Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.4103/ijri.IJRI_296_17
Performance of quantitative CT parameters in assessment of disease severity in COPD: A prospective study
Subject Editor: Financial support and sponsorship Nil.
![](https://www.thieme-connect.de/media/10.1055-s-00050590/201801/lookinside/thumbnails/10-4103-ijri-ijri_296_17_99-1.jpg)
Abstract
Background: Both emphysematous destruction of lung parenchyma and airway remodeling is thought to contribute to airflow limitation in cases of chronic obstructive pulmonary disease (COPD). Objective: To evaluate the value of quantitative computed tomography (QCT) parameters of emphysema and airway disease with disease severity in patients with COPD. Materials and Methods: We prospectively studied 50 patients with COPD, which included nonsmokers and patients with different degrees of cumulative smoking exposure. Three QCT parameters namely LAA% (low attenuation area percentage), WA% (Wall area percentage), and pi10 were calculated as per the standard technique. Forced expiratory volume in 1 s (FEV1), BODE score, and MMRC dyspnea scale were used as measures of disease severity. Results: FEV1 was inversely and significantly associated with all three QCT parameters. Receiver operated characteristic curves in prediction of GOLD class 3 COPD yielded cut-off values of 12.2, 61.45, and 3.5 for LAA%, WA%, and pi10, respectively, with high sensitivities and specificities. In multiple linear regression model, however, only LAA% proved to be significantly associated with FEV1, BODE, and dyspnea. Conclusion: QCT indices of both emphysema and airway disease influence FEV1, dyspnea, and BODE score in patients with COPD. Emphysema, however, appears to be more closely related to disease severity.
Publication History
Article published online:
26 July 2021
© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
-
References
- 1 Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Bethesda, Md: National Heart, Lung, and Blood Institute, World Health Organization; 2008
- 2 Murray CJL, Lopez AD. Evidence-based health policy—Lessons from the Global Burden of Disease Study. Science 1996; 274: 740-3
- 3 Fujimoto K, Kitaguchi Y, Kubo K, Honda T. Clinical analysis of chronic obstructive pulmonary disease phenotypes classified using high-resolution computed tomography. Respirology 2006; 11: 731-40
- 4 Makita H, Nasuhara Y, Nagai K, Ito Y, Hasegawa M, Betsuyaku T. et al. Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease. Thorax 2007; 62: 932-7
- 5 Webb WR, Muller NL, Naidich DP. High-resolution CT of the lung. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009
- 6 Tschirren J, Hoffman EA, McLennan G, Sonka M. Segmentation and quantitative analysis of intrathoracic airway trees from computed tomography images. Proc Am Thorac Soc 2005; 2: 484-7
- 7 Martinez CH, Chen YH, Westgate PM, Liu LX, Murray S, Curtis JL. et al. Relationship between quantitative CT metrics and health status and BODE in chronic obstructive pulmonary disease. Thorax 2012; 67: 399-406
- 8 Patel BD, Coxson HO, Pillai SG, Agusti AG, Calverley PM, Donner CF. et al. Airway Wall Thickening and Emphysema Show Independent Familial Aggregation in COPD. Am J Respir Crit Care Med 2008; 178: 500-5
- 9 Nakano Y, Wong JC, de Jong PA, Buzatu L, Nagao T, Coxson HO. et al. The prediction of small airway dimensions using computed tomography. Am J Respir Crit Care Med 2005; 171: 142-6
- 10 American Thoracic Society. Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 1995; 152: 1107e36
