CT Quantification of Emphysema in Young Subjects with No Recognizable Chest Disease

Irion, Klaus; Marchiori, Edson; Hochhegger, Bruno; Porto, Nelson da Silva; Moreira, José da Silva; Anselmi, Carlos Eduardo; Holemans, John A.; Irion, Paulo Oliveira

doi:10.2214/ajr.07.3502

Cited by 39 publications

(51 citation statements)

References 38 publications

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“…(3,5) Interestingly, the age-related changes are remarkably homogeneous, as opposed to the irregular distribution of airspace enlargement in emphysema. (5) The EI values observed in our cohort of patients were higher than were those reported in a study involving single-slice CT (22) and lower than were those reported in a study involving HRCT. (24) Factors that might have influenced the results include the reconstruction algorithm, radiation dose, collimation, CT scan manufacturer, and HU range selected for lung segmentation.…”

Section: Resultscontrasting

confidence: 61%

“…(18,20,21,27,28) The software used in the present study segments the lungs within a range of −1,024 HU to −400 HU, which results in a TLV that is lower than is that obtained with lung segmentation within a range of −1,024 HU to −250 HU. (22) Therefore, although lung volumes can be similar at densities below −950 HU, proportional differences among TLV values can be observed at higher densities.…”

Section: Resultsmentioning

confidence: 97%

“…(22)(23)(24)(25)(26) In addition, the EI has been shown to increase with age. (24,26) One group of authors (22) investigated this issue in a cohort of healthy individuals younger than 40 years of age, showing that EI values ≤ 0.35% should be considered normal for volumetric measurements performed with 10-mm collimation, 50 mAs, and a standard reconstruction algorithm; those authors found that the EI was not significantly influenced by age in that age group, a finding that is consistent with those of the present study. However, other studies, (24,26) particularly those involving older cohorts, have found significant evidence that EI increases with age, as observed in our older group.…”

Section: Resultsmentioning

confidence: 99%

“…(17) Reference EI values establishing normality are required in order to distinguish between patients with no emphysema and those with mild emphysema or early disease. In order to select a reference value for comparing the EI values in a given patient, we should take into consideration the radiation dose, (18,19) the slice thickness, (18) the reconstruction algorithm, (20) the type of scanner, (21) the HU range selected for lung segmentation (usually −1,024 HU to −400 HU or −1,024 HU to −250 HU), (19,22) and the HU threshold selected in order to distinguish between normal and emphysematous lung (usually −970 HU, −950 HU, or −910 HU). (11)(12)(13)22) Various HU thresholds have been proposed in order to distinguish between normal and abnormal lungs.…”

Section: Discussionmentioning

confidence: 99%

“…In order to select a reference value for comparing the EI values in a given patient, we should take into consideration the radiation dose, (18,19) the slice thickness, (18) the reconstruction algorithm, (20) the type of scanner, (21) the HU range selected for lung segmentation (usually −1,024 HU to −400 HU or −1,024 HU to −250 HU), (19,22) and the HU threshold selected in order to distinguish between normal and emphysematous lung (usually −970 HU, −950 HU, or −910 HU). (11)(12)(13)22) Various HU thresholds have been proposed in order to distinguish between normal and abnormal lungs. (10)(11)(12)(13) The initial suggestion was a threshold of −910 HU for axial scanners, with thicker collimation (i.e., 10 mm), and for examinations performed with the administration of intravenous contrast medium.…”

Section: Discussionmentioning

confidence: 99%

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Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

