Top

Published in:

01-02-2018 | Chest

Effect of smoking cessation on quantitative computed tomography in smokers at risk in a lung cancer screening population

Authors: Bertram J. Jobst, Oliver Weinheimer, Mila Trauth, Nikolaus Becker, Erna Motsch, Marie-Luise Groß, Jan Tremper, Stefan Delorme, Anke Eigentopf, Monika Eichinger, Hans-Ulrich Kauczor, Mark O. Wielpütz

Published in: European Radiology | Issue 2/2018

Abstract

Objective

To longitudinally evaluate effects of smoking cessation on quantitative CT in a lung cancer screening cohort of heavy smokers over 4 years.

Methods

After 4 years, low-dose chest CT was available for 314 long-term ex-smokers (ES), 404 continuous smokers (CS) and 39 recent quitters (RQ) who quitted smoking within 2 years after baseline CT. CT acquired at baseline and after 3 and 4 years was subjected to well-evaluated densitometry software, computing mean lung density (MLD) and 15th percentile of the lung density histogram (15TH).

Results

At baseline, active smokers showed significantly higher MLD and 15TH (-822±35 and -936±25 HU, respectively) compared to ES (-831±31 and -947±22 HU, p<0.01–0.001). After 3 years, CS again had significantly higher MLD and 15TH (-801±29 and -896±23 HU) than ES (-808±27 and -906±20 HU, p<0.01–0.001) but also RQ (-813±20 and -909±15 HU, p<0.05-0.001). Quantitative CT parameters did not change significantly after 4 years. Importantly, smoking status independently predicted MLD at baseline and year 3 (p<0.001) in multivariate analysis.

Conclusion

On quantitative CT, lung density is higher in active smokers than ex-smokers, and sustainably decreases after smoking cessation, reflecting smoking-induced inflammation. Interpretations of quantitative CT data within clinical trials should consider smoking status.

Key Points

• Lung density is higher in active smokers than ex-smokers.

• Lung density sustainably decreases after smoking cessation.

• Impact of smoking cessation on lung density is independent of potentially confounding factors.

• Smoke-induced pulmonary inflammation and particle deposition influence lung density on CT.

Coxson HO, Mayo J, Lam S, Santyr G, Parraga G, Sin DD (2009) New and current clinical imaging techniques to study chronic obstructive pulmonary disease. Am J Respir Crit Care Med 180:588–597CrossRefPubMed

Rabe KF, Hurd S, Anzueto A et al (2007) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176:532–555CrossRefPubMed

Lynch DA, Austin JH, Hogg JC et al (2015) CT-definable subtypes of chronic obstructive pulmonary disease: a statement of the Fleischner Society. Radiology. doi:https://doi.org/10.1148/radiol.2015141579:141579

Coxson HO, Rogers RM (2005) Quantitative computed tomography of chronic obstructive pulmonary disease. Acad Radiol 12:1457–1463CrossRefPubMed

Kauczor HU, Wielputz MO, Owsijewitsch M, Ley-Zaporozhan J (2011) Computed tomographic imaging of the airways in COPD and asthma. Journal of thoracic imaging 26:290–300CrossRefPubMed

Ley-Zaporozhan J, van Beek EJ (2010) Imaging phenotypes of chronic obstructive pulmonary disease. Journal of magnetic resonance imaging : JMRI 32:1340–1352CrossRefPubMed

Heussel CP, Herth FJ, Kappes J et al (2009) Fully automatic quantitative assessment of emphysema in computed tomography: comparison with pulmonary function testing and normal values. Eur Radiol 19:2391–2402CrossRefPubMed

Hoffman EA, Simon BA, McLennan G (2006) State of the Art. A structural and functional assessment of the lung via multidetector-row computed tomography: phenotyping chronic obstructive pulmonary disease. Proc Am Thorac Soc 3:519–532CrossRefPubMedPubMedCentral

Coxson HO, Dirksen A, Edwards LD et al (2013) The presence and progression of emphysema in COPD as determined by CT scanning and biomarker expression: a prospective analysis from the ECLIPSE study. The Lancet Respiratory medicine 1:129–136CrossRefPubMed

10.

