Distinct Quantitative Computed Tomography Emphysema Patterns Are Associated with Physiology and Function in Smokers

Castaldi, Peter J.; Estépar, Raúl San Jośe; Mendoza, Carlos S.; Hersh, Craig P.; Laird, Nan M.; Crapo, James D.; Lynch, David A.; Silverman, Edwin K.; Washko, George R.

doi:10.1164/rccm.201305-0873oc

Cited by 123 publications

(131 citation statements)

References 43 publications

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“…Castaldi, et al, used a local histogram-based technique to characterize and quantify distinct patterns of low attenuation in 9,313 smokers in the COPDGene® Study. 60 They found that these patterns were more predictive than thresholdbased emphysema measurement for lung function, dyspnea, quality of life, and health care use, and were strongly associated with pulmonary functional impairment even after adjustment for %LAA -950 . …”

Section: Advanced Computerized Analysis Methodsmentioning

confidence: 98%

Progress in Imaging COPD, 2004 - 2014

Lynch¹

2014

J COPD F

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Abbreviations: computed tomography, CT; magnetic resonance imaging, MRI; positron emission tomography, PET; Global Initiative for chronic Obstructive Lung Disease, GOLD; quantitative CT, QCT; Hounsfield Units, HU; percentage of low attenuation area, %LAA; relative area of lung less than -950 HU, RA950; Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints, ECLIPSE; forced expiratory volume in 1 second, FEV1; forced vital capacity, FVC. Journal of the COPD Foundation(GOLD) stage may have substantial, little, or no emphysema. Discrete subphenotypes of COPD include emphysema of varying morphologic appearance, large airway abnormality and small airway obstruction. Increasing awareness of the heterogeneity of COPD has led to increased use of CT to characterize COPD for purposes of genetic evaluation and identification of specific subgroups which may be amenable to therapeutic trials. 1-3 While visual assessment is important in determining the presence and character of emphysema, the last decade has been characterized by increasing use of quantitative imaging to provide precise estimates of the severity and distribution of emphysema, gas trapping and airway wall thickening. Several large cohorts of cigarette smokers have now been quite extensively characterized by CT, resulting in increased knowledge of the clinical correlates of quantitative CT parameters. [4][5][6] The purpose of this paper is to present the substantial contribution that imaging has made to our understanding of COPD over the past 10 years. AbstractComputed tomography (CT) has contributed substantially to our understanding of COPD over the past decade. Visual and quantitative assessments of CT in COPD are complementary. Visual assessment should provide assessment of centrilobular, panlobular and paraseptal emphysema, airway wall thickening, bronchiectasis, findings of respiratory bronchiolitis, and enlargement of the pulmonary artery. Quantitative CT permits evaluation of severity of emphysema, airway wall thickening, and expiratory air trapping, and is now being used for longitudinal evaluation of the progression of COPD. Innovative techniques are being developed to use CT to characterize the pattern of emphysema and smoking-related respiratory bronchiolitis. Magnetic resonance imaging (MRI) and positron emission tomography PET-CT are useful research tools in the evaluation of COPD.

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Section: Advanced Computerized Analysis Methodsmentioning

confidence: 98%

Progress in Imaging COPD, 2004 - 2014

Lynch¹

2014

J COPD F

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“…Additional quantitative CT analysis included classification of emphysema pattern based on local histogram information; the method for generating local histogram-based quantitative emphysema patterns in the COPDGene Study has been previously defined (30,31). On the basis of a set of expert-defined training images, an algorithm was developed to classify each lung region into one of six categories according to emphysema pattern: normal; mild, moderate, or severe centrilobular emphysema; panlobular emphysema; or pleural-based emphysema.…”

Section: Chest Ct Imagingmentioning

confidence: 99%

“…Castaldi and colleagues reported that local histogram measures of emphysema (including centrilobular, panlobular, and pleural-based emphysema patterns) provide novel information relating to respiratory symptoms, complications, and physiology in participants with COPD (31). Given the CT and surgical studies reporting an excess of subpleural blebs and bullae in participants suffering a pneumothorax, we sought a tool for an automated and quantified evaluation of subpleural lung abnormalities.…”

