Paired inspiratory-expiratory chest CT scans to assess for small airways disease in COPD

Respiratory Research

Edwin K Silverman^1,10  James D Crapo⁵  Frank C Sciurba⁶  John D Newell³  Nathaniel Marchetti⁸  Barry J Make⁵  David A Lynch^1,11  Philip F Judy⁹  John E Hokanson⁴  MeiLan K Han¹  Paul J Friedman⁷  Sharon Lutz²  Raúl San José Estépar^1,10  George R Washko^1,10  Craig P Hersh^1,10 

[1] Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA;Department of Biostatistics, Colorado School of Public Health, Aurora, CO, USA;Department of Radiology, University of Iowa, Iowa City, IA, USA;Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA;Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA;Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA;Department of Radiology, University of California, San Diego, CA, USA;Section of Pulmonary and Critical Care Medicine, Temple University, Philadelphia, PA, USA;Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA;Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA;Department of Radiology, National Jewish Health, Denver, CO, USA

关键词: Smoking;    Lung function tests;    Small airways;    Chest CT scan;    Emphysema;   

Others  :  794781
DOI  :  10.1186/1465-9921-14-42

 received in 2012-11-08, accepted in 2013-03-14,  发布年份 2013

【 摘 要 】

Background

Gas trapping quantified on chest CT scans has been proposed as a surrogate for small airway disease in COPD. We sought to determine if measurements using paired inspiratory and expiratory CT scans may be better able to separate gas trapping due to emphysema from gas trapping due to small airway disease.

Methods

Smokers with and without COPD from the COPDGene Study underwent inspiratory and expiratory chest CT scans. Emphysema was quantified by the percent of lung with attenuation < −950HU on inspiratory CT. Four gas trapping measures were defined: (1) Exp₋₈₅₆, the percent of lung < −856HU on expiratory imaging; (2) E/I MLA, the ratio of expiratory to inspiratory mean lung attenuation; (3) RVC_856-950, the difference between expiratory and inspiratory lung volumes with attenuation between −856 and −950 HU; and (4) Residuals from the regression of Exp₋₈₅₆ on percent emphysema.

Results

In 8517 subjects with complete data, Exp₋₈₅₆ was highly correlated with emphysema. The measures based on paired inspiratory and expiratory CT scans were less strongly correlated with emphysema. Exp₋₈₅₆, E/I MLA and RVC_856-950 were predictive of spirometry, exercise capacity and quality of life in all subjects and in subjects without emphysema. In subjects with severe emphysema, E/I MLA and RVC_856-950 showed the highest correlations with clinical variables.

Conclusions

Quantitative measures based on paired inspiratory and expiratory chest CT scans can be used as markers of small airway disease in smokers with and without COPD, but this will require that future studies acquire both inspiratory and expiratory CT scans.

