Emphysema radiology

Abstract The syndrome resulting from combined pulmonary fibrosis and emphysema has not been comprehensively described. The current authors conducted a retrospective study of 61 patients with both emphysema of the upper zones and diffuse parenchymal lung disease with fibrosis of the lower zones of the lungs on chest computed tomography. Patients (all smokers) included 60 males and one female, with a mean age of 65 yrs. Dyspnoea on exertion was present in all patients. Basal crackles were found in 87% and finger clubbing in 43%. Pulmonary function tests were as follows (mean± sd): total lung capacity 88%±17, forced vital capacity (FVC) 88%±18, forced expiratory volume in one second (FEV 1) 80%±21 (% predicted), FEV 1/FVC 69%±13, carbon monoxide diffusion capacity of the lung 37%±16 (% predicted), carbon monoxide transfer coefficient 46%±19. Pulmonary hypertension was present in 47% of patients at diagnosis, and 55% during follow-up. Patients were followed for a mean of 2.1±2.8 yrs from diagnosis. Survival was 87.5% at 2 yrs and 54.6% at 5 yrs, with a median of 6.1 yrs. The presence of pulmonary hypertension at diagnosis was a critical determinant of prognosis. The authors hereby individualise the computer tomography-defined syndrome of combined pulmonary fibrosis and emphysema characterised by subnormal spirometry, severe impairment of gas exchange, high prevalence of pulmonary hypertension, and poor survival. • • • • Emphysema and the idiopathic interstitial pneumonias, inc...

Bilateral increased lung parenchymal lucency with centrilobular emphysema having central or peripheral dots of broncho-vascular bundles. These changes are distributed predominantly in both upper lobes and upper segments of both lower lobes. Advanced destructive emphysema with expansion and architectural distortion in the upper lobes.

Purpose Small airways disease (SAD), a major cause of airflow obstruction in COPD patients, has been identified as a precursor to emphysema. Nevertheless, there is a lack of clinical techniques that can quantify the progression of SAD. We aim to determine if our Parametric Response Mapping (PRM) method to quantify SAD offers insight into lung progression from healthy to emphysema. Materials and Methods PRM metrics quantifying normal lung (PRM Norm) and functional SAD (PRM fSAD) were generated from CT scans collected as part of the COPDGene study (n=8956). Volume density (V) and Euler-Poincaré Characteristic (χ) maps, measures of extent and coalescence of pocket formations, respectively, were determined for both PRM Norm and PRM fSAD. Association with COPD severity, emphysema, and spirometric measures were assessed via multivariable regression models. Results Across all GOLD, we observed a strong linear correlation between χ fSAD and χ Norm (ρ =-0.745, p<0.001). Values of χ fSAD and χ Norm were found to flip signs in unison between GOLD 2 and 4, demonstrating an inversion in parenchymal topology. For subjects with COPD, multivariable analysis showed that both χ fSAD (β of 0.106, p<0.001) and V fSAD (β of 0.065, p=0.004) were independently associated with FEV 1% predicted. V and χ measures for PRM fSAD and PRM Norm were independently associated with the amount of emphysema. Conclusions We demonstrated that χ of fSAD and Norm have independent value when associated with lung f...

Author Affiliations • Department of Surgery, Section of Diagnostic Imaging, University of Parma, Parma, Italy • Division of Radiology, National Jewish Health, Denver, CO • Section of Respiratory Medicine, Department of Internal Medicine, University of Florence, Italy • Diagnostic and Interventional Radiology, University Clinic Heidelberg, Germany • Service de Radiologie Polyvalente, Diagnostique and Interventionelle, Hospital Pitie-Salpetriere, Paris, France • Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO • Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO Abstract Background: The purpose of this study was to define the differences between centrilobular emphysema (CLE) and panlobular emphysema (PLE) phenotypes in cigarette smokers with COPD by a combined qualitative-quantitative computed tomography (CT) analysis . Methods: Chest CT scans of 116 cigarette smokers were visually scored by 22 chest radiologists and 29 pulmonologists in a single setting for the predominant emphysema phenotype (e.g. CLE or PLE) and automatically quantified for emphysema: percentage ratio of low attenuation area to corresponding lung area (LAA%) ≤ -950 Hounsfield Units (HU) - %LAA insp-950; gas trapping extent and bronchial metrics (wall area % for segmental [%WAsegm] and subsegmental [%WAsubsegm] bronchi). These quantitative CT indexes were compared and related to forced expiratory volume in 1 second (FEV 1), ratio of F...