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Normal spectrum of pulmonary parametric response map to differentiate lung collapsibility: distribution of densitometric classifications in healthy adult volunteers

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Abstract

Objectives

Pulmonary parametric response map (PRM) was proposed for quantitative densitometric phenotypization of chronic obstructive pulmonary disease. However, little is known about this technique in healthy subjects. The purpose of this study was to describe the normal spectrum of densitometric classification of pulmonary PRM in a group of healthy adults.

Methods

15 healthy volunteers underwent spirometrically monitored chest CT at total lung capacity (TLC) and functional residual capacity (FRC). The paired CT scans were analyzed by PRM for voxel-by-voxel characterization of lung parenchyma according to 4 densitometric classifications: normal lung (TLC ≥ -950 HU, FRC ≥ -856 HU); expiratory low attenuation area (LAA) (TLC ≥ -950 HU, FRC < -856 HU); dual LAA (TLC<-950 HU, FRC < -856 HU); uncharacterized (TLC < -950 HU, FRC ≥ -856 HU).

Results

PRM spectrum was 78 % ± 10 % normal lung, 20 % ± 8 % expiratory LAA, and 1 % ± 1 % dual LAA. PRM was similar between genders, there was moderate correlation between dual LAA and spirometrically assessed TLC (R = 0.531; p = 0.042), and between expiratory LAA and VolExp/Insp ratio (R = -0.572; p = 0.026).

Conclusions

PRM reflects the predominance of normal lung parenchyma in a group of healthy volunteers. However, PRM also confirms the presence of physiological expiratory LAA seemingly related to air trapping and a minimal amount of dual LAA likely reflecting emphysema.

Key points

• Co-registration of inspiratory and expiratory computed tomography allows dual-phase densitometry.

• Dual-phase co-registered densitometry reflects heterogeneous regional changes in lung function.

• Quantification of lung in healthy subjects is needed to set reference values.

• Expiratory low attenuation areas <30 % could be considered within normal range.

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Abbreviations

ATS:

American Thoracic Society

BMI:

body mass index

COPD:

chronic obstructive pulmonary disease

ERS:

European Respiratory Society

FRC:

functional residual capacity

LAA:

low attenuation area

PRM:

parametric response map

QCT:

quantitative computed tomography

SD:

standard deviation

TLC:

total lung capacity

VolExp/Insp ratio:

ratio between expiratory and inspiratory lung volume

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Acknowledgments

The scientific guarantor of this publication is Dr Mario Silva. The authors of this manuscript declare relationships with the following companies: A. A. Bankier is consultant for Spiration (Olympus Medical Systems) and has received authorship honoraria from Elsevier. R. Chamberlain is employed at Imbio, LLC (Minneapolis, MN). Imbio received NIH grant for validation of parametric response map (NIH R44HL118837).

The authors state that this work has not received any funding. Professor Dr. Alexander A. Bankier has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Our study population has been previously reported in “Dufresne V. et al. Effect of systemic inflammation on inspiratory and limb muscle strength and bulk in cystic fibrosis. Am J Respir Crit Care Med 2009” and “Nemec SF et al. Comparison of four software packages for CT lung volumetry in healthy individuals. Eur Radiol 2015”. Methodology: retrospective, experimental, performed at one institution.

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Authors and Affiliations

  1. Section of Cardiothoracic Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA

    Mario Silva, Mariaelena Occhipinti, Benedikt H. Heidinger & Alexander A. Bankier

  2. Section of Radiology, Department of Surgical Sciences, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy

    Mario Silva

  3. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria

    Stefan F. Nemec

  4. Pneumologie, CHU de Charleroi – Hôpital Vésale, Rue de Gozé 706, 6110, Montigny-le-Tilleul, Belgium

    Valerie Dufresne

  5. Imbio, 227 Colfax Ave North, Suite 144, Minneapolis, MN, USA

    Ryan Chamberlain

Authors
  1. Mario Silva
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  2. Stefan F. Nemec
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  3. Valerie Dufresne
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  4. Mariaelena Occhipinti
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  5. Benedikt H. Heidinger
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  6. Ryan Chamberlain
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  7. Alexander A. Bankier
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Correspondence to Mario Silva.

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Silva, M., Nemec, S.F., Dufresne, V. et al. Normal spectrum of pulmonary parametric response map to differentiate lung collapsibility: distribution of densitometric classifications in healthy adult volunteers. Eur Radiol 26, 3063–3070 (2016). https://doi.org/10.1007/s00330-015-4133-1

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  • DOI: https://doi.org/10.1007/s00330-015-4133-1

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