【 授权许可】

   
2013 Hersh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Hogg JC, Macklem PT, Thurlbeck WM: Site and nature of airway obstruction in chronic obstructive lung disease. N Engl J Med 1968, 278(25):1355-1360.
• [2]Han MK, Agusti A, Calverley PM, Celli BR, Criner G, Curtis JL, Fabbri LM, Goldin JG, Jones PW, Macnee W, Make BJ, Rabe KF, Rennard SI, Sciurba FC, Silverman EK, Vestbo J, Washko GR, Wouters EF, Martinez FJ: Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med 2010, 182(5):598-604.
• [3]Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD: Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011, 365(5):395-409.
• [4]Busacker A, Newell JD Jr, Keefe T, Hoffman EA, Granroth JC, Castro M, Fain S, Wenzel S: A multivariate analysis of risk factors for the air-trapping asthmatic phenotype as measured by quantitative CT analysis. Chest 2009, 135(1):48-56.
• [5]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(4):1290-1294.
• [6]Kubo K, Eda S, Yamamoto H, Fujimoto K, Matsuzawa Y, Maruyama Y, Hasegawa M, Sone S, Sakai F: Expiratory and inspiratory chest computed tomography and pulmonary function tests in cigarette smokers. Eur Respir J 1999, 13(2):252-256.
• [7]Lee YK, Oh YM, Lee JH, Kim EK, Kim N, Seo JB, Lee SD: Quantitative assessment of emphysema, air trapping, and airway thickening on computed tomography. Lung 2008, 186(3):157-165.
• [8]Matsuoka S, Kurihara Y, Yagihashi K, Hoshino M, Watanabe N, Nakajima Y: Quantitative assessment of air trapping in chronic obstructive pulmonary disease using inspiratory and expiratory volumetric MDCT. AJR Am J Roentgenol 2008, 190(3):762-769.
• [9]Mets OM, Murphy K, Zanen P, Gietema HA, Lammers JW, van Ginneken B, Prokop M, de Jong PA: The relationship between lung function impairment and quantitative computed tomography in chronic obstructive pulmonary disease. Eur Radiol 2012, 22(1):120-128.
• [10]O’Donnell RA, Peebles C, Ward JA, Daraker A, Angco G, Broberg P, Pierrou S, Lund J, Holgate ST, Davies DE, Delany DJ, Wilson SJ, Djukanovic R: Relationship between peripheral airway dysfunction, airway obstruction, and neutrophilic inflammation in COPD. Thorax 2004, 59(10):837-842.
• [11]Mets OM, Buckens CF, Zanen P, Isgum I, van Ginneken B, Prokop M, Gietema HA, Lammers JW, Vliegenthart R, Oudkerk M, van Klaveren RJ, de Koning HJ, Mali WP, de Jong PA: Identification of chronic obstructive pulmonary disease in lung cancer screening computed tomographic scans. JAMA 2011, 306(16):1775-1781.
• [12]Regan EA, Hokanson JE, Murphy JR, Make B, Lynch DA, Beaty TH, Curran-Everett D, Silverman EK, Crapo JD: Genetic epidemiology of COPD (COPDGene) study design. COPD 2010, 7(1):32-43.
• [13]Mahler DA, Wells CK: Evaluation of clinical methods for rating dyspnea. Chest 1988, 93(3):580-586.
• [14]Jones PW, Quirk FH, Baveystock CM, Littlejohns P: A self-complete measure of health status for chronic airflow limitation. The St. George’s respiratory questionnaire. Am Rev Respir Dis 1992, 145(6):1321-1327.
• [15]Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007, 176(6):532-555.
• [16]Brusasco V: Spirometric definition of COPD: exercise in futility or factual debate? Thorax 2012, 67(7):569-570.
• [17]Estepar RS, Washko GG, Silverman EK, Reilly JJ, Kikinis R, Westin CF: Accurate airway wall estimation using phase congruency. Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv 2006, 9(Pt 2):125-134.
• [18]Hersh CP, Washko GR, Jacobson FL, Gill R, Estepar RS, Reilly JJ, Silverman EK: Interobserver variability in the determination of upper lobe-predominant emphysema. Chest 2007, 131(2):424-431.
• [19]Gevenois PA, De Vuyst P, de Maertelaer V, Zanen J, Jacobovitz D, Cosio MG, Yernault JC: Comparison of computed density and microscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 1996, 154(1):187-192.
