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European Radiology
Published in: European Radiology 3/2009

01-03-2009 | Chest

CT of pulmonary emphysema - current status, challenges, and future directions

Authors: Diana Litmanovich, Phillip M. Boiselle, Alexander A. Bankier

Published in: European Radiology | Issue 3/2009

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Abstract

Pulmonary emphysema is characterized by irreversible destruction of lung parenchyma. Emphysema is a major contributor to chronic obstructive pulmonary disease (COPD), which by itself is a major cause of morbidity and mortality in the western world. Computed tomography (CT) is an established method for the in-vivo analysis of emphysema. This review first details the pathological basis of emphysema and shows how the subtypes of emphysema can be characterized by CT. The review then shows how CT is used to quantify emphysema, and describes the requirements and foundations for quantification to be accurate. Finally, the review discusses new challenges and their potential solution, notably focused on multi-detector-row CT, and emphasizes the open questions that future research on CT of pulmonary emphysema will have to address.
Literature
1.
Abusriwil H, Stockley RA (2006) Alpha-1-antitrypsin replacement therapy: current status. Curr Opin Pulm Med 12:125–131CrossRefPubMed
2.
3.
Gierada DS, Slone RM, Bae KT, Yusen RD, Lefrak SS, Cooper JD (1997) Pulmonary emphysema: comparison of preoperative quantitative CT and physiologic index values with clinical outcome after lung-volume reduction surgery. Radiology 205:235–242PubMed
4.
Higuchi T, Reed A, Oto T, Holsworth L, Ellis S, Bailey MJ, Williams TJ, Snell GI (2006) Relation of interlobar collaterals to radiological heterogeneity in severe emphysema. Thorax 61:409–413CrossRefPubMed
5.
Martinez FJ, Foster G, Curtis JL, Criner G, Weinmann G, Fishman A, DeCamp MM, Benditt J, Sciurba F, Make B, Mohsenifar Z, Diaz P, Hoffman E, Wise R (2006) Predictors of mortality in patients with emphysema and severe airflow obstruction. Am J Respir Crit Care Med 173:1326–1334CrossRefPubMed
6.
Newell JD Jr, Hogg JC, Snider GL (2004) Report of a workshop: quantitative computed tomography scanning in longitudinal studies of emphysema. Eur Respir J 23:769–775CrossRefPubMed
7.
8.
MacNee W (2005) Pathogenesis of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2:258–266, discussion 290–251CrossRefPubMed
9.
Snider GL, Kleinerman JL, Thurlbeck WM, Bengali ZH (1985) The definition of emphysema: report of a National Heart, Lung, and Blood Institute, Division of Lung Diasease Workshop. Am Rev Respir Dis 132:182–183
10.
Kim WD, Eidelman DH, Izquierdo JL, Ghezzo H, Saetta MP, Cosio MG (1991) Centrilobular and panlobular emphysema in smokers. Two distinct morphologic and functional entities. Am Rev Respir Dis 144:1385–1390PubMed
11.
Hogg JC (2004) Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet 364:709–721CrossRefPubMed
12.
Thurlbeck WM, Mueller NL (1994) Emphysema: definition, imaging, and quantification. AJR Am J Roentgenol 163:1017–1025PubMed
13.
Webb WR, Stein MG, Finkbeiner WE, Im JG, Lynch D, Gamsu G (1988) Normal and diseased isolated lungs: high-resolution CT. Radiology 166:81–87PubMed
14.
Webb WR (2006) Thin-section CT of the secondary pulmonary lobule: anatomy and the image–the 2004 Fleischner lecture. Radiology 239:322–338CrossRefPubMed
15.
16.
17.
18.
Müller NL, Coxon H (2002) Chronic obstructive pulmonary disease. 4: imaging the lungs in patients with chronic obstructive pulmonary disease. Thorax 57:982–985CrossRefPubMed
19.
Thurlbeck WM, Simon G (1978) Radiographic appearance of the chest in emphysema. AJR Am J Roentgenol 130:429–440PubMed
20.
