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Lidén M, Spahr A, Hjelmgren O, Bendazzoli S, Sundh J, Sköld M, Bergström G, Wang C, Thunberg P. Machine learning slice-wise whole-lung CT emphysema score correlates with airway obstruction. Eur Radiol 2024; 34:39-49. [PMID: 37552259 PMCID: PMC10791709 DOI: 10.1007/s00330-023-09985-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/18/2023] [Accepted: 05/29/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES Quantitative CT imaging is an important emphysema biomarker, especially in smoking cohorts, but does not always correlate to radiologists' visual CT assessments. The objectives were to develop and validate a neural network-based slice-wise whole-lung emphysema score (SWES) for chest CT, to validate SWES on unseen CT data, and to compare SWES with a conventional quantitative CT method. MATERIALS AND METHODS Separate cohorts were used for algorithm development and validation. For validation, thin-slice CT stacks from 474 participants in the prospective cross-sectional Swedish CArdioPulmonary bioImage Study (SCAPIS) were included, 395 randomly selected and 79 from an emphysema cohort. Spirometry (FEV1/FVC) and radiologists' visual emphysema scores (sum-visual) obtained at inclusion in SCAPIS were used as reference tests. SWES was compared with a commercially available quantitative emphysema scoring method (LAV950) using Pearson's correlation coefficients and receiver operating characteristics (ROC) analysis. RESULTS SWES correlated more strongly with the visual scores than LAV950 (r = 0.78 vs. r = 0.41, p < 0.001). The area under the ROC curve for the prediction of airway obstruction was larger for SWES than for LAV950 (0.76 vs. 0.61, p = 0.007). SWES correlated more strongly with FEV1/FVC than either LAV950 or sum-visual in the full cohort (r = - 0.69 vs. r = - 0.49/r = - 0.64, p < 0.001/p = 0.007), in the emphysema cohort (r = - 0.77 vs. r = - 0.69/r = - 0.65, p = 0.03/p = 0.002), and in the random sample (r = - 0.39 vs. r = - 0.26/r = - 0.25, p = 0.001/p = 0.007). CONCLUSION The slice-wise whole-lung emphysema score (SWES) correlates better than LAV950 with radiologists' visual emphysema scores and correlates better with airway obstruction than do LAV950 and radiologists' visual scores. CLINICAL RELEVANCE STATEMENT The slice-wise whole-lung emphysema score provides quantitative emphysema information for CT imaging that avoids the disadvantages of threshold-based scores and is correlated more strongly with reference tests than LAV950 and reader visual scores. KEY POINTS • A slice-wise whole-lung emphysema score (SWES) was developed to quantify emphysema in chest CT images. • SWES identified visual emphysema and spirometric airflow limitation significantly better than threshold-based score (LAV950). • SWES improved emphysema quantification in CT images, which is especially useful in large-scale research.
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Affiliation(s)
- Mats Lidén
- Department of Radiology and Medical Physics, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.
| | - Antoine Spahr
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology School of Technology and Health, Stockholm, Sweden
| | - Ola Hjelmgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Simone Bendazzoli
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology School of Technology and Health, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Magnus Sköld
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Chunliang Wang
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology School of Technology and Health, Stockholm, Sweden
| | - Per Thunberg
- Department of Radiology and Medical Physics, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
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Ma D, Shi H, Tan C, Zou W, Sun F, Wang K, Lei Q, Zheng X, Zhong Y, Tu C, Chen M, Huang Y, Wang Z, Wu J, Liang Y, Liu J. Quantitative CT Metrics for the Prediction of Therapeutic Effect in Asthma. J Clin Med 2023; 12:639. [PMID: 36675568 PMCID: PMC9861330 DOI: 10.3390/jcm12020639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Background: Few studies have explored the correlation between asthma medication and features on HRCT images. We aim to analyse the differences and temporal changes of lung function and airway resistance in asthma with diverse HRCT phenotypes in a short period after inhalation of budesonide/formoterol. Method: This observational study recruited 55 adult patients with varying severities of asthma. We performed detailed airway metrics measurements of chest CT scans, such as airway wall thickness (WT), wall area percentage (WA%), wall thickness percentage (T/OR), and airways with an inner perimeter of 10 mm (Pi10). The effect of lung structural features on asthma medication response was explored according to the WA% and T/OR twelve hours post-drug administration. Using multivariable regression models, we then assessed the influence of WA% on lung function. Results: WA% (p < 0.001) and T/OR (p < 0.001) significantly increased in asthma than in healthy control subjects. Compared to mild asthma, airway walls were further thickened (WA%, p = 0.023; T/OR: p = 0.029) and associated with lumen narrowing (Pi10, p = 0.055) in moderate to severe asthma. WA% and T/OR correlated well with lung function (FEV1, FVC, MMEF, and PEF) and airway resistance (R5, R20, Rp, and Fres). Regression analysis showed that MEF25 decreased with increasing age and WA% (R2 = 0.58, p < 0.001). Patients with thickened airway walls experienced a maximal increase in FVC, FEV1, and PEF at 2 h (p < 0.001) and a maximal decrease of R5, Z5, and Rp at 2 h (p < 0.001) in those with a thickened airway pattern. Conclusions: Asthma patients with different bronchial wall thicknesses exhibited variable lung function changes. Specifically, patients with thick airway wall patterns were more sensitive to inhaled budesonide in the short term.
