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Elbehairy AF, Marshall H, Naish JH, Wild JM, Parraga G, Horsley A, Vestbo J. Advances in COPD imaging using CT and MRI: linkage with lung physiology and clinical outcomes. Eur Respir J 2024; 63:2301010. [PMID: 38548292 DOI: 10.1183/13993003.01010-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/16/2024] [Indexed: 05/04/2024]
Abstract
Recent years have witnessed major advances in lung imaging in patients with COPD. These include significant refinements in images obtained by computed tomography (CT) scans together with the introduction of new techniques and software that aim for obtaining the best image whilst using the lowest possible radiation dose. Magnetic resonance imaging (MRI) has also emerged as a useful radiation-free tool in assessing structural and more importantly functional derangements in patients with well-established COPD and smokers without COPD, even before the existence of overt changes in resting physiological lung function tests. Together, CT and MRI now allow objective quantification and assessment of structural changes within the airways, lung parenchyma and pulmonary vessels. Furthermore, CT and MRI can now provide objective assessments of regional lung ventilation and perfusion, and multinuclear MRI provides further insight into gas exchange; this can help in structured decisions regarding treatment plans. These advances in chest imaging techniques have brought new insights into our understanding of disease pathophysiology and characterising different disease phenotypes. The present review discusses, in detail, the advances in lung imaging in patients with COPD and how structural and functional imaging are linked with common resting physiological tests and important clinical outcomes.
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Affiliation(s)
- Amany F Elbehairy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Helen Marshall
- POLARIS, Imaging, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Josephine H Naish
- MCMR, Manchester University NHS Foundation Trust, Manchester, UK
- Bioxydyn Limited, Manchester, UK
| | - Jim M Wild
- POLARIS, Imaging, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for in silico Medicine, Sheffield, UK
| | - Grace Parraga
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Division of Respirology, Western University, London, ON, Canada
| | - Alexander Horsley
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Park J, Kim EK, Lee SH, Kim MA, Kim JH, Lee SM, Lee JS, Oh YM, Lee SD, Lee JH. Phenotyping COPD Patients with Emphysema Distribution Using Quantitative CT Measurement; More Severe Airway Involvement in Lower Dominant Emphysema. Int J Chron Obstruct Pulmon Dis 2022; 17:2013-2025. [PMID: 36072609 PMCID: PMC9441583 DOI: 10.2147/copd.s362906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jisoo Park
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eun-Kyung Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Se Hee Lee
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jung-Hyun Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
- Correspondence: Ji-Hyun Lee, Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea, Tel +82-31-780-5205, Fax +82-31-780-2992, Email
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3
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Kooner HK, McIntosh MJ, Desaigoudar V, Rayment JH, Eddy RL, Driehuys B, Parraga G. Pulmonary functional MRI: Detecting the structure-function pathologies that drive asthma symptoms and quality of life. Respirology 2022; 27:114-133. [PMID: 35008127 PMCID: PMC10025897 DOI: 10.1111/resp.14197] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/09/2021] [Accepted: 12/12/2021] [Indexed: 12/21/2022]
Abstract
Pulmonary functional MRI (PfMRI) using inhaled hyperpolarized, radiation-free gases (such as 3 He and 129 Xe) provides a way to directly visualize inhaled gas distribution and ventilation defects (or ventilation heterogeneity) in real time with high spatial (~mm3 ) resolution. Both gases enable quantitative measurement of terminal airway morphology, while 129 Xe uniquely enables imaging the transfer of inhaled gas across the alveolar-capillary tissue barrier to the red blood cells. In patients with asthma, PfMRI abnormalities have been shown to reflect airway smooth muscle dysfunction, airway inflammation and remodelling, luminal occlusions and airway pruning. The method is rapid (8-15 s), cost-effective (~$300/scan) and very well tolerated in patients, even in those who are very young or very ill, because unlike computed tomography (CT), positron emission tomography and single-photon emission CT, there is no ionizing radiation and the examination takes only a few seconds. However, PfMRI is not without limitations, which include the requirement of complex image analysis, specialized equipment and additional training and quality control. We provide an overview of the three main applications of hyperpolarized noble gas MRI in asthma research including: (1) inhaled gas distribution or ventilation imaging, (2) alveolar microstructure and finally (3) gas transfer into the alveolar-capillary tissue space and from the tissue barrier into red blood cells in the pulmonary microvasculature. We highlight the evidence that supports a deeper understanding of the mechanisms of asthma worsening over time and the pathologies responsible for symptoms and disease control. We conclude with a summary of approaches that have the potential for integration into clinical workflows and that may be used to guide personalized treatment planning.
