MLD), and percentage of pixels with lung density (LD) less than thresholds of -910 HU and -950 HU. The Student t test and the Mann-Whitney test were used to evaluate for differences in mean values between groups. The Pearson correlation coefficient was used to correlate mean FD value and LD data with pulmonary function. RESULTS Significant correlations of ROI MLD, LD -910 HU, and LD -950 HU with age and sex were shown (P = 0.029-0.003). The ROI mean FD value was greater in younger individuals compared with older individuals (76.5 ± 1.7 vs. 70.3 ± 1.2; P = 0.004). There was a correlation between Kco (gas-diffusing capacity adjusted for alveolar volume) and mean FD value (P = 0.006) and MLD (P = 0.015). CONCLUSION The lung parenchyma of nonsmoking older urban-dwelling asymptomatic individuals has significantly different CT density and complexity compared with younger individuals.
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Affiliation(s)
- Susan J Copley
- Department of Radiology, Hammersmith Hospitals NHS Trust, London, UK.
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Mohamed Hoesein FAA, Zanen P, Boezen HM, Groen HJM, van Ginneken B, de Jong PA, Postma DS, Lammers JWJ. Lung function decline in male heavy smokers relates to baseline airflow obstruction severity. Chest 2013; 142:1530-1538. [PMID: 22722231 DOI: 10.1378/chest.11-2837] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Recent evidence indicates that the rate of lung function decline is steepest in mild COPD and slower in moderate to severe COPD. The current study assessed whether lung function decline relates to baseline airflow obstruction severity in male heavy smokers. METHODS In total, 2,003 male smokers with a mean (SD) age of 59.8 (5.3) years underwent pulmonary function testing at baseline and after 3-year follow-up. Participants were classified by entry FEV1/FVC as follows: group 1, >70%; group 2, <70%, but greater than lower limit of normal (LLN); and group 3, less than LLN. Differences in lung function decline among the groups were assessed using multiple regression after adjustment for pack-years, smoking status (current or former smoker), presence or absence of mucus production, medical center, height, age, CT scan-derived emphysema severity (15th percentile), observation time (years in study), and the baseline values. RESULTS Over 3 years, the mean (SD) FEV₁/FVC, FEV₁, and maximum expiratory flow at 50% of FVC decreases in group 1 were 3.1% (1), 0.21 L (0.07), and 0.40 L/s (0.26), respectively. In group 3, these decreases were 2.4% (1.1), 0.15 L (0.08), and 0.06 L/s (0.19), respectively. All lung function parameters showed the greatest decline in group 1 (P < .001). CONCLUSIONS Diagnosing COPD based on the presence of more severe airflow obstruction (as defined by FEV₁/FVC less than LLN) means that, at the time of such a diagnosis, subjects had passed the phase of strong lung-function decline. TRIAL REGISTRY ISRCTN Register; No.: ISRCTN63545820; URL: www.trialregister.nl
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Affiliation(s)
| | - Pieter Zanen
- Division of Heart and Lungs, Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht.
| | - H Marike Boezen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen
| | - Harry J M Groen
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen
| | - Bram van Ginneken
- Image Sciences Institute, Department of Radiology, University Medical Center Utrecht, Utrecht; Diagnostic Image Analysis Group, Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht
| | - Dirkje S Postma
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen
| | - Jan-Willem J Lammers
- Division of Heart and Lungs, Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht
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Holme J, Stockley JA, Stockley RA. Age related development of respiratory abnormalities in non-index α-1 antitrypsin deficient studies. Respir Med 2013; 107:387-93. [DOI: 10.1016/j.rmed.2012.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/16/2012] [Accepted: 12/06/2012] [Indexed: 12/29/2022]
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Abstract
