COPD: Do Imaging Measurements of Emphysema and Airway Disease Explain Symptoms and Exercise Capacity?

Kirby, Miranda; Pike, Damien; Sin, Don D.; Coxson, Harvey O.; McCormack, David G.; Párraga, Grace

doi:10.1148/radiol.2015150037

Cited by 36 publications

(28 citation statements)

References 46 publications

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“…New methods and algorithms of lung imaging continue to be proposed to evaluate COPD, with the goal of delineating phenotypic characteristics associated with clinical outcomes (9)(10)(11) and disease progression (12,13). One strength of the recently introduced parametric response mapping (PRM) computed tomography (CT) analysis method is its ability to distinguish emphysematous from nonemphysematous gas trapping, with the latter termed functional small airways abnormality (PRM FSA ) (14)(15)(16)(17).…”

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confidence: 99%

Age and Small Airway Imaging Abnormalities in Subjects with and without Airflow Obstruction in SPIROMICS

Martínez

Díaz

Meldrum

et al. 2017

Am J Respir Crit Care Med

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Rationale: Aging is associated with reduced FEV 1 to FVC ratio (FEV 1 /FVC), hyperinflation, and alveolar enlargement, but little is known about how age affects small airways. Objectives: To determine if chest computed tomography (CT)assessed functional small airway would increase with age, even among asymptomatic individuals. Methods: We used parametric response mapping analysis of paired inspiratory/expiratory CTs to identify functional small airway abnormality (PRM FSA) and emphysema (PRM EMPH) in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) cohort. Using adjusted linear regression models, we analyzed associations between PRM FSA and age in subjects with or without airflow obstruction. We subdivided participants with normal spirometry based on respiratory-related impairment (6-minute-walk distance ,350 m, modified Medical Research Council >2, chronic bronchitis, St. George's Respiratory Questionnaire .25, respiratory events requiring treatment [antibiotics and/or steroids or hospitalization] in the year before enrollment). Measurements and Main Results: Among 580 never-and eversmokers without obstruction or respiratory impairment, PRM FSA increased 2.7% per decade, ranging from 3.6% (ages 40-50 yr) to 12.7% (ages 70-80 yr). PRM EMPH increased nonsignificantly (0.1% [ages 40-50 yr] to 0.4% [ages 70-80 yr]; P = 0.34). Associations were similar among nonobstructed individuals with respiratory-related impairment. Increasing PRM FSA in subjects without airflow obstruction was associated with increased FVC (P = 0.004) but unchanged FEV 1 (P = 0.94), yielding lower FEV 1 /FVC ratios (P , 0.001). Although emphysema was also significantly associated with lower FEV 1 /FVC (P = 0.04), its contribution relative to PRM FSA in those without airflow obstruction was limited by its low burden. Conclusions: In never-and ever-smokers without airflow obstruction, aging is associated with increased FVC and CT-defined functional small airway abnormality regardless of respiratory symptoms.

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mentioning

confidence: 99%

Age and Small Airway Imaging Abnormalities in Subjects with and without Airflow Obstruction in SPIROMICS

Martínez

Díaz

Meldrum

et al. 2017

Am J Respir Crit Care Med

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“…With the current interest in different phenotypes of COPD, many CT-biomarkers have been suggested, but are often difficult to interpret or replicate in a clinical setting [23,24]. For example, the expiratory to inspiratory mean lung density (E/I-ratio MLD ) can be used to capture air trapping on CT, but it is not able to distinguish between air trapping as a result from emphysema or air trapping as a result from small airway disease.…”

Section: Discussionmentioning

confidence: 99%

Parametric response mapping on chest computed tomography associates with clinical and functional parameters in chronic obstructive pulmonary disease

