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Recent Advances in Computed Tomography Imaging in Chronic Obstructive Pulmonary Disease.

ABSTRACT: Lung imaging is increasingly being used to diagnose, quantify, and phenotype chronic obstructive pulmonary disease (COPD). Although spirometry is the gold standard for the diagnosis of COPD and for severity staging, the role of computed tomography (CT) imaging has expanded in both clinical practice and research. COPD is a heterogeneous disease with considerable variability in clinical features, radiographic disease, progression, and outcomes. Recent studies have examined the utility of CT imaging in enhancing diagnostic certainty, improving phenotyping, predicting disease progression and prognostication, selecting patients for intervention, and also in furthering our understanding of the complex pathophysiology of this disease. Multiple CT metrics show promise for use as imaging biomarkers in COPD.

SUBMITTER: Bodduluri S

PROVIDER: S-EPMC5880521 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Recent Advances in Computed Tomography Imaging in Chronic Obstructive Pulmonary Disease.

Bodduluri Sandeep S Reinhardt Joseph M JM Hoffman Eric A EA Newell John D JD Bhatt Surya P SP

Annals of the American Thoracic Society 20180301 3

Lung imaging is increasingly being used to diagnose, quantify, and phenotype chronic obstructive pulmonary disease (COPD). Although spirometry is the gold standard for the diagnosis of COPD and for severity staging, the role of computed tomography (CT) imaging has expanded in both clinical practice and research. COPD is a heterogeneous disease with considerable variability in clinical features, radiographic disease, progression, and outcomes. Recent studies have examined the utility of CT imagin ...[more]

PMID: 28812906

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Project description:BackgroundThe fractal dimension characterizing the cumulative size distribution of low attenuation area (LAA) clusters, identified with a fixed threshold such as -?950 Hounsfield Units (HU), on computed tomography (CT) sensitively detects parenchymal destruction in chronic obstructive pulmonary disease (COPD) even when the percent LAA (LAA%), a standard emphysema index, is unchanged. This study examines whether the cumulative size distribution of LAA clusters, defined with thresholds of the 15th, 25th, and 35th percentiles of a CT density histogram instead of the fixed-threshold of -?950 HU, exhibits a fractal property and whether its fractal dimension (D'15, D'25, and D'35, respectively) provides additional structural information in emphysematous lungs that is difficult to detect with the conventional -?950-HU-based fractal dimension (D950).MethodsChest inspiratory CT scans and pulmonary functions were cross-sectionally examined in 170 COPD subjects. A proxy for the inspiration level at CT scan was obtained by dividing CT-measured total lung volume (CT-TLV) by physiologically measured total lung capacity. Moreover, long-term (>?5 years) changes in D950 and the new fractal dimensions were longitudinally evaluated in 17 current and 42 former smokers with COPD.ResultsD950, but not D'15, D'25, or D'35 was weakly correlated with the proxy for the inspiration. D950, D'25, and D'35 but not D'15 correlated with LAA% and diffusion capacity. In the long-term longitudinal study, LAA% was increased and D950 and D'35 were decreased in both current and former smokers, while D'25 was decreased only in current smokers and D'15 was not changed in either group. The longitudinal changes in D'25 but not those in LAA%, D950, D'15, and D'35 were greater in current smokers than in former smokers. This greater change in D'25 in current smokers was confirmed after adjusting the change in CT-TLV and the baseline D'25.ConclusionsD'25 reflects diffusion capacity in emphysematous lungs and is robust against inspiration levels during CT scans. This new fractal dimension might provide additional structural information that is difficult to detect with the conventional D950 and LAA% and allow for more sensitive evaluation of emphysema progression over time.

Project description:RationaleThe rate of decline of lung function is greater than age-related change in a substantial proportion of patients with chronic obstructive pulmonary disease, even after smoking cessation. Regions of the lung adjacent to emphysematous areas are subject to abnormal stretch during respiration, and this biomechanical stress likely influences emphysema initiation and progression.ObjectivesTo assess whether quantifying this penumbra of lung at risk would predict FEV1 decline.MethodsWe analyzed paired inspiratory-expiratory computed tomography images at baseline of 680 subjects participating in a large multicenter study (COPDGene) over approximately 5 years. By matching inspiratory and expiratory images voxel by voxel using image registration, we calculated the Jacobian determinant, a measure of local lung expansion and contraction with respiration. We measured the distance between each normal voxel to the nearest emphysematous voxel, and quantified the percentage of normal voxels within each millimeter distance from emphysematous voxels as mechanically affected lung (MAL). Multivariable regression analyses were performed to assess the relationship between the Jacobian determinant, MAL, and FEV1 decline.Measurements and main resultsThe mean (SD) rate of decline in FEV1 was 39.0 (58.6) ml/yr. There was a progressive decrease in the mean Jacobian determinant of both emphysematous and normal voxels with increasing disease stage (P < 0.001). On multivariable analyses, the mean Jacobian determinant of normal voxels within 2 mm of emphysematous voxels (MAL2) was significantly associated with FEV1 decline. In mild-moderate disease, for participants at or above the median MAL2 (threshold, 36.9%), the mean decline in FEV1 was 56.4 (68.0) ml/yr versus 43.2 (59.9) ml/yr for those below the median (P = 0.044).ConclusionsAreas of normal-appearing lung are mechanically influenced by emphysematous areas and this lung at risk is associated with lung function decline. Clinical trial registered with www.clinicaltrials.gov (NCT00608764).

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Recent Advances in Computed Tomography Imaging in Chronic Obstructive Pulmonary Disease.

Publications

Recent Advances in Computed Tomography Imaging in Chronic Obstructive Pulmonary Disease.

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