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Affiliation(s)
- Harkiran K Kooner
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Marrissa J McIntosh
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Vedanth Desaigoudar
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jonathan H Rayment
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel L Eddy
- Centre of Heart Lung Innovation, Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Centre, Durham, North Carolina, USA
| | - Grace Parraga
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
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Abstract
Lung emphysema represents a major public health burden and still accounts for five percent of all deaths worldwide. Hence, it is essential to further understand this disease in order to develop effective diagnostic and therapeutic strategies. Lung emphysema is an irreversible enlargement of the airways distal to the terminal bronchi (i.e., the alveoli) due to the destruction of the alveolar walls. The two most important causes of emphysema are (I) smoking and (II) α1-antitrypsin-deficiency. In the former lung emphysema is predominant in the upper lung parts, the latter is characterized by a predominance in the basal areas of the lungs. Since quantification and evaluation of the distribution of lung emphysema is crucial in treatment planning, imaging plays a central role. Imaging modalities in lung emphysema are manifold: computed tomography (CT) imaging is nowadays the gold standard. However, emerging imaging techniques like dynamic or functional magnetic resonance imaging (MRI), scintigraphy and lately also the implementation of radiomics and artificial intelligence are more and more diffused in the evaluation, diagnosis and quantification of lung emphysema. The aim of this review is to shortly present the different subtypes of lung emphysema, to give an overview on prediction and risk assessment in emphysematous disease and to discuss not only the traditional, but also the new imaging techniques for diagnosis, quantification and evaluation of lung emphysema.
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Affiliation(s)
- Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Emerging Interventional Pulmonary Therapies for Chronic Obstructive Pulmonary Disease. J Thorac Imaging 2020; 34:248-257. [PMID: 31145187 DOI: 10.1097/rti.0000000000000424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic obstructive pulmonary disease is a condition characterized by progressive airflow limitation caused by airway and parenchymal inflammation. Current medical therapies, including bronchodilators, corticosteroids, and anti-inflammatory medications, have been shown to variably improve pulmonary function or quality of life without providing a long-term mortality benefit. Mortality benefits to therapy have been demonstrated in only 2 therapeutic interventions to date: long-term use of daily supplemental oxygen and surgical lung volume reduction (LVRS) for upper-lobe-predominant disease in patients with a low baseline exercise capacity. Newer bronchoscopic techniques for lung volume reduction (bLVR) have attracted interest from clinicians and researchers. To achieve successful results, these advanced therapies require an interdisciplinary approach between general and interventional pulmonologists and thoracic radiologists. In this article, we aim to review the latest interventional pulmonary techniques for treatment of chronic obstructive pulmonary disease with an emphasis on bLVR. We will review the bLVR preprocedure imaging evaluation, postprocedure imaging findings, and explore the potential benefits and risks of therapy based on the most recent clinical trial evidence.
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Muehlematter UJ, Caviezel C, Martini K, Messerli M, Vokinger KN, Wetzler IR, Tutic-Horn M, Weder W, Frauenfelder T. Applicability of color-coded computed tomography images in lung volume reduction surgery planning. J Thorac Dis 2019; 11:766-776. [PMID: 31019764 DOI: 10.21037/jtd.2019.02.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Adequate patient selection is the key to successful lung volume reduction in patients with pulmonary emphysema. Computed tomography (CT) enables a reliable detection of pulmonary emphysema and allows an accurate quantification of the severity. Our goal was to investigate the usefulness and reliability of color-coded (CC) CT images in classification of emphysema and preoperative lung volume reduction planning. Methods Fifty patients undergoing lung volume reduction surgery at our institution between September 2015 and February 2016 were retrospectively investigated. Three readers visually assessed the amount and distribution patterns of pulmonary emphysema on axial, multi-planar and CC CT images using the Goddard scoring system and a surgically oriented grading system (bilateral markedly heterogenous, bilateral intermediately heterogenous, bilateral homogenous and unilateral heterogenous emphysema). Observer dependency was investigated by using Fleiss' kappa (κ) and the intraclass correlation coefficient (ICC). Results were compared to quantitative results from densitometry measurements and lung perfusion scintigraphy by using Spearman correlation. Recommendations for lung volume reduction sites based on emphysema amount and distribution of all readers were compared to removal sites from the surgical reports. Results Inter-rater agreement for emphysema distribution rating was substantial for CC images (κ=0.70; 95% CI, 0.64-0.80) and significantly better compared to axial and multiplanar images (P≤0.001). The inter-rater agreement for recommended segment removal was moderate for CC images (κ=0.56; 95% CI, 0.49-0.63) and significantly better compared to axial and multiplanar images (P<0.001). Visual emphysema rating correlated significantly with measurements from densitometry and perfusion scintigraphy in the upper and lower lung zones in all image types. Conclusions CC CT images allow a precise, less observer-dependent evaluation of distribution of pulmonary emphysema and resection recommendation compared to axial and multiplanar CT images and might therefore be useful in lung volume resection surgery planning.
