Small airways diseases: detection and insights with computed tomography

Dm, Hansell

doi:10.1183/09031936.01.00206101

Cited by 146 publications

(78 citation statements)

References 154 publications

(153 reference statements)

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“…Air-trapping has to be considered pathological when it affects a volume of lung equal or greater than a pulmonary segment and not limited to the superior segment of the lower lobe (18). Abnormal air-trapping is a hallmark of small airway disease but it may also be seen in a variety of lung diseases, including emphysema, bronchiectasis, bronchiolitis obliterans, and asthma (19). The tree-in-bud sign reflects the presence of dilated centrilobular bronchioles with lumina that are impacted with mucus, fluid, or pus; it is often associated with peribronchiolar inflammation (20).…”

Section: Visual Analysismentioning

confidence: 99%

Imaging phenotypes of chronic obstructive pulmonary disease

Ley‐Zaporozhan¹,

Beek²

2010

Magnetic Resonance Imaging

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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 and/or the parenchyma with different severity during the course of the disease. These different aspects of COPD can be addressed by imaging using a combination of morphological and functional techniques. Computed tomography (CT) 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 ventilation and perfusion, mainly provided by magnetic resonance imaging (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 the disease.

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Section: Visual Analysismentioning

confidence: 99%

Imaging phenotypes of chronic obstructive pulmonary disease

Ley‐Zaporozhan¹,

Beek²

2010

Magnetic Resonance Imaging

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“…Three lowdose volumetric CT scans and quantitative analyses are to be conducted as a tool for dividing COPD into subgroups based on structural changes and evaluation of disease progression. CT lung density measurements are to be used for the evaluation of both degree and distribution of emphysema and airway wall dimensions [17]. This area is clearly not yet fully developed, but previous data suggest that risk factors for COPD may differ depending upon the identification of emphysema/airway remodelling on CT.…”

Section: Study Organisationmentioning

confidence: 99%

Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE)

Vestbo

Anderson

Coxson³

et al. 2008

Eur Respir J

634

575

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Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease and not well understood. The forced expiratory volume in one second is used for the diagnosis and staging of COPD, but there is wide acceptance that it is a crude measure and insensitive to change over shorter periods of time.Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) is a 3-yr longitudinal study with four specific aims: 1) definition of clinically relevant COPD subtypes; 2) identification of parameters that predict disease progression in these subtypes; 3) examination of biomarkers that correlate with COPD subtypes and may predict disease progression; and 4) identification of novel genetic factors and/or biomarkers that both correlate with clinically relevant COPD subtypes and predict disease progression. ECLIPSE plans to recruit 2,180 COPD subjects in Global Initiative for Chronic Obstructive Lung Disease categories II-IV and 343 smoking and 223 nonsmoking control subjects. Study procedures are to be performed at baseline, 3 months, 6 months and every 6 months thereafter. Assessments include pulmonary function measurements (spirometry, impulse oscillometry and plethysmography), chest computed tomography, biomarker measurement (in blood, sputum, urine and exhaled breath condensate), health outcomes, body impedance, resting oxygen saturation and 6-min walking distance.Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points is the largest study attempting to better describe the subtypes of chronic obstructive pulmonary disease, as well as defining predictive markers of its progression.

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“…An expiratory CT should be obtained in nonsmoking patients who do not have asthma but present with dyspnea, reduced FVC, normal FEV 1 /FVC, and irrelevant or normal chest X-ray findings. (18) In patients with bronchiectasis, bronchiolitis obliterans is common, and RV can be elevated. (19) Obesity is a common cause of nonspecific lung disease.…”

Section: Discussionmentioning

confidence: 99%

Predizendo redução da CPT em pacientes com CVF reduzida e relação VEF1/CVF normal ou elevada

et al. 2010

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Objective: To use clinical and spirometry findings in order to distinguish between the restrictive and nonspecific patterns of pulmonary function test results in patients with low FVC and a normal or elevated FEV 1 /FVC ratio. Methods: We analyzed the pulmonary function test results of 211 adult patients submitted to spirometry and lung volume measurements. We used the clinical diagnosis at the time spirometry was ordered, together with various functional data, in order to distinguish between patients presenting with a "true" restrictive pattern (reduced TLC) and those presenting with a nonspecific pattern (normal TLC). Results: In the study sample, TLC was reduced in 144 cases and was within the normal range in 67. The most common causes of a nonspecific pattern were obstructive disorders, congestive heart failure, obesity, bronchiolitis, interstitial diseases, and neuromuscular disorders. In patients given a working diagnosis of pulmonary fibrosis, pleural disease, or chest wall disease, the positive predictive value (PPV) for restriction was ≥ 90%. In males, an FVC ≤ 60% of predicted had a PPV for restriction of 98.8%. In females, the restrictive pattern was found in 84.4% of those with an FVC ≤ 50% of predicted. A difference of ≥ 0% between the FEV 1 % and the FVC% had a PPV for restriction of 89.5%. After performing logistic regression, we developed a point scale for predicting the restrictive pattern. Conclusions: In many patients with reduced FEV 1 , reduced FVC, and a normal FEV 1 /FVC ratio, the restrictive pattern can be identified with confidence through the use of an algorithm that takes the clinical diagnosis and certain spirometry measurements into account.Keywords: Spirometry; Airway resistance; Respiratory function tests; Vital capacity. ResumoObjetivo: Utilizar os dados clínicos e espirométricos para distinguir entre os padrões restritivo e inespecífico dos resultados dos testes de função pulmonar em pacientes com CVF reduzida e relação VEF 1 /CVF normal ou elevada. Métodos: Foram avaliados resultados de testes de função pulmonar de 211 pacientes adultos submetidos à espirometria e a medidas de volumes pulmonares. O diagnóstico clínico na solicitação do exame e diversos dados funcionais foram utilizados para diferenciar pacientes com o padrão restritivo "verdadeiro" (CPT reduzida) daqueles com o padrão inespecífico (CPT normal). Resultados: Na amostra estudada, a CPT estava reduzida em 144 casos e estava dentro da faixa normal em 67. As causas mais comuns do padrão inespecífico foram doenças pulmonares obstrutivas, insuficiência cardíaca congestiva, obesidade, bronquiolite, doenças intersticiais e doenças neuromusculares. Em pacientes com hipótese diagnóstica de fibrose pulmonar, doenças pleurais ou doenças da parede torácica, o valor preditivo positivo (VPP) para restrição foi ≥ 90%. Em homens, a CVF ≤ 60% do previsto teve um VPP para restrição de 98,8%. Em mulheres, o padrão restritivo foi encontrado em 84,4% daquelas com CVF ≤ 50% do previsto. Uma diferença entre VEF 1 % e CVF% ≥ 0% t...

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Small airways diseases: detection and insights with computed tomography

Cited by 146 publications

References 154 publications

Imaging phenotypes of chronic obstructive pulmonary disease

Imaging phenotypes of chronic obstructive pulmonary disease

Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE)

Predizendo redução da CPT em pacientes com CVF reduzida e relação VEF1/CVF normal ou elevada

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