Gevenois PA, De Vuyst P, de Maertelaer V et al (1996) Comparison of computed density and microscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 154:187–192CrossRefPubMed

11.

Coxson HO, Rogers RM, Whittall KP et al (1999) A quantification of the lung surface area in emphysema using computed tomography. Am J Respir Crit Care Med 159:851–856CrossRefPubMed

12.

Regan EA, Hokanson JE, Murphy JR et al (2010) Genetic epidemiology of COPD (COPDGene) study design. COPD 7:32–43CrossRefPubMedPubMedCentral

13.

Han MK, Kazerooni EA, Lynch DA et al (2011) Chronic obstructive pulmonary disease exacerbations in the COPDGene study: associated radiologic phenotypes. Radiology 261:274–282CrossRefPubMedPubMedCentral

14.

Sciurba FC, Ernst A, Herth FJ et al (2010) A randomized study of endobronchial valves for advanced emphysema. N Engl J Med 363:1233–1244CrossRefPubMed

15.

Grydeland TB, Dirksen A, Coxson HO et al (2009) Quantitative computed tomography: emphysema and airway wall thickness by sex, age and smoking. The European respiratory journal 34:858–865CrossRefPubMed

16.

Camiciottoli G, Cavigli E, Grassi L et al (2009) Prevalence and correlates of pulmonary emphysema in smokers and former smokers. A densitometric study of participants in the ITALUNG trial. Eur Radiol 19:58–66CrossRefPubMed

17.

Mohamed Hoesein FA, Zanen P, de Jong PA et al (2013) Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study. Respiratory research 14:55CrossRefPubMedPubMedCentral

18.

Zach JA, Williams A, Jou SS et al (2016) Current Smoking Status Is Associated With Lower Quantitative CT Measures of Emphysema and Gas Trapping. Journal of thoracic imaging 31:29–36CrossRefPubMed

19.

Shaker SB, Stavngaard T, Laursen LC, Stoel BC, Dirksen A (2011) Rapid fall in lung density following smoking cessation in COPD. COPD 8:2–7CrossRefPubMed

20.

Ashraf H, Lo P, Shaker SB et al (2011) Short-term effect of changes in smoking behaviour on emphysema quantification by CT. Thorax 66:55–60CrossRefPubMed

21.

Becker N, Motsch E, Gross ML et al (2012) Randomized study on early detection of lung cancer with MSCT in Germany: study design and results of the first screening round. J Cancer Res Clin Oncol 138:1475–1486CrossRefPubMed

22.

Becker N, Motsch E, Gross ML et al (2015) Randomized Study on Early Detection of Lung Cancer with MSCT in Germany: Results of the First 3 Years of Follow-up After Randomization. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 10:890–896CrossRef

23.

Bade M, Bahr V, Brandt U et al (2016) Effect of smoking cessation counseling within a randomised study on early detection of lung cancer in Germany. J Cancer Res Clin Oncol 142:959–968CrossRefPubMed

24.

Miller MR, Hankinson J, Brusasco V et al (2005) Standardisation of spirometry. The European respiratory journal 26:319–338CrossRefPubMed

25.

Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC (1993) Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 16:5–40CrossRefPubMed

26.

Weinheimer O, Achenbach T, Heussel CP, Düber C (2011) Automatic Lung Segmentation in MDCT Images Fourth International Workshop on Pulmonary Image Analysis 2011, pp 241-255

27.

Wielputz MO, Weinheimer O, Eichinger M et al (2013) Pulmonary emphysema in cystic fibrosis detected by densitometry on chest multidetector computed tomography. PLoS One 8:e73142CrossRefPubMedPubMedCentral

28.

Wielputz MO, Bardarova D, Weinheimer O et al (2014) Variation of densitometry on computed tomography in COPD--influence of different software tools. PloS one 9:e112898CrossRefPubMedPubMedCentral

29.

Heussel CP, Kappes J, Hantusch R et al (2009) Contrast enhanced CT-scans are not comparable to non-enhanced scans in emphysema quantification. Eur J Radiol 74:473–478CrossRefPubMed

30.

Wielputz MO, Eichinger M, Weinheimer O et al (2013) Automatic airway analysis on multidetector computed tomography in cystic fibrosis: correlation with pulmonary function testing. Journal of thoracic imaging 28:104–113CrossRefPubMed

31.

