Relationship between lung function, ventilation–perfusion inequality and extent of emphysema as assessed by high-resolution computed tomography

Sandek, K.; Bratel, T.; Lagerstrand, Lars; Rosell, Henrik

doi:10.1053/rmed.2002.1371

Cited by 50 publications

(37 citation statements)

References 41 publications

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“…Interestingly, a number of studies using scintigraphy or SPECT have shown imperfect correlations between areas with most pronounced morphological changes and areas of decreased lung perfusion in pulmonary emphysema. 5,10,31,32 Our data are in line with these previous results because we found only moderate correlations between the pulmonary PBV values and the visual and densitometric degree of parenchymal changes both in a per-patient analysis and a per-region analysis.…”

Section: Discussionsupporting

confidence: 92%

“…Because pulmonary emphysema involves a complex pathophysiology of parenchymal destruction and hypoxic vasoconstriction, the correlation between areas of parenchymal destruction and areas of hypoperfusion is known to be strong but imperfect. 5,6 This reflects the complex pathophysiology of pulmonary emphysema in which airflow obstruction, parenchymal destruction, and hypoxic vasoconstriction all contribute to impaired gas exchange.Assessing the regional distribution of pulmonary emphysema and integrating the complementary information of lung morphology and lung perfusion are particularly relevant in the assessment of patients with emphysema who are considered for lung volume reduction surgery (LVRS) or endobronchial interventions. 7,8 A study in 25 patients showed a superior prediction of postoperative outcome after LVRS for coregistered perfusion single-photon emission computed tomography (SPECT) and computed tomography (CT) as compared with planar scintigraphy, stand-alone SPECT, or qualitative assessment of stand-alone CT.…”

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confidence: 99%

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confidence: 99%

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Assessing Pulmonary Perfusion in Emphysema

Meinel¹,

Graef²,

Thieme³

et al. 2013

Investigative Radiology

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Objectives: The objective of this study was to determine whether automated quantification of lung perfused blood volume (PBV) in dual-energy computed tomographic pulmonary angiography (DE-CTPA) can be used to assess the severity and regional distribution of pulmonary hypoperfusion in emphysema. Materials and Methods: We retrospectively analyzed 40 consecutive patients (mean age, 67 [13] years) with pulmonary emphysema, who have no cardiopulmonary comorbidities, and a DE-CTPA negative for pulmonary embolism. Automated quantification of global and regional pulmonary PBV was performed using the syngo Dual Energy application (Siemens Healthcare). Similarly, the global and regional degrees of parenchymal hypodensity were assessed automatically as the percentage of voxels with a computed tomographic density less than j900 Hounsfield unit. Emphysema severity was rated visually, and pulmonary function tests were obtained by chart review, if available. Results: Global PBV generated by automated quantification of pulmonary PBV in the DE-CTPA data sets showed a moderately strong but highly significant negative correlation with residual volume in percentage of the predicted residual volume (r = j0.62; P = 0.002; n = 23) and a positive correlation with forced expiratory volume in 1 second in percentage of the predicted forced expiratory volume in 1 second (r = 0.67; P G 0.001; n = 23). Global PBV values strongly correlated with diffusing lung capacity for carbon monoxide (r = 0.80; P G 0.001; n = 15). Pulmonary PBV values decreased with visual emphysema severity (r = j0.46, P = 0.003, n = 40). Moderate negative correlations were found between global PBV values and parenchymal hypodensity both in a per-patient (r = j0.63; P G 0.001; n = 40) and per-region analyses (r = j0.62; P G 0.001; n = 40). Conclusions: Dual-energy computed tomographic pulmonary angiography allows simultaneous assessment of lung morphology, parenchymal density, and pulmonary PBV. In patients with pulmonary emphysema, automated quantification of pulmonary PBV in DE-CTPA can be used for a quick, reader-independent estimation of global and regional pulmonary perfusion, which correlates with several lung function parameters.Key Words: pulmonary emphysema, severity, distribution, pulmonary perfusion, dual-energy CT (Invest Radiol 2013;48: 79Y85) C hronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide.1,2 It is characterized by airflow limitation and lung inflammation resulting in a progressive deterioration in lung function. Emphysema is a common component of COPD, in which airway obstruction, inflammation, and aberrant activity of proteolytic enzymes cause irreversible destruction of the alveolar walls and enlargement of distal airspaces. Currently, screening for and early diagnosis of COPD and emphysema largely rely on spirometric lung function tests. 4 Spirometry, however, strongly depends on patients' cooperation and is unable to localize emphysematous changes within the lung. Because pulmonary e...