- 11 Launois C, Barbe C, Bertin E, Nardi J, Perotin JM, Dury S. et al. The modified medical research council scale for the assessment of dyspnea in daily living in obesity: A pilot study. BMC Pulm Med 2012; 12: 61
- 12 Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA. et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004; 350: 1005-12
- 13 Diaz AA, Bartholmai B, San José Estépar R, Ross J, Matsuoka S, Yamashiro T. et al. Relationship of emphysema and airway disease assessed by CT to exercise capacity in COPD. Respir Med 2010; 104: 1145-51
- 14 Matsuoka S, Yamashiro T, Washko GR, Kurihara Y, Nakajima Y, Hatabu H. Quantitative CT assessment of chronic obstructive pulmonary disease. RadioGraphics 2010; 30: 55-66
- 15 The definition of emphysema. Report of a National Heart, Lung, and Blood Institute, Division of Lung Diseases workshop. Am Rev Respir Dis 1985; 132: 182-5
- 16 Petty TL, Silvers GW, Stanford RE. Radial traction and small airways disease in excised human lungs. Am Rev Respir Dis 1986; 133: 132-5
- 17 Jones NL, Killian KJ. Exercise limitation in health and disease. N Engl J Med 2000; 343: 632-41
- 18 Gelb AF, Schein M, Kuei J, Tashkin DP, Müller NL, Hogg JC. et al. Limited contribution of emphysema in advanced chronic obstructive pulmonary disease. Am Rev Respir Dis 1993; 147: 1157-61
- 19 Gelb AF, Hogg JC, Muller NL, Schein MJ, Kuei J, Tashkin DP. et al. Contribution of emphysema and small airways in COPD. Chest 1996; 109: 353-9
- 20 Stoel BC, Stolk J. Optimization and standardization of lung densitometry in the assessment of pulmonary emphysema. Investig Radiol 2004; 39: 681-8
- 21 Stolk J, Dirksen A, Van Der LUGT AA, Hutsebaut J, Mathieu J, de Ree J. et al. Repeatability of Lung Density Measurements with Low-Dose Computed Tomography in Subjects with α-1-Antitrypsin Deficiency–Associated Emphysema. Investig Radiol 2001; 36: 648-51
- 22 Müller NL, Staples CA, Miller RR, Abboud RT. “Density mask”. An objective method to quantitate emphysema using computed tomography. Chest 1988; 94: 782-7
- 23 Madani A, Zanen J, de Maertelaer V, Gevenois PA. Pulmonary emphysema: Objective quantification at multi-detector row CT--comparison with macroscopic and microscopic morphometry. Radiology 2006; 238: 1036-43
- 24 Lynch DA, Al-Qaisi MA. Quantitative computed tomography in chronic obstructive pulmonary disease. J Thorac Imaging 2013; 28: 284-90
- 25 Mishima M, Hirai T, Itoh H, Nakano Y, Sakai H, Muro S. et al. Complexity of terminal airspace geometry assessed by lung computed tomography in normal subjects and patients with chronic obstructive pulmonary disease. Proc Natl Acad Sci U S A 1999; 96: 8829-34
- 26 Madani A, De Maertelaer V, Zanen J, Gevenois PA. Pulmonary emphysema: radiation dose and section thickness at multidetector CT quantification--comparison with macroscopic and microscopic morphometry. Radiology 2007; 243: 250-7
- 27 Boedeker KL, McNitt-Gray MF, Rogers SR, Truong DA, Brown MS, Gjertson DW. et al. Emphysema: Effect of reconstruction algorithm on CT imaging measures. Radiology 2004; 232: 295-301
- 28 Hogg JC, Chu F, Utokaparch S, Woods R, Elliott WM, Buzatu L. et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med 2004; 350: 2645-53
- 29 Lucidarme O, Coche E, Cluzel P, Mourey-Gerosa I, Howarth N, Grenier P. Expiratory CT scans for chronic airway disease: Correlation with pulmonary function test results. AJR Am J Roentgenol 1998; 170: 301-7
- 30 Knudson RJ, Standen JR, Kaltenborn WT, Knudson DE, Rehm K, Habib MP. et al. Expiratory computed tomography for assessment of suspected pulmonary emphysema. Chest 1991; 99: 1357-66
