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PHYSIOLOGIC AND QUANTITATIVE COMPUTED TOMOGRAPHY DIFFERENCES BETWEEN CENTRILOBULAR AND PANLOBULAR EMPHYSEMA IN COPD.

ABSTRACT: BACKGROUND:The purpose was to define the differences between centrilobular (CLE) and panlobular emphysema (PLE) phenotypes in cigarette smokers with COPD by a combined qualitative-quantitative computed tomography (CT) analysis. METHODS:Chest CT scans of 116 cigarette smokers were visually scored by 22 chest radiologists and 29 pulmonologists in a single setting for the predominant emphysema phenotype (e.g. CLE or PLE) and automatically quantified for emphysema{% low attenuation area (LAA) ? -950 HU - %LAAinsp-950, gas trapping extent and bronchial metrics{wall area % for segmental (%WAsegm) and subsegmental (%WAsubsegm) bronchi}. These quantitative CT indexes were compared and related to FEV1, FEV1/FVC, and smoking history as stratified for emphysema phenotype. RESULTS:Although more frequent than CLE in GOLD stages 3 and 4 (p = 0.01), PLE was also scored in 38.2% of combined GOLD stages 1 and 2. PLE was positively associated with %LAAinsp-950 (OR = 1.18, 95% CI: 1.12 to 1.27, ? coefficient = 0.17, p = <0.0001) and negatively associated with pack-years of smoking (OR = 0.97, 95% CI: 0.95 to 0.99, ? coefficient = -0.02, p = 0.03). Both %WAsegm and %WAsubsegm were more strongly associated with FEV1% (R2 = 0.6 for both measures, p< 0.001) in CLE as compared to PLE (R2= 0.15, p = 0.02; R2 = 0.26, p< 0.001). CONCLUSIONS:PLE likely represents a more advanced phase of emphysema, which may also occur in earlier COPD stages and show different interplay with airway disease as compared to CLE.

SUBMITTER: Sverzellati N

PROVIDER: S-EPMC4447143 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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PHYSIOLOGIC AND QUANTITATIVE COMPUTED TOMOGRAPHY DIFFERENCES BETWEEN CENTRILOBULAR AND PANLOBULAR EMPHYSEMA IN COPD.

Sverzellati Nicola N Lynch David A DA Pistolesi Massimo M Kauczor Hans-Ulrich HU Grenier P A PA Wilson C C Crapo J D JD

Chronic obstructive pulmonary diseases (Miami, Fla.) 20140101 1

<h4>Background</h4>The purpose was to define the differences between centrilobular (CLE) and panlobular emphysema (PLE) phenotypes in cigarette smokers with COPD by a combined qualitative-quantitative computed tomography (CT) analysis.<h4>Methods</h4>Chest CT scans of 116 cigarette smokers were visually scored by 22 chest radiologists and 29 pulmonologists in a single setting for the predominant emphysema phenotype (e.g. CLE or PLE) and automatically quantified for emphysema{% low attenuation ar ...[more]

PMID: 26029738

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Project description:BackgroundIn chronic obstructive pulmonary disease (COPD) abnormal lung function is related to emphysema and airway obstruction, but their relative contribution in each GOLD-stage is not fully understood. In this study, we used quantitative computed tomography (QCT) parameters for phenotyping of emphysema and airway abnormalities, and to investigate the relative contribution of QCT emphysema and airway parameters to airflow limitation specifically in each GOLD stage.MethodsNon-contrast computed tomography (CT) of 492 patients with COPD former GOLD 0 COPD and COPD stages GOLD 1-4 were evaluated using fully automated software for quantitative CT. Total lung volume (TLV), emphysema index (EI), mean lung density (MLD), and airway wall thickness (WT), total diameter (TD), lumen area (LA), and wall percentage (WP) were calculated for the entire lung, as well as for all lung lobes separately. Results from the 3rd-8th airway generation were aggregated (WT3-8, TD3-8, LA3-8, WP3-8). All subjects underwent whole-body plethysmography (FEV1%pred, VC, RV, TLC).ResultsEI was higher with increasing GOLD stages with 1.0 ± 1.8% in GOLD 0, 4.5 ± 9.9% in GOLD 1, 19.4 ± 15.8% in GOLD 2, 32.7 ± 13.4% in GOLD 3 and 41.4 ± 10.0% in GOLD 4 subjects (p < 0.001). WP3-8 showed no essential differences between GOLD 0 and GOLD 1, tended to be higher in GOLD 2 with 52.4 ± 7.2%, and was lower in GOLD 4 with 50.6 ± 5.9% (p = 0.010 - p = 0.960). In the upper lobes WP3-8 showed no significant differences between the GOLD stages (p = 0.824), while in the lower lobes the lowest WP3-8 was found in GOLD 0/1 with 49.9 ± 6.5%, while higher values were detected in GOLD 2 with 51.9 ± 6.4% and in GOLD 3/4 with 51.0 ± 6.0% (p < 0.05). In a multilinear regression analysis, the dependent variable FEV1%pred can be predicted by a combination of both the independent variables EI (p < 0.001) and WP3-8 (p < 0.001).ConclusionQCT parameters showed a significant increase of emphysema from GOLD 0-4 COPD. Airway changes showed a different spatial pattern with higher values of relative wall thickness in the lower lobes until GOLD 2 and subsequent lower values in GOLD3/4, whereas there were no significant differences in the upper lobes. Both, EI and WP5-8 are independently correlated with lung function decline.

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Dataset Information

PHYSIOLOGIC AND QUANTITATIVE COMPUTED TOMOGRAPHY DIFFERENCES BETWEEN CENTRILOBULAR AND PANLOBULAR EMPHYSEMA IN COPD.

Publications

PHYSIOLOGIC AND QUANTITATIVE COMPUTED TOMOGRAPHY DIFFERENCES BETWEEN CENTRILOBULAR AND PANLOBULAR EMPHYSEMA IN COPD.

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