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How much do GOLD stages reflect CT abnormalities in COPD patients?

Fino a che punto la stadiazione GOLD riflette le alterazioni TC nei pazienti con BPCO?

  • Chest Radiology/Radiologia Toracica
  • Published:
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Abstract

Purpose

Severity of chronic obstructive pulmonary disease (COPD) can be graded using the classification released in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report. Such classification is essentially based on spirometry and does not recognise the role of other measures. The aim of this study was to assess whether the GOLD stages correlate with the extent of pulmonary emphysema and other ancillary computed tomography CT features in a population of smokers with stable COPD.

Materials and methods

Based on clinical assessment and lung-function testing, patients were classified according to the GOLD criteria. CT scans were visually evaluated for extent of emphysema and airway abnormalities.

Results

A total of 43 patients were enrolled. The amount of emphysema was described as minimal in six patients with stage 0, and as moderate in seven patients with stage 0. In stages I and II, the extent of emphysema ranged from minimal to severe, whereas we observed the presence of severe emphysema in most patients in stages III and IV. According to the regression model, only CT emphysema extent independently predicted the GOLD stage (r 2=0.58; p<0.001). The cutoff value of emphysema extent of 31.5% allowed us to distinguish patients with a GOLD stage ≥III.

Conclusions

Although we found a significant correlation between CT emphysema extent and GOLD stages, different percentage of emphysema extent can be observed among each GOLD stage. The upper limit of 31.5% of emphysema extent may indicate a boundary for a clinically worsening status.

Riassunto

Obiettivo

La gravità della broncopneumopatia cronica ostruttiva (BPCO) può essere classificata impiegando una stadiazione stilata dal Progetto Mondiale per la Diagnosi, il Trattamento e la Prevenzione della Broncopneumopatia Cronica Ostruttiva (Global Iniziative for the diagnosis, Management and Prevention of Chronic Obstructive Lung Disease — GOLD). Tale classificazione è basata essenzialmente sulla spirometria e non riconosce il ruolo di altri parametri. Lo scopo del nostro studio è valutare se le classi GOLD correlano con l’estensione dell’enfisema polmonare ed altre caratteristiche rilevabili alla TC in una popolazione di fumatori con BPCO in fase stabilizzata.

Materiali e metodi

Sulla base dei test di funzionalità polmonare e sulla valutazione clinica, i pazienti sono stati classificati secondo i criteri GOLD. Le scansioni TC sono state studiate visivamente per valutare l’estensione dell’enfisema e le anomalie delle vie aeree.

Risultati

Sono stati esaminati 43 pazienti. La quantità di enfisema era minima in 6 pazienti in stadio 0, mentre in 7 pazienti nella stessa classe era moderata. Nelle classi I ed II, l’estensione dell’enfisema variava da minima a severa, mentre nella maggior parte dei pazienti in stadio III e IV abbiamo osservato enfisema di grado severo. Secondo il modello di regressione, soltanto il valore di estensione dell’ enfisema, valutato alla TC, ha predetto in modo indipendente la classe GOLD (r 2=0,58; p<0,001). Il valore cut-off di estensione dell’enfisema pari a 31,5% ci ha permesso di distinguere i pazienti appartenenti ad uno stadio GOLD superiore a III.

Conclusioni

Anche se abbiamo trovato una correlazione significativa fra l’estensione dell’ enfisema alla TC e le classi GOLD, una percentuale differente di enfisema può essere osservata in ciascuna di esse. Il cut-off di 31,5% nell’estensione dell’enfisema può indicare un valore limite per una condizione di peggioramento clinico del paziente.

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Authors and Affiliations

  1. Dipartimento di Scienze Cliniche, Sezione di Radiologia, Università di Parma, Parma, Italy

    M. Pescarolo, N. Sverzellati, M. De Filippo & M. Zompatori

  2. Sezione di Malattie Respiratorie, Università di Parma, Parma, Italy

    A. Verduri, A. Chetta, E. Marangio & D. Olivieri

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  1. M. Pescarolo
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  2. N. Sverzellati
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  3. A. Verduri
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  4. A. Chetta
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Correspondence to M. Pescarolo.

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Pescarolo, M., Sverzellati, N., Verduri, A. et al. How much do GOLD stages reflect CT abnormalities in COPD patients?. Radiol med 113, 817–829 (2008). https://doi.org/10.1007/s11547-008-0284-3

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  • DOI: https://doi.org/10.1007/s11547-008-0284-3

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