The evolving role of MDCT in the assessment of patients with chronic obstructive pulmonary disease

Karia, Sumit; Mahadeva, Ravi; Balan, Anu; Babar, Judith

doi:10.1016/j.crad.2015.02.015

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…Emphysema is defined as a permanent enlargement of the airspace distal to the terminal bronchioles, with destruction of the alveolar wall and loss of alveolar attachments. Emphysematous changes were observed as low attenuation areas on computed tomography (CT) [ 9 ]. Although the low attenuation value could well affect the dose distribution for SBRT for lung tumor, it appears that this has not been well studied to date.…”

Section: Introductionmentioning

confidence: 99%

The impact of emphysema on dosimetric parameters for stereotactic body radiotherapy of the lung

Ochiai¹,

Nomoto²,

Yamashita³

et al. 2016

Journal of Radiation Research

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The purpose of this study was to evaluate the impact of emphysematous changes in lung on dosimetric parameters in stereotactic body radiation therapy (SBRT) for lung tumor. A total of 72 treatment plans were reviewed, and dosimetric factors [including homogeneity index (HI) and conformity index (CI)] were evaluated. Emphysematous changes in lung were observed in 43 patients (60%). Patients were divided into three groups according to the severity of emphysema: no emphysema (n = 29), mild emphysema (n = 22) and moderate to severe emphysema groups (n = 21). The HI (P < 0.001) and the CI (P = 0.029) were significantly different in accordance with the severity of emphysema in one-way analysis of variance (ANOVA). The HI value was significantly higher in the moderate to severe emphysema group compared with in the no emphysema (Tukey, P < 0.001) and mild emphysema groups (P = 0.002). The CI value was significantly higher in the moderate to severe emphysema group compared with in the no emphysema group (P = 0.044). In multiple linear regression analysis, the severity of emphysema (P < 0.001) and the mean material density of the lung within the PTV (P < 0.001) were significant factors for HI, and the mean density of the lung within the PTV (P = 0.005) was the only significant factor for CI. The mean density of the lung within the PTV was significantly different in accordance with the severity of emphysema (one-way ANOVA, P = 0.008) and the severity of emphysema (P < 0.001) was one of the significant factors for the density of the lung within the PTV in multiple linear regression analysis. Our results suggest that emphysematous changes in the lung significantly impact on several dosimetric parameters in SBRT, and they should be carefully evaluated before treatment planning.

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Section: Introductionmentioning

confidence: 99%

The impact of emphysema on dosimetric parameters for stereotactic body radiotherapy of the lung

Ochiai¹,

Nomoto²,

Yamashita³

et al. 2016

Journal of Radiation Research

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“…Quantitatively, it allows assessment of the density of each voxel (three-dimensional [3D] volume unit representing a pixel on the 2D image) of lung parenchyma using vendor-specific software that calculates total lung volume (TLV) and emphysematous volume (EV) of both lungs. 3 The typical value for the attenuation coefficient, Housefield units, is set at -950 to differentiate between emphysema (seen as red dots) and normal lung tissue (Figure).3 The EV/TLV or the emphysema ratio (ER) (%) can then be calculated for individual lobes of the lungs.2 The Figure shows an overall ER of 17.1%, which signifies that at least 17% of the patient's lungs are not The table in the lower aspect of the image reflects the ratio between the air-trapped emphysematous volume (EV) and normal lung volumes. The blue areas are the large airways and were not included in the calculation of this patient's 17.1% EV ratio.…”

