Repeatability of Lung Density Measurements with Low-Dose Computed Tomography in Subjects with α-1-Antitrypsin Deficiency–Associated Emphysema

Stolk, Jan; Dirksen, Asger; Lugt, Aad van der; Hutsebaut, Jacques; Mathieu, J; Ree, Juliette D e; Reiber, Johan H. C.; Stoel, Berend C.

doi:10.1097/00004424-200111000-00004

Cited by 78 publications

(68 citation statements)

References 11 publications

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“…27 The percentile approach may be more robust for longitudinal evaluation of emphysema, and less sensitive to change in lung volumes. [28][29][30] The first percentile value is optimal for correlation with histology. 26 However, because of concern regarding artifact from image noise and truncation artifact at the first percentile level, most studies have used the 15th percentile threshold.…”

Section: Emphysemamentioning

confidence: 99%

“…26 However, because of concern regarding artifact from image noise and truncation artifact at the first percentile level, most studies have used the 15th percentile threshold. 30,31 It is important to remember that the measurement of the percentage of low attenuation areas (%LAA), while it correlates moderately well with histologic severity of emphysema (with r values between 0.5 and 0.6), is not a direct measurement of emphysema. The term percentage of emphysema (% emphysema) is widely used to refer to such CT measurements, but is imprecise and may give rise to confusion.…”

Section: Emphysemamentioning

confidence: 99%

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Progress in Imaging COPD, 2004 - 2014

Lynch¹

2014

J COPD F

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Abbreviations: computed tomography, CT; magnetic resonance imaging, MRI; positron emission tomography, PET; Global Initiative for chronic Obstructive Lung Disease, GOLD; quantitative CT, QCT; Hounsfield Units, HU; percentage of low attenuation area, %LAA; relative area of lung less than -950 HU, RA950; Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints, ECLIPSE; forced expiratory volume in 1 second, FEV1; forced vital capacity, FVC. Journal of the COPD Foundation(GOLD) stage may have substantial, little, or no emphysema. Discrete subphenotypes of COPD include emphysema of varying morphologic appearance, large airway abnormality and small airway obstruction. Increasing awareness of the heterogeneity of COPD has led to increased use of CT to characterize COPD for purposes of genetic evaluation and identification of specific subgroups which may be amenable to therapeutic trials. 1-3 While visual assessment is important in determining the presence and character of emphysema, the last decade has been characterized by increasing use of quantitative imaging to provide precise estimates of the severity and distribution of emphysema, gas trapping and airway wall thickening. Several large cohorts of cigarette smokers have now been quite extensively characterized by CT, resulting in increased knowledge of the clinical correlates of quantitative CT parameters. [4][5][6] The purpose of this paper is to present the substantial contribution that imaging has made to our understanding of COPD over the past 10 years. AbstractComputed tomography (CT) has contributed substantially to our understanding of COPD over the past decade. Visual and quantitative assessments of CT in COPD are complementary. Visual assessment should provide assessment of centrilobular, panlobular and paraseptal emphysema, airway wall thickening, bronchiectasis, findings of respiratory bronchiolitis, and enlargement of the pulmonary artery. Quantitative CT permits evaluation of severity of emphysema, airway wall thickening, and expiratory air trapping, and is now being used for longitudinal evaluation of the progression of COPD. Innovative techniques are being developed to use CT to characterize the pattern of emphysema and smoking-related respiratory bronchiolitis. Magnetic resonance imaging (MRI) and positron emission tomography PET-CT are useful research tools in the evaluation of COPD.

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Section: Emphysemamentioning

confidence: 99%

Section: Emphysemamentioning

confidence: 99%

Progress in Imaging COPD, 2004 - 2014

Lynch¹

2014

J COPD F

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“…In the case of a four detector row MDCT, four transverse images of nominal slice thickness can be obtained per 360u rotation [9]. Current four row MDCT, depending on the manufacturer, can obtain four 1 mm or four 1.25 mm images of nominal slice thickness of both lungs in a single breath-hold, 25-30 s; eight row MDCT scanners achieve this in 10 s and 16 row MDCT can achieve this in 5 s. MDCT has shown excellent repeatability of measurement of emphysema in patients scanned 2 weeks apart [10].…”

Section: Image Acquisitionmentioning

confidence: 99%

Report of a workshop: quantitative computed tomography scanning in longitudinal studies of emphysema

Newell

Hogg²,

Snider³

2004

Eur Respir J

156

138

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It has been reported that quantitative computed tomography (CT) scanning of the lungs showed decreased progression of emphysema in a randomised clinical trial in patients with severe a 1 -antitrypsin (a 1 -AT) deficiency receiving monthly intravenous augmentation therapy with human a 1 -AT. Comparable results were not obtained using rate of decline of forced expiratory volume in one second.Accordingly, the Alpha-1 Foundation convened a workshop to explore the feasibility of using quantitative CT data as a primary outcome variable in trials of drugs for treating a 1 -AT deficiency.This report reviews the following: the principles for the use of modern CT scanners for quantifying emphysema; the methods and data on validation by comparison with measurements of severity of emphysema in inflation-fixed specimens of lungs; and the possibility of decreasing radiation dosage from CT to make it safe and ethically possible to use CT in longitudinal studies.The workshop concluded that it is feasible, safe and ethically possible to use computed tomography in longitudinal studies of emphysema. It recommended that the primary end-point should be a significant shift in the 15th percentile of lung density. Eur Respir J 2004; 23: 769-775.

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“…However, because of concerns regarding increased image artifacts and noise at the first percentile level, the 15th percentile threshold is most commonly used (8,10). The percentile index has been reported to be more robust for evaluating longitudinal variations in emphysema, and as being less sensitive to lung volume changes (8,11).…”

Section: Emphysema Quantificationmentioning

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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Repeatability of Lung Density Measurements with Low-Dose Computed Tomography in Subjects with α-1-Antitrypsin Deficiency–Associated Emphysema

Abstract: Lung density parameters of emphysema derived by MSCT provide an opportunity for analysis of the treatment effects of new drugs on the progression of emphysema.

Cited by 78 publications

References 11 publications

Progress in Imaging COPD, 2004 - 2014

Progress in Imaging COPD, 2004 - 2014

Report of a workshop: quantitative computed tomography scanning in longitudinal studies of emphysema

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

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