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Prevalence and correlates of pulmonary emphysema in smokers and former smokers. A densitometric study of participants in the ITALUNG trial

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Abstract

We assessed with computed tomography (CT) densitometry the prevalence of emphysema in 266 (175 men and 91 women; mean age 64 ± 4 years) smokers and former smokers enrolled in the ITALUNG trial of lung cancer screening with low-dose thin-slice CT. Whole-lung volume and the relative area at −950 Hounsfield units (RA950) and mean lung attenuation (MLA) in 1 of every 10 slices (mean, 24 slices per subject) were measured. Lung volume, MLA and RA950 significantly correlated each other and with age. Average RA950 >6.8% qualifying for emphysema was present in 71 (26.6%) of 266 subjects, with a higher prevalence in men than in women (30.3% vs 19.8%; p = 0.003). Only in smokers was a weak (r = 0.18; p = 0.05) correlation between RA950 and packs/year observed. In multiple regression analysis, the variability of RA950 (R2 = 0.24) or MLA (R2 = 0.34) was significantly, but weakly explained by age, lung volume and packs/year. Other factors besides smoking may also have a significant role in the etiopathogenesis of pulmonary emphysema.

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Author information

Authors and Affiliations

  1. Radiodiagnostica, Dipartimento Fisiopatologia Clinica, Università di Firenze, Viale Morgagni 85, Firenze, Italy

    Edoardo Cavigli, Luca Grassi, Ilaria Orlandi, Giulia Picozzi & Mario Mascalchi

  2. Dipartimento Area Critica, Università di Firenze, Firenze, Italy

    Gianna Camiciottoli

  3. Dipartimento Elettronica e Telecomunicazioni, Università di Firenze, Firenze, Italy

    Stefano Diciotti

  4. Radiodiagnostica II, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy

    Fabio Falaschi

  5. Pneumologia, Azienda Ospedaliera-Universitaria di Careggi, Firenze, Italy

    Andrea Lopes Pegna

  6. Centro di Studio e Prevenzione Oncologica, Firenze, Italy

    Marco Zappa & Eugenio Paci

Authors
  1. Gianna Camiciottoli
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  2. Edoardo Cavigli
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  9. Eugenio Paci
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  10. Fabio Falaschi
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Correspondence to Mario Mascalchi.

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Table 1

Spearman rank correlation between averaged (three levels) RA at −930, −940, −950, −960 and −970 HU measured from low dose thin-section spiral acquisitions and RA at −950 HU measured from standard dose thin-section sequential acquisitions (PDF 20.3 KB)

Fig. 4

Mean values of FRC and DLCO (%of predicted ± SD) in subjects without emphysema (black columns) and with emphysema (white columns). ***p < 0.001 (PDF 26.3 KB)

Appendices

Appendix 1

To establish which RA using low-dose spiral CT better correlates with RA950 in the standard-dose sequential CT, we obtained in 25 consecutive subjects (14 men, 11 women, mean age 60.8 years after further informed consent) of the 266 undergoing lung cancer screening supplemental 1-mm-thick slices with sequential acquisition at standard dose (140 kVp and 200 mAs) and with a sharp reconstruction filter (B60). According to widely accepted protocols [4, 23, 49] and to contain the supplemental radiation dose, only three thin slices of sequential CT at standard dose were obtained at predetermined levels: at the carina and 5 cm below and above the carina. Using the Pulmo software, the operator selected in the 25 subjects the three spiral slices corresponding to the three levels at which the sequential slices had been acquired. In the spiral CT mode, the RA at −930 HU (RA930), −940 HU( RA940), −950 HU (RA950), −960 HU (RA960) and −970 HU (RA970) was calculated for each slice and averaged, whereas on the sequential CT images only the single slice and average RA950 values were calculated. The Spearman rank correlation test (Supplementary Table 1) showed that the average RA950 from low-dose spiral acquisitions was the RA value more closely correlated (R = 0.90) to average RA950 from standard-dose sequential acquisitions.

Appendix 2

Pulmonary function tests (PFT) are not part of the protocol of the ITALUNG trial. To obtain an independent confirmation of the diagnosis of emphysema, 25 of the 71 subjects with emphysema and 25 of the 195 subjects without emphysema at lung densitometry matched for gender, age and packs/year underwent PFT. Functional residual capacity (FRC) and single-breath lung diffusion capacity for carbon monoxide (DLCO) were measured using a constant volume body plethysmograph equipped with a multi-gas analyzer (V6200 Autobox DL, Sensor Medics, Yorba Linda, CA), according to American Thoracic Society standards and expressed as percent of predicted value [50, 51]. Subjects with emphysema showed significantly lower DLco and higher FRC values as compared to subjects without emphysema (Fig. 4, supplementary material).

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Camiciottoli, G., Cavigli, E., Grassi, L. et al. Prevalence and correlates of pulmonary emphysema in smokers and former smokers. A densitometric study of participants in the ITALUNG trial. Eur Radiol 19, 58–66 (2009). https://doi.org/10.1007/s00330-008-1131-6

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