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Quantification of emphysema: a composite physiologic index derived from CT estimation of disease extent

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Abstract

The combination of functional indices best reflecting the extent of emphysema is not known. High-resolution computed tomography (HRCT) studies of 106 patients with emphysema [men=71; median age=61 (range=26–86 years)] were reviewed and the extent of emphysema was quantified: (a) visually (emphysemavis) and (b) by automated estimation (emphysemaauto). Functional-morphologic relationships were compared for the two scoring systems, and a composite physiologic index (CPI) (providing the best fit of functional indices against emphysema extent) was derived. Emphysemavis and emphysemaauto were strongly correlated (r=0.90; p<0.0005), but the extent of emphysemavis was consistently greater (p<0.00005). Emphysemavis correlated most strongly with indices of gas transfer [percent predicted single-breath carbon monoxide diffusing capacity (Dlco) and alveolar volume (Kco); r=−0.70, both p<0.0005]. The combination of physiologic indices most representative of emphysema extent on CT (using visual or automated methods) consisted of Kco and forced expiratory volume in 1 s (FEV1) levels. The equation explanatory power was higher for visual scoring [emphysemavis=96.8-(0.67×% predicted Kco)-(0.41×% predicted FEV1); equation r 2=0.57] than automated estimation (equation r 2=0.48). Weighted combinations of Kco and FEV1 levels provide a CPI best reflecting morphologic emphysema extent. CPI has the potential to refine the stratification of patients in epidemiological and therapeutic studies.

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Authors and Affiliations

  1. Department of Radiology, Royal Brompton Hospital (SRD, DMH, MW, SLSM, FC), Sydney Street, London, SW3 6NP, UK

    Sujal R. Desai, David M. Hansell, Amanda Walker, Sharon L.S. MacDonald, François Chabat & Athol U. Wells

  2. Department of Radiology, King’s College Hospital (SRD), Denmark Hill, London, SE5 9RS, UK

    Sujal R. Desai, David M. Hansell, Amanda Walker, Sharon L.S. MacDonald, François Chabat & Athol U. Wells

  3. Interstitial Lung Disease Unit (AUW), Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK

    Sujal R. Desai, David M. Hansell, Amanda Walker, Sharon L.S. MacDonald, François Chabat & Athol U. Wells

Authors
  1. Sujal R. Desai
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  2. David M. Hansell
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  3. Amanda Walker
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  4. Sharon L.S. MacDonald
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  5. François Chabat
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  6. Athol U. Wells
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Correspondence to Sujal R. Desai.

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Desai, S.R., Hansell, D.M., Walker, A. et al. Quantification of emphysema: a composite physiologic index derived from CT estimation of disease extent. Eur Radiol 17, 911–918 (2007). https://doi.org/10.1007/s00330-006-0369-0

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  • DOI: https://doi.org/10.1007/s00330-006-0369-0

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