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Affiliation(s)
- Urs J Muehlematter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kerstin N Vokinger
- Academic Chair for Public Law, Health Law, Digitalization, and Health Policy, Law School, University of Zurich, Zurich, Switzerland
| | - Iris R Wetzler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michaela Tutic-Horn
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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7
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Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. One of the main findings is pulmonary emphysema in association with chronic bronchitis. Clinical signs, pulmonary function tests and imaging are the current used methods to diagnose and stage emphysema. Lung volume reduction (LVR) and endoscopic lung volume reduction (ELVR) are the current therapeutic options beside lung transplantation in cases of severe emphysema. Nowadays imaging is one of the key factors for the success of these therapies. Especially quantitative computed tomography (CT) with its increasing possibilities has become a viable tool, providing detailed information about distribution and heterogeneity of emphysema. Other imaging techniques like dual-energy CT (DECT) and functional magnetic resonance (MR) have shown to add functional information. These structural and functional information support thoracic surgeons and interventional pulmonologists in selecting patients and optimizing LVR procedures but also enables the development of new endobronchial therapies. Imaging will further improve the individual outcome by supporting the choice of optimal therapy.
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Affiliation(s)
- Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Bahig H, Campeau MP, Lapointe A, Bedwani S, Roberge D, de Guise J, Blais D, Vu T, Lambert L, Chartrand-Lefebvre C, Lord M, Filion E. Phase 1-2 Study of Dual-Energy Computed Tomography for Assessment of Pulmonary Function in Radiation Therapy Planning. Int J Radiat Oncol Biol Phys 2017; 99:334-343. [DOI: 10.1016/j.ijrobp.2017.05.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/24/2017] [Accepted: 05/30/2017] [Indexed: 12/25/2022]
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9
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Messerli M, Ottilinger T, Warschkow R, Leschka S, Alkadhi H, Wildermuth S, Bauer RW. Emphysema quantification and lung volumetry in chest X-ray equivalent ultralow dose CT - Intra-individual comparison with standard dose CT. Eur J Radiol 2017. [PMID: 28629554 DOI: 10.1016/j.ejrad.2017.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine whether ultralow dose chest CT with tin filtration can be used for emphysema quantification and lung volumetry and to assess differences in emphysema measurements and lung volume between standard dose and ultralow dose CT scans using advanced modeled iterative reconstruction (ADMIRE). METHODS 84 consecutive patients from a prospective, IRB-approved single-center study were included and underwent clinically indicated standard dose chest CT (1.7±0.6mSv) and additional single-energy ultralow dose CT (0.14±0.01mSv) at 100kV and fixed tube current at 70mAs with tin filtration in the same session. Forty of the 84 patients (48%) had no emphysema, 44 (52%) had emphysema. One radiologist performed fully automated software-based pulmonary emphysema quantification and lung volumetry of standard and ultralow dose CT with different levels of ADMIRE. Friedman test and Wilcoxon rank sum test were used for multiple comparison of emphysema and lung volume. Lung volumes were compared using the concordance correlation coefficient. RESULTS The median low-attenuation areas (LAA) using filtered back projection (FBP) in standard dose was 4.4% and decreased to 2.6%, 2.1% and 1.8% using ADMIRE 3, 4, and 5, respectively. The median values of LAA in ultralow dose CT were 5.7%, 4.1% and 2.4% for ADMIRE 3, 4, and 5, respectively. There was no statistically significant difference between LAA in standard dose CT using FBP and ultralow dose using ADMIRE 4 (p=0.358) as well as in standard dose CT using ADMIRE 3 and ultralow dose using ADMIRE 5 (p=0.966). In comparison with standard dose FBP the concordance correlation coefficients of lung volumetry were 1.000, 0.999, and 0.999 for ADMIRE 3, 4, and 5 in standard dose, and 0.972 for ADMIRE 3, 4 and 5 in ultralow dose CT. CONCLUSIONS Ultralow dose CT at chest X-ray equivalent dose levels allows for lung volumetry as well as detection and quantification of emphysema. However, longitudinal emphysema analyses should be performed with the same scan protocol and reconstruction algorithms for reproducibility.
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Affiliation(s)
- Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University Zurich, Switzerland; Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland.
| | - Thorsten Ottilinger
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland
| | - René Warschkow
- Department of Surgery, Cantonal Hospital St. Gallen, Switzerland
| | - Sebastian Leschka
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Switzerland
| | - Simon Wildermuth
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland
| | - Ralf W Bauer
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland
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10
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De Wolf J, Bonnette P, Sage É, Hamid A. [What place for lung volume reduction surgery for emphysema?]. Rev Mal Respir 2016; 34:147-154. [PMID: 27444695 DOI: 10.1016/j.rmr.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022]
Abstract
Lung volume reduction surgery (LVRS) has been part of the management for the treatment of selected emphysematous patients for two decades. In a large randomized American trial (NETT), lung volume reduction surgery was shown to improve overall survival at 5 years as well as exercise capacity and health-related quality of life, especially in cases of upper-lobe-predominant emphysema and low exercise capacity. Inclusion criteria were pretreatment FEV1≤45 %, TLC≥100 %, RV≥150 %, room air resting PaCO2≤60mmHg and PaO2≥45mmHg. Patients with FEV1≤20 % and either a DLCO<20 % or homogeneous emphysema were at increased risk of mortality following LVRS and should not be considered for this procedure. Despite this evidence base, lung volume reduction surgery is performed infrequently, competing with lung transplantation and new endoscopic volume reduction techniques.