Pompe

Galbán

Ross

et al. 2017

Respiratory Medicine

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Background In the search for specific phenotypes of chronic obstructive pulmonary disease (COPD) computed tomography (CT) derived Parametric Response Mapping (PRM) has been introduced. This study evaluates the association between PRM and currently available biomarkers of disease severity in COPD. Methods Smokers with and without COPD were characterized based on questionnaires, pulmonary function tests, body plethysmography, and low-dose chest CT scanning. PRM was used to calculate the amount of emphysema (PRMEmph) and non-emphysematous air trapping (i.e. functional small airway disease, PRMfSAD). PRM was first compared with other biomarkers for emphysema (Perc15) and air trapping (E/I-ratioMLD). Consequently, linear regression models were utilized to study associations of PRM measurements with clinical parameters. Results 166 participants were included with a mean ± SD age of 50.5 ± 17.7 years. Both PRMEmph and PRMfSAD were more strongly correlated with lung function parameters as compared to Perc15 and E/I-ratioMLD. PRMEmph and PRMfSAD were higher in COPD participants than non-COPD participants (14.0% vs. 1.1%, and 31.6% vs. 8.2%, respectively, both p < 0.001) and increased with increasing GOLD stage (all p < 0.001). Multivariate analysis showed that PRMfSAD was mainly associated with total lung capacity (TLC) (β = −7.90, p < 0.001), alveolar volume (VA) (β = 7.79, p < 0.001), and residual volume (β = 6.78, p < 0.001), whilst PRMEmph was primarily associated with Kco (β = 8.95, p < 0.001), VA (β = −6.21, p < 0.001), and TLC (β = 6.20, p < 0.001). Conclusions PRM strongly associates with the presence and severity of COPD. PRM therefore appears to be a valuable tool in differentiating COPD phenotypes.

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“…3 Longitudinal worsening of MRI ventilation-defect-percent (VDP) was shown to be related to symptoms and exercise capacity in COPD patients in whom FEV 1 was not predictive. 4 The apparent diffusion coefficient (ADC) measured using 3 He and 129 Xe MRI has also been demonstrated in patients with AATD. 5 Although 3 He MRI ADC is highly reproducible, 6 these values only report from well-ventilated lung, which is important because as AATD emphysema worsens over time, no inhaled gas MRI information can be gleaned from unventilated lung regions.…”

Section: To the Editormentioning

confidence: 99%

Hyperpolarized ³He MRI ventilatory apparent diffusion coefficient of alpha‐1 antitrypsin deficiency

Westcott

Capaldi

Ouriadov

et al. 2018

Magnetic Resonance Imaging

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COPD: Do Imaging Measurements of Emphysema and Airway Disease Explain Symptoms and Exercise Capacity?

Abstract: In patients with mild-to-moderate COPD, MR imaging emphysema measurements played a dominant role in the expression of exercise limitation, while both CT and MR imaging measurements of emphysema explained symptoms.

Cited by 36 publications

References 46 publications

Age and Small Airway Imaging Abnormalities in Subjects with and without Airflow Obstruction in SPIROMICS

Age and Small Airway Imaging Abnormalities in Subjects with and without Airflow Obstruction in SPIROMICS

Parametric response mapping on chest computed tomography associates with clinical and functional parameters in chronic obstructive pulmonary disease

Hyperpolarized ³He MRI ventilatory apparent diffusion coefficient of alpha‐1 antitrypsin deficiency

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COPD: Do Imaging Measurements of Emphysema and Airway Disease Explain Symptoms and Exercise Capacity?

Abstract: In patients with mild-to-moderate COPD, MR imaging emphysema measurements played a dominant role in the expression of exercise limitation, while both CT and MR imaging measurements of emphysema explained symptoms.

Cited by 36 publications

References 46 publications

Age and Small Airway Imaging Abnormalities in Subjects with and without Airflow Obstruction in SPIROMICS

Age and Small Airway Imaging Abnormalities in Subjects with and without Airflow Obstruction in SPIROMICS

Parametric response mapping on chest computed tomography associates with clinical and functional parameters in chronic obstructive pulmonary disease

Hyperpolarized 3He MRI ventilatory apparent diffusion coefficient of alpha‐1 antitrypsin deficiency

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Hyperpolarized ³He MRI ventilatory apparent diffusion coefficient of alpha‐1 antitrypsin deficiency