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      Assessment Of Changes In Regional Xenon-Ventilation, Perfusion, And Ventilation-Perfusion Mismatch Using Dual-Energy Computed Tomography After Pharmacological Treatment In Patients With Chronic Obstructive Pulmonary Disease: Visual And Quantitative Analysis

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          Abstract

          Purpose

          To assess changes in regional ventilation (V), perfusion (Q), and V-Q mismatch in patients with chronic obstructive pulmonary disease (COPD) after pharmacologic treatment using combined xenon-enhanced V and iodine-enhanced Q dual-energy CT (DECT).

          Patients and methods

          Combined V and Q DECT were performed at baseline and after three-month pharmacologic treatment in 52 COPD patients. Anatomically co-registered virtual non-contrast images, V, Q, and V/Q ratio maps were obtained. V/Q pattern was visually determined to be matched, mismatched, or reversed-mismatched and compared with the regional parenchymal disease patterns of each segment. DECT parameters for V, Q, and V-Q imbalance were quantified.

          Results

          The parenchymal patterns on CT were not changed at follow-up. The segments with matched V/Q pattern were increased (80.2% to 83.6%) as the segments with reversed-mismatched V/Q pattern were decreased with improving ventilation (17.6% to 13.8%) after treatment. Changes of V/Q patterns were mostly observed in segments with bronchial wall thickening. Compared with patients without bronchial wall thickening, the quantified DECT parameters of V-Q imbalance were significantly improved in patients with bronchial wall thickening ( p < 0.05). Changes in forced expiratory volume in one second after treatment were correlated with changes in the quantified DECT parameters ( r = 0.327–0.342 or r = −0.406 and −0.303; p < 0.05).

          Conclusion

          DECT analysis showed that the V-Q imbalance was improved after the pharmacological treatment in COPD patients, although the parenchymal disease patterns remained unchanged. This improvement of V-Q imbalance may occur mostly in the areas with bronchial wall thickening.

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          Most cited references 32

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          Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper

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              Health status measurement in chronic obstructive pulmonary disease.

               G Jones (2001)
              Health status measurement is a common feature of studies in chronic obstructive pulmonary disease (COPD). This review assesses recent evidence for the validity of these measurements and their role as measures of the overall impact of the disease on the patient's daily life and wellbeing. It reviews the mostly widely used COPD specific questionnaires and examines the contribution that they make to an assessment of the overall effect of treatment. Finally, it addresses the question of how symptomatic benefit may be assessed in individual patients in routine practice.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                COPD
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                25 September 2019
                2019
                : 14
                : 2195-2203
                Affiliations
                [1 ]Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Songpa-Gu, Seoul 138-736, South Korea
                [2 ]Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine , Songpa-Gu, Seoul 138-736, South Korea
                [3 ]Department of Radiology, Ansan Hospital, Korea University College of Medicine , Danwon-gu, Ansan-si, Gyeonggi-do, Korea
                Author notes
                Correspondence: Sang Min Lee Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center , 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul138-736, South KoreaTel +82 2 3010 5766Fax +82 2 476 4719 Email asellion@hanmail.net
                Article
                210555
                10.2147/COPD.S210555
                6768130
                © 2019 Hwang 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. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 4, Tables: 2, References: 34, Pages: 9
                Categories
                Original Research

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