European Radiology

, Volume 19, Issue 10, pp 2391–2402 | Cite as

Fully automatic quantitative assessment of emphysema in computed tomography: comparison with pulmonary function testing and normal values

  • C. P. Heussel
  • F. J. F. Herth
  • J. Kappes
  • R. Hantusch
  • S. Hartlieb
  • O. Weinheimer
  • H. U. Kauczor
  • R. Eberhardt


Characterisation and quantification of emphysema are necessary for planning of local treatment and monitoring. Sensitive, easy to measure, and stable parameters have to be established and their relation to the well-known pulmonary function testing (PFT) has to be investigated. A retrospective analysis of 221 nonenhanced thin-section MDCT with a corresponding PFT was carried out, with a subgroup analysis in 102 COPD stage III+IV, 44 COPD stage 0, and 33 investigations into interstitial lung disease (ILD). The in-house YACTA software was used for automatic quantification of lung and emphysema volume [l], emphysema index, mean lung density (MLD [HU]) and 15th percentile [HU]. CT-derived lung volume is significantly smaller in ILD (3.8) and larger in COPD (7.2) than in controls (5.9, p < 0.0001). Emphysema volume and index are significantly higher in COPD than in controls (3.2 vs. 0.5, p < 0.0001, 45% vs. 8%, p < 0.0001). MLD and 15th percentile are significantly smaller in COPD (−877/−985, p < 0.0001) and significantly higher in ILD (−777, p < 0.0006/−914, p < 0.0001) than in controls (−829/−935). A relevant amount of COPD patients apparently do not suffer from emphysema, while controls who do not fulfil PFT criteria for COPD also demonstrate CT features of emphysema. Automatic quantification of thin-section CT delivers convincing parameters and ranges that are able to differentiate among emphysema, control and ILD. An emphysema index of lower 20%, MLD higher than −850, and 15th percentile lower than −950 might be regarded as normal (thin-section, nonenhanced, B40, YACTA). These ranges might be helpful in the judgement of individual measures.


Emphysema MDCT  COPD Lung attenuation Quantitative assessment 



six-minute-walk test


chronic obstructive pulmonary disease


emphysema index


emphysema volume


forced expiratory volume in 1 s


forced vital capacity


interstitial lung disease


intrathoracic gas volume


lung volume


mean lung density


nonspecific interstitial pneumonia


pulmonary function test


residual volume


total lung capacity


usual interstitial pneumonia


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Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • C. P. Heussel
    • 1
    • 2
  • F. J. F. Herth
    • 1
    • 3
  • J. Kappes
    • 1
    • 3
  • R. Hantusch
    • 1
    • 2
  • S. Hartlieb
    • 1
    • 2
  • O. Weinheimer
    • 4
  • H. U. Kauczor
    • 5
  • R. Eberhardt
    • 1
    • 3
  1. 1.Thoraxklinik HeidelbergUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Department of Interventional and Diagnostic Radiology, Thoraxklinik HeidelbergUniversity Hospital HeidelbergHeidelbergGermany
  3. 3.Department of Pneumology and Critical Care MedicineJohannes Gutenberg UniversityHeidelbergGermany
  4. 4.Department of Interventional and Diagnostic Radiology (Prof. Dr. C. Düber)Johannes Gutenberg UniversityMainzGermany
  5. 5.Department of Diagnostic RadiologyUniversity Hospital HeidelbergHeidelbergGermany

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