Longitudinal Study of Spatially Heterogeneous Emphysema Progression in Current Smokers with Chronic Obstructive Pulmonary Disease

Tanabe, Naoya; Muro, Shigeo; Satô, Susumu; Tanaka, Shiro; Oguma, Tsuyoshi; Kiyokawa, Hirofumi; Takahashi, T; Kinose, Daisuke; Hoshino, Yuma; Kubo, Takeshi; Hirai, Toyohiro; Mishima, Michiaki

doi:10.1371/journal.pone.0044993

Cited by 24 publications

(39 citation statements)

References 32 publications

(75 reference statements)

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“…Consistent with previous studies (Matsuoka et al ., ; Tanabe et al ., ), the current study demonstrated that pulmonary emphysema in patients with COPD progressed during the follow‐up period. However, a gradual time‐dependent change in small pulmonary vascular CSA was not observed for the %CSA <5 .…”

Section: Discussionsupporting

confidence: 59%

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Quantitative CT measurements of small pulmonary vessels in chronic obstructive pulmonary disease: do they change on follow‐up scans?

Saruya

Matsuoka

Yamashiro

et al. 2014

Clin Physio Funct Imaging

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The aims of this study were to perform a longitudinal evaluation of the cross-sectional area (CSA) of small pulmonary vessels and the extent of emphysema measured on computed tomography (CT) scans of patients with chronic obstructive pulmonary disease (COPD), and to correlate the pulmonary vascular measurements with extent of emphysema. The institutional review board approved this retrospective study and waived the need for patients' informed consent. Seventy-four patients with COPD who underwent both initial and follow-up CT scans at an interval of ≥12 months were analysed. The CSA of small pulmonary vessels <5 mm(2) was measured, and the percentage of total CSA of the area of the lung (%CSA<5 ) was calculated. The extent of emphysema was assessed as the percentage of low attenuation area (%LAA, <-950 Hounsfield units). Comparisons between initial and follow-up measurements were performed using the Wilcoxon signed-rank test. The relationship between longitudinal changes in %CSA<5 and %LAA during the follow-up period was assessed using the Spearman rank correlation. The %LAA increased significantly on follow-up CT scans (P<0·0001). The %CSA<5 was slightly decreased on follow-up scans, but the difference was not significant. Although longitudinal change in %LAA was positively correlated with duration of follow-up period (ρ = 0·505, P<0·0001), longitudinal change in %CSA<5 was not. In conclusion, there was a progressive increase in the extent of emphysema over time, but no significant decrease in the CSA of small pulmonary vessels over the same time period.

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Section: Discussionsupporting

confidence: 59%

“…Previous longitudinal studies have shown that the extent of emphysema gradually increases over time (Matsuoka et al ., ; Tanabe et al ., ). However, to the best of our knowledge, longitudinal changes of small pulmonary vessels in patients with COPD have not been evaluated.…”

Section: Introductionmentioning

confidence: 97%

Quantitative CT measurements of small pulmonary vessels in chronic obstructive pulmonary disease: do they change on follow‐up scans?

Saruya

Matsuoka

Yamashiro

et al. 2014

Clin Physio Funct Imaging

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“…The outcome of these procedures was then compared to the CT image of the subject taken at a later time. This modeling approach not only confirmed the original force-based coalescence of LAA clusters, but also revealed that the model works only when small LAA clusters merge into nearby larger clusters providing evidence that diseased areas tend to grow possibly due to larger than average stresses around the perimeter of existing already damaged regions (34). …”

Section: Modeling Alveolar Structure In 2dsupporting

confidence: 52%

Computational modeling helps uncover mechanisms related to the progression of emphysema

Suki

Parameswaran

2015

Drug Discovery Today: Disease Models

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Emphysema is a progressive disease characterized by deterioration of alveolar structure and decline in lung function. While morphometric and molecular biology studies have not fully uncovered the underlying mechanisms, they have produced data to advance computational modeling. In this review, we discuss examples in which modeling has led to novel insight into mechanisms related to disease progression. Finally, we propose a general scheme of multiscale modeling approach that could help unravel the progressive nature of emphysema and provide patient specific mechanisms perhaps suitable for use in treatment therapies.

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“…In COPD, it has been demonstrated that patients with higher quantities of emphysema on CT have an increased rate of decline of FEV1 [34,50]. CT emphysema progression is also associated with frequent exacerbations [64] and current smoking status [65]. The largest longitudinal study to date assessed CT scans from the ECLIPSE cohort [66] where they found lung density and low attenuation areas progressed on an annual basis.…”

Section: Emphysemamentioning

confidence: 99%

Present and future utility of computed tomography scanning in the assessment and management of COPD

Ostridge

Wilkinson

2016

Eur Respir J

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likely to have important implications for understanding disease progression and the future management of this condition [2]. There are currently no significant diseasemodifying medications for COPD and there have not been the improvements in outcome seen in other chronic diseases. Other tools are required in addition to spirometry to help explain the heterogeneity and provide further insights into approaches to study and treat COPD. CT has current practical applications in the routine management and investigation of the disease and with the development of novel analysis techniques has the potential to provide further details about the pulmonary and extra-pulmonary manifestations of COPD. Computed Tomography in Current Clinical PractisePrior to the 1970s histological and post mortem studies were required to study structural changes of the lung. The introduction of CT made it possible to visualise the thorax and assess lung structure non-invasively. In COPD CT can identify key morphological features, including emphysema, bronchial wall thickening and gas trapping. These pathologies contribute directly to airflow obstruction and therefore CT has the potential to provide vital insights into the underlying pathophysiological changes of COPD. Despite this, routine CT imaging has not necessarily been widely adopted in clinical practise and its place in the management and investigation of COPD has not been firmly established. The GOLD guidelines do not routinely recommend CT scanning in COPD and only advise that it may be helpful in differential diagnosis or when surgical options are being considered [3]. This general ambivalence is highlighted by a study of attitudes in respiratory physicians and surgeons in the UK where only 32% thought it necessary for patients with severe COPD to have a CT scan [4].There are a number of reasons why the use of CT has not become routine in COPD. One of the most important is the perceived notion that using CT does not alter management, although this is not strictly true. The National Emphysema Treatment Trial (NETT) demonstrated that patients with advanced upper lobe emphysema and limited exercise ability improved after lung volume reduction surgery [5]. There has also been considerable progress and experience in using endobronchial treatments for severe emphysema including coils, valves, sealant and airway bypass. In the correct patients with severe heterogeneous emphysema these treatments can lead to significant improvement in pulmonary physiology and functional capacity [6, 7]. CT imaging can also identify bullous disease, which may be amenable to surgery and bullectomy can lead to improved health status [8]. It therefore seems clear that patients with severe COPD require CT imaging to determine which patients are appropriate for these techniques.CT imaging can also detect concomitant pulmonary pathology in COPD. Bronchiectasis is particularly prevalent, with studies demonstrating 50% of COPD patients having CT evidence of the disease [9][10][11]. When present bronchiectasis is asso...

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Longitudinal Study of Spatially Heterogeneous Emphysema Progression in Current Smokers with Chronic Obstructive Pulmonary Disease

Cited by 24 publications

References 32 publications

Quantitative CT measurements of small pulmonary vessels in chronic obstructive pulmonary disease: do they change on follow‐up scans?

Quantitative CT measurements of small pulmonary vessels in chronic obstructive pulmonary disease: do they change on follow‐up scans?

Computational modeling helps uncover mechanisms related to the progression of emphysema

Present and future utility of computed tomography scanning in the assessment and management of COPD

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