Fully automatic quantitative assessment of emphysema in computed tomography: comparison with pulmonary function testing and normal values

Heußel, Claus Peter; Herth, Felix J.F.; Kappes, Jutta; Hantusch, R.; Hartlieb, S.; Weinheimer, Oliver; Kauczor, H.-U.; Eberhardt, Ralf

doi:10.1007/s00330-009-1437-z

Cited by 123 publications

(123 citation statements)

References 34 publications

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“…(7)(8)(9)(10)(11)(12)(13)(14)(15) The method has been recommended for use in longitudinal studies of emphysema and is currently considered to be better than functional tests for disease assessment. (6,16) In addition, previous studies have reported that the correlation between CT densitometry and macroscopic morphometry is higher than is that between macroscopic morphometry and subjective visual grading of emphysema.…”

Section: Discussionmentioning

confidence: 99%

“…(6) Additionally, HRCT and helical CT can detect and quantify pulmonary emphysema, HRCT and helical CT findings correlating well with histopathological findings. (7)(8)(9)(10)(11)(12)(13)(14) Finally, modern CT scanners with multiple rows of detectorsmultidetector CT (MDCT)-allow the acquisition of thin (< 1-mm) slices of the whole chest in a few seconds, improving spatial resolution and avoiding respiratory artifacts.…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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“…26 However, because of concern regarding artifact from image noise and truncation artifact at the first percentile level, most studies have used the 15th percentile threshold. 30,31 It is important to remember that the measurement of the percentage of low attenuation areas (%LAA), while it correlates moderately well with histologic severity of emphysema (with r values between 0.5 and 0.6), is not a direct measurement of emphysema. The term percentage of emphysema (% emphysema) is widely used to refer to such CT measurements, but is imprecise and may give rise to confusion.…”

Section: Emphysemamentioning

confidence: 99%

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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“…In 2006, Madani et al (7) has shown the optimal HU threshold to be -960 HU or -970 HU according to macroscopic and microscopic pathologic correlations. However, because higher threshold values result in higher sensitivity to image noise, the most commonly accepted threshold value is -950 HU (8), with the percentage area of lung less than -950 HU (the emphysema index, or %LAA-950) being widely used to estimate the emphysema component in COPD patients (Fig. 1A, B) (9).…”

Section: Emphysema Quantificationmentioning

confidence: 99%

“…However, because of concerns regarding increased image artifacts and noise at the first percentile level, the 15th percentile threshold is most commonly used (8,10). The percentile index has been reported to be more robust for evaluating longitudinal variations in emphysema, and as being less sensitive to lung volume changes (8,11).…”

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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Fully automatic quantitative assessment of emphysema in computed tomography: comparison with pulmonary function testing and normal values

Cited by 123 publications

References 34 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

Progress in Imaging COPD, 2004 - 2014

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

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