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Affiliation(s)
- Donghai Ma
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital Sun Yat-sen University, Zhuhai 519000, China
| | - Honglei Shi
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital Sun Yat-sen University, Zhuhai 519000, China
| | - Cuiyan Tan
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Wei Zou
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital Sun Yat-sen University, Zhuhai 519000, China
| | - Fengfei Sun
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital Sun Yat-sen University, Zhuhai 519000, China
| | - Kongqiu Wang
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Qianqian Lei
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Xiaobin Zheng
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Yuanyuan Zhong
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Changli Tu
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Meizhu Chen
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Yiying Huang
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Zhenguo Wang
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Jian Wu
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Yingjian Liang
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Jing Liu
- Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital Sun Yat-sen University, Zhuhai 519000, China
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Zhao Y, Hernandez AM, Boone JM, Molloi S. Quantification of Airway Dimensions using a High-Resolution CT Scanner: A Phantom Study. Med Phys 2021; 48:5874-5883. [PMID: 34287955 DOI: 10.1002/mp.15103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Small airways with inner diameters less than 2 mm are sites of major airflow limitations in patients with chronic obstructive pulmonary disease (COPD) and asthma. The purpose of this study is to investigate the limitations for accurate assessment of small airway dimensions using both high-resolution CT (HRCT) and conventional normal-resolution CT at low dose levels. METHODS To model the normal human airways from the 3rd to 20th generations, a cylindrical polyurethane phantom with 14 airway tubes of inner diameters (ID) ranging from 0.3 to 3.4 mm and wall thicknesses (WT) ranging from 0.15 to 1.6 mm was placed within an Anthropomorphic QRM-Thorax phantom. The Aquilion Precision (Canon Medical Systems Corporation) HRCT scanner was used to acquire images at 80, 100 and 120 kV using high resolution mode (HR, 0.25 mm x 160 detector configuration) and normal resolution mode (NR, 0.5 mm x 80 detector configuration). The HR data were reconstructed using 1024 x 1024 matrix (0.22 x 0.22 x 0.25 mm voxel size) and the NR data were reconstructed using a 512 x 512 matrix (0.43 x 0.43 x 0.50 mm). Two reconstruction algorithms (filtered back projection; FBP and an adaptive iterative dose reduction 3D algorithm; AIDR 3D) and three reconstruction kernels (FC30, FC52 and FC56) were investigated. The CTDIvol dose values ranged from 0.2 to 6.2 mGy. A refined automated full-width half-maximum (FWHM) method was used for the measurement of airway dimensions, where the density profiles were computed by radial oversampling using a polar coordinate system. Both ID and WT were compared to the known dimensions using a regression model, and the root-mean-squared-error (RMSE) and average error were computed across all 14 airway tubes. RESULTS The results indicate that the ID can be measured within a 15% error down to approximately 0.8 mm and 2.0 mm using the HR and NR modes, respectively. The overall RMSE (and average error) of ID measurements for HR and NR were 0.10 mm (-0.70%) and 0.31 mm (-2.63%), respectively. The RMSE (and average error) of WT measurements using HR and NR were 0.10 mm (23.27%) and 0.27 mm (53.56%), respectively. The WT measurement using HR yielded a factor of two improvement in accuracy as compared to NR. CONCLUSIONS High-resolution CT can provide more accurate measurements of airway dimensions as compared with normal resolution CT, potentially improving quantitative assessment of pathologies such as COPD and asthma. The high resolution mode acquired and reconstructed with AIDR3D and the FC52 kernel provides most accurate measurement of airway dimensions. Low-dose high resolution measurements at dose level above 0.9 mGy can provide improved accuracy on both inner diameters and wall thicknesses compared to full dose normal resolution airway phantom measurements.
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Affiliation(s)
- Yixiao Zhao
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, USA
| | - Andrew M Hernandez
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - John M Boone
- Department of Radiology, University of California Davis, Sacramento, CA, USA.,Department of Biomedical Engineering, University of California Davis, Davis, CA, USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, USA
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Bakker JT, Klooster K, Vliegenthart R, Slebos DJ. Measuring pulmonary function in COPD using quantitative chest computed tomography analysis. Eur Respir Rev 2021; 30:30/161/210031. [PMID: 34261743 PMCID: PMC9518001 DOI: 10.1183/16000617.0031-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/08/2021] [Indexed: 12/25/2022] Open
Abstract
COPD is diagnosed and evaluated by pulmonary function testing (PFT). Chest computed tomography (CT) primarily serves a descriptive role for diagnosis and severity evaluation. CT densitometry-based emphysema quantification and lobar fissure integrity assessment are most commonly used, mainly for lung volume reduction purposes and scientific efforts. A shift towards a more quantitative role for CT to assess pulmonary function is a logical next step, since more, currently underutilised, information is present in CT images. For instance, lung volumes such as residual volume and total lung capacity can be extracted from CT; these are strongly correlated to lung volumes measured by PFT. This review assesses the current evidence for use of quantitative CT as a proxy for PFT in COPD and discusses challenges in the movement towards CT as a more quantitative modality in COPD diagnosis and evaluation. To better understand the relevance of the traditional PFT measurements and the role CT might play in the replacement of these parameters, COPD pathology and traditional PFT measurements are discussed. CT may be used as a proxy for lung function in COPD diagnosis and evaluation, particularly for the hyperinflation markershttps://bit.ly/2RrGAZf
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Affiliation(s)
- Jens T Bakker
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Klooster
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Dept of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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5
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Moon DH, Kim J, Lim MN, Bak SH, Kim WJ. Correlation between Telomere Length and Chronic Obstructive Pulmonary Disease-Related Phenotypes: Results from the Chronic Obstructive Pulmonary Disease in Dusty Areas (CODA) Cohort. Tuberc Respir Dis (Seoul) 2021; 84:188-199. [PMID: 33979985 PMCID: PMC8273013 DOI: 10.4046/trd.2021.0015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease with increased prevalence in the elderly. Telomeres are repetitive DNA sequences found at the end of the chromosome, which progressively shorten as cells divide. Telomere length is known to be a molecular marker of aging. This study aimed to assess the relationship between telomere length and the risk of COPD, lung function, respiratory symptoms, and emphysema index in Chronic Obstructive Pulmonary Disease in Dusty Areas (CODA) cohort. Methods We extracted DNA from the peripheral blood samples of 446 participants, including 285 COPD patients and 161 control participants. We measured absolute telomere length using quantitative real-time polymerase chain reaction. All participants underwent spirometry and quantitative computed tomography scan. Questionnaires assessing respiratory symptoms and the COPD Assessment Test was filled by all the participants. Results The mean age of participants at the baseline visit was 72.5±7.1 years. Males accounted for 72% (321 participants) of the all participants. The mean telomere length was lower in the COPD group compared to the non-COPD group (COPD, 16.81±13.90 kb; non-COPD, 21.97±14.43 kb). In COPD patients, 112 (75.7%) were distributed as tertile 1 (shortest), 91 (61.1%) as tertile 2 and 82 (55%) as tertile 3 (longest). We did not find significant associations between telomere length and lung function, exacerbation, airway wall thickness, and emphysema index after adjusting for sex, age, and smoking status. Conclusion In this study, the relationship between various COPD phenotypes and telomere length was analyzed, but no significant statistical associations were shown.