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

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confidence: 99%

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Assessing Pulmonary Perfusion in Emphysema

Meinel¹,

Graef²,

Thieme³

et al. 2013

Investigative Radiology

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“…Keeping these limitations in mind, it was not surprising to fail to detect any significant difference in mean lobar attenuation when comparing our third group of smokers, namely smokers without emphysema, with non-smokers. Our attention was drawn to the former subgroup as several studies have already reported perfusion defects in normal lung areas on CT in pulmonary emphysema patients [28,[26][27][28][29]. Perfusion alterations in smokers without emphysema might be theoretically explained by two situations.…”

Section: Discussionmentioning

confidence: 99%

Assessment of lobar perfusion in smokers according to the presence and severity of emphysema: preliminary experience with dual-energy CT angiography

et al. 2009

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The purpose of the study was to assess pulmonary perfusion on a lobar level in smokers using dual-energy computed tomography (CT). Forty-seven smokers and ten non-smokers underwent a dual-energy multi-detector CT angiogram of the chest that allowed automatic quantification of emphysema and determination of the iodine content at the level of the microcirculation (i.e. "perfusion imaging"). Emphysema was present in 37 smokers and absent in ten smokers. Smokers with an upper lobe predominance of emphysema (n = 8) had: (1) significantly lower attenuation enhancement values in the upper lobes compared with smokers without emphysema; (2) the lobes with the most severe emphysematous changes had a statistically significantly higher percentage of emphysema (p = 0.0001) and lower mean attenuation enhancement values (p = 0.0001) than the ipsilateral lobes with less severe emphysema, matching parenchymal destruction; (3) a correlation was found between the difference in percentage of emphysema between the upper and lower lobes and the difference in attenuation attenuation enhancement values in the corresponding lobes (p = 0.0355; r = -0.54). Regional alterations of lung perfusion can be depicted by dual-energy CT in smokers with predominant emphysema.

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“…The reduction of the pulmonary vascular bed is related to the severity of parenchymal destruction [43]; however, the distribution of perfusion does not necessarily match parenchymal destruction (Fig. 5) [44,45]. Conventional radionuclide perfusion scintigraphy has been used to assess these abnormalities, but it has substantial limitations with respect to spatial and temporal resolution.…”

Section: Perfusionmentioning

confidence: 99%

Morphological and functional imaging in COPD with CT and MRI: present and future

2007

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Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. COPD is defined by irreversible airflow obstruction. It is a heterogeneous disease affecting the airways (i.e. chronic bronchitis, airway collapse), the parenchyma (i.e. hyperinflation, air trapping and emphysematous destruction) as well as the vasculature (i.e. hypoxic vasoconstriction, rarefication and pulmonary arterial hypertension) with different severity during the course of the disease. These different aspects of COPD can be best addressed by imaging using a combination of morphological and functional techniques. Three-dimensional high-resolution computed tomography (3D-HRCT) is the technique of choice for morphological imaging of the lung parenchyma and airways. This morphological information is to be accomplished by functional information about perfusion, regional lung mechanics, and ventilation mainly provided by MRI. The comprehensive diagnostic possibilities of CT complemented by MRI will allow for a more sensitive detection, phenotype-driven characterization and dedicated therapy monitoring of COPD as presented in this review.

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Relationship between lung function, ventilation–perfusion inequality and extent of emphysema as assessed by high-resolution computed tomography

Cited by 50 publications

References 41 publications

Assessing Pulmonary Perfusion in Emphysema

Assessing Pulmonary Perfusion in Emphysema

Assessment of lobar perfusion in smokers according to the presence and severity of emphysema: preliminary experience with dual-energy CT angiography

Morphological and functional imaging in COPD with CT and MRI: present and future

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