Time to Exhale: Additional Value of Expiratory Chest CT in Chronic Obstructive Pulmonary Disease

Joshua Gawlitza, Frederik Trinkmann, Hans Scheffel, Andreas Fischer, John W Nance, Claudia Henzler, Nils Vogler, Joachim Saur, Ibrahim Akin, Martin Borggrefe, Stefan O Schoenberg, Thomas Henzler, Joshua Gawlitza, Frederik Trinkmann, Hans Scheffel, Andreas Fischer, John W Nance, Claudia Henzler, Nils Vogler, Joachim Saur, Ibrahim Akin, Martin Borggrefe, Stefan O Schoenberg, Thomas Henzler

Abstract

Objectives: Diagnostic guidelines for chronic obstructive pulmonary disease (COPD) are based on spirometry and clinical criteria. However, this does not address the pathophysiological complexity of the disease sufficiently. Until now, inspiratory chest computed tomography (CT) has been considered as the preferred imaging method in these patients. We hypothesized that expiratory CT may be superior to demonstrate pathophysiological changes. The aim of this prospective study was to systematically compare lung function tests with quantified CT parameters in inspiration and expiration.

Materials and methods: Forty-six patients with diagnosed COPD underwent spirometry, body plethysmography, and dose-optimized CT in maximal inspiration and expiration. Four quantified CT parameters were acquired in inspiration, expiration, and their calculated delta values. These parameters were correlated with seven established lung function parameters.

Results: For inspiratory scans, a weak-to-moderate correlation with the lung function parameters was found. These correlations significantly improved when adding the expiratory scan (p < 0.05). Moreover, some parameters showed a significant correlation only in expiratory datasets. Calculated delta values showed even stronger correlation with lung function testing.

Conclusions: Expiratory quantified CT and calculated delta values significantly improve the correlation with lung function parameters. Thus, an additional expiratory CT may improve image-based phenotyping of patients with COPD.

Figures

Figure 1
Figure 1
Automatic detection of lung borders and lung parenchyma. Blue areas: low attenuation volume (LAV) with HU values below −950; red areas: high attenuation volume (HAV) with HU values above −200.
Figure 2
Figure 2
Heat map of correlations for inspiratory values. MLD: mean lung density; FWHM: full width half max; LAV: low attenuation volume; VC: vital capacity; FEV1: forced expiratory volume in one second; FEV1%VC: Tiffeneau index; RV: residual volume; TLC: total lung capacity; sRtot: specific total airway resistance.
Figure 3
Figure 3
Heat map of correlations for expiratory values. MLD: mean lung density; FWHM: full width half max; LAV: low attenuation volume; VC: vital capacity; FEV1: forced expiratory volume in one second; FEV1%VC: Tiffeneau index; RV: residual volume; TLC: total lung capacity; sRtot: specific total airway resistance.
Figure 4
Figure 4
Heat map of correlations for delta values. MLD: mean lung density; FWHM: full width half max; LAV: low attenuation volume; VC: vital capacity; FEV1: forced expiratory volume in one second; FEV1%VC: Tiffeneau index; RV: residual volume; TLC: total lung capacity; sRtot: specific total airway resistance.

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