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Affiliation(s)
- Da Hye Moon
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Jeeyoung Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myoung Nam Lim
- Biomedical Research Institute, Kangwon National University, Chuncheon, Republic of Korea
| | - So Hyen Bak
- Department of Radiology, Kangwon National University Hospital, Kangwon National University of School of Medicine, Chuncheon, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea.,Department of Internal Medicine and Environmental Health Center, Kangwon National University School of Medicine, Chuncheon Republic of Korea
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Quantification of Perinodular Emphysema in High-risk Patients Offers No Benefit in Lung Nodule Risk-Stratification of Malignancy Potential. J Thorac Imaging 2020; 35:108-114. [PMID: 31876554 DOI: 10.1097/rti.0000000000000465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Pulmonary nodules, found either incidentally or on lung cancer screening, are common. Evaluating the benign or malignant nature of these nodules is costly in terms of patient risk and expense. The presence of both global and regional emphysema has been linked to increased lung cancer risk. We sought to determine whether the measurement of emphysema directly adjacent to a lung nodule could inform the likelihood of a nodule being malignant. MATERIALS AND METHODS Within a population of Veterans at high risk for lung cancer, 58 subjects with malignant nodules found on computerized tomographic chest scans were matched by lobe and nodule size to 58 controls. Lung densitometry was measured via determination of the low attenuation area percentage at -950 Hounsfield units (LAA950) and the Hounsfield unit (HU) value at which 15% of lung voxels have a lower lung density (Perc15), at predefined lung volumes that encompassed the nodule to evaluate both perinodular and regional lung fields. The association between measured lung density and malignancy was investigated using conditional logistic regression models, with densitometry measurements used as the primary predictor, adjusting for age alone, or age and computerized tomographic scan characteristics. RESULTS No significant differences in emphysema measurements between malignant and benign nodules were identified at lung volumes encompassing both perinodular and regional emphysema. Furthermore, emphysema quantification remained stable across lung volumes within individuals. CONCLUSIONS In this study, quantifying the degree of perinodular or regional emphysema did not offer any benefit in the risk stratification of lung nodules.
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Zhang L, Pelgrim GJ, Yan J, Zhang H, Vliegenthart R, Xie X. Feasibility of bronchial wall quantification in low- and ultralow-dose third-generation dual-source CT: An ex vivo lung study. J Appl Clin Med Phys 2020; 21:218-226. [PMID: 32991062 PMCID: PMC7592972 DOI: 10.1002/acm2.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 07/21/2020] [Accepted: 08/27/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate image quality and bronchial wall quantification in low- and ultralow-dose third-generation dual-source computed tomography (CT). METHODS A lung specimen from a formerly healthy male was scanned using third-generation dual-source CT at standard-dose (51 mAs/120 kV, CTDIvol 3.41 mGy), low-dose (1/4th and 1/10th of standard dose), and ultralow-dose setting (1/20th). Low kV (70, 80, 90, and Sn100 kV) scanning was applied in each low/ultralow-dose setting, combined with adaptive mAs to keep a constant dose. Images were reconstructed at advanced modeled iterative reconstruction (ADMIRE) levels 1, 3, and 5 for each scan. Bronchial wall were semi-automatically measured from the lobar level to subsegmental level. Spearman correlation analysis was performed between bronchial wall quantification (wall thickness and wall area percentage) and protocol settings (dose, kV, and ADMIRE). ANOVA with a post hoc pairwise test was used to compare signal-to-noise ratio (SNR), noise and bronchial wall quantification values among standard- and low/ultralow-dose settings, and among ADMIRE levels. RESULTS Bronchial wall quantification had no correlation with dose level, kV, or ADMIRE level (|correlation coefficients| < 0.3). SNR and noise showed no statistically significant differences at different kV in the same ADMIRE level (1, 3, or 5) and in the same dose group (P > 0.05). Generally, there were no significant differences in bronchial wall quantification among the standard- and low/ultralow-dose settings, and among different ADMIRE levels (P > 0.05). CONCLUSION The combined use of low/ultralow-dose scanning and ADMIRE does not influence bronchial wall quantification compared to standard-dose CT. This specimen study suggests the potential that an ultralow-dose scan can be used for bronchial wall quantification.
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Affiliation(s)
- Lin Zhang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Radiology Department, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Gert Jan Pelgrim
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jing Yan
- Siemens Healthcare Ltd, Shanghai, China
| | - Hao Zhang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Xueqian Xie
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhang L, Li Z, Meng J, Xie X, Zhang H. Airway quantification using adaptive statistical iterative reconstruction-V on wide-detector low-dose CT: a validation study on lung specimen. Jpn J Radiol 2019; 37:390-398. [PMID: 30820822 DOI: 10.1007/s11604-019-00818-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/31/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the accuracy of airway quantification of adaptive statistical iterative reconstruction (ASIR)-V on low-dose CT using a human lung specimen. METHOD A lung specimen was scanned on Revolution CT with low-dose settings (20 mAs, 40 mAs and 60 mAs/100 kV) and standard-dose setting (100 mAs/120 kV). CT images were reconstructed using lung kernel with eleven ASIR-V levels from 0 to 100% with 10% interval. ASIR-V level from 0 to 100% with 10% interval was reconstructed on lung kernel. Wall area percentage (%WA) and wall thickness (WT) were measured. RESULTS Radiation dose of 20 mAs, 40 mAs and 60 mAs low-dose settings reduced by 87.6%, 75.2% and 62.8% compared to that on standard dose, respectively. Low-dose settings significantly decreased image SNR (p < 0.05) and increased noise (p < 0.001). ASIR-V level exponentially improved image SNR and linearly decreased image noise (all p < 0.001). The mean airway measurement ratios of low-dose to standard-dose were within 2% variation for %WA and within 3% variation for WT. Most %WA and WT values showed no obvious correlation with ASIR-V levels. CONCLUSION ASIR-V showed to improve image quality in low radiation dose. However, low-dose settings and ASIR-V strength did not significantly influence airway quantification values, although variation in measurements slightly increased with dose reduction.
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Affiliation(s)
- Lin Zhang
- Department of Radiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Zhengyu Li
- Department of Radiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Jie Meng
- Department of Radiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Xueqian Xie
- Department of Radiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Shanghai, 200080, People's Republic of China.
| | - Hao Zhang
- Department of Radiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Shanghai, 200080, People's Republic of China.