OBJECTIVES The purposes of this study were to evaluate the reference range of quantitative computed tomography (QCT) measures of lung attenuation and airway parameter measurements in healthy nonsmoking adults and to identify sources of variation in those measures and possible means to adjust for them. MATERIALS AND METHODS Within the COPDGene study, 92 healthy non-Hispanic white nonsmokers (29 men, 63 women; mean [SD] age, 62.7 [9.0] years; mean [SD] body mass index [BMI], 28.1 [5.1] kg/m(2)) underwent volumetric computed tomography (CT) at full inspiration and at the end of a normal expiration. On QCT analysis (Pulmonary Workstation 2, VIDA Diagnostics), inspiratory low-attenuation areas were defined as lung tissue with attenuation values -950 Hounsfield units or less on inspiratory CT (LAA(I-950)). Expiratory low-attenuation areas were defined as lung tissue -856 Hounsfield units or less on expiratory CT (LAA(E-856)). We used simple linear regression to determine the impact of age and sex on QCT parameters and multiple regression to assess the additional impact of total lung capacity and functional residual capacity measured by CT (TLC(CT) and FRC(CT)), scanner type, and mean tracheal air attenuation. Airways were evaluated using measures of airway wall thickness, inner luminal area, wall area percentage (WA%), and standardized thickness of an airway with inner perimeter of 10 mm (Pi10). RESULTS Mean (SD) %LAA(I-950) was 2.0% (2.7%), and mean (SD) %LAA(E-856) was 9.2% (6.8%). Mean (SD) %LAA(I-950) was 3.6% (3.2%) in men, compared with 1.3% (2.0%) in women (P < 0.001). The %LAA(I-950) did not change significantly with age (P = 0.08) or BMI (P = 0.52). %LAA(E-856) did not show any independent relationship with age (P = 0.33), sex (P = 0.70), or BMI (P = 0.32). On multivariate analysis, %LAA(I-950) showed a direct relationship to TLC(CT) (P = 0.002) and an inverse relationship to mean tracheal air attenuation (P = 0.003), and %LAA(E-856) was related to age (P = 0.001), FRC(CT) (P = 0.007), and scanner type (P < 0.001). Multivariate analysis of segmental airways showed that inner luminal area and WA% were significantly related to TLC(CT) (P < 0.001) and age (0.006). Moreover, WA% was associated with sex (P = 0.05), axial pixel size (P = 0.03), and slice interval (P = 0.04). Lastly, airway wall thickness was strongly influenced by axial pixel size (P < 0.001). CONCLUSIONS Although the attenuation characteristics of normal lung differ by age and sex, these differences do not persist on multivariate analysis. Potential sources of variation in measurement of attenuation-based QCT parameters include depth of inspiration/expiration and scanner type. Tracheal air attenuation may partially correct variation because of scanner type. Sources of variation in QCT airway measurements may include age, sex, BMI, depth of inspiration, and spatial resolution.
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Changes in volume-corrected whole-lung density in smokers and former smokers during the ITALUNG screening trial. J Thorac Imaging 2012; 27:255-62. [PMID: 22576761 DOI: 10.1097/rti.0b013e3182541165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate with a volume-corrected whole-lung approach changes in lung density over 2 years consistent with progression of pulmonary emphysema in smokers and former smokers enrolled in the ITALUNG trial of lung cancer screening using low-dose computed tomography (LDCT). MATERIALS AND METHODS A total of 103 subjects (mean age 63±4 y with a pack-year history of at least 20) underwent 2 whole-lung LDCT examinations 2 years apart. Visual assessment was made independently by 2 experienced observers on the initial LDCT examination with a 0 to 4 grading system for each of 6 regions (right and left upper, mid, and lower lung). The whole-lung 15th percentile of attenuation coefficient and relative area (RA) at -910 HU, both corrected to the individual lung volume (Perc15v and RA910v), were measured on the 2 LDCT examinations. The intrasubject variability of Perc15v and RA910v was previously determined in 32 other subjects of the trial examined using the same scanner and technique twice over a 3-month interval for suspicious nodules. RESULTS The 2 operators agreed on the presence of mild to severe emphysema (visual score ≥1 in at least 1 region) at initial LDCT examination in 24 (23%) of the 103 subjects. Fifteen subjects (15%) showed a Perc15v change between the 2 examinations exceeding the lower 95% limit of agreement, indicating progression of emphysema with a mean difference in lung density of -14.7%±2.6%. Ten of the 15 were identified as showing emphysema progression by RA910v as well. No association was observed between progression of emphysema and visual evidence of emphysema at initial LDCT examination, smoking status, or pack-years at baseline, or intervening changes in smoking habits. CONCLUSION Once variations in inspiratory lung volumes are taken into account, changes in lung density over 2 years consistent with progression of pulmonary emphysema in elderly smokers and former smokers are uncommon.
