RATIONALE: Angiographic investigation suggests that pulmonary vascular remodeling in smokers is characterized by distal pruning of the blood vessels. OBJECTIVES: Using volumetric computed tomography scans of the chest we sought to quantitatively evaluate this process and assess its clinical associations. METHODS: Pulmonary vessels were automatically identified, segmented, and measured. Total blood vessel volume (TBV) and the aggregate vessel volume for vessels less than 5 mm(2) (BV5) were calculated for all lobes. The lobe-specific BV5 measures were normalized to the TBV of that lobe and the nonvascular tissue volume (BV5/T(issue)V) to calculate lobe-specific BV5/TBV and BV5/T(issue)V ratios. Densitometric measures of emphysema were obtained using a Hounsfield unit threshold of -950 (%LAA-950). Measures of chronic obstructive pulmonary disease severity included single breath measures of diffusing capacity of carbon monoxide, oxygen saturation, the 6-minute-walk distance, St George's Respiratory Questionnaire total score (SGRQ), and the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. MEASUREMENTS AND MAIN RESULTS: The %LAA-950 was inversely related to all calculated vascular ratios. In multivariate models including age, sex, and %LAA-950, lobe-specific measurements of BV5/TBV were directly related to resting oxygen saturation and inversely associated with both the SGRQ and BODE scores. In similar multivariate adjustment lobe-specific BV5/T(issue)V ratios were inversely related to resting oxygen saturation, diffusing capacity of carbon monoxide, 6-minute-walk distance, and directly related to the SGRQ and BODE. CONCLUSIONS: Smoking-related chronic obstructive pulmonary disease is characterized by distal pruning of the small blood vessels (<5 mm(2)) and loss of tissue in excess of the vasculature. The magnitude of these changes predicts the clinical severity of disease.
RATIONALE: Angiographic investigation suggests that pulmonary vascular remodeling in smokers is characterized by distal pruning of the blood vessels. OBJECTIVES: Using volumetric computed tomography scans of the chest we sought to quantitatively evaluate this process and assess its clinical associations. METHODS: Pulmonary vessels were automatically identified, segmented, and measured. Total blood vessel volume (TBV) and the aggregate vessel volume for vessels less than 5 mm(2) (BV5) were calculated for all lobes. The lobe-specific BV5 measures were normalized to the TBV of that lobe and the nonvascular tissue volume (BV5/T(issue)V) to calculate lobe-specific BV5/TBV and BV5/T(issue)V ratios. Densitometric measures of emphysema were obtained using a Hounsfield unit threshold of -950 (%LAA-950). Measures of chronic obstructive pulmonary disease severity included single breath measures of diffusing capacity of carbon monoxide, oxygen saturation, the 6-minute-walk distance, St George's Respiratory Questionnaire total score (SGRQ), and the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. MEASUREMENTS AND MAIN RESULTS: The %LAA-950 was inversely related to all calculated vascular ratios. In multivariate models including age, sex, and %LAA-950, lobe-specific measurements of BV5/TBV were directly related to resting oxygen saturation and inversely associated with both the SGRQ and BODE scores. In similar multivariate adjustment lobe-specific BV5/T(issue)V ratios were inversely related to resting oxygen saturation, diffusing capacity of carbon monoxide, 6-minute-walk distance, and directly related to the SGRQ and BODE. CONCLUSIONS: Smoking-related chronic obstructive pulmonary disease is characterized by distal pruning of the small blood vessels (<5 mm(2)) and loss of tissue in excess of the vasculature. The magnitude of these changes predicts the clinical severity of disease.
Authors: Firdaus A A Mohamed Hoesein; Bartjan de Hoop; Pieter Zanen; Hester Gietema; Cas L J J Kruitwagen; Bram van Ginneken; Ivana Isgum; Christian Mol; Rob J van Klaveren; Akkelies E Dijkstra; Harry J M Groen; H Marike Boezen; Dirkje S Postma; Mathias Prokop; Jan-Willem J Lammers Journal: Thorax Date: 2011-04-07 Impact factor: 9.139
Authors: R Graham Barr; David A Bluemke; Firas S Ahmed; J Jeffery Carr; Paul L Enright; Eric A Hoffman; Rui Jiang; Steven M Kawut; Richard A Kronmal; João A C Lima; Eyal Shahar; Lewis J Smith; Karol E Watson Journal: N Engl J Med Date: 2010-01-21 Impact factor: 91.245
Authors: Anand S Iyer; J Michael Wells; Sonia Vishin; Surya P Bhatt; Keith M Wille; Mark T Dransfield Journal: Chest Date: 2014-04 Impact factor: 9.410
Authors: Farbod N Rahaghi; J Michael Wells; Carolyn E Come; Isaac A De La Bruere; Surya P Bhatt; James C Ross; Gonzalo Vegas-Sánchez-Ferrero; Alejandro A Diaz; Jasleen Minhas; Mark T Dransfield; Raúl San José Estépar; George R Washko Journal: J Comput Assist Tomogr Date: 2016 Nov/Dec Impact factor: 1.826
Authors: F N Rahaghi; J C Ross; M Agarwal; G González; C E Come; A A Diaz; G Vegas-Sánchez-Ferrero; A Hunsaker; R San José Estépar; A B Waxman; G R Washko Journal: Pulm Circ Date: 2016-03 Impact factor: 3.017
Authors: Wassim W Labaki; Carlos H Martinez; Fernando J Martinez; Craig J Galbán; Brian D Ross; George R Washko; R Graham Barr; Elizabeth A Regan; Harvey O Coxson; Eric A Hoffman; John D Newell; Douglas Curran-Everett; James C Hogg; James D Crapo; David A Lynch; Ella A Kazerooni; MeiLan K Han Journal: Am J Respir Crit Care Med Date: 2017-12-01 Impact factor: 21.405
Authors: Farbod N Rahaghi; Daniel Lazea; Saba Dihya; Raúl San José Estépar; Raphael Bueno; David Sugarbaker; Gyorgy Frendl; George R Washko Journal: Acad Radiol Date: 2014-06 Impact factor: 3.173