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

Newell, John D.; Hogg, James C.; Snider, G. L.

doi:10.1183/09031936.04.00026504

Cited by 156 publications

(144 citation statements)

References 53 publications

(67 reference statements)

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“…(7)(8)(9)(10)(11)(12)(13)(14)(15) The method has been recommended for use in longitudinal studies of emphysema and is currently considered to be better than functional tests for disease assessment. (6,16) In addition, previous studies have reported that the correlation between CT densitometry and macroscopic morphometry is higher than is that between macroscopic morphometry and subjective visual grading of emphysema. (14) Emphysema has a long and silent asymptomatic evolution, manifesting clinically only at an advanced stage.…”

Section: Discussionmentioning

confidence: 97%

“…A PD of 15% has been proposed as a parameter to evaluate emphysema progression. (6) However, Madani et al (11) found that a PD of 1% correlated best with histopathological findings. We chose to use EI rather than PD because we do not agree that PD, regardless of the chosen setting, can actually quantify emphysema.…”

Section: Discussionmentioning

confidence: 99%

“…(5) Because pulmonary emphysema is defined on an anatomical basis, CT is currently the modality of choice for an accurate and noninvasive assessment of in vivo pathological changes. (6) Additionally, HRCT and helical CT can detect and quantify pulmonary emphysema, HRCT and helical CT findings correlating well with histopathological findings. (7)(8)(9)(10)(11)(12)(13)(14) Finally, modern CT scanners with multiple rows of detectorsmultidetector CT (MDCT)-allow the acquisition of thin (< 1-mm) slices of the whole chest in a few seconds, improving spatial resolution and avoiding respiratory artifacts.…”

Section: Introductionmentioning

confidence: 99%

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Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

et al. 2012

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Objective: To investigate the effects of age on pulmonary emphysema, based on the values of the emphysema index (EI) in a cohort of patients who had never smoked and who had no recognizable lung disease. Methods: We reviewed the CT scans, reported as normal, of 315 patients. Exclusion criteria were a history of smoking, cardiorespiratory disease, and exposure to drugs that could cause lung disease. From this cohort, we selected 32 patients (16 men and 16 women), matched for gender and body mass index, who were divided equally into two groups by age (< 50 years and ≥ 50 years). We quantified emphysema using a computer program specific to that task. The EI was calculated with a threshold of −950 HU. We also evaluated total lung volume (TLV) and mean lung density (MLD). Results: The overall means for TLV, MLD, and EI were 5,027 mL, −827 HU, and 2.54%, respectively. Mean values in the older and younger groups, respectively, were as follows: for TLV, 5,229 mL vs. 4,824 mL (p > 0.05); for MLD, −846 HU vs. −813 HU (p < 0.04); and for EI, 3.30% vs. 1.28% (p < 0.001). Significant correlations were found between EI and age (r = 0.66; p = 0.001), EI and TLV (r = 0.58; p = 0.001), and EI and MLD (r = −0.67; p < 0.001). The predicted EI per age was defined by the regression equation (r 2 = 0.43): p50(EI) = 0.049 × age − 0.5353. Conclusions: It is important to consider the influence of age when quantifying emphysema in patients over 50 years of age. Based on the regression analysis, EI values of 2.6%, 3.5%, and 4.5% can be considered normal for patients 30, 50, and 70 years of age, respectively. Keywords: Pulmonary emphysema; Tomography, spiral computed; Aging; Pulmonary disease, chronic obstructive. ResumoObjetivo: Investigar os efeitos da idade no enfisema pulmonar, com base nos valores do índice de enfisema (IE) em uma coorte de pacientes que nunca fumou e que não possuía doença pulmonar conhecida. Métodos: Foram revisados exames de TC, considerados normais, de 315 pacientes. Tabagismo, doenças cardiorrespiratórias e exposição a drogas que poderiam causar doença pulmonar foram critérios de exclusão. Dessa coorte, selecionamos 32 pacientes (16 homens e 16 mulheres), igualmente divididos em dois grupos (idade < 50 anos e idade ≥ 50 anos), que foram pareados por gênero e índice de massa corpórea. Realizou-se a quantificação do enfisema utilizando um programa específico. O IE foi calculado com um limiar de −950 UH. O volume pulmonar total (VPT) e a densidade pulmonar média (DPM) também foram avaliados. Resultados: As médias gerais de VPT, DPM e IE foram 5.027 mL, −827 UH e 2,54%, respectivamente. A comparação entre os mais velhos e os mais novos mostrou as seguintes médias: VPT (5.229 mL vs. 4.824 mL; p > 0,05); DPM (−846 UH vs. −813 UH; p < 0,04) e IE (3,30% vs. 1,28%; p < 0,001). Houve correlações significativas entre IE e idade (r = 0,66; p = 0,001), IE e VPT (r = 0,58; p = 0,001) e IE e DPM (r = −0,67; p < 0,001). O IE previsto por idade foi definido através da equação de regressão (r 2 = 0,43): p50(IE) = 0,049 × i...

