Whole-lung densitometry versus visual assessment of emphysema

Cavigli, Edoardo; Camiciottoli, Gianna; Diciotti, Stefano; Orlandi, Ilaria; Spinelli, Cheti; Meoni, Eleonora; Grassi, L; Farfalla, Carmela; Pistolesi, Massimo; Falaschi, Fabio; Mascalchi, Mario

doi:10.1007/s00330-009-1320-y

Cited by 64 publications

(62 citation statements)

References 44 publications

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“…15 However, observer agreement with regard to severity of emphysema on visual assessment has been quite variable and quantitative CT is preferred for assessing disease severity. 16 Bronchial wall thickening is commonly identified in heavy cigarette smokers, and is often a sign of chronic bronchitis. However, identification of bronchial wall thickening is subjective, with considerable observer variation.…”

Section: Ct: Visual Evaluationmentioning

confidence: 99%

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: Ct: Visual Evaluationmentioning

confidence: 99%

Progress in Imaging COPD, 2004 - 2014

Lynch¹

2014

J COPD F

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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 morphometric estimation at pathological examination represents the gold standard for the evaluation of pulmonary emphysema; the pathophysiological hallmark of COPD is expiratory flow limitation (6,15). Treatment guidelines note that PFT is the preferred method for the diagnosis of COPD (2,3).…”

Section: Discussionmentioning

confidence: 99%

“…Treatment guidelines note that PFT is the preferred method for the diagnosis of COPD (2,3). Radiological studies, such as HRCT and CT densitometry, are frequently used to evaluate the extent and severity of parenchymal destruction (6,16). The destructive changes in the alveolar walls distal to the terminal bronchioles result in an increased amount of air per unit area of lung parenchyma, which, in the HRCT, is visualized as areas of lower attenuation.…”

Section: Discussionmentioning

confidence: 99%