Trine Stavngaard1, Saher B Shaker, Asger Dirksen. 1. Department of Clinical Physiology and Nuclear Medicine, University of Copenhagen, Rigshospitalet, 4011, Blegdamsvej 9, 2100 Copenhagen, Denmark. stavngaard@dadlnet.dk
Abstract
INTRODUCTION: Identification of upper lobe emphysema is mandatory before lung volume reduction surgery (LVRS). Here we introduce a CT-based objective model for describing the distribution of different types of emphysema. METHODS: Fifty COPD patients were included in the study. Half had alpha1-antitrypsin deficiency (alpha1-COPD) and the rest had smoking-induced emphysema (usual COPD). All patients were scanned 3 times. The relative area of emphysema in each CT slice was plotted against table position, and the cranio-caudal distribution was calculated as the slope of the regression line. RESULTS: The variation in slopes within a patient was much less than the variation in slopes between patients (P<0.0001). There was a significant difference between slopes in the alpha1-COPD and the usual COPD groups (P<0.0001). In the alpha1-COPD group, 24/25 patients had lower lobe emphysema. In the usual COPD group, 4 patients had upper lope predominance, 5 patients had heterogeneous distributions, and 16 patients had lower lobe predominance. CONCLUSIONS: The majority of patients with smoking-related emphysema have a homogeneous distribution and lower lobe predominance although not as noticeable as in alpha1-antitrypsin deficiency. An objective and quantitative method for determining the distribution of emphysema should be applied when selecting candidates for LVRS.
INTRODUCTION: Identification of upper lobe emphysema is mandatory before lung volume reduction surgery (LVRS). Here we introduce a CT-based objective model for describing the distribution of different types of emphysema. METHODS: Fifty COPD patients were included in the study. Half had alpha1-antitrypsin deficiency (alpha1-COPD) and the rest had smoking-induced emphysema (usual COPD). All patients were scanned 3 times. The relative area of emphysema in each CT slice was plotted against table position, and the cranio-caudal distribution was calculated as the slope of the regression line. RESULTS: The variation in slopes within a patient was much less than the variation in slopes between patients (P<0.0001). There was a significant difference between slopes in the alpha1-COPD and the usual COPD groups (P<0.0001). In the alpha1-COPD group, 24/25 patients had lower lobe emphysema. In the usual COPD group, 4 patients had upper lope predominance, 5 patients had heterogeneous distributions, and 16 patients had lower lobe predominance. CONCLUSIONS: The majority of patients with smoking-related emphysema have a homogeneous distribution and lower lobe predominance although not as noticeable as in alpha1-antitrypsin deficiency. An objective and quantitative method for determining the distribution of emphysema should be applied when selecting candidates for LVRS.
Authors: Tsuneo Yamashiro; Shin Matsuoka; Raúl San José Estépar; Alejandro Diaz; John D Newell; Robert A Sandhaus; Patricia J Mergo; Mark L Brantly; Sadayuki Murayama; John J Reilly; Hiroto Hatabu; Edwin K Silverman; George R Washko Journal: COPD Date: 2009-12 Impact factor: 2.409
Authors: Zhimin Wang; Suicheng Gu; Joseph K Leader; Shinjini Kundu; John R Tedrow; Frank C Sciurba; David Gur; Jill M Siegfried; Jiantao Pu Journal: Eur Radiol Date: 2012-11-01 Impact factor: 5.315
Authors: Gerard N McElvaney; Robert A Sandhaus; Marc Miravitlles; Gerard M Turino; Niels Seersholm; Marion Wencker; Robert A Stockley Journal: Eur Respir J Date: 2020-06-18 Impact factor: 16.671
Authors: Ben-Gary Harvey; Yael Strulovici-Barel; Thomas L Vincent; Jason G Mezey; Ramya Raviram; Cynthia Gordon; Jacqueline Salit; Ann E Tilley; Augustine Chung; Abraham Sanders; Ronald G Crystal Journal: PLoS One Date: 2013-09-09 Impact factor: 3.240