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Qing K, Tustison NJ, Mugler JP, Mata JF, Lin Z, Zhao L, Wang D, Feng X, Shin JY, Callahan SJ, Bergman MP, Ruppert K, Altes TA, Cassani JM, Shim YM. Probing Changes in Lung Physiology in COPD Using CT, Perfusion MRI, and Hyperpolarized Xenon-129 MRI. Acad Radiol 2019; 26:326-334. [PMID: 30087065 DOI: 10.1016/j.acra.2018.05.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 04/12/2018] [Accepted: 05/16/2018] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES Chronic obstructive pulmonary disease (COPD) is highly heterogeneous and not well understood. Hyperpolarized xenon-129 (Xe129) magnetic resonance imaging (MRI) provides a unique way to assess important lung functions such as gas uptake. In this pilot study, we exploited multiple imaging modalities, including computed tomography (CT), gadolinium-enhanced perfusion MRI, and Xe129 MRI, to perform a detailed investigation of changes in lung morphology and functions in COPD. Utility and strengths of Xe129 MRI in assessing COPD were also evaluated against the other imaging modalities. MATERIALS AND METHODS Four COPD patients and four age-matched normal subjects participated in this study. Lung tissue density measured by CT, perfusion measures from gadolinium-enhanced MRI, and ventilation and gas uptake measures from Xe129 MRI were calculated for individual lung lobes to assess regional changes in lung morphology and function, and to investigate correlations among the different imaging modalities. RESULTS No significant differences were found for all measures among the five lobes in either the COPD or age-matched normal group. Strong correlations (R > 0.5 or < -0.5, p < 0.001) were found between ventilation and perfusion measures. Also gas uptake by blood as measured by Xe129 MRI showed strong correlations with CT tissue density and ventilation measures (R > 0.5 or < -0.5, p < 0.001) and moderate to strong correlations with perfusion measures (R > 0.4 or < -0.5, p < 0.01). Four distinctive patterns of functional abnormalities were found in patients with COPD. CONCLUSION Xe129 MRI has high potential to uniquely identify multiple changes in lung physiology in COPD using a single breath-hold acquisition.
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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: 18] [Impact Index Per Article: 3.0] [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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Possebon L, Costa SS, Souza HR, Azevedo LR, Sant'Ana M, Iyomasa-Pilon MM, Oliani SM, Girol AP. Mimetic peptide AC2-26 of annexin A1 as a potential therapeutic agent to treat COPD. Int Immunopharmacol 2018; 63:270-281. [DOI: 10.1016/j.intimp.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/08/2018] [Accepted: 08/10/2018] [Indexed: 12/27/2022]
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Konietzke P, Weinheimer O, Wielpütz MO, Wagner WL, Kaukel P, Eberhardt R, Heussel CP, Kauczor HU, Herth FJ, Schuhmann M. Quantitative CT detects changes in airway dimensions and air-trapping after bronchial thermoplasty for severe asthma. Eur J Radiol 2018; 107:33-38. [PMID: 30292270 DOI: 10.1016/j.ejrad.2018.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/29/2018] [Accepted: 08/09/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Bronchial thermoplasty (BT) can be considered in the treatment of severe asthma to reduce airway smooth muscle mass and bronchoconstriction. We hypothesized that BT may thus have long-term effects on airway dimensions and air-trapping detectable by quantitative computed tomography (QCT). METHODS Paired in- and expiratory CT and inspiratory CT were acquired in 17 patients with severe asthma before and up to two years after bronchial thermoplasty and in 11 additional conservatively treated patients with serve asthma, respectively. A fully automatic software calculated the airways metrics for wall thickness (WT), wall percentage (WP), lumen area (LA) and total diameter (TD). Furthermore, lung air-trapping was quantified by determining the quotient of mean lung attenuation in expiration vs. inspiration (E/I MLA) and relative volume change in the Hounsfield interval -950 to -856 in expiration to inspiration (RVC856-950) in a generation- and lobe-based approach, respectively. RESULTS BT reduced WT for the combined analysis of the 2nd-7th airway generation significantly by 0.06 mm (p = 0.026) and WP by 2.05% (p < 0.001), whereas LA and TD did not change significantly (p = 0.147, p = 0.706). No significant changes were found in the control group. Furthermore, E/I MLA and RVC856-950 decreased significantly after BT by 12.65% and 1.77% (p < 0.001), respectively. CONCLUSION BT significantly reduced airway narrowing and air-trapping in patients with severe asthma. This can be interpreted as direct therapeutic effects caused by a reduction in airway-smooth muscle mass and changes in innervation. A reduction in air-trapping indicates an influence on more peripheral airways not directly treated by the BT procedure.
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Affiliation(s)
- Philip Konietzke
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126 Heidelberg, Germany.
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126 Heidelberg, Germany
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126 Heidelberg, Germany
| | - Willi L Wagner
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126 Heidelberg, Germany
| | - Philine Kaukel
- Department of Respiratory and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126 Heidelberg, Germany
| | - Ralf Eberhardt
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany; Department of Respiratory and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126 Heidelberg, Germany
| | - Claus P Heussel
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126 Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126 Heidelberg, Germany
| | - Felix J Herth
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany; Department of Respiratory and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126 Heidelberg, Germany
| | - Maren Schuhmann
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany; Department of Respiratory and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126 Heidelberg, Germany
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Yang Z, Jin H, Kim JH. Attenuation profile matching: An accurate and scan parameter-robust measurement method for small airway dimensions in low-dose CT scans. Med Phys 2018; 45:4145-4157. [PMID: 29969838 DOI: 10.1002/mp.13074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 06/24/2018] [Accepted: 06/24/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The dimensions of small airways with an internal diameter of less than 2-3 mm are important biomarkers for the evaluation of pulmonary diseases, such as asthma and chronic obstructive pulmonary disease (COPD). The resolution limitations of CT systems, however, have remained a barrier to be of use for determining the small airway dimensions. We present a novel approach, called the attenuation profile matching (APM) method, which allows for the accurate determination of the small airway dimension while being robust to varying CT scan parameters. METHOD For generating the synthetic attenuation profiles of an airway, we acquired and employed the point spread functions of a CT system by calculating its convolution with numerical airway models with varying wall thicknesses. The dimensions of a given airway were determined as per the numerical model yielding minimum error between the measured and the synthetic attenuation profiles across the airway. RESULTS In a phantom study with airway tubes, the APM method proved to be highly accurate in determining airway wall dimensions. The measurement error for the smallest tube (0.6 mm thickness, 3 mm diameter) was merely 0.02 mm (3.3%) in wall thickness and 0.17 mm (5.6%) in lumen diameter. In a pilot clinical test, the APM method was able to distinguish the airway wall thicknesses of COPD cases (1.16 ± 0.23 mm) from those of normal subjects (0.6 ± 0.18 mm), while the measurements using the full width at half maximum method substantially overlapped (1.45 ± 0.32 mm vs. 1.28 ± 0.30 mm, respectively) and were barely distinguishable from each other. CONCLUSION Our proposed APM method has the potential to overcome the resolution limitations of current CT systems and accurately determine the small airway dimensions in COPD patients.
