Quantitative assessment of air trapping in chronic obstructive pulmonary disease using inspiratory and expiratory volumetric MDCT.
OBJECTIVE
The purpose of our study was to determine the attenuation threshold value for the detection and quantification of air trapping using paired inspiratory and expiratory volumetric MDCT scans and to assess whether the densitometric parameter can be used for the quantification of airway dysfunction in chronic obstructive pulmonary disease (COPD) regardless of the degree of emphysema.


METHODS
This study included 36 patients with COPD who underwent 64-MDCT. The entire lung volume with attenuation between -500 and -1,024 H was segmented as whole lung. The lung volume with attenuation between -500 and -950 H was segmented as limited lung, while the lung volume of less than -950 H was segmented as emphysema and eliminated. The relative volumes for limited lung (relative volume(n-950)) with attenuation values below thresholds (n) ranging from -850 to -950 H, and relative volume for whole lung (relative volume(<n)) were obtained on inspiratory and expiratory CT. Then the differences of relative volumes after expiration in whole lung (relative volume change(<n)) and limited lung (relative volume change(n-950)) were calculated. Patients were classified into two groups according to mean relative volume less than -950 H. Correlations between densitometry parameters and pulmonary function tests (PFTs) reflecting airway dysfunction were evaluated.


RESULTS
The highest correlation with PFTs was observed at the upper threshold of -860 H. In the moderate to severe emphysema group (relative volume(<-950) > 15%), relative volume change(860-950) significantly correlated with the results of PFTs, whereas no significant correlations were seen between relative volume change(<-860) and PFTs. In the minimal or mild emphysema group (inspiratory relative volume(<-950) < 15%), all densitometric parameters correlated with PFTs.


CONCLUSIONS
The densitometric parameter of relative volume change calculated on paired inspiratory and expiratory MDCT using the threshold of -860 H in limited lung correlated closely with airway dysfunction in COPD regardless of the degree of emphysema.
Matsuoka
Shin
S
Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, Japan. shin4114@mac.com
Kurihara
Yasuyuki
Y
Yagihashi
Kunihiro
K
Hoshino
Makoto
M
Watanabe
Naoto
N
Nakajima
Yasuo
Y
D000368:Aged; D000369:Aged, 80 and over; D003720:Densitometry; D045853:Exhalation / Q000502:physiology*; D005260:Female; D006801:Humans; D001239:Inhalation / Q000502:physiology*; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D036542:Tomography, Spiral Computed