Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis - Comparison of different quantitative evaluations and pulmonary function test
Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis - Comparison of different quantitative evaluations and pulmonary function test
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DOI：
10.1378/chest.128.5.3212
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发表时间：
2005-11-01
期刊：
影响因子：
9.6
通讯作者：
Kauczor, HU
中科院分区：
文献类型：
--
作者：
Zaporozhan, J;Ley, S;Kauczor, HU
目的：本研究的目的是使用吸气和呼气时的三维高分辨率CT扫描数据集对肺气肿进行定量评估。使用先进的专用半自动分析工具，肺气肿体积和簇的功能性吸气/呼气移位进行量化。肺功能检查（PFT）作为临床的“金标准”。“材料和方法：31例COPD（慢性阻塞性肺疾病全球倡议[GOLD] III级和IV级）导致重度肺气肿的患者（9例女性和22例男性;平均[+/- SD]年龄，60 ± 8岁）入选本研究。所有患者均进行了成对的吸气/呼气多层螺旋CT扫描（层厚，1/0.8 mm）和肺功能检查（PFrs）。用自编的肺气肿检测软件对CT扫描数据进行分析。它提供肺容积（LV）、肺气肿容积（EV）、肺气肿指数（EI）和四个不同容积的肺气肿集群（2、8、65和120 mm（3））。结果：吸气时LV与TLC相关（r = 0.9），呼气时LV与ITGV相关（r = 0.87），RV相关（r = 0.83）。呼气EV与ITGV（r = 0.88）和RV（r = 0.93）的相关性好于吸气EV（r = 0.83和0.88）。平均吸气Ell为54 +/-13%，呼气时降至43 +/- 15%。然而，个体表现出广泛的El变化（平均值，11%;范围，1至28%），并且在GOLD III和GOLD IV患者之间没有发现吸气/呼气El和El或LV变化的差异。呼气时，从大的肺气肿簇（-37%）变为中等簇（+15%）和小簇（分别为+13%和+11%）。结论：呼气相MDCT测量的肺气肿体积较吸气相MDCT测量的肺气肿体积更能反映重度肺气肿患者的肺功能异常。体积聚类分析提供了更深入的了解局部过度充气和大的肺气肿集群呼气阻塞。
Purpose: The aim of the study was to use three-dimensional high-resolution CT scan data sets in inspiration and expiration for the quantitative evaluation of emphysema. Using an advanced dedicated semiautomatic analysis tool, the functional inspiratory/expiratory shifts of emphysema volume and clusters were quantified. The pulmonary function test (PFT) served as the clinical "gold standard."Materials and methods: Thirty-one patients (9 women and 22 men; mean [+/- SD] age, 60 +/- 8 years) who had severe emphysema due to COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] class III and IV) were included in the study. All patients underwent paired inspiratory/expiratory multidetector CT scans (slice thickness, 1/0.8 nun) and pulmonary function tests (PFrs). CT scan data were analyzed with self-written emphysema detection solftware. It provides lung volume (LV), emphysema volume (EV), emphysema index (EI), and four clusters of emphysema with different volumes (from 2, 8, 65, and 120 mm(3)). These results were correlated with total lung capacity (TLC), intrathoracic gas volume (ITGV), and residual volume (RV) derived from PFT results.Results: Inspiratory LV correlated with TLC (r = 0.9), expiratory LV with ITGV (r = 0.87), and RV (r = 0.83). Expiratory EV correlated better with ITGV (r = 0.88) and RV (r = 0.93) than with inspiratory EV (r = 0.83 and 0.88, respectively). The mean inspiratory Ell was 54 +/- 13%, and it decreased to 43 +/- 15% in expiration. However, the individuals showed a broad spectrum of changes of El (mean, 11%; range, 1 to 28%), and no differences in inspiratory/expiratory El and changes in El or LV were found between GOLD III and GOLD IV patients. In expiration, there was a change from the large emphysema cluster (-37%) to the intermediate cluster (+15%) and small cluster (+13% and +11%, respectively). The change of volume of the large emphysema cluster after expiration correlated well with the changes in LV (r = 0.9), EV (r = 0.99), El (r = 0.85), and MLD (r = 0.76).Conclusion: Emphysema volumes measured from expiratory MDCT scans better reflect PFT abnormalities in patients with severe emphysema than those from inspiratory scans. Volumettic cluster analysis provided deeper insights into the local hyperinflation and expiratory obstruction of large emphysematous clusters.