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Affiliation(s)
- Zepa Yang
- Program in Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Korea
| | - Hyeongmin Jin
- Program in Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Korea
| | - Jong Hyo Kim
- Program in Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Korea
- Centre for Medical-IT Convergence Technology Research, Advanced Institutes of Convergence Technology, Suwon, 16229, Korea
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14
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Oelsner EC, Smith BM, Hoffman EA, Kalhan R, Donohue KM, Kaufman JD, Nguyen JN, Manichaikul AW, Rotter JI, Michos ED, Jacobs DR, Burke GL, Folsom AR, Schwartz JE, Watson K, Barr RG. Prognostic Significance of Large Airway Dimensions on Computed Tomography in the General Population. The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study. Ann Am Thorac Soc 2018; 15:718-727. [PMID: 29529382 PMCID: PMC6137677 DOI: 10.1513/annalsats.201710-820oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/12/2018] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Large airway dimensions on computed tomography (CT) have been associated with lung function, symptoms, and exacerbations in chronic obstructive pulmonary disease (COPD), as well as with symptoms in smokers with preserved spirometry. Their prognostic significance in persons without lung disease remains undefined. OBJECTIVES To examine associations between large airway dimensions on CT and respiratory outcomes in a population-based cohort of adults without prevalent lung disease. METHODS The Multi-Ethnic Study of Atherosclerosis recruited participants ages 45-84 years without cardiovascular disease in 2000-2002; we excluded participants with prevalent chronic lower respiratory disease (CLRD). Spirometry was measured in 2004-2006 and 2010-2012. CLRD hospitalizations and deaths were classified by validated criteria through 2014. The average wall thickness for a hypothetical airway of 10-mm lumen perimeter on CT (Pi10) was calculated using measures of airway wall thickness and lumen diameter. Models were adjusted for age, sex, principal components of ancestry, body mass index, smoking, pack-years, scanner, percent emphysema, genetic risk score, and initial forced expiratory volume in 1 second (FEV1) percent predicted. RESULTS Greater Pi10 was associated with 9% faster FEV1 decline (95% confidence interval [CI], 2 to 15%; P = 0.012) and increased incident COPD (odds ratio, 2.22; 95% CI, 1.43-3.45; P = 0.0004) per standard deviation among 1,830 participants. Over 78,147 person-years, higher Pi10 was associated with a 57% higher risk of first CLRD hospitalization or mortality (P = 0.0496) per standard deviation. Of Pi10's component measures, both greater airway wall thickness and narrower lumen predicted incident COPD and CLRD clinical events. CONCLUSIONS In adults without CLRD, large airway dimensions on CT were prospectively associated with accelerated lung function decline and increased risks of COPD and CLRD hospitalization and mortality.
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Affiliation(s)
- Elizabeth C. Oelsner
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Benjamin M. Smith
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Respiratory Division, McGill University, Montreal, Quebec, Canada
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Ravi Kalhan
- Division of Pulmonary, Northwestern University, Chicago, Illinois
| | - Kathleen M. Donohue
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Jennifer N. Nguyen
- Division of Biostatistics and Epidemiology, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Ani W. Manichaikul
- Division of Biostatistics and Epidemiology, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Jerome I. Rotter
- Division of Genomic Outcomes, University of California, Los Angeles, School of Medicine, Torrance, California
| | - Erin D. Michos
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Gregory L. Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Joseph E. Schwartz
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Karol Watson
- Division of Cardiology, University of California, Los Angeles, School of Medicine, Los Angeles, California
| | - R. Graham Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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15
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Abstract
Lung densitometry assesses with computed tomography (CT) the X-ray attenuation of the pulmonary tissue which reflects both the degree of inflation and the structural lung abnormalities implying decreased attenuation, as in emphysema and cystic diseases, or increased attenuation, as in fibrosis. Five reasons justify replacement with lung densitometry of semi-quantitative visual scales used to measure extent and severity of diffuse lung diseases: (I) improved reproducibility; (II) complete vs. discrete assessment of the lung tissue; (III) shorter computation times; (IV) better correlation with pathology quantification of pulmonary emphysema; (V) better or equal correlation with pulmonary function tests (PFT). Commercially and open platform software are available for lung densitometry. It requires attention to technical and methodological issues including CT scanner calibration, radiation dose, and selection of thickness and filter to be applied to sections reconstructed from whole-lung CT acquisition. Critical is also the lung volume reached by the subject at scanning that can be measured in post-processing and represent valuable information per se. The measurements of lung density include mean and standard deviation, relative area (RA) at -970, -960 or -950 Hounsfield units (HU) and 1st and 15th percentile for emphysema in inspiratory scans, and RA at -856 HU for air trapping in expiratory scans. Kurtosis and skewness are used for evaluating pulmonary fibrosis in inspiratory scans. The main indication for lung densitometry is assessment of emphysema component in the single patient with chronic obstructive pulmonary diseases (COPD). Additional emerging applications include the evaluation of air trapping in COPD patients and in subjects at risk of emphysema and the staging in patients with lymphangioleiomyomatosis (LAM) and with pulmonary fibrosis. It has also been applied to assess prevalence of smoking-related emphysema and to monitor progression of smoking-related emphysema, alpha1 antitrypsin deficiency emphysema, and pulmonary fibrosis. Finally, it is recommended as end-point in pharmacological trials of emphysema and lung fibrosis.
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Affiliation(s)
- Mario Mascalchi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences
| | - Gianna Camiciottoli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences.,Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
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Hoff BA, Pompe E, Galbán S, Postma DS, Lammers JWJ, Ten Hacken NHT, Koenderman L, Johnson TD, Verleden SE, de Jong PA, Mohamed Hoesein FAA, van den Berge M, Ross BD, Galbán CJ. CT-Based Local Distribution Metric Improves Characterization of COPD. Sci Rep 2017; 7:2999. [PMID: 28592874 PMCID: PMC5462827 DOI: 10.1038/s41598-017-02871-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 04/20/2017] [Indexed: 02/04/2023] Open
Abstract
Parametric response mapping (PRM) of paired CT lung images has been shown to improve the phenotyping of COPD by allowing for the visualization and quantification of non-emphysematous air trapping component, referred to as functional small airways disease (fSAD). Although promising, large variability in the standard method for analyzing PRMfSAD has been observed. We postulate that representing the 3D PRMfSAD data as a single scalar quantity (relative volume of PRMfSAD) oversimplifies the original 3D data, limiting its potential to detect the subtle progression of COPD as well as varying subtypes. In this study, we propose a new approach to analyze PRM. Based on topological techniques, we generate 3D maps of local topological features from 3D PRMfSAD classification maps. We found that the surface area of fSAD (SfSAD) was the most robust and significant independent indicator of clinically meaningful measures of COPD. We also confirmed by micro-CT of human lung specimens that structural differences are associated with unique SfSAD patterns, and demonstrated longitudinal feature alterations occurred with worsening pulmonary function independent of an increase in disease extent. These findings suggest that our technique captures additional COPD characteristics, which may provide important opportunities for improved diagnosis of COPD patients.
