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      Emphysema extent on computed tomography is a highly specific index in diagnosing persistent airflow limitation: a real-world study in China

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          Abstract

          Objective

          The diagnostic value of emphysema extent in consistent air flow limitation remains controversial. Therefore, we aimed to assess the value of emphysema extent on computed tomography (CT) on the diagnosis of persistent airflow limitation. Furthermore, we developed a diagnostic criterion for further verification.

          Materials and methods

          We retrospectively enrolled patients who underwent chest CT and lung function test. To be specific, 671 patients were enrolled in the derivation group (Group 1.1), while 479 patients were in the internal validation group (Group 1.2). The percentage of lung volume occupied by low attenuation areas (LAA%) and the percentile of the histogram of attenuation values were calculated.

          Results

          In patients with persistent airflow limitation, the LAA% was higher and the percentile of the histogram of attenuation values was lower, compared with patients without persistent airflow limitation. Using LAA% with a threshold of −950 HU >1.4% as the criterion, the sensitivity was 44.3% and 47.2%, and the specificity was 95.2% and 95.7%, in Group 1.1 and Group 1.2, respectively. The specificity was influenced by the coexistence of interstitial lung disease, pneumothorax, and post-surgery, rather than the coexistence of pneumonia, nodule, or mass. Multivariable models were also developed.

          Conclusion

          The emphysema extent on CT is a highly specific marker in the diagnosis of persistent airflow limitation.

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          Most cited references 23

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          Evidence-based health policy--lessons from the Global Burden of Disease Study.

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            Computed tomographic measurements of airway dimensions and emphysema in smokers. Correlation with lung function.

            Chronic obstructive pulmonary disease (COPD) is characterized by the presence of airflow obstruction caused by emphysema or airway narrowing, or both. Low attenuation areas (LAA) on computed tomography (CT) have been shown to represent macroscopic or microscopic emphysema, or both. However CT has not been used to quantify the airway abnormalities in smokers with or without airflow obstruction. In this study, we used CT to evaluate both emphysema and airway wall thickening in 114 smokers. The CT measurements revealed that a decreased FEV(1) (%predicted) is associated with an increase of airway wall area and an increase of emphysema. Although both airway wall thickening and emphysema (LAA) correlated with measurements of lung function, stepwise multiple regression analysis showed that the combination of airway and emphysema measurements improved the estimate of pulmonary function test abnormalities. We conclude that both CT measurements of airway dimensions and emphysema are useful and complementary in the evaluation of the lung of smokers.
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              Comparison of computed density and macroscopic morphometry in pulmonary emphysema.

              High-resolution computed tomography (HRCT) scans were obtained at 1 cm intervals in 63 subjects referred for surgical resection of a cancer or for transplantation to find out whether the relative area of lung occupied by attenuation values lower than a threshold would be a measurement of macroscopic emphysema. Using a semiautomatic procedure, the relative areas occupied by attenuation values lower than eight thresholds ranging from -900 to -970 HU were calculated on the set of scans obtained through the lobe or the lung to be resected. The extent of emphysema was quantified by a computer-assisted method on horizontal paper-mounted lung sections obtained every 1 to 2 cm. The only level for which no statistically significant difference was found between the HRCT and the morphometric data was -950 HU. To determine the number of scans sufficient for an accurate quantification, we recalculated the relative area occupied by attenuation values lower than -950 HU on progressively fewer numbers of scans and investigated the departure from the results obtained with 1 cm intervals. Because of wide variations in this departure from patient to patient, a standard cannot be recommended as the optimal distance between scans.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2019
                17 December 2018
                : 14
                : 13-26
                Affiliations
                [1 ]Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China, hy_wan2013@ 123456163.com
                [2 ]School of Public Health, Fudan University, Shanghai, China
                [3 ]Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China, hy_wan2013@ 123456163.com , shiguochao@ 123456hotmail.com
                [4 ]Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, shiguochao@ 123456hotmail.com
                [5 ]Department of Radiology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
                Author notes
                Correspondence: Huan Ying Wan, Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, No 999, Xiwang Road, Malu Town, Jiading, Shanghai 201801, China, Tel +86 1 812 126 3363, Fax +86 0 216 788 8855, Email hy_wan2013@ 123456163.com
                Guo Chao Shi, Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No 197, Ruijin Er Road, Huangpu District, Shanghai 200025, China, Email shiguochao@ 123456hotmail.com
                Article
                copd-14-013
                10.2147/COPD.S157141
                6301435
                © 2019 Cheng et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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