Sutinen S, Christoforidis AJ, Klugh GA, Pratt PC (1965) Roentgenologic Criteria for the Recognition of Nonsymptomatic Pulmonary Emphysema. Correlation between Roentgenologic Findings and Pulmonary Pathology. Am Rev Respir Dis 91:69–76PubMed
21.
Aziz ZA, Wells AU, Desai SR, Ellis SM, Walker AE, MacDonald S, Hansell DM (2005) Functional impairment in emphysema: contribution of airway abnormalities and distribution of parenchymal disease. AJR Am J Roentgenol 185:1509–1515CrossRefPubMed
22.
Madani A, Zanen J, de Maertelaer V, Gevenois PA (2006) Pulmonary emphysema: objective quantification at multi-detector row CT–comparison with macroscopic and microscopic morphometry. Radiology 238:1036–1043CrossRefPubMed
23.
Remy-Jardin MR, Gosselin B, Copin MC, Wurtz A, Duhamel A (1996) Sliding thin slab, minimum intensity projection technique in the diagnosis of emphysema: histopathologic-CT correlation. Radiology 200:665–671PubMed
24.
Hruban RH, Meziane MA, Zerhouni EA, Khouri NF, Fishman EK, Wheeler PS, Dumler JS, Hutchins GM (1987) High resolution computed tomography of inflation-fixed lungs. Pathologic-radiologic correlation of centrilobular emphysema. Am Rev Respir Dis 136:935–940PubMed
25.
Murata K, Itoh H, Todo G, Kanaoka M, Noma S, Itoh T, Furuta M, Asamoto H, Torizuka K (1986) Centrilobular lesions of the lung: demonstration by high-resolution CT and pathologic correlation. Radiology 161:641–645PubMed
26.
Murata K, Khan A, Herman PG (1989) Pulmonary parenchymal disease: evaluation with high-resolution CT. Radiology 170:629–635PubMed
27.
Kuwano K, Matsuba K, Ikeda T, Murakami J, Araki A, Nishitani H, Ishida T, Yasumoto K, Shigematsu N (1990) The diagnosis of mild emphysema. Correlation of computed tomography and pathology scores. Am Rev Respir Dis 141:169–178PubMed
28.
Gevenois PA, de Maertelaer V, Zanen J, Jacobovitz D, Cosio MG, Yernault JC (1996) Comparison of computed density and microscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 154:187–192PubMed
29.
Gevenois PA, de Maertelaer V, De Vuyst P, Zanen J, Yernault JC (1995) Comparison of computed density and macroscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 152:653–657PubMed
30.
Bankier AA, De Maertelaer V, Keyzer C, Gevenois PA (1999) Pulmonary emphysema: subjective visual grading versus objective quantification with macroscopic morphometry and thin-section CT densitometry. Radiology 211:851–858PubMed
31.
Gelb AF, Zamel N, Hogg JC, Müller NL, Schein MJ (1998) Pseudophysiologic emphysema resulting from severe small-airways disease. Am J Respir Crit Care Med 158:815–819PubMed
32.
Müller NL, Staples CA, Miller RR, Abboud RT (1988) “Density mask". An objective method to quantitate emphysema using computed tomography. Chest 94:782–787CrossRefPubMed
33.
Gevenois PA, Yernault JC (1995) Can computed tomography quantify pulmonary emphysema? Eur Respir J 8:843–848PubMed
34.
Hayhurst MD, MacNee W, Flenley DC, Wright D, McLean A, Lamb D, Wightman AJ, Best J (1984) Diagnosis of pulmonary emphysema by computerised tomography. Lancet 2:320–322CrossRefPubMed
35.
Gould GA, MacNee W, McLean A, Warren PM, Redpath A, Best JJ, Lamb D, Flenley DC (1988) CT measurements of lung density in life can quantitate distal airspace enlargement–an essential defining feature of human emphysema. Am Rev Respir Dis 137:380–392PubMed
36.
Hartley PG, Galvin JR, Hunninghake GW, Merchant JA, Yagla SJ, Speakman SB, Schwartz DA (1994) High-resolution CT-derived measures of lung density are valid indexes of interstitial lung disease. J Appl Physiol 76:271–277PubMed
37.
Rienmuller RK, Behr J, Kalender WA, Schatzl M, Altmann I, Merin M, Beinert T (1991) Standardized quantitative high resolution CT in lung diseases. J Comput Assist Tomogr 15:742–749PubMedCrossRef
38.
Thurlbeck WM, Dunnill MS, Hartung W, Heard BE, Heppleston AG, Ryder RC (1970) A comparison of three methods of measuring emphysema. Hum Pathol 1:215–226CrossRefPubMed