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Affiliation(s)
- J De Wolf
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital Foch, 92150 Suresnes, France
| | - P Bonnette
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital Foch, 92150 Suresnes, France.
| | - É Sage
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital Foch, 92150 Suresnes, France
| | - A Hamid
- Service de pneumologie, hôpital Foch, 92150 Suresnes, France
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Influence of Sinogram-Affirmed Iterative Reconstruction on Computed Tomography–Based Lung Volumetry and Quantification of Pulmonary Emphysema. J Comput Assist Tomogr 2016; 40:96-101. [DOI: 10.1097/rct.0000000000000313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Velroyen A, Yaroshenko A, Hahn D, Fehringer A, Tapfer A, Müller M, Noël PB, Pauwels B, Sasov A, Yildirim AÖ, Eickelberg O, Hellbach K, Auweter SD, Meinel FG, Reiser MF, Bech M, Pfeiffer F. Grating-based X-ray Dark-field Computed Tomography of Living Mice. EBioMedicine 2015; 2:1500-6. [PMID: 26629545 PMCID: PMC4634200 DOI: 10.1016/j.ebiom.2015.08.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 02/01/2023] Open
Abstract
Changes in x-ray attenuating tissue caused by lung disorders like emphysema or fibrosis are subtle and thus only resolved by high-resolution computed tomography (CT). The structural reorganization, however, is of strong influence for lung function. Dark-field CT (DFCT), based on small-angle scattering of x-rays, reveals such structural changes even at resolutions coarser than the pulmonary network and thus provides access to their anatomical distribution. In this proof-of-concept study we present x-ray in vivo DFCTs of lungs of a healthy, an emphysematous and a fibrotic mouse. The tomographies show excellent depiction of the distribution of structural – and thus indirectly functional – changes in lung parenchyma, on single-modality slices in dark field as well as on multimodal fusion images. Therefore, we anticipate numerous applications of DFCT in diagnostic lung imaging. We introduce a scatter-based Hounsfield Unit (sHU) scale to facilitate comparability of scans. In this newly defined sHU scale, the pathophysiological changes by emphysema and fibrosis cause a shift towards lower numbers, compared to healthy lung tissue. We present so far unreported x-ray scatter dark-field CT scans of living mice performed with a Talbot–Lau interferometer. Dark field gives access to structural information not provided by attenuation CT at scales below the detector pixel size. Changes of lung alveoli structure are clearly visualized by dark-field CT for emphysema and fibrosis.
Lung diseases pose one of the leading causes of death worldwide. They are often difficult to diagnose at an early stage due to low sensitivity of conventional medical imaging systems towards structural changes of the lung tissue. With dark-field imaging based on scattering of x-rays such structural changes can be visualized even at imaging system resolutions coarser than the lung alveoli, as opposed to conventional x-ray imaging based on attenuation. By overcoming experimental scan time and dose issues, we report the first dark-field computed tomography scans on living mice, demonstrating excellent depiction of the anatomical distribution of pathological lung changes.
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Affiliation(s)
- A Velroyen
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - A Yaroshenko
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - D Hahn
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - A Fehringer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - A Tapfer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - M Müller
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - P B Noël
- Department of Radiology, Technische Universität München, Munich, Germany
| | | | - A Sasov
- Bruker microCT, Kontich, Belgium
| | - A Ö Yildirim
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum München and Ludwig-Maximilians-University Hospital Munich, Munich, Germany ; German Center for Lung Research (DZL), Germany
| | - O Eickelberg
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum München and Ludwig-Maximilians-University Hospital Munich, Munich, Germany ; German Center for Lung Research (DZL), Germany
| | - K Hellbach
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - S D Auweter
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - F G Meinel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - M F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany ; German Center for Lung Research (DZL), Germany
| | - M Bech
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany ; Medical Radiation Physics, Lund University, Lund, Sweden
| | - F Pfeiffer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
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13
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Abstract
OBJECTIVES The purpose of this study was to assess whether the recently developed method of grating-based x-ray dark-field radiography can improve the diagnosis of pulmonary emphysema in vivo. MATERIALS AND METHODS Pulmonary emphysema was induced in female C57BL/6N mice using endotracheal instillation of porcine pancreatic elastase and confirmed by in vivo pulmonary function tests, histopathology, and quantitative morphometry. The mice were anesthetized but breathing freely during imaging. Experiments were performed using a prototype small-animal x-ray dark-field scanner that was operated at 35 kilovolt (peak) with an exposure time of 5 seconds for each of the 10 grating steps. Images were compared visually. For quantitative comparison of signal characteristics, regions of interest were placed in the upper, middle, and lower zones of each lung. Receiver-operating-characteristic statistics were performed to compare the effectiveness of transmission and dark-field signal intensities and the combined parameter "normalized scatter" to differentiate between healthy and emphysematous lungs. RESULTS A clear visual difference between healthy and emphysematous mice was found for the dark-field images. Quantitative measurements of x-ray dark-field signal and normalized scatter were significantly different between the mice with pulmonary emphysema and the control mice and showed good agreement with pulmonary function tests and quantitative histology. The normalized scatter showed a significantly higher discriminatory power (area under the receiver-operating-characteristic curve [AUC], 0.99) than dark-field (AUC, 0.90; P = 0.01) or transmission signal (AUC, 0.69; P < 0.001) alone did, allowing for an excellent discrimination of healthy and emphysematous lung regions. CONCLUSIONS In a murine model, x-ray dark-field radiography is technically feasible in vivo and represents a substantial improvement over conventional transmission-based x-ray imaging for the diagnosis of pulmonary emphysema.