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Affiliation(s)
- Benjamin A Hoff
- Department of Radiology, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI, United States
| | - Esther Pompe
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefanie Galbán
- Department of Radiology, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI, United States
| | - Dirkje S Postma
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Disease, Utrecht, The Netherlands
| | - Jan-Willem J Lammers
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nick H T Ten Hacken
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Disease, Utrecht, The Netherlands
| | - Leo Koenderman
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Timothy D Johnson
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Stijn E Verleden
- Lung transplant Unit, Department of clinical and experimental medicine, KU Leuven, Leuven, Belgium
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Disease, Utrecht, The Netherlands
| | - Brian D Ross
- Department of Radiology, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI, United States
| | - Craig J Galbán
- Department of Radiology, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI, United States.
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Selim AO, Gouda ZA, Selim SA. An experimental study of a rat model of emphysema induced by cigarette smoke exposure and the effect of Survanta therapy. Ann Anat 2017; 211:69-77. [DOI: 10.1016/j.aanat.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/18/2016] [Accepted: 12/19/2016] [Indexed: 12/26/2022]
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18
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Aberle DR. Implementing lung cancer screening: the US experience. Clin Radiol 2017; 72:401-406. [PMID: 28069160 DOI: 10.1016/j.crad.2016.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 11/28/2016] [Accepted: 12/05/2016] [Indexed: 11/29/2022]
Abstract
The reduced lung cancer mortality observed with low-dose computed tomography (LDCT) screening in the National Lung Screening Trial (NLST) has led to annual screening in the United States as a covered benefit by both private insurers and the federal health insurance programme, the Centers for Medicare and Medicaid Services. Reimbursement for screening requires data submission to a federal registry on all individuals, whether privately or federally insured. Data must document individual patient eligibility as well as shared decision-making regarding the benefits and risks of LDCT screening, smoking cessation counselling, and the importance of annual screening. Beyond these requirements lie opportunities to maximise the benefits of screening in the radiology setting. Individuals eligible for screening account for a minority of those diagnosed with lung cancer in the US; the evidence needed to improve patient selection must be collected systematically for both screen-detected and incidentally detected lung nodules. Current nodule management and tracking guidelines reduce the false-positive rates observed in the NLST, but fall short in their ability to correctly classify nodules as benign or malignant. Smoking cessation is inadequately managed in most busy clinician practices. As a common nidus for tobacco-associated lung diseases, imagers are uniquely poised to collect the longitudinal data to better inform screening eligibility and to improve indeterminate nodule management, while maximising the setting of screening to motivate and provide smoking cessation. By re-engineering the notion of imaging practice, radiologists can be major contributors to lung cancer early detection and mortality reduction.
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Affiliation(s)
- D R Aberle
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
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20
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Pompe E, van Rikxoort EM, Mets OM, Charbonnier JP, Kuhnigk JM, de Koning HJ, Oudkerk M, Vliegenthart R, Zanen P, Lammers JWJ, van Ginneken B, de Jong PA, Mohamed Hoesein FAA. Follow-up of CT-derived airway wall thickness: Correcting for changes in inspiration level improves reliability. Eur J Radiol 2016; 85:2008-2013. [PMID: 27776653 DOI: 10.1016/j.ejrad.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/09/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Airway wall thickness (AWT) is affected by changes in lung volume. This study evaluated whether correcting AWT on computed tomography (CT) for differences in inspiration level improves measurement agreement, reliability, and power to detect changes over time. METHODS Participants of the Dutch-Belgian lung cancer screening trial who underwent 3-month repeat CT for an indeterminate pulmonary nodule were included. AWT on CT was calculated by the square root of the wall area at a theoretical airway with an internal perimeter of 10mm (Pi10). The scan with the highest lung volume was labelled as the reference scan and the scan with the lowest lung volume was labelled as the comparison scan. Pi10 derived from the comparison scan was corrected by multiplying it with the ratio of CT lung volume of the comparison scan to CT lung volume on the reference scan. Agreement of uncorrected and corrected Pi10 was studied with the Bland-Altman method, reliability with intra-class correlation coefficients (ICC), and power to detect changes over time was calculated. RESULTS 315 male participants were included. Limit of agreement and reliability for Pi10 was -0.61 to 0.57mm (ICC=0.87), which improved to -0.38 to 0.37mm (ICC=0.94) after correction for inspiration level. To detect a 15% change over 3 months, 71 subjects are needed for Pi10 and 26 subjects for Pi10 adjusted for inspiration level. CONCLUSIONS Correcting Pi10 for differences in inspiration level improves reliability, agreement, and power to detect changes over time.
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Affiliation(s)
- Esther Pompe
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Eva M van Rikxoort
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Onno M Mets
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jean-Paul Charbonnier
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan-Martin Kuhnigk
- Institute for Medical Image Computing, Fraunhofer MEVIS, Bremen, Germany
| | - Harry J de Koning
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Groningen, Department of Radiology, The Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Groningen, Department of Radiology, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
| | - Pieter Zanen
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan-Willem J Lammers
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bram van Ginneken
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Postma DS, Weiss ST, van den Berge M, Kerstjens HAM, Koppelman GH. Revisiting the Dutch hypothesis. J Allergy Clin Immunol 2015; 136:521-9. [PMID: 26343936 DOI: 10.1016/j.jaci.2015.06.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 12/20/2022]
Abstract
The Dutch hypothesis was first articulated in 1961, when many novel and advanced scientific techniques were not available, such as genomics techniques for pinpointing genes, gene expression, lipid and protein profiles, and the microbiome. In addition, computed tomographic scans and advanced analysis techniques to dissect (small) airways disease and emphysema were not available. At that time, the group of researchers under the visionary guidance of Professor N. G. M. Orie put forward that both genetic and environmental factors can determine whether one would have airway obstructive diseases, such as asthma and chronic obstructive pulmonary disease (COPD). Moreover, they stipulated that the phenotype of obstructive airway disease could be affected by sex and changes with aging. Orie and colleagues' call to carefully phenotype patients with obstructive airways diseases has been adopted by many current researchers in an attempt to determine the heterogeneity of both asthma and COPD to better define these diseases and optimize their treatment. The founders of the Dutch hypothesis were far ahead of their time, and we can learn from their insights. We should fully characterize all patients in our clinical practice and not just state that they have asthma, COPD, or asthma and COPD overlap syndrome. This detailed phenotyping can help in understanding these obstructive airway diseases and provide guidance for disease management.
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Affiliation(s)
- Dirkje S Postma
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands.
