Atsushi Nambu1, Jordan Zach2, Joyce Schroeder3, Gong Yong Jin4, Song Soo Kim5, Yu-Il Kim6, Christina Schnell7, Russell Bowler8, David A Lynch9. 1. Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA; Department of Radiology, Teikyo University Mizonokuchi Hospital, Japan. Electronic address: nambu-a@gray.plala.or.jp. 2. Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA. Electronic address: ZachJ@NJHealth.org. 3. Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA. Electronic address: Joyce.schroeder@stanfordalumni.org. 4. Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA; Department of Radiology, Chonbuk National University Hospital, Republic of Korea. Electronic address: gyjin@chonbuk.ac.kr. 5. Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA; Department of Radiology, Chungnam National Hospital, Chungnam National University School of Medicine, Republic of Korea. Electronic address: haneul88@hanmail.net. 6. Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: kyionly@chonnam.ac.kr. 7. Department of Medicine, National Jewish Health, Denver, CO, USA. Electronic address: SchnellC@NJHealth.org. 8. Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, USA. Electronic address: BowlerR@NJHealth.org. 9. Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA. Electronic address: LynchD@NJHealth.org.
Abstract
PURPOSE: To evaluate the relationships between DLCO, and Quantitative CT (QCT) measurements and visual assessment of pulmonary emphysema and to test the relative roles of visual and quantitative assessment of emphysema. MATERIALS AND METHODS: The subjects included 199 current and former cigarette smokers from the COPDGene cohort who underwent inspiratory and expiratory CT and also had diffusing capacity for carbon monoxide corrected for alveolar volume (DLCO/VA). Quantitative CT measurements included % low attenuation areas (%LAA-950ins=voxels ≤-950 Hounsfield unit (HU), %LAA-910ins, and %LAA-856ins), mean CT attenuation and 15th percentile HU value on inspiratory CT, and %LAA-856exp (voxels ≤-856 HU on expiratory CT). The extent of emphysema was visually assessed using a 5-point grading system. Univariate and multiple variable linear regression analyses were employed to evaluate the correlations between DLCO/VA and QCT parameters and visual extent of emphysema. RESULTS: The DLCO/VA correlated most strongly with 15th percentile HU (R(2)=0.440, p<0.001) closely followed by %LAA-950ins (R(2)=0.417, p<0.001) and visual extent of emphysema (R(2)=0.411, p<0.001). Multiple variable analysis showed that visual extent of emphysema and 15th percentile HU were independent significant predictors of DLCO/VA at an R(2) of 0.599. CONCLUSIONS: 15th percentile HU seems the best parameter to represent the respiratory condition of COPD. Visual and Quantitative CT assessment of emphysema provide complementary information to QCT analysis.
PURPOSE: To evaluate the relationships between DLCO, and Quantitative CT (QCT) measurements and visual assessment of pulmonary emphysema and to test the relative roles of visual and quantitative assessment of emphysema. MATERIALS AND METHODS: The subjects included 199 current and former cigarette smokers from the COPDGene cohort who underwent inspiratory and expiratory CT and also had diffusing capacity for carbon monoxide corrected for alveolar volume (DLCO/VA). Quantitative CT measurements included % low attenuation areas (%LAA-950ins=voxels ≤-950 Hounsfield unit (HU), %LAA-910ins, and %LAA-856ins), mean CT attenuation and 15th percentile HU value on inspiratory CT, and %LAA-856exp (voxels ≤-856 HU on expiratory CT). The extent of emphysema was visually assessed using a 5-point grading system. Univariate and multiple variable linear regression analyses were employed to evaluate the correlations between DLCO/VA and QCT parameters and visual extent of emphysema. RESULTS: The DLCO/VA correlated most strongly with 15th percentile HU (R(2)=0.440, p<0.001) closely followed by %LAA-950ins (R(2)=0.417, p<0.001) and visual extent of emphysema (R(2)=0.411, p<0.001). Multiple variable analysis showed that visual extent of emphysema and 15th percentile HU were independent significant predictors of DLCO/VA at an R(2) of 0.599. CONCLUSIONS: 15th percentile HU seems the best parameter to represent the respiratory condition of COPD. Visual and Quantitative CT assessment of emphysema provide complementary information to QCT analysis.
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