39.
Kalender WA, Fichte H, Bautz W, Skalej M (1991) Semiautomatic evaluation procedures for quantitative CT of the lung. J Comput Assist Tomogr 15:248–255PubMed
40.
Gevenois PA, Koob MC, Jacobovitz D, De Vuyst P, Yernault JC, Struyven J (1993) Whole lung sections for computed tomographic-pathologic correlations. Modified Gough-Wentworth technique. Invest Radiol 28:242–246CrossRefPubMed
41.
Gevenois PA, Zanen J, de Maertelaer V, De Vuyst P, Dumortier P, Yernault JC (1995) Macroscopic assessment of pulmonary emphysema by image analysis. J Clin Pathol 48:318–322CrossRefPubMed
42.
McLean A, Warren PM, Gillooly M, MacNee W, Lamb D (1992) Microscopic and macroscopic measurements of emphysema: relation to carbon monoxide gas transfer. Thorax 47:144–149CrossRefPubMed
43.
Coxson HO, Rogers RM, Whittall KP, D'yachkova Y, Paré PD, Sciurba FC, Hogg JC (1999) A quantification of the lung surface area in emphysema using computed tomography. Am J Respir Crit Care Med 159:851–856PubMed
44.
Desai SR, Hansell DM, Walker A, MacDonald SL, Chabat F, Wells AU (2007) Quantification of emphysema: a composite physiologic index derived from CT estimation of disease extent. Eur Radiol 17:911–918CrossRefPubMed
45.
Hoffman EA, McLennan G (1997) Assessment of the pulmonary structure-function relationship and clinical outcomes measures: quantitative volumetric CT of the lung. Acad Radiol 4:758–776CrossRefPubMed
46.
Uppaluri R, Mitsa T, Sonka M, Hoffman EA, McLennan G (1997) Quantification of pulmonary emphysema from lung computed tomography images. Am J Respir Crit Care Med 156:248–254PubMed
47.
Mishima M, Hirai T, Itoh H, Nakano Y, Sakai H, Muro S, Nishimura K, Oku Y, Chin K, Ohi M, Nakamura T, Bates JH, Alencar AM, Suki B (1999) Complexity of terminal airspace geometry assessed by lung computed tomography in normal subjects and patients with chronic obstructive pulmonary disease. Proc Natl Acad Sci U S A 96:8829–8834CrossRefPubMed
48.
Mishima M, Itoh H, Sakai H, Nakano Y, Muro S, Hirai T, Takubo Y, Chin K, Ohi M, Nishimura K, Yamaguchi K, Nakamura T (1999) Optimized scanning conditions of high resolution CT in the follow-up of pulmonary emphysema. J Comput Assist Tomogr 23:380–384CrossRefPubMed
49.
Chabat F, Yang GZ, Hansell DM (2003) Obstructive lung diseases: texture classification for differentiation at CT. Radiology 228:871–877CrossRefPubMed
50.
Thurlbeck WM (1967) The internal surface area of nonemphysematous lungs. Am Rev Respir Dis 95:765–773PubMed
51.
Gillooly M, Lamb D (1993) Airspace size in lungs of lifelong non-smokers: effect of age and sex. Thorax 48:39–43CrossRefPubMed
52.
Gevenois PA, Scillia P, de Maertelaer V, Michils A, De Vuyst P, Yernault JC (1996) The effects of age, sex, lung size, and hyperinflation on CT lung densitometry. AJR Am J Roentgenol 167:1169–1173PubMed
53.
Soejima K, Yamaguchi K, Kohda E, Takeshita K, Ito Y, Mastubara H, Oguma T, Inoue T, Okubo Y, Amakawa K, Tateno H, Shiomi T (2000) Longitudinal follow-up study of smoking-induced lung density changes by high-resolution computed tomography. Am J Respir Crit Care Med 161:1264–1273PubMed
54.
55.
56.
Kohz P, Stabler A, Beinert T, Behr J, Egge T, Heuck A, Reiser M (1995) Reproducibility of quantitative, spirometrically controlled CT. Radiology 197:539–542PubMed
57.
Kauczor HU, Heussel CP, Fischer B, Klamm R, Mildenberger P, Thelen M (1998) Assessment of lung volumes using helical CT at inspiration and expiration: comparison with pulmonary function tests. AJR Am J Roentgenol 171:1091–1095PubMed
58.
Park KJ, Bergin CJ, Clausen JL (1999) Quantitation of emphysema with three-dimensional CT densitometry: comparison with two-dimensional analysis, visual emphysema scores, and pulmonary function test results. Radiology 211:541–547PubMed
59.