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Tanabe N, Muro S, Sato S, Tanaka S, Oguma T, Kiyokawa H, Takahashi T, Kinose D, Hoshino Y, Kubo T, Hirai T, Mishima M. Longitudinal study of spatially heterogeneous emphysema progression in current smokers with chronic obstructive pulmonary disease. PLoS One 2012; 7:e44993. [PMID: 23028728 PMCID: PMC3445600 DOI: 10.1371/journal.pone.0044993] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 08/14/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cigarette smoke is the main risk factor for emphysema, which is a key pathology in chronic obstructive pulmonary disease (COPD). Low attenuation areas (LAA) in computed tomography (CT) images reflect emphysema, and the cumulative size distribution of LAA clusters follows a power law characterized by the exponent D. This property of LAA clusters can be explained by model simulation, where mechanical force breaks alveolar walls causing local heterogeneous lung tissue destruction. However, a longitudinal CT study has not investigated whether continuous smoking causes the spatially heterogeneous progression of emphysema. METHODS We measured annual changes in ratios of LAA (LAA%), D and numbers of LAA clusters (LAN) in CT images acquired at intervals of ≥ 3 years from 22 current and 31 former smokers with COPD to assess emphysema progression. We constructed model simulations using CT images to morphologically interpret changes in current smokers. RESULTS D was decreased in current and former smokers, whereas LAA% and LAN were increased only in current smokers. The annual changes in LAA%, D, and LAN were greater in current, than in former smokers (1.03 vs. 0.37%, p=0.008; -0.045 vs. -0.01, p=0.004; 13.9 vs. 1.1, p=0.007, respectively). When LAA% increased in model simulations, the coalescence of neighboring LAA clusters decreased D, but the combination of changes in D and LAN in current smokers could not be explained by the homogeneous emphysema progression model despite cluster coalescence. Conversely, a model in which LAAs heterogeneously increased and LAA clusters merged somewhat in relatively advanced emphysematous regions could reflect actual changes. CONCLUSIONS Susceptibility to parenchymal destruction induced by continuous smoking is not uniform over the lung, but might be higher in local regions of relatively advanced emphysema. These could result in the spatially heterogeneous progression of emphysema in current smokers.
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Affiliation(s)
- Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiro Tanaka
- Division of Clinical Trial Design and Management, Translational Research Center, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirofumi Kiyokawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tamaki Takahashi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Daisuke Kinose
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuma Hoshino
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Choromańska A, Macura KJ. Role of computed tomography in quantitative assessment of emphysema. Pol J Radiol 2012; 77:28-36. [PMID: 22802863 PMCID: PMC3389962 DOI: 10.12659/pjr.882578] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/19/2012] [Indexed: 11/09/2022] Open
Abstract
Pulmonary emphysema, together with chronic bronchitis is a part of chronic obstructive pulmonary disease (COPD), which is one of the leading causes of death in the United States and worldwide. There are many methods to diagnose emphysema. Unfortunately many of them, for example pulmonary function tests (PFTs), clinical signs and conventional radiology are able to detect emphysema usually in its late stages when a great portion of lung parenchyma has been already destroyed by the disease. Computed tomography (CT) allows for early detection of emphysema. CT also makes it possible to quantify the total amount of emphysema in the lungs which is important in order to precisely estimate the severity of the disease. Those abilities of CT are important in monitoring the course of the disease and in attempts to prevent its further progression. In this review we discuss currently available methods for imaging emphysema with emphasis on the quantitative assessment of emphysema. To date, quantitative methods have not been widely used clinically, however, the initial results of several research studies regarding this subject are very encouraging.