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confidence: 99%

“…2 Quantitatively, it allows assessment of the density of each voxel (three-dimensional [3D] volume unit representing a pixel on the 2D image) of lung parenchyma using vendor-specific software that calculates total lung volume (TLV) and emphysematous volume (EV) of both lungs. 3 The typical value for the attenuation coefficient, Housefield units, is set at -950 to differentiate between emphysema (seen as red dots) and normal lung tissue (Figure). 3 The EV/TLV or the emphysema ratio (ER) (%) can then be calculated for individual lobes of the lungs.…”

mentioning

confidence: 99%

“…3 The typical value for the attenuation coefficient, Housefield units, is set at -950 to differentiate between emphysema (seen as red dots) and normal lung tissue (Figure). 3 The EV/TLV or the emphysema ratio (ER) (%) can then be calculated for individual lobes of the lungs. 2 The Figure shows an overall ER of 17.1%, which signifies that at least 17% of the patient's lungs are not available for active air exchange while at the same time being more susceptible to developing pneumothorax due to air-trapping.…”

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confidence: 99%

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Multidetector computed tomography-derived emphysema index for preoperative quantification of emphysema severity

Agarwal

Najim

Keshavamurthy

2016

Can J Anesth/J Can Anesth

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Emphysema is a chronic obstructive airway disease (COPD) characterized by loss of elastic recoil of the lungs, which results in alveolar hyperinflation and collapse of the airways during exhalation. This disease presents multiple challenges during anesthesia, and assessing its severity preoperatively may help with intraoperative management.Pulmonary function tests provide only functional information, and conventional chest radiography provides only a gross estimation of disease severity. Multidetector computed tomography (MDCT) combined with dedicated post-processing software however, is a novel tool that utilizes high-resolution imaging, thereby allowing quantitative assessment of emphysema. This rapidly evolving technology provides detailed anatomical information about lung parenchyma, the airways, and the distribution of emphysematous lung tissue.1 It requires no intravenous contrast material and can be used to differentiate between airway-predominant and emphysema-predominant COPD. Quantitatively, it allows assessment of the density of each voxel (three-dimensional [3D] volume unit representing a pixel on the 2D image) of lung parenchyma using vendor-specific software that calculates total lung volume (TLV) and emphysematous volume (EV) of both lungs. 3 The typical value for the attenuation coefficient, Housefield units, is set at -950 to differentiate between emphysema (seen as red dots) and normal lung tissue (Figure).3 The EV/TLV or the emphysema ratio (ER) (%) can then be calculated for individual lobes of the lungs.2 The Figure shows an overall ER of 17.1%, which signifies that at least 17% of the patient's lungs are not The table in the lower aspect of the image reflects the ratio between the air-trapped emphysematous volume (EV) and normal lung volumes. The blue areas are the large airways and were not included in the calculation of this patient's 17.1% EV ratio.

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The role of a multidisciplinary severe chronic obstructive pulmonary disease hyperinflation service in patient selection for lung volume reduction

Chew¹,

Mahadeva²

2018

J. Thorac. Dis

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Chronic obstructive pulmonary disease (COPD) is a complex disease and the management is focused on improving breathlessness, quality of life and healthcare utilisation. Our understanding of COPD phenotypes has improved in recent years and there is an increased drive towards delivering phenotypebased therapies. Lung volume reduction can offer the prospect of life changing benefit in breathlessness and quality of life in a select group of patients with severe emphysema already receiving maximum medical treatment. In spite of the available evidence, very few procedures are being performed relative to the disease burden and prevalence of suitable individuals. Currently the major barriers to patient accessibility are lack in standardised multidisciplinary severe COPD services with easy access to lung volume reduction procedures, as well as poorly informed perceptions of healthcare professionals. There is a recognised need to improve such services in many healthcare systems. We share our experiences with setting up and running a successful regional multidisciplinary severe COPD hyperinflation service.

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The evolving role of MDCT in the assessment of patients with chronic obstructive pulmonary disease

Cited by 3 publications

References 16 publications

The impact of emphysema on dosimetric parameters for stereotactic body radiotherapy of the lung

The impact of emphysema on dosimetric parameters for stereotactic body radiotherapy of the lung

Multidetector computed tomography-derived emphysema index for preoperative quantification of emphysema severity

The role of a multidisciplinary severe chronic obstructive pulmonary disease hyperinflation service in patient selection for lung volume reduction

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