- 31 Hansell DM, Rubens MB, Padley SP, Wells AU. Obliterative bronchiolitis: Individual CT signs of small airways disease and functional correlation. Radiology 1997; 203: 721-6
- 32 Eda S, Kubo K, Fujimoto K, Matsuzawa Y, Sekiguchi M, Sakai F. The relations between expiratory chest CT using helical CT and pulmonary function tests in emphysema. Am J Respir Crit Care Med 1997; 155: 1290-4
- 33 Matsuoka S, Kurihara Y, Yagihashi K, Nakajima Y. Quantitative assessment of peripheral airway obstruction on paired expiratory/inspiratory thin-section computed tomography in chronic obstructive pulmonary disease with emphysema. J Comput Assist Tomogr 2007; 31: 384-9
- 34 Grydeland TB, Thorsen E, Dirksen A, Jensen R, Coxson HO, Pillai SG. et al. Quantitative CT measures of emphysema and airway wall thickness are related to DLCO. Respir Med 2011; 105: 343-51
- 35 Nakano Y, Muro S, Sakai H, Hirai T, Chin K, Tsukino M. et al. Computed tomographic measurements of airway dimensions and emphysema in smokers: Correlation with lung function. Am J Respir Crit Care Med 2000; 162: 1102-8
- 36 Hasegawa M, Nasuhara Y, Onodera Y, Makita H, Nagai K, Fuke S. et al. Air ow limitation and airway dimensions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006; 173: 1309-15
- 37 Van Tho N, Ogawa E, Trang LT, Ryujin Y, Kanda R, Nakagawa H. et al. A mixed phenotype of airway wall thickening and emphysema is associated with dyspnea and hospitalization for chronic obstructive pulmonary disease. Ann Am Thorac Soc 2015; 12: 988-96
- 38 Cordasco EM, Beerel FR, Vance JW, Wende RW, Toffolo RR. Newer aspects of the pulmonary vasculature in chronic lung disease: A comparative study. Angiology 1968; 19: 399-407
- 39 Jang YM, Oh YM, Seo JB, Kim N, Chae EJ, Lee YK. et al. Quantitatively assessed dynamic contrast-enhanced magnetic resonance imaging in patients with chronic obstructive pulmonary disease: Correlation of perfusion parameters with pulmonary function test and quantitative computed tomography. Invest Radiol 2008; 43: 403-10
- 40 Butler C. Diaphragmatic changes in emphysema. Am Rev Respir Dis 1976; 114: 155-9
- 41 Lando Y, Boiselle PM, Shade D, Furukawa S, Kuzma AM, Travaline JM. et al. Effect of lung volume reduction surgery on diaphragm length in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 159: 796-805
- 42 Lee YK, Oh YM, Lee JH, Kim EK, Lee JH, Kim N. et al. Quantitative assessment of emphysema, air trapping, and airway thickening on computed tomography. Lung 2008; 186: 157-65
- 43 Mair G, Miller JJ, McAllister D, Maclay J, Connell M, Murchison JT. et al. Computed tomographic emphysema distribution: Relationship to clinical features in a cohort of smokers. Eur Respir J 2009; 33: 536-42
- 44 Sasaki T, Takahashi K, Takada N, Ohsaki Y. Ratios of peripheral-to-central airway lumen area and percentage wall area as predictors of severity of chronic obstructive pulmonary disease. Am J Roentgenol 2014; 203: 78-84
- 45 Schroeder JD, McKenzie AS, Zach JA, Wilson CG, Curran-Everett D, Stinson DS. et al. Relationships between airflow obstruction and quantitative CT measurements of emphysema, air trapping, and airways in subjects with and without chronic obstructive pulmonary disease. Am J Roentgenol 2013; 201: W460-70
- 46 Grydeland TB, Dirksen A, Coxson HO, Eagan TM, Thorsen E, Pillai SG. et al. Quantitative computed tomography measures of emphysema and airway wall thickness are related to respiratory symptoms. Am J Respir Crit Care Med 2010; 181: 353-9
- 47 Ozbay B, Uzun K, Arslan H, Zehir I. Functional and radiological impairment in women highly exposed to indoor biomass fuels. Respirology 2001; 6: 255-8