Section: Original Researchmentioning

confidence: 99%

Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

Hobbs¹,

Bowler²,

Jacobson³

et al. 2014

Annals ATS

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Rationale: The demographic, physiological, and computed tomography (CT) features associated with pneumothorax in smokers with and without chronic obstructive pulmonary disease (COPD) are not clearly defined.Objectives: We evaluated the hypothesis that pneumothorax in smokers is associated with male sex, tall and thin stature, airflow obstruction, and increased total and subpleural emphysema. Methods:The study included smokers with and without COPD from the COPDGene Study, with quantitative chest CT analysis. Pleural-based emphysema was assessed on the basis of local histogram measures of emphysema. Pneumothorax history was defined by subject self-report.Measurements and Main Results: Pneumothorax was reported in 286 (3.2%) of 9,062 participants. In all participants, risk of prior pneumothorax was significantly higher in men (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.08-2.22) and non-Hispanic white subjects (OR, 1.90; 95% CI, 1.34-2.69). Risk of prior pneumothorax was associated with increased percent CT emphysema in all participants and participants with COPD (OR, 1.04 for each 1% increase in emphysema; 95% CI, 1.03-1.06). Increased pleural-based emphysema was independently associated with risk of past pneumothorax in all participants (OR, 1.05 for each 1% increase; 95% CI, 1.01-1.10). In smokers with normal spirometry, risk of past pneumothorax was associated with non-Hispanic white race and lifetime smoking intensity (OR, 1.20 for every 10 pack-years; 95% CI, 1.09-1.33).Conclusions: Among smokers, pneumothorax is associated with male sex, non-Hispanic white race, and increased percentage of total and subpleural CT emphysema. Pneumothorax was not independently associated with height or lung function, even in participants with COPD.Clinical trial registered with www.clinicaltrials.gov (NCT00608764).

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“…In one report, the quantitatively measured heterogeneity of emphysema distribution was associated with a decrease in FEV1 and FEV1/forced vital capacity (FVC) (25). When com- severity of dyspnea, and quality of life (26). Additionally, the regional distribution of emphysema has been shown to be clinically important in selecting optimal candidates for lung volume reduction surgery (27).…”

Section: Emphysema Quantificationmentioning

confidence: 99%

Quantitative CT Imaging in Chronic Obstructive Pulmonary Disease: Review of Current Status and Future Challenges

Cho

Seo

Lee

et al. 2018

J Korean Soc Radiol

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Chronic Obstructive Pulmonary Disease (COPD) is a complex heterogeneous condition with various clinical and pathologic features. In recent years, technical advances in quantitative CT imaging have generated considerable interest because they can provide a more precise and objective assessment of COPD. Emphysema and small-airway disease, the two major components of COPD, and other comorbidities, including pulmonary vessel alterations, atherosclerosis, cachexia, and osteoporosis, can all be assessed by means of quantitative imaging parameters. Increasing numbers of studies provide promising reports indicating that such parameters are associated with clinical measures of disease severity, respiratory symptoms, COPD exacerbations, and mortality. Despite such optimistic results, there are still many obstacles to using this quantitative technology in everyday practice to manage COPD patients. In this article, we review the current technical status of quantitative CT assessment, emphasizing its clinical implications and limitations. We also discuss present challenges and the potential future role of quantitative CT imaging in assessing COPD.

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Distinct Quantitative Computed Tomography Emphysema Patterns Are Associated with Physiology and Function in Smokers

Cited by 123 publications

References 43 publications

Progress in Imaging COPD, 2004 - 2014

Progress in Imaging COPD, 2004 - 2014

Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

Quantitative CT Imaging in Chronic Obstructive Pulmonary Disease: Review of Current Status and Future Challenges

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