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Miravitlles M, Calle M, Soler-Cataluña JJ. Clinical Phenotypes of COPD: Identification, Definition and Implications for Guidelines. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Association of IREB2 and CHRNA3 polymorphisms with airflow obstruction in severe alpha-1 antitrypsin deficiency. Respir Res 2012; 13:16. [PMID: 22356581 PMCID: PMC3306733 DOI: 10.1186/1465-9921-13-16] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 02/22/2012] [Indexed: 11/10/2022] Open
Abstract
Background The development of COPD in subjects with alpha-1 antitrypsin (AAT) deficiency is likely to be influenced by modifier genes. Genome-wide association studies and integrative genomics approaches in COPD have demonstrated significant associations with SNPs in the chromosome 15q region that includes CHRNA3 (cholinergic nicotine receptor alpha3) and IREB2 (iron regulatory binding protein 2). We investigated whether SNPs in the chromosome 15q region would be modifiers for lung function and COPD in AAT deficiency. Methods The current analysis included 378 PIZZ subjects in the AAT Genetic Modifiers Study and a replication cohort of 458 subjects from the UK AAT Deficiency National Registry. Nine SNPs in LOC123688, CHRNA3 and IREB2 were selected for genotyping. FEV1 percent of predicted and FEV1/FVC ratio were analyzed as quantitative phenotypes. Family-based association analysis was performed in the AAT Genetic Modifiers Study. In the replication set, general linear models were used for quantitative phenotypes and logistic regression models were used for the presence/absence of emphysema or COPD. Results Three SNPs (rs2568494 in IREB2, rs8034191 in LOC123688, and rs1051730 in CHRNA3) were associated with pre-bronchodilator FEV1 percent of predicted in the AAT Genetic Modifiers Study. Two SNPs (rs2568494 and rs1051730) were associated with the post-bronchodilator FEV1 percent of predicted and pre-bronchodilator FEV1/FVC ratio; SNP-by-gender interactions were observed. In the UK National Registry dataset, rs2568494 was significantly associated with emphysema in the male subgroup; significant SNP-by-smoking interactions were observed. Conclusions IREB2 and CHRNA3 are potential genetic modifiers of COPD phenotypes in individuals with severe AAT deficiency and may be sex-specific in their impact.
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Miravitlles M, Calle M, Soler-Cataluña JJ. Clinical phenotypes of COPD: identification, definition and implications for guidelines. Arch Bronconeumol 2011; 48:86-98. [PMID: 22196477 DOI: 10.1016/j.arbres.2011.10.007] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 09/29/2011] [Accepted: 10/20/2011] [Indexed: 02/02/2023]
Abstract
The term phenotype in the field of COPD is defined as "a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes". Among all phenotypes described, there are three that are associated with prognosis and especially are associated with a different response to currently available therapies. There phenotypes are: the exacerbator, the overlap COPD-asthma and the emphysema-hyperinflation. The exacerbator is characterised by the presence of, at least, two exacerbations the previous year, and on top of long-acting bronchodilators, may require the use of antiinflammatory drugs. The overlap phenotype presents symptoms of increased variability of airflow and incompletely reversible airflow obstruction. Due to the underlying inflammatory profile, it uses to have a good therapeutic response to inhaled corticosteroids in addition to bronchodilators. Lastly, the emphysema phenotype presents a poor therapeutic response to the existing antiinflammatory drugs and long-acting bronchodilators together with rehabilitation are the treatments of choice. Identifying the peculiarities of the different phenotypes of COPD will allow us to implement a more personalised treatment, in which the characteristics of the patients, together with their severity will be key to choose the best treatment option.
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Affiliation(s)
- Marc Miravitlles
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Ciber de Enfermedades Respiratorias, Hospital Clínic, Barcelona, Spain.
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Diciotti S, Sverzellati N, Kauczor HU, Lombardo S, Falchini M, Favilli G, Macconi L, Kuhnigk JM, Marchianò A, Pastorino U, Zompatori M, Mascalchi M. Defining the intra-subject variability of whole-lung CT densitometry in two lung cancer screening trials. Acad Radiol 2011; 18:1403-11. [PMID: 21971258 DOI: 10.1016/j.acra.2011.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 07/26/2011] [Accepted: 08/01/2011] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES To define a statistically based variation of individual whole-lung densitometry above which a real increase of pulmonary extent can be suspected in lung cancer screening trials. MATERIALS AND METHODS Baseline and 3-month follow-up low-dose computed tomography (LDCT) examinations of 131 smokers or former smokers recruited in the ITALUNG (32 subjects) and MILD (99 subjects) trials were compared using for each data set two different image processing tools for whole-lung densitometry. Both trials were approved by institutional review boards, and written informed consent was obtained from all participants. Assuming that no change of emphysema extent can occur in a 3-month interval, the Bland and Altman method was used to assess the agreement between baseline and follow-up LDCT examinations for lung volume, 15th percentile (Perc15) of lung density and Perc15 corrected for lung volume by application of a linear detrend on log-transformed data. RESULTS Similar results were obtained in each data set using two different image processing tools. In the ITALUNG cohort the 95% limits of agreement (LoA) interval of volume corrected Perc15 was -9.7 to 10.7% using image processing method 1 and -10.3 to 11.5% using image processing method 2. In the MILD cohort, the 95% LoA interval of volume corrected Perc15 was -14.7 to 17.3% with both image processing methods. CONCLUSION In the two considered lung cancer screening settings a range of 9.7-14.7% decrease of volume corrected Perc15 represents a statistically defined threshold to suspect a real increase of emphysema extent in serial LDCT examinations.
