Chronic obstructive pulmonary disease * 4: Imaging the lungs in patients with chronic obstructive pulmonary disease

Müller, Néstor L.

doi:10.1136/thorax.57.11.982

Cited by 104 publications

(74 citation statements)

References 46 publications

(45 reference statements)

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“…The present finding of decreased lung 123 I-MIBG uptake and washout rate in PE patients is consistent with the recent pilot study of planar 123 I-MIBG scintigraphy, but the study evaluated only the upper lung zones, without comparison with lung perfusion, and showed correlations of lung 123 I-MIBG washout rate with the severity of emphysema on CT (23). Because 123 I-MIBG defects were occasionally seen without noticeable low-attenuation areas in our patients, CT may not be sufficiently sensitive to identify mild alveolar pathophysiology in PE (27,37).…”

Section: Rgbmentioning

confidence: 78%

“…To display the lung distribution of low-attenuation areas indicative of emphysematous lungs, density-mask CT images were created using M900 Quadra imaging software (Zio Soft K.K.). For segmentation of low-attenuation areas on density-mask CT, a threshold of 2960 HU was applied, according to previous studies (26,27). The density-mask CT used red to indicate low-attenuation areas in the lung.…”

Section: Chest Ctmentioning

confidence: 99%

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Impaired Lung ¹²³I-MIBG Uptake on SPECT in Pulmonary Emphysema

Suga¹,

Okada

Kunihiro

et al. 2011

J Nucl Med

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The aim of this study was to evaluate impaired lung uptake of 123 I-metaiodobenzylguanidine ( 123 I-MIBG) on SPECT, compared with perfusion SPECT and morphologic CT, in patients with pulmonary emphysema (PE). Methods: 123 I-MIBG SPECT was performed at 15 min and 4 h after intravenous injection of 123 I-MIBG in 36 PE patients with a history of smoking and variable-extent low-attenuation areas on CT, indicative of emphysematous changes, and in 16 controls with no history of smoking and no noticeable low-attenuation areas. The distribution of 123 I-MIBG was compared with that of low-attenuation areas on CT and perfusion on SPECT at the base of the 180 lung lobes of the PE patients. Total-lung 123 I-MIBG kinetics were calculated, including early and delayed lung-to-mediastinum uptake ratios and washout rate. Results: The controls showed a fairly uniform lung 123 I-MIBG distribution nearly consistent with perfusion. PE patients had heterogeneous 123 I-MIBG defects showing frequent discordance with low-attenuation areas or perfusion distribution; 123 I-MIBG defects were more extensive than low-attenuation areas in 76 lobes (42.2%) of 31 patients (86%) and more extensive than perfusion defects in 44 lobes (24.4%) of 22 patients (61%). 123 I-MIBG defects were seen regardless of the absence of noticeable low-attenuation areas and perfusion defects in 19 lobes (10.5%) of 16 patients (44%). All total-lung 123 I-MIBG kinetic parameters in PE patients were significantly lower than the control values (P , 0.0001), with significant correlation with alveolar-arterial oxygen tension gradient but without correlation with the extent of perfusion defects or low-attenuation areas. Conclusion: 123 I-MIBG SPECT allows evaluation of lung pathophysiology in PE independently of perfusion SPECT or morphologic CT, and impairment of lung 123 I-MIBG uptake may be more extensive than perfusion or morphologic abnormalities in PE.

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Section: Rgbmentioning

confidence: 78%

Section: Chest Ctmentioning

confidence: 99%

Impaired Lung ¹²³I-MIBG Uptake on SPECT in Pulmonary Emphysema

Suga¹,

Okada

Kunihiro

et al. 2011

J Nucl Med

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“…Percent of emphysema-like lung (also known as percent low-attenuation area and hereafter referred to as percent emphysema) was defi ned as the percentage of total voxels within the lung fi eld that was , 2 910 Hounsfi eld units (HU). 33 …”

