Reproducibility and Validity of Lung Density Measures from Cardiac CT Scans—The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study1

Hoffman, Eric A.; Jiang, Rui; Baumhauer, Heather; Brooks, Michael; Carr, J. Jeffrey; Detrano, Robert; Reinhardt, Joseph M.; Rodriguez, Josanna; Stukovsky, Karen Hinckley; Wong, Nathan D.; Barr, R. Graham

doi:10.1016/j.acra.2008.12.024

Cited by 89 publications

(97 citation statements)

References 32 publications

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“…Previous studies that have reported inter-and intra-observer repeatability in a smoking population (19, 20) have used either spirometric or effort-driven volume control, but have rarely accounted for volume deviations. We utilized a volume-controlled pneumo-tachometer with volume monitoring that allowed us to carefully account for volume differences between scan.…”

Section: Discussionmentioning

confidence: 99%

Repeatability and Sample Size Assessment Associated with Computed Tomography-Based Lung Density Metrics

Iyer¹,

Grout²,

Zamba³

et al. 2014

J COPD F

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Rationale and Objectives Density-based metrics assess severity of lung disease but vary with lung inflation and method of scanning. The aim of this study was to evaluate the repeatability of single center, CT-based density metrics of the lung in a normal population and assess study sample sizes needed to detect meaningful changes in lung density metrics when scan parameters and volumes are tightly controlled. Materials and Methods Thirty-seven subjects (normal smokers and non-smokers) gave consent to have randomly assigned repeated, breath-held scans at either inspiration (90% vital capacity: TLC) or expiration (20% vital capacity: FRC). Repeated scans were analyzed for: mean lung density (MLD), 15th percentile point of the density histogram (P15), low attenuation areas (LAA) and alpha (fractal measure of hole size distribution). Using inter-subject differences and previously reported bias, sample size was estimated from month or yearly change in density metrics obtained from published literature (i.e. meaningful change). Results Inter-scan difference measurements were small for density metrics (ICC > 0.80) and average ICCs for whole lung alpha−910 and alpha−950 were 0.57 and 0.64, respectively. Power analyses demonstrated that, under the control conditions with minimal extrinsic variation, population sizes needed to detect meaningful changes in density measures for TLC or FRC repeated scans ranged from a few (20–40) to a few hundred subjects, respectively. Conclusion A meaningful sample size was predicted from this study using volume-controlled normal subjects in a controlled imaging environment. Under proper breath-hold conditions, high repeatability was obtained in cohorts of normal smokers and non-smokers.

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Section: Discussionmentioning

confidence: 99%

Repeatability and Sample Size Assessment Associated with Computed Tomography-Based Lung Density Metrics

Iyer¹,

Grout²,

Zamba³

et al. 2014

J COPD F

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“…12 The upper lobes are classically involved in smoking-related centrilobular emphysema, and a recent study showed that upper-lobepredominant emphysema was signifi cantly associated with greater lung function decline in former and current heavy smokers. 28 However, cardiac scans assess lower and central regions of the lung, which receive the greatest amount of pulmonary blood fl ow in the upright position.…”

Section: Acknowledgmentsmentioning

confidence: 98%

Percent Emphysema and Right Ventricular Structure and Function

Grau

Barr

Lima

et al. 2013

Chest

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“…We assessed emphysema quantitatively, which has much greater precision than radiologist assessment but for which a standard threshold of normality is currently lacking. 58,59 Therefore, we used an arbitrary but reasonable threshold of the median value of percent emphysema. Sensitivity anal yses showed that results were similar using a 25th percentile threshold and using a 2 950 HU definition (median or 25th percentile) to defi ne percent emphysema.…”

Section: Discussionmentioning

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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Reproducibility and Validity of Lung Density Measures from Cardiac CT Scans—The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study1

Cited by 89 publications

References 32 publications

Repeatability and Sample Size Assessment Associated with Computed Tomography-Based Lung Density Metrics

Repeatability and Sample Size Assessment Associated with Computed Tomography-Based Lung Density Metrics

Percent Emphysema and Right Ventricular Structure and Function

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

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