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The evolving role of MDCT in the assessment of patients with chronic obstructive pulmonary disease. Clin Radiol 2015; 70:752-9. [PMID: 25861874 DOI: 10.1016/j.crad.2015.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/05/2015] [Accepted: 02/20/2015] [Indexed: 12/21/2022]
Abstract
The purpose of this article is to educate the reader in the value a radiologist can offer in the multidetector (MD) CT assessment of patients with chronic obstructive pulmonary disease (COPD). MDCT can identify patients in whom treatments such as lung volume reduction surgery or newer endobronchial therapies may be of benefit. We will also discuss important and under-recognised associated cardiorespiratory disease, which may be incidentally identified.
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Improved prediction of lobar perfusion contribution using technetium-99m-labeled macroaggregate of albumin single photon emission computed tomography/computed tomography with attenuation correction. J Thorac Cardiovasc Surg 2014; 148:2345-52. [PMID: 24882061 DOI: 10.1016/j.jtcvs.2014.04.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/03/2014] [Accepted: 04/16/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Lung cancer resection can require removal of an entire lobe and, at times, bilobectomy or pneumonectomy. Many patients will also have significantly compromised lung function that requires limiting the extent of surgery or could preclude surgery altogether. The preoperative assessment should include predicted postoperative forced expiratory volume in 1 second (ppoFEV1), because a ppoFEV1 of <40% predicts significantly increased perioperative morbidity. The ppoFEV1 can be estimated by multiplying the preoperative FEV1 by the residual perfused territory percentage, as predicted on planar perfusion scintigraphy (PPS). However, ppoFEV1 using PPS has shown variable correlation with spirometry-measured postoperative FEV1. METHODS We propose an improved method for assessing regional lung perfusion in preoperative lung surgery patients. Patients undergo single photon emission computed tomography/computed tomography (SPECT/CT) imaging with attenuation correction using the conventional perfusion agent, technetium-99m-labeled macroaggregate of albumin. The CT image provides information for manual segmentation of each lobe. These segmentations are applied to the SPECT images to determine lobar perfusion. This proposed method was compared with PPS. RESULTS This technique was evaluated in 17 patients. As expected, the perfusion contributions of the right and left lungs, calculated from SPECT/CT, correlated closely with those obtained from PPS (Pearson r=0.995). However, the lobar perfusion contributions obtained by PPS and SPECT/CT were significantly different, by 2 methods of comparison (Hotelling's P=1.7×10(-6) and P=1.7×10(-4)). CONCLUSIONS This new SPECT/CT technique provides an anatomically more accurate assessment of lobar perfusion. This technique can refine which patients should be operative candidates and allow better prediction of postoperative function in contrast to the anatomically inaccurate planar scintigraphic predictions, which often underestimate the postoperative FEV1. This new technique is expected to have a significant effect on the resectability of patients with lung cancer.
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Meinel FG, Schwab F, Schleede S, Bech M, Herzen J, Achterhold K, Auweter S, Bamberg F, Yildirim AÖ, Bohla A, Eickelberg O, Loewen R, Gifford M, Ruth R, Reiser MF, Pfeiffer F, Nikolaou K. Diagnosing and mapping pulmonary emphysema on X-ray projection images: incremental value of grating-based X-ray dark-field imaging. PLoS One 2013; 8:e59526. [PMID: 23555692 PMCID: PMC3608711 DOI: 10.1371/journal.pone.0059526] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 02/15/2013] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To assess whether grating-based X-ray dark-field imaging can increase the sensitivity of X-ray projection images in the diagnosis of pulmonary emphysema and allow for a more accurate assessment of emphysema distribution. MATERIALS AND METHODS Lungs from three mice with pulmonary emphysema and three healthy mice were imaged ex vivo using a laser-driven compact synchrotron X-ray source. Median signal intensities of transmission (T), dark-field (V) and a combined parameter (normalized scatter) were compared between emphysema and control group. To determine the diagnostic value of each parameter in differentiating between healthy and emphysematous lung tissue, a receiver-operating-characteristic (ROC) curve analysis was performed both on a per-pixel and a per-individual basis. Parametric maps of emphysema distribution were generated using transmission, dark-field and normalized scatter signal and correlated with histopathology. RESULTS Transmission values relative to water were higher for emphysematous lungs than for control lungs (1.11 vs. 1.06, p<0.001). There was no difference in median dark-field signal intensities between both groups (0.66 vs. 0.66). Median normalized scatter was significantly lower in the emphysematous lungs compared to controls (4.9 vs. 10.8, p<0.001), and was the best parameter for differentiation of healthy vs. emphysematous lung tissue. In a per-pixel analysis, the area under the ROC curve (AUC) for the normalized scatter value was significantly higher than for transmission (0.86 vs. 0.78, p<0.001) and dark-field value (0.86 vs. 0.52, p<0.001) alone. Normalized scatter showed very high sensitivity for a wide range of specificity values (94% sensitivity at 75% specificity). Using the normalized scatter signal to display the regional distribution of emphysema provides color-coded parametric maps, which show the best correlation with histopathology. CONCLUSION In a murine model, the complementary information provided by X-ray transmission and dark-field images adds incremental diagnostic value in detecting pulmonary emphysema and visualizing its regional distribution as compared to conventional X-ray projections.