Section: Chest Ct Scan and Quantitative Assessment Of Emphysemamentioning

confidence: 99%

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Smith

Prince

Hoffman

et al. 2013

Chest

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1143C hronic lower respiratory disease is the third-leading cause of death in the United States. 1 The most morbid components of chronic lower respiratory dis ease are COPD, defi ned by spirometry as airfl ow obstruction that is not fully reversible, and pulmonary emphysema, defi ned by morphology as permanent enlargement of airspaces accompanied by destruction of their walls. 2,3 Emphysema on CT imaging is present in approximately one-half of patients with COPD, 4-7 and an estimated 2% of the general population aged . 50 years has emphysema without spirometry-defi ned COPD. 8 The number of Americans with a diagnosis of heart failure was 5.7 million in 2008, and approximately one-half of prevalent heart failure cases are characterized by preserved ejection fraction. 9,10 By comparison, 12 million Americans have a diagnosis of COPD and an additional 12 million may have undiagnosed COPD and emphysema. 11Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) fi lling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. Methods: The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defi ned by spirometry. Percent emphysema was defi ned as regions , 2 910 Hounsfi eld units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking. Results: Among 165 participants, the mean ( Ϯ SD) total pulmonary vein area was 558 Ϯ 159 mm 2 in patients with COPD and 623 Ϯ 145 mm 2 in control subjects. Total pulmonary vein area was smaller in patients with COPD ( 2 57 mm 2 ; 95% CI, 2 106 to 2 7 mm 2 ; P 5 .03) and inversely associated with percent emphysema ( P , .001) in fully adjusted models. Signifi cant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defi ned COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These fi ndings support a mechanism of upstream pulmonary causes of underfi lling of the LV in COPD and in patients with emphysema on CT scan. CHEST 2013; 144(4):1143-1151Abbreviations: E/A ratio 5 ratio of peak fi lling rates during early phase diastole and atrial contraction; E/A ratioMR 5 ratio of peak fi lling rates during early phase diastole and atrial contraction estimated by magnetic resonance; EDV 5 end-diastolic volume; LV 5 left ventricle; MESA 5 Multi-Ethnic Study of Atherosclero...

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“…This structural change can be quantified in the human by a computed tomography (CT) X-ray scanner [11,12]. Although pulmonary function tests are the conventional method for diagnosis and clinical management of COPD and emphysema, they have weaknesses [13,14].…”

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confidence: 99%

Three-dimensional computed tomography imaging in an animal model of emphysema

Froese

Ask²,

Labiris³

et al. 2007

European Respiratory Journal

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Emphysema is a major health problem and novel drugs are needed. Animal disease models are pivotal in their development, but the validity and sensitivity of current tools for the evaluation of drug efficacy is limited. The usefulness of micro computed tomography (CT) as an innovative tool to assess emphysema in a mouse model was investigated.Serial CT scans were performed in bi-weekly intervals in Smad3 knockout (KO) mice, which spontaneously develop airspace enlargement. Lung density was quantified in two-and threedimensional images and correlated to mean linear intercept and lung compliance.CT scans of Smad3 KO lungs revealed a significant decrease in lung density at age 8 weeks and a further progression at age 14 weeks with respect to age-matched wild-type (WT) animals. Emphysema could be reliably assessed with both the two-and three-dimensional approach, but the three-dimensional approach was superior, due to normalisation to lung volumes and less variability. Lung compliance by week 14 was 0.053¡0.005 and 0.034¡0.002% of maximum volume?cmH 2 O -1 for KO and WT mice, respectively, reflecting significant physiologically relevant emphysema. Small animal computed tomography imaging and density quantification in a reconstructed three-dimensional image is a useful tool for quantifying emphysematous changes in an animal disease model. It adds significant information to conventional assessment.

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Chronic obstructive pulmonary disease * 4: Imaging the lungs in patients with chronic obstructive pulmonary disease

Cited by 104 publications

References 46 publications

Impaired Lung ¹²³I-MIBG Uptake on SPECT in Pulmonary Emphysema

Impaired Lung ¹²³I-MIBG Uptake on SPECT in Pulmonary Emphysema

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Three-dimensional computed tomography imaging in an animal model of emphysema

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Chronic obstructive pulmonary disease * 4: Imaging the lungs in patients with chronic obstructive pulmonary disease

Cited by 104 publications

References 46 publications

Impaired Lung 123I-MIBG Uptake on SPECT in Pulmonary Emphysema

Impaired Lung 123I-MIBG Uptake on SPECT in Pulmonary Emphysema

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Three-dimensional computed tomography imaging in an animal model of emphysema

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Impaired Lung ¹²³I-MIBG Uptake on SPECT in Pulmonary Emphysema

Impaired Lung ¹²³I-MIBG Uptake on SPECT in Pulmonary Emphysema