title: Variation in the percent of emphysema-like lung in a healthy, nonsmoking multiethnic sample. The MESA lung study.
abstract: BACKGROUND
  Computed tomography (CT)-based lung density is used to quantitate the percentage of emphysema-like lung (hereafter referred to as percent emphysema), but information on its distribution among healthy nonsmokers is limited.
  
  
  OBJECTIVE
  We evaluated percent emphysema and total lung volume on CT scans of healthy never-smokers in a multiethnic, population-based study.
  
  
  METHODS
  The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study investigators acquired full-lung CT scans of 3,137 participants (ages 54-93 yr) between 2010-12. The CT scans were taken at full inspiration following the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) protocol. "Healthy never-smokers" were defined as participants without a history of tobacco smoking or respiratory symptoms and disease. "Percent emphysema" was defined as the percentage of lung voxels below -950 Hounsfield units. "Total lung volume" was defined by the volume of lung voxels.
  
  
  RESULTS
  Among 854 healthy never-smokers, the median percent emphysema visualized on full-lung scans was 1.1% (interquartile range, 0.5-2.5%). The percent emphysema values were 1.2 percentage points higher among men compared with women and 0.7, 1.2, and 1.2 percentage points lower among African Americans, Hispanics, and Asians compared with whites, respectively (P < 0.001). Percent emphysema was positively related to age and height and inversely related to body mass index. The findings were similar for total lung volume on CT scans and for percent emphysema defined at -910 Hounsfield units and measured on cardiac scans. Reference equations to account for these differences are presented for never, former and current smokers.
  
  
  CONCLUSIONS
  Similar to lung function, percent emphysema varies substantially by demographic factors and body size among healthy never-smokers. The presented reference equations will assist in defining abnormal values for percent emphysema and total lung volume on CT scans, although validation is pending.
authors.affiliation: 1 Department of Radiology.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Hoffman
authors.forename: Firas S
authors.initials: FS
authors.lastname: Ahmed
authors.forename: Heather
authors.initials: H
authors.lastname: Baumhauer
authors.forename: Mathew
authors.initials: M
authors.lastname: Budoff
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.forename: Richard
authors.initials: R
authors.lastname: Kronmal
authors.forename: S
authors.initials: S
authors.lastname: Reddy
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000208:ethnology*; D012016:Reference Values; D017678:Sex Distribution; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
keywords: emphysema; lung volumes; quantitative computed tomography; reference equations