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Affiliation(s)
- Felix G Meinel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
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Oxygen-enhanced MRI, thin-section MDCT, and perfusion SPECT/CT: comparison of clinical implications to patient care for lung volume reduction surgery. AJR Am J Roentgenol 2012; 199:794-802. [PMID: 22997370 DOI: 10.2214/ajr.11.8250] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to prospectively and directly compare capability of O2-enhanced MRI, MDCT, and perfusion SPECT/CT to clinical outcome measurements in candidates for lung volume reduction surgery (LVRS). SUBJECTS AND METHODS Twenty-five consecutive candidates for LVRS (20 men and five women; age range, 45-76 years) underwent MDCT, O2-enhanced MRI, and perfusion SPECT/CT before and after LVRS. Clinical outcomes for each candidate were evaluated in terms of differences between pre- and postoperative percentage forced expiratory volume in 1 second (%FEV1), Pao2, and 6-minute walking distance. Quantitatively assessed upper/lower lung ratios on O2-enhanced MRI, MDCT, and SPECT/CT were calculated from regional relative enhancement ratios, functional lung volumes, and radioisotope uptakes between upper and lower lungs. Qualitatively assessed upper/lower lung ratios on O2-enhanced MRI, MDCT, and SPECT/CT were estimated using visual scoring systems. To evaluate the correlation for individual upper/lower lung ratios and clinical outcomes, all upper/lower lung ratios were correlated with clinical outcomes. Improvements in mean relative enhancement ratio were directly correlated with clinical outcomes to assess the capability of O2-enhanced MRI to assess therapeutic effect. RESULTS All quantitatively (-0.63≤r≤-0.47, p<0.05) and qualitatively (0.41≤r≤0.57, p<0.05) assessed upper/lower lung ratios showed moderate and statistically significant correlation with clinical outcomes, and improvement in mean relative enhancement ratio showed moderate or good correlation, both statistically significant (-0.44≤r≤0.71, p<0.05). CONCLUSION O2-enhanced MRI shows potential for more accurate evaluation of postoperative clinical outcome for LVRS candidates than SPECT/CT and can be considered at least as reliable as MDCT.
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Tanabe N, Muro S, Tanaka S, Sato S, Oguma T, Kiyokawa H, Takahashi T, Kinose D, Hoshino Y, Kubo T, Ogawa E, Hirai T, Mishima M. Emphysema distribution and annual changes in pulmonary function in male patients with chronic obstructive pulmonary disease. Respir Res 2012; 13:31. [PMID: 22512922 PMCID: PMC3478996 DOI: 10.1186/1465-9921-13-31] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The progression of chronic obstructive pulmonary disease (COPD) considerably varies among patients. Those with emphysema identified by quantitative computed tomography (CT) are associated with the rapid progression assessed by forced expiratory volume in one second (FEV1). However, whether the rate of the decline in lung function is independently affected by the regional distribution or the severity of emphysema in the whole lung is unclear. METHODS We followed up 131 male patients with COPD for a median of 3.7 years. We measured wall area percent (WA%) in right apical segmental bronchus, total lung volume, percent low attenuation volume (LAV%), and the standard deviation (SD) of LAV% values from CT images of 10 isovolumetric partitions (SD-LAV) as an index of cranial-caudal emphysema heterogeneity. Annual changes in FEV1 were then determined using a random coefficient model and relative contribution of baseline clinical parameters, pulmonary function, and CT indexes including LAV%, SD-LAV, and WA% to annual changes in FEV1 were examined. RESULTS The mean (SD) annual change in FEV1 was -44.4 (10.8) mL. Multivariate random coefficient model showed that higher baseline FEV1, higher LAV%, current smoking, and lower SD-LAV independently contributed to an excessive decline in FEV1, whereas ratio of residual volume to total lung capacity, ratio of diffusing capacity to alveolar ventilation, and WA% did not, after adjusting for age, height, weight, and ratio of CT-measured total lung volume to physiologically-measured total lung capacity. CONCLUSIONS A more homogeneous distribution of emphysema contributed to an accelerated decline in FEV1 independently of baseline pulmonary function, whole-lung emphysema severity, and smoking status. In addition to whole-lung analysis of emphysema, CT assessment of the cranial-caudal distribution of emphysema might be useful for predicting rapid, progressive disease and for developing a targeted strategy with which to prevent disease progression.
