Incidental findings on chest CT imaging are associated with increased COPD exacerbations and mortality

Jairam, Pushpa M.; Graaf, Yolanda van der; Lammers, Jan‐Willem J.; Mali, Willem P.Th.M.; Jong, Pim A. de

doi:10.1136/thoraxjnl-2014-206160

Cited by 59 publications

(54 citation statements)

References 29 publications

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“…A total of 14 studies met the inclusion criteria, including 5329 COPD patients, and1572 (29.5%) patients were comorbid with bronchiectasis. Association of the presence of bronchiectasis with COPD exacerbations (ECOPD) [9][10][11][12]18,19,20]was reported in seven studies, isolation of PPMs [9,10,12,21,22]and specifically of Pseudomonas aeruginosa (P. aeruginosa) [9,10,23,24]in five and four studies respectively, severe airflow obstruction [9,11,12,18,19,25,26] in seven studies, mortality in four studies [10,19,23,27], and higher levels of inflammatory cytokines in three studies [10,11,21]which were not enough to conduct a metaanalysis.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

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Bronchiectasis as a Comorbidity of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

Jin

Liu

2016

Chest

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Section: Description Of Included Studiesmentioning

confidence: 99%

“…Most studies lacked adjustment for potential confounders. In seven articles, bronchiectasis was graded by scoring systems proposed by Smith [21,24], Naidich [10,12] and Bhalla [11], and other systems [18,20] respectively. Selection of subjects was either from primary care, outpatient recruitment, or from hospitalization.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

Bronchiectasis as a Comorbidity of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

Jin

Liu

2016

Chest

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“…Patients with greater quantitative measures of emphysema were reported to have more rapid decline of PFT parameters (19). Furthermore, quantified measures of emphysema showed associations with frequent exacerbation and worse clinical outcomes from exacerbation events (20)(21)(22). When the heterogeneity of emphysema assessed using quantitative CT was taken into account, the basal distribution of emphysema was associated with greater impairment in forced expiratory volume in 1 second (FEV1), with central areas of emphysema showing a stronger correlation with airflow limitation than those in the periphery of the lung (23,24).…”

Section: Emphysema Quantificationmentioning

confidence: 99%

“…It is hypothesized that increased bronchial wall thickness may be closely related to inflammation of the airway, and thus may have an association with aggravated symptoms of bronchitis or exacerbations. Accordingly, increased quantitative parameters of airway wall thickness were related to an increased frequency of, and mortality from, COPD exacerbations (20,21). However, compared with emphysema quantification, there are still many technical difficulties and uncertainties regarding measurements of airway changes in COPD patients, and further investigation is warranted.…”

Section: Airway Disease: Direct Measurementmentioning

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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“…Computed tomography (CT) of the lungs provides an excellent opportunity to assess COPD in vivo and quantify its macroscopic pathology [1][2][3]. Emphysema and airway remodelling can be visually assessed and automatically quantified, and several studies have shown associations with morbidity and mortality [4][5][6][7]. In addition, CT can provide information on the spatial distribution of disease.…”

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confidence: 99%

Air trapping on computed tomography: regional versus diffuse

Hoesein

Jong

2017

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is diagnosed and classified by spirometry, assessing the presence of airflow obstruction and extent of forced expiratory flow deterioration. Spirometry, however, is unsuitable for characterising and quantifying the underlying pulmonary pathology of COPD, including alveolar destruction (emphysema) and airway remodelling (large-and small-airway disease). Accurate diagnosis of the pulmonary pathologies underlying COPD is seen as an important step towards better understanding its biology and "personalised" treatment. Computed tomography (CT) of the lungs provides an excellent opportunity to assess COPD in vivo and quantify its macroscopic pathology [1][2][3]. Emphysema and airway remodelling can be visually assessed and automatically quantified, and several studies have shown associations with morbidity and mortality [4][5][6][7]. In addition, CT can provide information on the spatial distribution of disease.In this issue of the European Respiratory Journal, KARIMI et al. [8] hypothesise that regional air trapping maybe a new imaging marker, in addition to emphysema, large-airway remodelling and diffuse air trapping.The small airways, commonly defined as those <2 mm in diameter, are regarded as the most important site of airflow obstruction in COPD [9]. Measuring small-airway disease on CT can be challenging as these cannot be visualised directly because they are too small and below the resolution of the CT scanner. Indirect measures are thus used to measure small-airway disease on CT. Air trapping on CT, sometimes also referred to as gas trapping, is often used to asses small-airway disease [10]. Pathophysiologically, it is defined as retention of air in the lung distal to an obstruction, but it is difficult to prove this by radiology-pathology correlation studies. To assess air trapping, both inspiratory and some form of expiratory scans are needed.The definition of regional air trapping on CT consists of three components. First, the trapped areas have a relatively high attenuation on expiratory CT scans. Fully inflated alveoli have an average attenuation of −850 Hounsfield units (HU) and with a good expiratory effort, the average attenuation increases by 150 HU. The second component is volume, as areas with air trapping do not lose much of their volume on expiration. The third component is morphology, as air trapping has a sharp delineation at the border of the secondary pulmonary lobule.The radiological diagnosis of regional air trapping is challenging for several reasons. First, proper expiration is needed for the air trapping to become visible. This needs compliance from patients or research participants, properly trained technicians, and/or spirometric gating. CT technicians tend to train patients to only a limited extent before the CT acquisition and they also sometimes start the scan too

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Incidental findings on chest CT imaging are associated with increased COPD exacerbations and mortality

Abstract: Morphological correlates of COPD such as emphysema and airway thickening detected on CT scans obtained for other non-pulmonary indications are strong independent predictors of subsequent development of acute exacerbations of COPD resulting in hospitalisation or death.

Cited by 59 publications

References 29 publications

Bronchiectasis as a Comorbidity of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

Bronchiectasis as a Comorbidity of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

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

Air trapping on computed tomography: regional versus diffuse

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