Skip to main content
SpringerLink
Log in

Bildgebung des Lungenemphysems

Imaging of emphysema

  • Leitthema
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Das Lungenemphysem, histologisch definiert als eine abnorme permanente Erweiterung der Lufträume distal der terminalen Bronchiolen, begleitet von Destruktionen der Alveolarwände und ohne Zeichen einer wesentlichen Fibrose, ist eine überaus häufige Erkrankung mit hoher Mortalität und Morbidität. Dem typischerweise beim angeborenen α1-Antitrypsinmangel angetroffenen panlobulären Emphysem steht das häufigere durch Zigarettenrauchen induzierte zentrilobuläre Emphysem gegenüber. Die Computertomographie (CT) weist im Gegensatz zum konventionellen Röntgen und zu den Lungenfunktionstests eine hohe Sensitivität für die Detektion des Emphysems auf, ermöglicht eine Bestimmung des Schweregrads, eine Quantifizierung der emphysematösen Veränderungen und weist assoziierte Veränderungen und Komplikationen nach. Das bildgebend durch das Fehlen klar definierter Ränder gekennzeichnete Emphysem ist differenzialdiagnostisch von zystischen Lungenerkrankungen, Bullae, Lungenlazerationen, der Langerhans-Zell-Histiozytose und Lymphangioleiomyomatose abzugrenzen, die computertomographisch eine Wandbegrenzung zeigen.

Abstract

Emphysema is defined as a condition of the lung characterized by abnormal, permanent enlargement of airspaces distal to the terminal bronchiole accompanied by destruction of the alveolar walls and without obvious fibrosis. It is a very common disease with high morbidity and mortality. Histopathologically, there are two types of emphysema: panlobular emphysema, typically occurring in α1-antitrypsin deficiency, and centrilobular emphysema, which is strongly associated with cigarette smoking. Computed tomography (CT) allows detection of emphysema with higher sensitivity than conventional chest radiography and pulmonary function tests. CT also allows quantification of emphysema and depicts associated changes and complications. The differential diagnosis of emphysema, which is characterized by the absence of clearly definable walls on CT, includes cystic lung disease, bullae, lung laceration, Langerhans cell histiocytosis, and lymphangioleiomyomatosis –which are all characterized by visible walls on CT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Literatur

  1. American Thoracic Society (1962) A statement by the committee on diagnostic standards for non-tuberculosis respiratory diseases: Definition and classification of chronic bronchitis, asthma and pulmonary emphysema. Am Rev Dis 85: 762–768

    Google Scholar 

  2. Stern EJ, Frank MS (1994) CT of the lung in patients with pulmonary emphysema: diagnosis, quantification, and correlation with pathologic and physiologic findings. AJR Am J Roentgenol 162: 791–798

    PubMed  Google Scholar 

  3. Jacobi V, Thalhammer A, Vogl T (2003) Erkrankungen der Atemwege. In: Freyschmidt J, Galanski M (Hrsg). Handbuch diagnostische Radiologie Thorax. Springer, Berlin Heidelberg New York, S 151–198

  4. Hansell DM (2005) Airways diseases. In: Hansell DM, Armstrong P, Lynch DA, McAdams HP (eds) Imaging of the diseases of the chest, 4th edn. Elsevier Mosby, New York

  5. Sobonya RE, Burrows B (1983) The epidemiology of emphysema. Clin Chest Med 4: 351–358

    PubMed  Google Scholar 

  6. Laurell CB, Eriksson S (1963) The electrophoretic alpha-1-globulin pattern of serum in alpha-1-antitrypsin deficiency. Scand J Clin Lab Invest 15: 132–140

    Google Scholar 

  7. Eriksson S (1964) Pulmonary emphysema and alpha-1-antitrypsin deficiency. Acta Med Scand 175: 197–205

    PubMed  Google Scholar 

  8. Gross P, Babyak MA, Tolker E, Kaschak M (1964) Enzymatically produced pulmonary emphysema: a preliminary report. J Occup Med 6: 481–484

    PubMed  Google Scholar 

  9. Kuhn C (1986) The biochemical pathogenesis of chronic obstructive pulmonary diseases: protease-antiprotease imbalance in emphysema and disease of the airways. J Thorac Imag 1: 1

    Google Scholar 

  10. Hunninghake GW, Gadek JE, Fales HM, Crystal RG (1980) Human alveolar macrophage derived chemotactic factors for neutrophils. J Clin Invest 66: 473–483

    PubMed  Google Scholar 

  11. Senior R, Connolly NL, Cury JD et al. (1989) Elastin degradation by human alveolar macrophages. Am Rev Respir Dis 139: 1251–1256