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Affiliation(s)
- Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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Le Pimpec-Barthes F, Das Neves-Pereira JC, Cazes A, Arame A, Grima R, Hubsch JP, Zukerman C, Hernigou A, Badia A, Bagan P, Delclaux C, Dusser D, Riquet M. [Lung volume reduction surgery for emphysema and bullous pulmonary emphysema]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:131-145. [PMID: 22361067 DOI: 10.1016/j.pneumo.2012.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 05/31/2023]
Abstract
The improvement of respiratory symptoms for emphysematous patients by surgery is a concept that has evolved over time. Initially used for giant bullae, this surgery was then applied to patients with diffuse microbullous emphysema. The physiological and pathological concepts underlying these surgical procedures are the same in both cases: improve respiratory performance by reducing the high intrapleural pressure. The functional benefit of lung volume reduction surgery (LVRS) in the severe diffuse emphysema has been validated by the National Emphysema Treatment Trial (NETT) and the later studies which allowed to identify prognostic factors. The quality of the clinical, morphological and functional data made it possible to develop recommendations now widely used in current practice. Surgery for giant bullae occurring on little or moderately emphysematous lung is often a simpler approach but also requires specialised support to optimize its results.
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Affiliation(s)
- F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, AP-HP, université Paris V-René Descartes, 20 rue Leblanc, Paris cedex 15, France.
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Amdo T, Godoy MCB, Ost D, Naidich DP. Imaging-bronchoscopic correlations for interventional pulmonology. Thorac Surg Clin 2010; 20:103-19. [PMID: 20378063 DOI: 10.1016/j.thorsurg.2009.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The improvements to patient care that can be achieved by combining advanced imaging techniques and bronchoscopy are considerable. In this regard, CT imaging often plays an indispensable role in both the selection of appropriate candidates tor therapy as well as the choice of optimal interventional techniques. However, it is apparent that alternate methods for evaluating the airways and lung including ultrasound and electromagnetic navigation will likely play an increasingly important diagnostic role, necessitating a thorough understanding of their advantages and limitations. Disease-specific applications for which imaging technologies, including CT and VB, are either currently routinely used or show the greatest promise are for suspected or diagnosed lung cancers, central and peripheral, and emphysema. It may be anticipated that with growing experience, the potential for additional indications of these remarkable technologies are likely to increase in the near future.
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Affiliation(s)
- Tshering Amdo
- Division of Pulmonary and Critical Care Medicine, New York University-Langone Medical Center, Tisch Hospital, 560 First Avenue, New York, NY 10016, USA
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Chandra D, Lipson DA, Hoffman EA, Hansen-Flaschen J, Sciurba FC, Decamp MM, Reilly JJ, Washko GR. Perfusion scintigraphy and patient selection for lung volume reduction surgery. Am J Respir Crit Care Med 2010; 182:937-46. [PMID: 20538961 DOI: 10.1164/rccm.201001-0043oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE It is unclear if lung perfusion can predict response to lung volume reduction surgery (LVRS). OBJECTIVES To study the role of perfusion scintigraphy in patient selection for LVRS. METHODS We performed an intention-to-treat analysis of 1,045 of 1,218 patients enrolled in the National Emphysema Treatment Trial who were non-high risk for LVRS and had complete perfusion scintigraphy results at baseline. The median follow-up was 6.0 years. Patients were classified as having upper or non-upper lobe-predominant emphysema on visual examination of the chest computed tomography and high or low exercise capacity on cardiopulmonary exercise testing at baseline. Low upper zone perfusion was defined as less than 20% of total lung perfusion distributed to the upper third of both lungs as measured on perfusion scintigraphy. MEASUREMENTS AND MAIN RESULTS Among 284 of 1,045 patients with upper lobe-predominant emphysema and low exercise capacity at baseline, the 202 with low upper zone perfusion had lower mortality with LVRS versus medical management (risk ratio [RR], 0.56; P = 0.008) unlike the remaining 82 with high perfusion where mortality was unchanged (RR, 0.97; P = 0.62). Similarly, among 404 of 1,045 patients with upper lobe-predominant emphysema and high exercise capacity, the 278 with low upper zone perfusion had lower mortality with LVRS (RR, 0.70; P = 0.02) unlike the remaining 126 with high perfusion (RR, 1.05; P = 1.00). Among the 357 patients with non-upper lobe-predominant emphysema (75 with low and 282 with high exercise capacity) there was no improvement in survival with LVRS and measurement of upper zone perfusion did not contribute new prognostic information. CONCLUSIONS Compared with optimal medical management, LVRS reduces mortality in patients with upper lobe-predominant emphysema when there is low rather than high perfusion to the upper lung.