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Affiliation(s)
- Stefano Diciotti
- Computational Biomedical Imaging Laboratory, Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Hofmann M, Bezrukov I, Mantlik F, Aschoff P, Steinke F, Beyer T, Pichler BJ, Schölkopf B. MRI-based attenuation correction for whole-body PET/MRI: quantitative evaluation of segmentation- and atlas-based methods. J Nucl Med 2011; 52:1392-9. [PMID: 21828115 DOI: 10.2967/jnumed.110.078949] [Citation(s) in RCA: 202] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED PET/MRI is an emerging dual-modality imaging technology that requires new approaches to PET attenuation correction (AC). We assessed 2 algorithms for whole-body MRI-based AC (MRAC): a basic MR image segmentation algorithm and a method based on atlas registration and pattern recognition (AT&PR). METHODS Eleven patients each underwent a whole-body PET/CT study and a separate multibed whole-body MRI study. The MR image segmentation algorithm uses a combination of image thresholds, Dixon fat-water segmentation, and component analysis to detect the lungs. MR images are segmented into 5 tissue classes (not including bone), and each class is assigned a default linear attenuation value. The AT&PR algorithm uses a database of previously aligned pairs of MRI/CT image volumes. For each patient, these pairs are registered to the patient MRI volume, and machine-learning techniques are used to predict attenuation values on a continuous scale. MRAC methods are compared via the quantitative analysis of AC PET images using volumes of interest in normal organs and on lesions. We assume the PET/CT values after CT-based AC to be the reference standard. RESULTS In regions of normal physiologic uptake, the average error of the mean standardized uptake value was 14.1% ± 10.2% and 7.7% ± 8.4% for the segmentation and the AT&PR methods, respectively. Lesion-based errors were 7.5% ± 7.9% for the segmentation method and 5.7% ± 4.7% for the AT&PR method. CONCLUSION The MRAC method using AT&PR provided better overall PET quantification accuracy than the basic MR image segmentation approach. This better quantification was due to the significantly reduced volume of errors made regarding volumes of interest within or near bones and the slightly reduced volume of errors made regarding areas outside the lungs.
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Affiliation(s)
- Matthias Hofmann
- Department of Empirical Inference, Max Planck Institute for Intelligent Systems, Tübingen, Germany
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Palma DA, van Sörnsen de Koste JR, Verbakel WFAR, Senan S. A new approach to quantifying lung damage after stereotactic body radiation therapy. Acta Oncol 2011; 50:509-17. [PMID: 21174519 DOI: 10.3109/0284186x.2010.541934] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Radiological pneumonitis and fibrosis are common after stereotactic body radiotherapy (SBRT) but current scoring systems are qualitative and subjective. We evaluated the use of CT density measurements and a deformable registration tool to quantitatively measure lung changes post-SBRT. Material and methods. Four-dimensional CT datasets from 25 patients were imported into an image analysis program. Deformable registration was done using a B-spline algorithm (VelocityAI) and evaluated by landmark matching. The effects of respiration, contrast, and CT scanner on density measurements were evaluated. The relationship between density and clinician-scored radiological pneumonitis was assessed. Results. Deformable registration resulted in more accurate image matching than rigid registration. CT lung density was maximal at end-expiration, and most deformation with breathing occurred in the lower thorax. Use of contrast increased mean lung density by 18 HU (range 16-20 HU; p = 0.004). Diagnostic scans had a lower mean lung density than planning scans (mean difference 57 HU in lung contralateral to tumor; p = 0.048). Post-treatment CT density measurements correlated strongly with clinician-scored radiological pneumonitis (r = 0.75; p < 0.001). Conclusions. Quantitative analysis of changes in lung density correlated strongly with physician-assigned radiologic pneumonitis scores. Deformable registration and CT density measurements permit objective assessment of treatment toxicity.
