Der Radiologe

, Volume 47, Issue 5, pp 401–406

Bildgebung des Lungenemphysems

Leitthema

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.

Schlüsselwörter

Emphysem Chronisch obstruktive Lungenerkrankungen (COPD) Computertomographie (CT) Quantifizierungsmethoden Lungenfunktionstests 

Imaging of emphysema

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.

Keywords

Emphysema Chronic obstructive pulmonary disease (COPD) Computed tomography (CT) Quantitative methods Pulmonary function tests 

Literatur

  1. 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: 762–768Google Scholar
  2. 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: 791–798PubMedGoogle Scholar
  3. 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 151–198Google Scholar
  4. 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 YorkGoogle Scholar
  5. 5.
    Sobonya RE, Burrows B (1983) The epidemiology of emphysema. Clin Chest Med 4: 351–358PubMedGoogle Scholar
  6. 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: 132–140Google Scholar
  7. 7.
    Eriksson S (1964) Pulmonary emphysema and alpha-1-antitrypsin deficiency. Acta Med Scand 175: 197–205PubMedGoogle Scholar
  8. 8.
    Gross P, Babyak MA, Tolker E, Kaschak M (1964) Enzymatically produced pulmonary emphysema: a preliminary report. J Occup Med 6: 481–484PubMedGoogle Scholar
  9. 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: 1Google Scholar
  10. 10.
    Hunninghake GW, Gadek JE, Fales HM, Crystal RG (1980) Human alveolar macrophage derived chemotactic factors for neutrophils. J Clin Invest 66: 473–483PubMedGoogle Scholar
  11. 11.
    Senior R, Connolly NL, Cury JD et al. (1989) Elastin degradation by human alveolar macrophages. Am Rev Respir Dis 139: 1251–1256PubMedGoogle Scholar
  12. 12.
    Turner-Stokes L, Turton C, Pope FM et al. (1983) Emphysema and cutis laxa. Thorax 38: 790–792PubMedGoogle Scholar
  13. 13.
    Bolande RP, Tucker AS (1964) Pulmonary emphysema and other cardiorespiratory lesions as part of the Marfan abiotrophy. Pediatrics 33: 356–366PubMedGoogle Scholar
  14. 14.
    Bense L, Eklund G, Lewander R (2002) Hereditary pulmonary emphysema. Chest 121: 297–300CrossRefPubMedGoogle Scholar
  15. 15.
    Macklem PT, Fraser RG, Brown WG (1965) Bronchial pressure measurements in emphysema and bronchitis. J Clin Invest 44: 897–905PubMedGoogle Scholar
  16. 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: 182–185PubMedGoogle Scholar
  17. 17.
    Kuhlman JE, Reyes BL, Hruban RH et al. (1993) Abnormal air-filled spaces in the lung. RadioGraphics 13: 47–75PubMedGoogle Scholar
  18. 18.
    Sanders C (1991) The radiographic diagnosis of emphysema. Radiol Clin North Am 29: 1019–1030PubMedGoogle Scholar
  19. 19.
    Glossary of terms for thoracic radiology: recommendations of the nomenclature committee of the Fleischner Society (1984). AJR Am J Roentgenol 143: 509–517PubMedGoogle Scholar
  20. 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: 82–145CrossRefGoogle Scholar
  21. 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: 889–899PubMedGoogle Scholar
  22. 22.
    Katsura S, Martin CJ (1967) The roentgenologic diagnosis of anatomic emphysema. Am Rev Respir Dis 96: 700–706PubMedGoogle Scholar
  23. 23.
    Sutinen S, Christoforidis AJ, Klugh GA et al. (1965) Roentgenologic criteria for the recognition of nonsymptomatic pulmonary emphysema. Am Rev Respir Dis 91: 69–76PubMedGoogle Scholar
  24. 24.
    Bergin CJ, Müller NL, Miller RR (1986) CT in the qualitative assessment of emphysema. J Thorac Imaging 1: 94–103PubMedGoogle Scholar
  25. 25.
    Adams H, Bernard MS, McConnochie K (1991) An appraisal of CT pulmonary density mapping in normal subjects. Clin Radiol 43: 238–242CrossRefPubMedGoogle Scholar
  26. 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: 327–331PubMedGoogle Scholar
  27. 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): 19–34PubMedGoogle Scholar
  28. 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): 806–813PubMedGoogle Scholar
  29. 29.
    Müller NL, Staples CA, Miller RR et al. (1988) „Density mask“. An objective method to quantitate emphysema using computed tomography. Chest 94: 782–787PubMedGoogle Scholar
  30. 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: 653–657PubMedGoogle Scholar
  31. 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: 8829–8834CrossRefPubMedGoogle Scholar
  32. 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: 705–714PubMedGoogle Scholar
  33. 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: 384–389PubMedGoogle Scholar
  34. 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: 187–192PubMedGoogle Scholar
  35. 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: 380–392PubMedGoogle Scholar
  36. 36.
    Hayhurst MD, Flenley DC, McLean A et al. (1984) Diagnosis of pulmonary emphysema by computerised tomography. Lancet 2: 320–322CrossRefPubMedGoogle Scholar
  37. 37.
    Thurlbeck WM, Dunnil MS, Hartung W et al. (1970) A comparison of three methods measuring emphysema. Hum Pathol 1:215–226CrossRefPubMedGoogle Scholar
  38. 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: 1169–1173PubMedGoogle Scholar
  39. 39.
    Gevenois PA, De Vuyst P, Sy M et al. (1996) Pulmonary emphysema: quantitative CT during exspiration. Radiology 199: 825–829PubMedGoogle Scholar
  40. 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: 380–384CrossRefPubMedGoogle Scholar
  41. 41.
    Stoel BC, Vrooman HA, Stolk J et al. (1999) Sources of error in lung densitometry with CT. Invest Radiol 34: 303–309CrossRefPubMedGoogle Scholar
  42. 42.
    Kohz P, Stäbler A, Beinert T et al. (1995) Reproductibility of quantitative, spirometrically controlled CT. Radiology 197: 539–542PubMedGoogle Scholar
  43. 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: 1091–1095PubMedGoogle Scholar
  44. 44.
    Lamers RJ, Thelissen GR, Kessels AG et al. (1994) Chronic obstructive pulmonary disease: evaluation with spirometrically controlled CT lung densitometry. Radiology 193: 109–113PubMedGoogle Scholar
  45. 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: 248–254PubMedGoogle Scholar
  46. 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: 262–266CrossRefPubMedGoogle Scholar
  47. 47.
    Gurney JW (1998) Pathophysiology of obstructive airways disease. Radiol Clin North Am 36: 15–27CrossRefPubMedGoogle Scholar
  48. 48.
    Rienmüller RK, Behr J, Kalender A et al. (1991) Standardized quantitative high resolution CT in lung diseases. J Comput Assist Tomogr 15: 742–749PubMedGoogle Scholar
  49. 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: 457–463PubMedGoogle Scholar
  50. 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: 125–129CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Institut für RadiodiagnostikMedizinische UniversitätWienÖsterreich

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