    PubMed  Google Scholar 

  12. Turner-Stokes L, Turton C, Pope FM et al. (1983) Emphysema and cutis laxa. Thorax 38: 790–792

    PubMed  Google Scholar 

  13. Bolande RP, Tucker AS (1964) Pulmonary emphysema and other cardiorespiratory lesions as part of the Marfan abiotrophy. Pediatrics 33: 356–366

    PubMed  Google Scholar 

  14. Bense L, Eklund G, Lewander R (2002) Hereditary pulmonary emphysema. Chest 121: 297–300

    Article  PubMed  Google Scholar 

  15. Macklem PT, Fraser RG, Brown WG (1965) Bronchial pressure measurements in emphysema and bronchitis. J Clin Invest 44: 897–905

    PubMed  Google Scholar 

  16. Snider GL, Kleinerman J, Thurlbeck WM et al. (1985) The definition of emphysema. Report of a National Heart, Lung, and Blood Institute, Division of Lung Diseases workshops. Am Rev Respir Dis 132: 182–185

    PubMed  Google Scholar 

  17. Kuhlman JE, Reyes BL, Hruban RH et al. (1993) Abnormal air-filled spaces in the lung. RadioGraphics 13: 47–75

    PubMed  Google Scholar 

  18. Sanders C (1991) The radiographic diagnosis of emphysema. Radiol Clin North Am 29: 1019–1030

    PubMed  Google Scholar 

  19. Glossary of terms for thoracic radiology: recommendations of the nomenclature committee of the Fleischner Society (1984). AJR Am J Roentgenol 143: 509–517

    PubMed  Google Scholar 

  20. Thurlbeck WM, Henderson JA, Fraser RG et al. (1970) Chronic obstructive lung disease: a comparison between clinical, roentgenologic, functional and morphologic criteria in chronic bronchitis, emphysema, asthma and bronchiectasis. Medicine 49: 82–145

    Article  Google Scholar 

  21. Nicklaus TM, Stowell DW, Christiansen WR et al. (1966) The accuracy of the roentgenologic diagnosis of chronic pulmonary emphysema. Am Rev Respir Dis 93: 889–899

    PubMed  Google Scholar 

  22. Katsura S, Martin CJ (1967) The roentgenologic diagnosis of anatomic emphysema. Am Rev Respir Dis 96: 700–706

    PubMed  Google Scholar 

  23. Sutinen S, Christoforidis AJ, Klugh GA et al. (1965) Roentgenologic criteria for the recognition of nonsymptomatic pulmonary emphysema. Am Rev Respir Dis 91: 69–76

    PubMed  Google Scholar 

  24. Bergin CJ, Müller NL, Miller RR (1986) CT in the qualitative assessment of emphysema. J Thorac Imaging 1: 94–103

    PubMed  Google Scholar 

  25. Adams H, Bernard MS, McConnochie K (1991) An appraisal of CT pulmonary density mapping in normal subjects. Clin Radiol 43: 238–242

    Article  PubMed  Google Scholar 

  26. Austin JHM, Müller NL, Friedman PJ et al. (1996) Glossary of terms for CT of the lungs: recommendations of the nomenclature committee of the Fleischner Society. Radiology 200: 327–331

    PubMed  Google Scholar 

  27. Mishima M, Oku Y, Kawakami K et al. (1997) Quantitative assessment of the spatial distribution of low attenuation areas on X-ray CT using texture analysis in patients with chronic pulmonary emphysema. Front Med Biol Eng 8(1): 19–34

    PubMed  Google Scholar 

  28. Watanuki Y, Suzuki S, Nishikawa M et al. (1994) Correlation of quantitative CT with selective alveolobronchogram and pulmonary function tests in emphysema. Chest 106(3): 806–813

    PubMed  Google Scholar 

  29. Müller NL, Staples CA, Miller RR et al. (1988) „Density mask“. An objective method to quantitate emphysema using computed tomography. Chest 94: 782–787

    PubMed  Google Scholar 

  30. Gevenois PA, de Maertelaer V, De Vuyst P et al. (1995) Comparison of computed density and macroscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 152: 653–657

    PubMed  Google Scholar 

  31. Mishima M, Hirai T, Itoh H et al. (1999) Complexity of terminal airspace geometry assessed by lung computed tomography in normal subjects and patients with chronic obstructive pulmonary disease. Proc Natl Acad Sci 96: 8829–8834

    Article  PubMed  Google Scholar 

  32. Bae KT, Slone RM, Gierada DS et al. (1997) Patients with emphysema: quantitative CT analysis before and after lung volume reduction surgery. Radiology 203: 705–714