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Affiliation(s)
- David A Palma
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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Hesselbacher SE, Ross R, Schabath MB, Smith EO, Perusich S, Barrow N, Smithwick P, Mammen MJ, Coxson H, Krowchuk N, Corry DB, Kheradmand F. Cross-sectional analysis of the utility of pulmonary function tests in predicting emphysema in ever-smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:1324-40. [PMID: 21655122 PMCID: PMC3108112 DOI: 10.3390/ijerph8051324] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 04/20/2011] [Accepted: 04/22/2011] [Indexed: 12/30/2022]
Abstract
Emphysema is largely an under-diagnosed medical condition that can exist in smokers in the absence of airway obstruction. We aimed to determine the sensitivity and specificity of pulmonary function tests (PFTs) in assessing emphysema using quantitative CT scans as the reference standard. We enrolled 224 ever-smokers (current or former) over the age of 40. CT of thorax was used to quantify the low attenuation area (% emphysema), and to measure the standardized airway wall thickness. PFTs were used individually and in combination to predict their ability to discriminate radiographic emphysema. Significant emphysema (>7%) was detected in 122 (54%) subjects. Twenty six (21%) emphysema subjects had no evidence of airflow obstruction (FEV(1)/FVC ratio <70%), while all subjects with >23% emphysema showed airflow obstruction. The sensitivity and specificity of spirometry for detecting radiographic emphysema were 79% and 75%, respectively. Standardized airway wall thickness was increased in subjects with airflow obstruction, but did not correlate with emphysema severity. In this cohort of lifetime ever-smokers, PFTs alone were inadequate for diagnosing emphysema. Airway wall thickness quantified by CT morphometry was associated with airflow limitation, but not with emphysema indicating that the heterogeneous nature of lung disease in smokers may represent distinct phenotypes.
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Affiliation(s)
- Sean E. Hesselbacher
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; E-Mails: (S.E.H.); (R.R.); (S.P.); (N.B.); (P.S.); (M.J.M.); (D.B.C.)
| | - Robert Ross
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; E-Mails: (S.E.H.); (R.R.); (S.P.); (N.B.); (P.S.); (M.J.M.); (D.B.C.)
| | - Matthew B. Schabath
- Division of Cancer Prevention and Control, The H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA; E-Mail:
| | - E. O’Brian Smith
- Children’s Nutrition Research Center (CNRC), Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; E-Mail:
| | - Sarah Perusich
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; E-Mails: (S.E.H.); (R.R.); (S.P.); (N.B.); (P.S.); (M.J.M.); (D.B.C.)
| | - Nadia Barrow
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; E-Mails: (S.E.H.); (R.R.); (S.P.); (N.B.); (P.S.); (M.J.M.); (D.B.C.)
| | - Pamela Smithwick
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; E-Mails: (S.E.H.); (R.R.); (S.P.); (N.B.); (P.S.); (M.J.M.); (D.B.C.)
| | - Manoj J. Mammen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; E-Mails: (S.E.H.); (R.R.); (S.P.); (N.B.); (P.S.); (M.J.M.); (D.B.C.)
| | - Harvey Coxson
- University of British Columbia, Vancouver Campus, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada; E-Mails: (H.C.); (N.K.)
| | - Natasha Krowchuk
- University of British Columbia, Vancouver Campus, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada; E-Mails: (H.C.); (N.K.)
| | - David B. Corry
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; E-Mails: (S.E.H.); (R.R.); (S.P.); (N.B.); (P.S.); (M.J.M.); (D.B.C.)
| | - Farrah Kheradmand
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; E-Mails: (S.E.H.); (R.R.); (S.P.); (N.B.); (P.S.); (M.J.M.); (D.B.C.)