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Mass
| | - Maarten van den Berge
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerard H Koppelman
- University of Groningen, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, and the Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, Groningen, The Netherlands
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22
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Lutchmedial SM, Creed WG, Moore AJ, Walsh RR, Gentchos GE, Kaminsky DA. How Common Is Airflow Limitation in Patients With Emphysema on CT Scan of the Chest? Chest 2015; 148:176-184. [PMID: 25539080 DOI: 10.1378/chest.14-1556] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND COPD has traditionally been defined by the presence of irreversible airflow limitation on spirometry using either the GOLD (Global Initiative for Chronic Obstructive Lung Disease) or American Thoracic Society/European Respiratory Society criteria (lower limit of normal [LLN]). We have observed that some patients with clinical COPD and emphysema on chest CT scan have no obstruction on spirometry. The purpose of this study was to assess the prevalence of obstruction by GOLD and LLN criteria in patients with emphysema on CT scan and determine which radiographic criteria were associated with a clinical diagnosis of COPD. METHODS We retrospectively analyzed the clinical records and spirometry of all patients who had radiographically defined emphysema on chest CT scans completed at the University of Vermont in 2011. We compared spirometric criteria and CT scan factors with the presence of clinical COPD based on chart review. RESULTS We identified 274 patients with CT scan-defined emphysema. GOLD criteria detected obstruction in 228 patients (83%), and LLN detected obstruction in 206 patients (75%). However, GOLD failed to correctly identify 19 patients (6.9%) and LLN failed to identify 38 patients (13.9%) (average 10.4%) who had radiographic emphysema and a clinical diagnosis of COPD. Obese patients had a lower prevalence of obstruction whether classified by LLN or GOLD. Among patients with spirometric obstruction, there were greater degrees of emphysema and more severely increased airway wall thickness. Factors that were independently associated with clinical COPD were lower FVC % predicted, lower FEV1/FVC ratio, and increasing airway wall thickness. CONCLUSIONS Spirometry missed 10.4% of patients with clinical COPD who have significant emphysema on chest CT scan.
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Affiliation(s)
| | | | | | | | | | - David A Kaminsky
- Division of Pulmonary and Critical Care Medicine, Burlington, VT.
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23
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Dijkstra AE, Postma DS, van Ginneken B, Wielpütz MO, Schmidt M, Becker N, Owsijewitsch M, Kauczor HU, de Koning HJ, Lammers JW, Oudkerk M, Brandsma CA, Bossé Y, Nickle DC, Sin DD, Hiemstra PS, Wijmenga C, Smolonska J, Zanen P, Vonk JM, van den Berge M, Boezen HM, Groen HJM. Novel Genes for Airway Wall Thickness Identified with Combined Genome-Wide Association and Expression Analyses. Am J Respir Crit Care Med 2015; 191:547-56. [DOI: 10.1164/rccm.201405-0840oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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24
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Mohamed Hoesein FAA, de Jong PA, Lammers JWJ, Mali WPTM, Schmidt M, de Koning HJ, van der Aalst C, Oudkerk M, Vliegenthart R, Groen HJM, van Ginneken B, van Rikxoort EM, Zanen P. Airway wall thickness associated with forced expiratory volume in 1 second decline and development of airflow limitation. Eur Respir J 2015; 45:644-51. [PMID: 25614166 DOI: 10.1183/09031936.00020714] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Airway wall thickness and emphysema contribute to airflow limitation. We examined their association with lung function decline and development of airflow limitation in 2021 male smokers with and without airflow limitation. Airway wall thickness and emphysema were quantified on chest computed tomography and expressed as the square root of wall area of a 10-mm lumen perimeter (Pi10) and the 15th percentile method (Perc15), respectively. Baseline and follow-up (median (interquartile range) 3 (2.9-3.1) years) spirometry was available. Pi10 and Perc15 correlated with baseline forced expiratory volume in 1 s (FEV1) (r= -0.49 and 0.11, respectively (p<0.001)). Multiple linear regression showed that Pi10 and Perc15 at baseline were associated with a lower FEV1 after follow-up (p<0.05). For each sd increase in Pi10 and decrease in Perc15 the FEV1 decreased by 20 mL and 30.2 mL, respectively. The odds ratio for developing airflow limitation after 3 years was 2.45 for a 1-mm higher Pi10 and 1.46 for a 10-HU lower Perc15 (p<0.001). A greater degree of airway wall thickness and emphysema was associated with a higher FEV1 decline and development of airflow limitation after 3 years of follow-up.
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Affiliation(s)
| | - Pim A de Jong
- Dept of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan-Willem J Lammers
- Dept of Respiratory Medicine, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem P T M Mali
- Dept of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael Schmidt
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | | | | | - Matthijs Oudkerk
- Center for Medical Imaging - North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Dept of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry J M Groen
- Dept of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands GRIAD Research Institute, University Medical Center Groningen, Groningen, The Netherlands
| | - Bram van Ginneken
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Eva M van Rikxoort
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Pieter Zanen
- Dept of Respiratory Medicine, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
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25
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Shaw JG, Vaughan A, Dent AG, O'Hare PE, Goh F, Bowman RV, Fong KM, Yang IA. Biomarkers of progression of chronic obstructive pulmonary disease (COPD). J Thorac Dis 2014; 6:1532-47. [PMID: 25478195 DOI: 10.3978/j.issn.2072-1439.2014.11.33] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/21/2014] [Indexed: 01/02/2023]
Abstract
Disease progression of chronic obstructive pulmonary disease (COPD) is variable, with some patients having a relatively stable course, while others suffer relentless progression leading to severe breathlessness, frequent acute exacerbations of COPD (AECOPD), respiratory failure and death. Radiological markers such as CT emphysema index, bronchiectasis and coronary artery calcification (CAC) have been linked with increased mortality in COPD patients. Molecular changes in lung tissue reflect alterations in lung pathology that occur with disease progression; however, lung tissue is not routinely accessible. Cell counts (including neutrophils) and mediators in induced sputum have been associated with lung function and risk of exacerbations. Examples of peripheral blood biological markers (biomarkers) include those associated with lung function (reduced CC-16), emphysema severity (increased adiponectin, reduced sRAGE), exacerbations and mortality [increased CRP, fibrinogen, leukocyte count, IL-6, IL-8, and tumor necrosis factor α (TNF-α)] including increased YKL-40 with mortality. Emerging approaches to discovering markers of gene-environment interaction include exhaled breath analysis [volatile organic compounds (VOCs), exhaled breath condensate], cellular and systemic responses to exposure to air pollution, alterations in the lung microbiome, and biomarkers of lung ageing such as telomere length shortening and reduced levels of sirtuins. Overcoming methodological challenges in sampling and quality control will enable more robust yet easily accessible biomarkers to be developed and qualified, in order to optimise personalised medicine in patients with COPD.
