title: Diffusing capacity for carbon monoxide correlates best with tissue volume from quantitative CT scanning analysis.
abstract: BACKGROUND
  Quantitative analysis of high-resolution chest CT scan (QCT) is an established method for determining the severity and distribution of lung parenchymal destruction inpatients with emphysema. Diffusing capacity of the lung for carbon monoxide (D(LCO)) is a traditional physiologic measure of emphysema severity and is probably influenced more by destruction of the alveolar capillary bed than by membrane diffusion per se. We reasoned that D(LCO) should correlate with tissue volume from QCT.
  
  
  METHODS
  A total of 460 patients with upper-lobe-predominant emphysema were enrolled in the study. Th e mean (SD) of percent predicted values for FEV 1 , total lung capacity, and D(LCO) were 30.6% (8.0%), 129.5% (18.1%), and 6.7% (13.1%), respectively. QCT was performed using custom soft ware; the relationship between D(LCO) and various metrics from QCT were evaluated using Pearson correlation coefficients.
  
  
  RESULTS
  On average, whole-body plethysmography volumes were higher by 841 mL compared with QCT-calculated total lung volume. However, there was a strong correlation between these measurements (r=0.824, P < .0001). D(LCO) correlated with total lung volume (r=0.314, P<.0001), total tissue volume (r=0.498, P<.0001), and percentage of lung with low density (-950 Hounsfield units) (r=-0.337, P<.0001).
  
  
  CONCLUSIONS
  In patients with severe emphysema, D(LCO) correlates best with total tissue volume,supporting the hypothesis that pulmonary capillary blood volume is the main determinant of D(LCO) in the human lung. Th e relationships between D(LCO) and various anatomic metrics of lung parenchymal destruction from QCT inform our understanding of the relationship between structure and function of the human lung.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
authors.forename: Igor
authors.initials: I
authors.lastname: Barjaktarevic
authors.affiliation: Spiration, Inc, Redmond, WA.
authors.forename: Steven
authors.initials: S
authors.lastname: Springmeyer
authors.affiliation: Spiration, Inc, Redmond, WA.
authors.forename: Xavier
authors.initials: X
authors.lastname: Gonzalez
authors.affiliation: Spiration, Inc, Redmond, WA.
authors.forename: William
authors.initials: W
authors.lastname: Sirokman
authors.affiliation: Department of Radiology, UBC James Hogg Research Centre, Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: Harvey O
authors.initials: HO
authors.lastname: Coxson
authors.affiliation: Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Department of Medicine, and Department of Physiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA. Electronic address: ccooper@mednet.ucla.edu.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Cooper
mesh_terms: D000368:Aged; D001810:Blood Volume / Q000502:physiology; D002248:Carbon Monoxide / Q000378:metabolism*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010991:Plethysmography; D011653:Pulmonary Diffusing Capacity / Q000502:physiology*; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000473:pathology; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014109:Total Lung Capacity / Q000502:physiology
chemical_list: D002248:Carbon Monoxide