et al. 2012

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Objective: To investigate the effects of age on pulmonary emphysema, based on the values of the emphysema index (EI) in a cohort of patients who had never smoked and who had no recognizable lung disease. Methods: We reviewed the CT scans, reported as normal, of 315 patients. Exclusion criteria were a history of smoking, cardiorespiratory disease, and exposure to drugs that could cause lung disease. From this cohort, we selected 32 patients (16 men and 16 women), matched for gender and body mass index, who were divided equally into two groups by age (< 50 years and ≥ 50 years). We quantified emphysema using a computer program specific to that task. The EI was calculated with a threshold of −950 HU. We also evaluated total lung volume (TLV) and mean lung density (MLD). Results: The overall means for TLV, MLD, and EI were 5,027 mL, −827 HU, and 2.54%, respectively. Mean values in the older and younger groups, respectively, were as follows: for TLV, 5,229 mL vs. 4,824 mL (p > 0.05); for MLD, −846 HU vs. −813 HU (p < 0.04); and for EI, 3.30% vs. 1.28% (p < 0.001). Significant correlations were found between EI and age (r = 0.66; p = 0.001), EI and TLV (r = 0.58; p = 0.001), and EI and MLD (r = −0.67; p < 0.001). The predicted EI per age was defined by the regression equation (r 2 = 0.43): p50(EI) = 0.049 × age − 0.5353. Conclusions: It is important to consider the influence of age when quantifying emphysema in patients over 50 years of age. Based on the regression analysis, EI values of 2.6%, 3.5%, and 4.5% can be considered normal for patients 30, 50, and 70 years of age, respectively. Keywords: Pulmonary emphysema; Tomography, spiral computed; Aging; Pulmonary disease, chronic obstructive. ResumoObjetivo: Investigar os efeitos da idade no enfisema pulmonar, com base nos valores do índice de enfisema (IE) em uma coorte de pacientes que nunca fumou e que não possuía doença pulmonar conhecida. Métodos: Foram revisados exames de TC, considerados normais, de 315 pacientes. Tabagismo, doenças cardiorrespiratórias e exposição a drogas que poderiam causar doença pulmonar foram critérios de exclusão. Dessa coorte, selecionamos 32 pacientes (16 homens e 16 mulheres), igualmente divididos em dois grupos (idade < 50 anos e idade ≥ 50 anos), que foram pareados por gênero e índice de massa corpórea. Realizou-se a quantificação do enfisema utilizando um programa específico. O IE foi calculado com um limiar de −950 UH. O volume pulmonar total (VPT) e a densidade pulmonar média (DPM) também foram avaliados. Resultados: As médias gerais de VPT, DPM e IE foram 5.027 mL, −827 UH e 2,54%, respectivamente. A comparação entre os mais velhos e os mais novos mostrou as seguintes médias: VPT (5.229 mL vs. 4.824 mL; p > 0,05); DPM (−846 UH vs. −813 UH; p < 0,04) e IE (3,30% vs. 1,28%; p < 0,001). Houve correlações significativas entre IE e idade (r = 0,66; p = 0,001), IE e VPT (r = 0,58; p = 0,001) e IE e DPM (r = −0,67; p < 0,001). O IE previsto por idade foi definido através da equação de regressão (r 2 = 0,43): p50(IE) = 0,049 × i...

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Section: Resultscontrasting

confidence: 61%

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

et al. 2012

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Pulmonary function and emphysema in Williams–Beuren syndrome

Wan

Pober

Washko

et al. 2010

American J of Med Genetics Pt A

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Williams-Beuren Syndrome (WBS) is caused by a submicroscopic deletion on chromosome 7q11.23 that encompasses the entire elastin (ELN) gene. Elastin, a key component of elastic fibers within the lung, is progressively destroyed in emphysema. Defects in the elastin gene have been associated with increased susceptibility towards developing chronic obstructive pulmonary disease (COPD) and emphysema in both humans and mice. We postulate that hemizygosity at the elastin gene locus may increase susceptibility towards the development of COPD and emphysema in subjects with WBS. We describe an adult subject with WBS who was a lifelong non-smoker and was found to have moderate emphysema. We also examined the pulmonary function of a separate cohort of adolescents and young adults with WBS. Although no significant spirometric abnormalities were identified, a significant proportion of subjects reported respiratory symptoms. Thus while significant obstructive disease does not appear to be common in relatively young adults with WBS, subclinical emphysema and lung disease may exist which possibly could worsen with advancing age. Further investigation may elucidate the pathogenesis of non-smoking related emphysema.

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Normal spectrum of pulmonary parametric response map to differentiate lung collapsibility: distribution of densitometric classifications in healthy adult volunteers

et al. 2015

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CT Quantification of Emphysema in Young Subjects with No Recognizable Chest Disease

Cited by 39 publications

References 38 publications

Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

Pulmonary function and emphysema in Williams–Beuren syndrome

Normal spectrum of pulmonary parametric response map to differentiate lung collapsibility: distribution of densitometric classifications in healthy adult volunteers

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