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Affiliation(s)
- Janet G Shaw
- 1 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia ; 2 UQ Thoracic Research Centre, School of Medicine, the University of Queensland, Brisbane, Australia
| | - Annalicia Vaughan
- 1 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia ; 2 UQ Thoracic Research Centre, School of Medicine, the University of Queensland, Brisbane, Australia
| | - Annette G Dent
- 1 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia ; 2 UQ Thoracic Research Centre, School of Medicine, the University of Queensland, Brisbane, Australia
| | - Phoebe E O'Hare
- 1 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia ; 2 UQ Thoracic Research Centre, School of Medicine, the University of Queensland, Brisbane, Australia
| | - Felicia Goh
- 1 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia ; 2 UQ Thoracic Research Centre, School of Medicine, the University of Queensland, Brisbane, Australia
| | - Rayleen V Bowman
- 1 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia ; 2 UQ Thoracic Research Centre, School of Medicine, the University of Queensland, Brisbane, Australia
| | - Kwun M Fong
- 1 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia ; 2 UQ Thoracic Research Centre, School of Medicine, the University of Queensland, Brisbane, Australia
| | - Ian A Yang
- 1 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia ; 2 UQ Thoracic Research Centre, School of Medicine, the University of Queensland, Brisbane, Australia
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26
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Chronic respiratory symptoms associated with airway wall thickening measured by thin-slice low-dose CT. AJR Am J Roentgenol 2014; 203:W383-90. [PMID: 25247967 DOI: 10.2214/ajr.13.11536] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In lung cancer screening, the prevalence of chronic respiratory symptoms is high among heavy smokers. The purpose of this study was to compare CT-derived airway wall measurements between male smokers with and those without chronic respiratory symptoms. MATERIALS AND METHODS Fifty male heavy smokers with chronic respiratory symptoms (cough, excessive mucus secretion, dyspnea, and wheezing) and 50 without any respiratory symptom were randomly selected from the Dutch-Belgian Randomized Lung Cancer Screening Trial. Thin-slice low-dose CT images were evaluated with dedicated software for airway measurements. Wall area percentage and airway wall thickness were measured from trachea to bronchi in five different pulmonary lobes of airways with a luminal diameter of 5 mm or greater. Association between airway wall measurements and respiratory symptoms was analyzed by multiple linear regression adjusted for age, body mass index, smoking status, emphysema, and pulmonary function. RESULTS After adjustment for relevant factors, a significant positive association between airway wall measurements and respiratory symptoms was found in airways with a luminal diameter between 5 to 10 mm (p < 0.01), but not in airways measuring 10 mm or greater (p > 0.05). At the airway level between 5 to 10 mm, the mean wall area percentages were 51.5% ± 7.9%. Airway wall thicknesses were 1.54 ± 0.39 mm and 1.37 ± 0.35 mm (p < 0.001). CONCLUSION Male heavy smokers with chronic respiratory symptoms in lung cancer screening, who are at high-risk of chronic bronchitis, have bronchial wall thickening in airways with a luminal diameter of 5-10 mm but not in larger airways.
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27
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Wille MMW, Thomsen LH, Dirksen A, Petersen J, Pedersen JH, Shaker SB. Emphysema progression is visually detectable in low-dose CT in continuous but not in former smokers. Eur Radiol 2014; 24:2692-9. [PMID: 25038853 DOI: 10.1007/s00330-014-3294-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/26/2014] [Accepted: 06/26/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate interobserver agreement and time-trend in chest CT assessment of emphysema, airways, and interstitial abnormalities in a lung cancer screening cohort. METHODS Visual assessment of baseline and fifth-year examination of 1990 participants was performed independently by two observers. Results were standardised by means of an electronic score sheet; kappa and time-trend analyses were performed. RESULTS Interobserver agreement was substantial in early emphysema diagnosis; highly significant (p < 0.001) time-trends in both emphysema presence and grading were found (higher prevalence and grade of emphysema in late CT examinations). Significant progression in emphysema was seen in continuous smokers, but not in former smokers. Agreement on centrilobular emphysema subtype was substantial; agreement on paraseptal subtype, moderate. Agreement on panlobular and mixed subtypes was only fair. Agreement was fair regarding airway analysis. Interstitial abnormalities were infrequent in the cohort, and agreement on these was fair to moderate. A highly significant time-trend was found regarding interstitial abnormalities, which were more frequent in late examinations. CONCLUSIONS Visual scoring of chest CT is able to characterise the presence, pattern, and progression of early emphysema. Continuous smokers progress; former smokers do not. KEY POINTS • Substantial interobserver consistency in determining early-stage emphysema in low-dose CT. • Longitudinal analyses show clear time-trends for emphysema presence and grading. • For continuous smokers, progression of emphysema was seen in all lung zones. • For former smokers, progression of emphysema was undetectable by visual assessment. • Onset and progression of interstitial abnormalities are visually detectable.
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Affiliation(s)
- Mathilde Marie Winkler Wille
- Department of Respiratory Medicine, Gentofte Hospital, Niels Andersensvej 65, opg. 30A, st.th., 2900, Hellerup, Denmark,
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28
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Effect of inspiration on airway dimensions measured in maximal inspiration CT images of subjects without airflow limitation. Eur Radiol 2014; 24:2319-25. [PMID: 24903230 DOI: 10.1007/s00330-014-3261-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/14/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To study the effect of inspiration on airway dimensions measured in voluntary inspiration breath-hold examinations. METHODS 961 subjects with normal spirometry were selected from the Danish Lung Cancer Screening Trial. Subjects were examined annually for five years with low-dose CT. Automated software was utilized to segment lungs and airways, identify segmental bronchi, and match airway branches in all images of the same subject. Inspiration level was defined as segmented total lung volume (TLV) divided by predicted total lung capacity (pTLC). Mixed-effects models were used to predict relative change in lumen diameter (ALD) and wall thickness (AWT) in airways of generation 0 (trachea) to 7 and segmental bronchi (R1-R10 and L1-L10) from relative changes in inspiration level. RESULTS Relative changes in ALD were related to relative changes in TLV/pTLC, and this distensibility increased with generation (p < 0.001). Relative changes in AWT were inversely related to relative changes in TLV/pTLC in generation 3--7 (p < 0.001). Segmental bronchi were widely dispersed in terms of ALD (5.7 ± 0.7 mm), AWT (0.86 ± 0.07 mm), and distensibility (23.5 ± 7.7%). CONCLUSIONS Subjects who inspire more deeply prior to imaging have larger ALD and smaller AWT. This effect is more pronounced in higher-generation airways. Therefore, adjustment of inspiration level is necessary to accurately assess airway dimensions. KEY POINTS Airway lumen diameter increases and wall thickness decreases with inspiration. The effect of inspiration is greater in higher-generation (more peripheral) airways. Airways of generation 5 and beyond are as distensible as lung parenchyma. Airway dimensions measured from CT should be adjusted for inspiration level.
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