• [20]Nakano Y, Wong JC, de Jong PA, Buzatu L, Nagao T, Coxson HO, Elliott WM, Hogg JC, Pare PD: The prediction of small airway dimensions using computed tomography. Am J Respir Crit Care Med 2005, 171(2):142-146.
• [21]Hersh CP, Hokanson JE, Lynch DA, Washko GR, Make BJ, Crapo JD, Silverman EK: Family history is a risk factor for COPD. Chest 2011, 140(2):343-350.
• [22]Kim DK, Jacobson FL, Washko GR, Casaburi R, Make BJ, Crapo JD, Silverman EK, Hersh CP: Clinical and radiographic correlates of hypoxemia and oxygen therapy in the COPDGene study. Respir Med 2011, 105(8):1211-1221.
• [23]Rambod M, Porszasz J, Make BJ, Crapo JD, Casaburi R: Six-minute walk distance predictors, including CT scan measures, in the COPDGene cohort. Chest 2012, 141(4):867-875.
• [24]Shaker SB, Stavngaard T, Laursen LC, Stoel BC, Dirksen A: Rapid fall in lung density following smoking cessation in COPD. COPD 2011, 8(1):2-7.
• [25]Washko GR, Hunninghake GM, Fernandez IE, Nishino M, Okajima Y, Yamashiro T, Ross JC, Estepar RS, Lynch DA, Brehm JM, Andriole KP, Diaz AA, Khorasani R, D’Aco K, Sciurba FC, Silverman EK, Hatabu H, Rosas IO: Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med 2011, 364(10):897-906.
• [26]Wan ES, Hokanson JE, Murphy JR, Regan EA, Make BJ, Lynch DA, Crapo JD, Silverman EK: Clinical and radiographic predictors of GOLD-unclassified smokers in the COPDGene study. Am J Respir Crit Care Med 2011, 184(1):57-63.
• [27]Newman KB, Lynch DA, Newman LS, Ellegood D, Newell JD Jr: Quantitative computed tomography detects air trapping due to asthma. Chest 1994, 106(1):105-109.
• [28]Dame Carroll JR, Chandra A, Jones AS, Berend N, Magnussen JS, King GG: Airway dimensions measured from micro-computed tomography and high-resolution computed tomography. Eur Respir J 2006, 28(4):712-720.
• [29]Han MK, Kazerooni EA, Lynch DA, Liu LX, Murray S, Curtis JL, Criner GJ, Kim V, Bowler RP, Hanania NA, Anzueto AR, Make BJ, Hokanson JE, Crapo JD, Silverman EK, Martinez FJ, Washko GR: Chronic obstructive pulmonary disease exacerbations in the COPDGene study: associated radiologic phenotypes. Radiology 2011, 261(1):274-282.
• [30]Kim V, Han MK, Vance GB, Make BJ, Newell JD, Hokanson JE, Hersh CP, Stinson D, Silverman EK, Criner GJ: The chronic bronchitic phenotype of COPD: an analysis of the COPDGene Study. Chest 2011, 140(3):626-633.
• [31]Diaz AA, Come CE, Ross JC, San Jose Estepar R, Han MK, Loring SH, Silverman EK, Washko GR: Association between airway caliber changes with lung inflation and emphysema assessed by volumetric CT scan in subjects with COPD. Chest 2012, 141(3):736-744.
• [32]Martinez CH, Chen YH, Westgate PM, Liu LX, Murray S, Curtis JL, Make BJ, Kazerooni EA, Lynch DA, Marchetti N, Washko GR, Martinez FJ, Han MK: Relationship between quantitative CT metrics and health status and BODE in chronic obstructive pulmonary disease. Thorax 2012, 67(5):399-406.
• [33]Vestbo J, Anderson W, Coxson HO, Crim C, Dawber F, Edwards L, Hagan G, Knobil K, Lomas DA, MacNee W, Silverman EK, Tal-Singer R: Evaluation of COPD longitudinally to identify predictive surrogate End-points (ECLIPSE). Eur Respir J 2008, 31(4):869-873.
• [34]Silverman EK, Vestbo J, Agusti A, Anderson W, Bakke PS, Barnes KC, Barr RG, Bleecker ER, Boezen HM, Burkart KM, Celli BR, Cho MH, Cookson WO, Croxton T, Daley D, DeMeo DL, Gan W, Garcia-Aymerich J, Hall IP, Hansel NN, Hersh CP, Kalsheker N, Kiley JP, Kim WJ, Lambrechts D, Lee SD, Litonjua AA, Lomas DA, London SJ, Nishimura M: Opportunities and challenges in the genetics of COPD 2010: an international COPD genetics conference report. COPD 2011, 8(2):121-135.