Lim HJ, Weinheimer O, Wielputz MO et al (2016) Fully Automated Pulmonary Lobar Segmentation: Influence of Different Prototype Software Programs onto Quantitative Evaluation of Chronic Obstructive Lung Disease. PLoS One 11:e0151498CrossRefPubMedPubMedCentral

32.

Holm S (1979) A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics 6:65–70

33.

Zaporozhan J, Ley S, Weinheimer O et al (2006) Multi-detector CT of the chest: influence of dose onto quantitative evaluation of severe emphysema: a simulation study. Journal of computer assisted tomography 30:460–468CrossRefPubMed

34.

Yuan R, Mayo JR, Hogg JC et al (2007) The effects of radiation dose and CT manufacturer on measurements of lung densitometry. Chest 132:617–623CrossRefPubMed

35.

Gierada DS, Bierhals AJ, Choong CK et al (2010) Effects of CT section thickness and reconstruction kernel on emphysema quantification relationship to the magnitude of the CT emphysema index. Acad Radiol 17:146–156CrossRefPubMedPubMedCentral

36.

Smith BM, Barr RG (2013) Establishing normal reference values in quantitative computed tomography of emphysema. Journal of thoracic imaging 28:280–283CrossRefPubMedPubMedCentral

37.

Gietema HA, Schilham AM, van Ginneken B, van Klaveren RJ, Lammers JW, Prokop M (2007) Monitoring of smoking-induced emphysema with CT in a lung cancer screening setting: detection of real increase in extent of emphysema. Radiology 244:890–897CrossRefPubMed

38.

Soejima K, Yamaguchi K, Kohda E et al (2000) Longitudinal follow-up study of smoking-induced lung density changes by high-resolution computed tomography. Am J Respir Crit Care Med 161:1264–1273CrossRefPubMed

39.

Kauczor HU, Heussel CP, Herth FJ (2013) Longitudinal quantitative low-dose CT in COPD: ready for use? The Lancet Respiratory medicine 1:95–96CrossRefPubMed

40.

Sieren JP, Newell JD, Judy PF et al (2012) Reference standard and statistical model for intersite and temporal comparisons of CT attenuation in a multicenter quantitative lung study. Medical physics 39:5757–5767CrossRefPubMedPubMedCentral

41.

Stoel BC, Putter H, Bakker ME et al (2008) Volume correction in computed tomography densitometry for follow-up studies on pulmonary emphysema. Proc Am Thorac Soc 5:919–924CrossRefPubMed

42.

Madani A, Van Muylem A, Gevenois PA (2010) Pulmonary emphysema: effect of lung volume on objective quantification at thin-section CT. Radiology 257:260–268CrossRefPubMed

Title: Effect of smoking cessation on quantitative computed tomography in smokers at risk in a lung cancer screening population
Authors: Bertram J. Jobst
Oliver Weinheimer
Mila Trauth
Nikolaus Becker
Erna Motsch
Marie-Luise Groß
Jan Tremper
Stefan Delorme
Anke Eigentopf
Monika Eichinger
Hans-Ulrich Kauczor
Mark O. Wielpütz
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 2/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-5030-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of smoking cessation on quantitative computed tomography in smokers at risk in a lung cancer screening population

Abstract

Objective

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 2/2018

Comparison of hybrid 68Ga-PSMA-PET/CT and 99mTc-DPD-SPECT/CT for the detection of bone metastases in prostate cancer patients: Additional value of morphologic information from low dose CT

Effective collateral circulation may indicate improved perfusion territory restoration after carotid endarterectomy

Prostate cancer detection among readers with different degree of experience using ultra-high b-value diffusion-weighted Imaging: Is a non-contrast protocol sufficient to detect significant cancer?

How to differentiate acute pelvic inflammatory disease from acute appendicitis ? A decision tree based on CT findings

Invasive placenta previa: Placental bulge with distorted uterine outline and uterine serosal hypervascularity at 1.5T MRI – useful features for differentiating placenta percreta from placenta accreta

Metastatic and non-metastatic lymph nodes: quantification and different distribution of iodine uptake assessed by dual-energy CT