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Quantitative CT detects progression in COPD patients with severe emphysema in a 3-month interval

  • Computed Tomography
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Abstract

Objectives

Chronic obstructive pulmonary disease (COPD) is characterized by variable contributions of emphysema and airway disease on computed tomography (CT), and still little is known on their temporal evolution. We hypothesized that quantitative CT (QCT) is able to detect short-time changes in a cohort of patients with very severe COPD.

Methods

Two paired in- and expiratory CT each from 70 patients with avg. GOLD stage of 3.6 (mean age = 66 ± 7.5, mean FEV1/FVC = 35.28 ± 7.75) were taken 3 months apart and analyzed by fully automatic software computing emphysema (emphysema index (EI), mean lung density (MLD)), air-trapping (ratio expiration to inspiration of mean lung attenuation (E/I MLA), relative volume change between − 856 HU and − 950 HU (RVC856–950)), and parametric response mapping (PRM) parameters for each lobe separately and the whole lung. Airway metrics measured were wall thickness (WT) and lumen area (LA) for each airway generation and the whole lung.

Results

The average of the emphysema parameters (EI, MLD) increased significantly by 1.5% (p < 0.001) for the whole lung, whereas air-trapping parameters (E/I MLA, RVC856–950) were stable. PRMEmph increased from 34.3 to 35.7% (p < 0.001), whereas PRMNormal decrased from 23.6% to 22.8% (p = 0.012). WT decreased significantly from 1.17 ± 0.18 to 1.14 ± 0.19 mm (p = 0.036) and LA increased significantly from 25.08 ± 4.49 to 25.84 ± 4.87 mm2 (p = 0.041) for the whole lung. The generation-based analysis showed heterogeneous results.

Conclusion

QCT detects short-time progression of emphysema in severe COPD. The changes were partly different among lung lobes and airway generations, indicating that QCT is useful to address the heterogeneity of COPD progression.

Key Points

• QCT detects short-time progression of emphysema in severe COPD in a 3-month period.

• QCT is able to quantify even slight parenchymal changes, which were not detected by spirometry.

• QCT is able to address the heterogeneity of COPD, revealing inconsistent changes individual lung lobes and airway generations.

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Abbreviations

AS:

Active smokers

COPD:

Chronic obstructive pulmonary disease

CT:

Computed tomography

EI:

Emphysema index

E/I MLA:

Expiratory to inspiratory ratio of mean lung attenuation

ES:

Ex-smokers

FEV1:

Forced expiratory volume

GOLD:

Global Initiative for Obstructive Lung Disease

HU:

Hounsfield units

LA:

Lumen area

LLi:

Lingula

LLL:

Left lower lobe

LUL:

Left upper lobe

MEF50 :

Maximum expiratory flow after exhalation of 75% of FVC

MLD:

Mean lung density

PEF:

Peak expiratory flow

PFT:

Pulmonary function test

PRM:

Parametric response mapping

QCT:

Quantitative computed tomography

RML:

Middle lobe

RLL:

Right lower lobe

RUL:

Right upper lobe

RQ:

Recent quitters

RV:

Residual volume

RVC856–950 :

Relative volume change between − 856 HU and − 950 HU

SAD:

Small airway disease

TD:

Total diameter

TLC:

Total lung capacity

TLV:

Total lung volume

VC:

Vital capacity

WP:

Wall percentage

WT:

Wall thickness

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Funding

This study was supported by grants from the Bundesministerium für Bildung und Forschung (BMBF) to the German Center for Lung Research (DZL) (82DZL004A, 82DZL004A2).

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Philip Konietzke, Mark O. Wielpütz, Willi L. Wagner, Felix Wuennemann, Hans-Ulrich Kauczor, Claus P. Heussel & Oliver Weinheimer

  2. Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany

    Philip Konietzke, Mark O. Wielpütz, Willi L. Wagner, Felix Wuennemann, Hans-Ulrich Kauczor, Claus P. Heussel, Monika Eichinger, Ralf Eberhardt, Daniela Gompelmann & Oliver Weinheimer

  3. Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany

    Philip Konietzke, Mark O. Wielpütz, Willi L. Wagner, Felix Wuennemann, Hans-Ulrich Kauczor, Claus P. Heussel, Monika Eichinger & Oliver Weinheimer

  4. Department of Respiratory and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany

    Ralf Eberhardt & Daniela Gompelmann

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  1. Philip Konietzke
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  10. Oliver Weinheimer
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Corresponding author

Correspondence to Philip Konietzke.

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Guarantor

The scientific guarantor of this publication is Philip Konietzke.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Parts of the lobe segmentation algorithm that are used for labeling of the airways have been licensed to the company Imbio, LCC. There are no further patents, products in development, or marketed products to declare.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• Retrospective

• Observational

• performed at one institution

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Konietzke, P., Wielpütz, M.O., Wagner, W.L. et al. Quantitative CT detects progression in COPD patients with severe emphysema in a 3-month interval. Eur Radiol 30, 2502–2512 (2020). https://doi.org/10.1007/s00330-019-06577-y

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