    PubMed  Google Scholar 

  33. Nakano Y, Sakai H, Hirai T et al. (1999) Comparison of low attenuation areas on computed tomographic scans between inner and outer segments of the lung in patients with chronic obstructive pulmonary disease: incidence and contribution to lung function. Thorax 54: 384–389

    PubMed  Google Scholar 

  34. Gevenois PA, De Vuyst P, de Maertelaer V et al. (1996) Comparison of computed density and microscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 154: 187–192

    PubMed  Google Scholar 

  35. Gould GA, Macnee W, McLean A et al. (1988) CT measurements of lung density in life can quantitate distal airspace enlargement: an essential defining feature of human emphysema. Am Rev Respir Dis 137: 380–392

    PubMed  Google Scholar 

  36. Hayhurst MD, Flenley DC, McLean A et al. (1984) Diagnosis of pulmonary emphysema by computerised tomography. Lancet 2: 320–322

    Article  PubMed  Google Scholar 

  37. Thurlbeck WM, Dunnil MS, Hartung W et al. (1970) A comparison of three methods measuring emphysema. Hum Pathol 1:215–226

    Article  PubMed  Google Scholar 

  38. Gevenois PA, Scillia P, de Maertelaer V et al. (1996) The effects of age, sex, lung size, and hyperinflation on CT lung densitometry. AJR Am J Roentgenol 167: 1169–1173

    PubMed  Google Scholar 

  39. Gevenois PA, De Vuyst P, Sy M et al. (1996) Pulmonary emphysema: quantitative CT during exspiration. Radiology 199: 825–829

    PubMed  Google Scholar 

  40. Mishima M, Itoh H, Sakai H et al. (1999) Optimized scanning conditions of high resolution CT in the follow-up of pulmonary emphysema. J Comput Assist Tomogr 23: 380–384

    Article  PubMed  Google Scholar 

  41. Stoel BC, Vrooman HA, Stolk J et al. (1999) Sources of error in lung densitometry with CT. Invest Radiol 34: 303–309

    Article  PubMed  Google Scholar 

  42. Kohz P, Stäbler A, Beinert T et al. (1995) Reproductibility of quantitative, spirometrically controlled CT. Radiology 197: 539–542

    PubMed  Google Scholar 

  43. Kauczor HU, Heussel CP, Fisher B et al. (1998) Assessment of lung volumes using helical CT at inspiration and expiration: comparison with pulmonary function tests. AJR Am J Roentgenol 171: 1091–1095

    PubMed  Google Scholar 

  44. Lamers RJ, Thelissen GR, Kessels AG et al. (1994) Chronic obstructive pulmonary disease: evaluation with spirometrically controlled CT lung densitometry. Radiology 193: 109–113

    PubMed  Google Scholar 

  45. Uppaluri R, Mitsa T, Sonka M et al. (1997) Quantification of pulmonary emphysema from lung computed tomography images. Am J Respir Crit Care Med 156: 248–254

    PubMed  Google Scholar 

  46. Sanders C, Nath PH, Bailey WC (1988) Detection of emphysema with computed tomography: correlation with pulmonary function tests and chest radiography. Invest Radiol 23: 262–266

    Article  PubMed  Google Scholar 

  47. Gurney JW (1998) Pathophysiology of obstructive airways disease. Radiol Clin North Am 36: 15–27

    Article  PubMed  Google Scholar 

  48. Rienmüller RK, Behr J, Kalender A et al. (1991) Standardized quantitative high resolution CT in lung diseases. J Comput Assist Tomogr 15: 742–749

    PubMed  Google Scholar 

  49. Gurney JW, Jones KK, Robbins RA et al. (1992) Regional distribution of emphysema: correlation of high-resolution CT with pulmonary function tests in unselected smokers. Radiology 183: 457–463

    PubMed  Google Scholar 

  50. Haragushi M, Shimura S, Hida W, Shirato K (1998) Pulmonary function and regional distribution of emphysema as determined by high-resolution computed tomography. Respiration 65: 125–129

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Institut für Radiodiagnostik, Medizinische Universität, Währinger Gürtel 18-20, A-1090, Wien, Österreich

    C. Grosse & A. Bankier

Authors
  1. C. Grosse
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Bankier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Grosse.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grosse, C., Bankier, A. Bildgebung des Lungenemphysems. Radiologe 47, 401–406 (2007). https://doi.org/10.1007/s00117-006-1459-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-006-1459-3

Schlüsselwörter

Keywords

Search

Navigation