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA
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Shaker SB, Stavngaard T, Laursen LC, Stoel BC, Dirksen A. Rapid Fall in Lung Density Following Smoking Cessation in COPD. COPD 2011; 8:2-7. [DOI: 10.3109/15412555.2010.541306] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lee PN, Fry JS. Systematic review of the evidence relating FEV1 decline to giving up smoking. BMC Med 2010; 8:84. [PMID: 21156048 PMCID: PMC3017006 DOI: 10.1186/1741-7015-8-84] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/14/2010] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The rate of forced expiratory volume in 1 second (FEV1) decline ("beta") is a marker of chronic obstructive pulmonary disease risk. The reduction in beta after quitting smoking is an upper limit for the reduction achievable from switching to novel nicotine delivery products. We review available evidence to estimate this reduction and quantify the relationship of smoking to beta. METHODS Studies were identified, in healthy individuals or patients with respiratory disease, that provided data on beta over at least 2 years of follow-up, separately for those who gave up smoking and other smoking groups. Publications to June 2010 were considered. Independent beta estimates were derived for four main smoking groups: never smokers, ex-smokers (before baseline), quitters (during follow-up) and continuing smokers. Unweighted and inverse variance-weighted regression analyses compared betas in the smoking groups, and in continuing smokers by amount smoked, and estimated whether beta or beta differences between smoking groups varied by age, sex and other factors. RESULTS Forty-seven studies had relevant data, 28 for both sexes and 19 for males. Sixteen studies started before 1970. Mean follow-up was 11 years. On the basis of weighted analysis of 303 betas for the four smoking groups, never smokers had a beta 10.8 mL/yr (95% confidence interval (CI), 8.9 to 12.8) less than continuing smokers. Betas for ex-smokers were 12.4 mL/yr (95% CI, 10.1 to 14.7) less than for continuing smokers, and for quitters, 8.5 mL/yr (95% CI, 5.6 to 11.4) less. These betas were similar to that for never smokers. In continuing smokers, beta increased 0.33 mL/yr per cigarette/day. Beta differences between continuing smokers and those who gave up were greater in patients with respiratory disease or with reduced baseline lung function, but were not clearly related to age or sex. CONCLUSION The available data have numerous limitations, but clearly show that continuing smokers have a beta that is dose-related and over 10 mL/yr greater than in never smokers, ex-smokers or quitters. The greater decline in those with respiratory disease or reduced lung function is consistent with some smokers having a more rapid rate of FEV1 decline. These results help in designing studies comparing continuing smokers of conventional cigarettes and switchers to novel products.
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Affiliation(s)
- Peter N Lee
- PN Lee Statistics and Computing Ltd, Surrey, UK.
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Miller M, Cho JY, Pham A, Friedman PJ, Ramsdell J, Broide DH. Persistent airway inflammation and emphysema progression on CT scan in ex-smokers observed for 4 years. Chest 2010; 139:1380-1387. [PMID: 20966041 DOI: 10.1378/chest.10-0705] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Tobacco smoking is a principal cause of COPD-emphysema (COPD-E). Whether discontinuing smoking for at least 4 years halts airway inflammation and progression of COPD-E in prior smokers is unknown. In this study we investigated whether discontinuing smoking for approximately 4 years in ex-smokers with GOLD (Global Initiative for Chronic Lung Disease) stage IIb (moderately severe) COPD-E stopped airway inflammation (ie, sputum biomarkers) and halted the progression of COPD-E on chest CT scan. METHODS Ten ex-smokers with COPD-E who had quit smoking underwent chest CT scans to document the extent of COPD-E, assessment of lung function (FEV(1) and diffusing capacity of lung for carbon monoxide), sputum induction for biomarkers of inflammation (measured by enzyme-linked immunosorbent assay), and blood cotinine levels at baseline and approximately 4 years later. Normal healthy subjects (n = 7) and normal current smokers with no CT scan evidence of COPD-E (n = 8) served as sputum biomarker comparison groups. RESULTS After approximately 4 years of not smoking (documented by cotinine levels), ex-smokers with COPD-E had persistent increased levels of mediators of inflammation in sputum (myeloperoxidase, leukotriene B4, IL-8, monocyte chemoattractant protein-1, matrix metalloprotease-9), which was associated with significant progression of COPD-E on chest CT scan. CONCLUSIONS Cessation of tobacco smoking in heavy smokers with moderately severe COPD-E is associated with evidence of persistent airway inflammation and progression of COPD-E on CT scan 4 years later. Discontinuing smoking may slow the rate of progression of moderate severity COPD-E, but it does not prevent persistent airway inflammation and significant progression of COPD-E on CT scan.
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Affiliation(s)
- Marina Miller
- Department of Medicine, University of California, San Diego, CA
| | - Jae Youn Cho
- Department of Medicine, University of California, San Diego, CA
| | - Alexa Pham
- Department of Medicine, University of California, San Diego, CA
| | - Paul J Friedman
- Department of Radiology, University of California, San Diego, CA
| | - Joe Ramsdell
- Department of Medicine, University of California, San Diego, CA
| | - David H Broide
- Department of Medicine, University of California, San Diego, CA.
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Madani A, Van Muylem A, Gevenois PA. Pulmonary Emphysema: Effect of Lung Volume on Objective Quantification at Thin-Section CT. Radiology 2010; 257:260-8. [DOI: 10.1148/radiol.10091446] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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