Value of chest radiography in phenotyping chronic obstructive pulmonary disease

Abstract

The objectives of the present study were to reappraise chest radiography for the diagnosis of emphysema, using computed tomography (CT) as the reference standard, and to establish whether or not chest radiography is useful for phenotyping chronic obstructive pulmonary disease (COPD).Patients (n5154) who had undergone posteroanterior and lateral chest radiography and CT for diagnostic purposes were studied. CT data were scored for emphysema using the picture-grading method. Chest radiographs were examined independently by five raters using four criteria for emphysema that had been validated against lung pathology. These criteria were then used to assess the prevalence of emphysema in 458 COPD patients. Patients with and without evidence of emphysema were compared with regard to age, sex, smoking history, body mass index (BMI), forced expiratory volume in one second (FEV1), diffusing capacity of the lung for carbon monoxide (DL,CO) and health status.Chest radiography yielded a sensitivity of 90% and a specificity of 98% for emphysema. Of the 458 COPD patients, 245 showed radiological evidence of emphysema. Emphysemic patients had a significantly lower BMI, FEV1 and DL,CO, greater restriction of physical activity and worse quality of life than nonemphysemic patients. There was no difference across the two groups with regard to age, sex or smoking history.Chest radiography is a simple means of diagnosing moderate-to-severe emphysema. It is useful in phenotyping chronic obstructive pulmonary disease and may aid physicians in their choice of treatment.

Emphysema: Imaging for Endoscopic Lung Volume Reduction

“…The validity of the criteria for emphysema already defined in 1965 was confirmed once again by Miniati et al 2008 [31]. We routinely see flat, low-lying diaphragmatic arches, increased lung transparency, and enlarged retrosternal space as well as ex- panded intercostal spaces, a barrel chest and, as the case may be, a teardrop-shaped, narrow heart silhouette.…”

Effects of emphysema on oxygen uptake during maximal exercise in COPD

“…In particular, we believe that randomized trials are warranted to establish whether pulmonary rehabilitation programs are more effective than standard pharmacological In the present study, volumetric CT of the thorax was used as the reference standard for diagnosing emphysema. In our experience, digital chest radiography is a valuable alternative to the CT scan in routine clinical practice, provided that explicit diagnostic criteria are used [5].…”

“…In addition, emphysemic patients were found to have greater restriction of physical activity and worse quality of life than non-emphysemic ones [5]. The latter findings were based on the results of a self-administered respiratory questionnaire [7].…”

“…A recent study, comprising 458 patients with established COPD, shows that patients with radiologic evidence of emphysema feature significantly lower body mass index, greater airflow obstruction, and more severe impairment of lung diffusing capacity than those without emphysema [5]. In addition, emphysemic patients were found to have greater restriction of physical activity and worse quality of life than non-emphysemic ones [5].…”

“…Over the years, evidence has emerged that patients with COPD and predominant emphysema differ remarkably from those with predominant airway disease [2][3][4][5][6].…”