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Affiliation(s)
- Divay Chandra
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Co-registered perfusion SPECT/CT: Utility for prediction of improved postoperative outcome in lung volume reduction surgery candidates. Eur J Radiol 2010; 74:465-72. [DOI: 10.1016/j.ejrad.2009.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Accepted: 03/05/2009] [Indexed: 11/23/2022]
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Abstract
Chronic obstructive pulmonary disease is a preventable and treatable disease characterized by progressive and debilitating limitations of airflow. Despite aggressive medical therapy, many patients with advanced emphysema continue to decline and exhibit disabling symptoms. Lung volume reduction surgery and lung transplantation can offer improved quality of life, enhanced exercise tolerance, and improvement in mortality rates in selected patients with advanced disease. In addition, newer bronchoscopic techniques to reduce lung volume in patients with emphysema are under development in an effort to duplicate the results of lung volume reduction surgery without significant morbidity. This article discusses the results of a variety of surgical and bronchoscopic interventions, with an emphasis upon the role of imaging.
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Remy-Jardin M, Faivre JB, Pontana F, Hachulla AL, Tacelli N, Santangelo T, Remy J. Thoracic Applications of Dual Energy. Radiol Clin North Am 2010; 48:193-205. [DOI: 10.1016/j.rcl.2009.08.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Felix JHDS, Cortez PC, Costa RCS, Fortaleza SCB, Pereira EDB, Holanda MA. Avaliação computacional de enfisema pulmonar em TC: comparação entre um sistema desenvolvido localmente e um sistema de uso livre. J Bras Pneumol 2009; 35:868-76. [DOI: 10.1590/s1806-37132009000900008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 04/22/2009] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Apresentar um sistema de visão computacional em imagens de TCAR, desenvolvido localmente e denominado SIStema para a Detecção e a quantificação de Enfisema Pulmonar (SISDEP). Comparar esse sistema a um sistema computacional de acesso livre. MÉTODOS: Foram utilizadas 33 imagens de TCAR de 11 pacientes com DPOC com cortes tomográficos em ápice, hilo e base. O SISDEP foi comparado a Osiris Medical Imaging Software Program quanto à segmentação do parênquima pulmonar; precisão das medidas da área de secção transversal dos pulmões em mm², densidade pulmonar média (DPM), porcentagem da relative area (RA, área relativa) dos voxels com densidade < -950 unidades hounsfield (ra -950), valores de 15º percentil de baixa atenuação (perc15) e visualização das áreas hiperaeradas por máscara colorida. RESULTADOS: Os dois sistemas realizaram uma segmentação pulmonar eficiente; porém o SISDEP o fez de modo automático e mais rápido. Na comparação das medidas de área de secção dos pulmões, DPM, Perc15 e RA -950, houve alta correlação (r² = 0,99; 0,99; 0,99; e 1,00, respectivamente) entre os dois sistemas. A ferramenta de máscara colorida do SISDEP permitiu excelente visualização das áreas hiperaeradas, discriminado-as das áreas normais. CONCLUSÕES: O SISDEP se mostrou eficiente na segmentação dos pulmões e na extração de dados quantitativos da aeração pulmonar com excelente correlação com o sistema Osiris. O SISDEP constitui uma promissora ferramenta computacional para a avaliação diagnóstica e o acompanhamento da evolução do enfisema em imagens de TCAR de pacientes com DPOC.
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Pansini V, Remy-Jardin M, Faivre JB, Schmidt B, Dejardin-Bothelo A, Perez T, Delannoy V, Duhamel A, Remy J. Assessment of lobar perfusion in smokers according to the presence and severity of emphysema: preliminary experience with dual-energy CT angiography. Eur Radiol 2009; 19:2834-43. [DOI: 10.1007/s00330-009-1475-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 04/02/2009] [Accepted: 04/26/2009] [Indexed: 11/28/2022]
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Amdo T, Godoy MCB, Ost D, Naidich DP. Imaging-bronchoscopic correlations for interventional pulmonology. Radiol Clin North Am 2009; 47:271-87. [PMID: 19249456 DOI: 10.1016/j.rcl.2008.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The development and rapid advancement of both bronchoscopic, CT and ultrasound imaging technology has had considerable impact on the management of a wide variety of pulmonary diseases. The synergy between these newer imaging modalities and advanced interventional endoscopic procedures has led to a revolution in diagnostic and therapeutic options in patients with both central and peripheral airway disease. Given the broad clinical implications of these technological advances, only the most important areas of interventional pulmonology in which imaging has had a major impact will be selectively reviewed to highlight fundamental principles.
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Affiliation(s)
- Tshering Amdo
- Division of Pulmonary and Critical Care Medicine, New York University-Langone Medical Center, Tisch Hospital, 560 First Avenue, New York, NY 10016, USA
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Choong CK, Mahesh B, Patterson GA, Cooper JD. Concomitant Lung Cancer Resection and Lung Volume Reduction Surgery. Thorac Surg Clin 2009; 19:209-16. [DOI: 10.1016/j.thorsurg.2009.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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