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

et al. 2012

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“…HRCT imaging detects early emphysema by identifying pulmonary tissue with radiologic attenuation below a predetermined threshold, findings that roughly correlate with a low DL CO and pathologic evidence of emphysema (74)(75)(76)(77)(78)(79)(80). Although several studies have shown that a significant proportion of asymptomatic smokers have HRCT evidence of emphysema (78,(81)(82)(83), early HRCT findings of ''emphysema'' are not proven to be correlated directly with lung destruction (84)(85)(86)(87)(88)(89)(90).…”

Section: Early Detection Of Lung Destructionmentioning

confidence: 99%

Circulating Endothelial Microparticles as a Measure of Early Lung Destruction in Cigarette Smokers

Gordon

Gudi

Krause

et al. 2011

Am J Respir Crit Care Med

200

173

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Rationale: There is increasing evidence that emphysema is associated with primary loss of pulmonary capillary endothelium. Plasma levels of endothelial microparticles (EMPs), small vesicles released from activated or apoptotic endothelial cells, are elevated in vascularrelated disorders. Objectives: To evaluate whether plasma EMP levels are elevated in smokers with early lung destruction as assessed by normal spirometry but reduced diffusing capacity of the lung for carbon monoxide (DL CO ). Methods: Lung health was assessed by pulmonary function tests (PFTs: spirometry, total lung capacity, DL CO ) and chest X-ray; smoking status was assessed by urine nicotine and cotinine. EMP levels (CD42b 2 CD31 1 microparticles) were quantified as activated or apoptotic. The initial cohort (n 5 92) included healthy nonsmokers (normal PFTs), healthy smokers (normal PFTs), and smokers with early evidence of lung destruction (normal spirometry, low DL CO ). Two prospective cohorts were then tested: a group similar to the initial cohort and an HIV1 1 cohort. Measurements and Main Results: Healthy smokers had mildly increased levels of EMPs. Strikingly, 95% of smokers with normal spirometry, low DL CO had increased EMPs, with reduced CD62 1 / CD31 1 ratios (P , 10 24 ) and elevated CD42b 2 CD31 1 annexin V 1 EMPs (P , 10 24 ), suggesting derivation from endothelial apoptosis. Most elevated EMPs were angiotensin-converting enzyme positive, suggesting derivation from pulmonary capillaries. Both prospective cohorts confirmed the initial cohort data. Conclusions: Plasma EMPs with apoptotic characteristics are elevated in smokers with normal spirometry but reduced DL CO , consistent with the concept that emphysema is associated, in part, with capillary endothelium apoptosis, suggesting that the early development of emphysema might be monitored with plasma EMP levels.

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“…The effective radiation dose to the chest for a helical CT examination has been estimated to be 8.9 to 10.9 milliSieverts. Conventional examinations are done with a mAs setting of 180 to 240, but with a kVp of 120 to 140, doses of 100 mAs are common in chest screening, and 20 t 40 mAs can be used for emphysema quantification, representing a 6-to 10-fold dose reduction (33). The noise level of the image, and hence the variance of the density or the blurriness of the structures, varies with the dose.…”

Section: Radiation Dose Effectsmentioning

confidence: 99%

Imaging Studies in Emphysema

Friedman¹

2008

Proceedings of the American Thoracic Society

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Definitions of types of emphysema within the framework of chronic obstructive pulmonary disease are given. The classic findings on the chest radiograph are described, and the advances in sensitivity and specificity achieved with computed tomography (CT) scanning are noted. The ''density mask'' and the ''percentile point'' measurements rely on the densitometric property of X-rays, but the scan also shows the severity and distribution of low-attenuation regions that usually represent pathologic emphysema. The alteration of absolute density with changes in lung inflation, CT slice thickness, collimation, and reconstruction algorithm make comparison between CT scans and across studies more difficult. Nevertheless, quantitative CT has superseded subjective scoring of scan appearance by readers as a sensitive way to measure emphysema.

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

Cited by 156 publications

References 53 publications

Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

Circulating Endothelial Microparticles as a Measure of Early Lung Destruction in Cigarette Smokers

Imaging Studies in Emphysema

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