Mayo JR, Aldrich J, Muller NL (2003) Radiation exposure at chest CT: a statement of the Fleischner Society. Radiology 228:15–21CrossRefPubMed
60.
Madani A, De Maertelaer V, Zanen J, Gevenois PA (2007) Pulmonary emphysema: radiation dose and section thickness at multidetector CT quantification–comparison with macroscopic and microscopic morphometry. Radiology 243:250–257CrossRefPubMed
61.
Knudson RJ, Standen JR, Kaltenborn WT, Knudson DE, Rehm K, Habib MP, Newell JD (1991) Expiratory computed tomography for assessment of suspected pulmonary emphysema. Chest 99:1357–1366CrossRefPubMed
62.
Nishimura K, Murata K, Yamagishi M, Itoh H, Ikeda A, Tsukino M, Koyama H, Sakai N, Mishima M, Izumi T (1998) Comparison of different computed tomography scanning methods for quantifying emphysema. J Thorac Imaging 13:193–198CrossRefPubMed
63.
Eda S, Kubo K, Fujimoto K, Matsuzawa Y, Sekiguchi M, Sakai F (1997) The relations between expiratory chest CT using helical CT and pulmonary function tests in emphysema. Am J Respir Crit Care Med 155:1290–1294PubMed
64.
Gevenois PA, Sy M, Scillia P, Chaminade L, de Maertelaer V, Zanen J, Yernault JC (1996) Pulmonary emphysema: quantitative CT during expiration. Radiology 199:825–829PubMed
65.
Lamers RJ, Thelissen GR, Kessels AG, Wouters EF, van Engelshoven JM (1994) Chronic obstructive pulmonary disease: evaluation with spirometrically controlled CT lung densitometry. Radiology 193:109–113PubMed
66.
67.
Sanders C, Nath PH, Bailey WC (1988) Detection of emphysema with computed tomography. Correlation with pulmonary function tests and chest radiography. Invest Radiol 23:262–266CrossRefPubMed
68.
Gurney JW, Jones KK, Robbins RA, Gossman GL, Nelson KJ, Daughton D, Spurzem JR, Rennard SI (1992) Regional distribution of emphysema: correlation of high-resolution CT with pulmonary function tests in unselected smokers. Radiology 183:457–463PubMed
69.
Haraguchi M, Shimura S, Hida W, Shirato K (1998) Pulmonary function and regional distribution of emphysema as determined by high-resolution computed tomography. Respiration 65:125–129CrossRefPubMed
70.
Saitoh T, Koba H, Shijubo N, Tanaka H, Sugaya F (2000) Lobar distribution of emphysema in computed tomographic densitometric analysis. Invest Radiol 35:235–243CrossRefPubMed
71.
Nakano Y, Sakai H, Muro S, Hirai T, Oku Y, Nishimura K, Mishima M (1999) Comparison of low attenuation areas on computed tomographic scans between inner and outer segments of the lung in patients with chronic obstructive pulmonary disease: incidence and contribution to lung function. Thorax 54:384–389CrossRefPubMed
72.
Morrison NJ, Abboud RT, Ramadan F, Miller RR, Gibson NN, Evans KG, Nelems B, Muller NL (1989) Comparison of single breath carbon monoxide diffusing capacity and pressure-volume curves in detecting emphysema. Am Rev Respir Dis 139:1179–1187PubMed
73.
Kinsella M, Müller NL, Abboud RT, Morrison NJ, DyBuncio A (1990) Quantitation of emphysema by computed tomography using a “density mask” program and correlation with pulmonary function tests. Chest 97:315–321CrossRefPubMed
74.
Watanuki Y, Suzuki S, Nishikawa M, Miyashita A, Okubo T (1994) Correlation of quantitative CT with selective alveolobronchogram and pulmonary function tests in emphysema. Chest 106:806–813CrossRefPubMed
75.
Gelb AF, Hogg JC, Müller NL, Schein MJ, Kuei J, Tashkin DP, Epstein JD, Kollin J, Green RH, Zamel N, Elliott WM, Hadjiaghai L (1996) Contribution of emphysema and small airways in COPD. Chest 109:353–359CrossRefPubMed
Metadata
Title
CT of pulmonary emphysema - current status, challenges, and future directions
Authors
Diana Litmanovich
Phillip M. Boiselle
Alexander A. Bankier
Publication date
01-03-2009
Publisher
Springer-Verlag
Published in
European Radiology / Issue 3/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-008-1186-4

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