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01-01-2009 | Chest

Prevalence and correlates of pulmonary emphysema in smokers and former smokers. A densitometric study of participants in the ITALUNG trial

Authors: Gianna Camiciottoli, Edoardo Cavigli, Luca Grassi, Stefano Diciotti, Ilaria Orlandi, Marco Zappa, Giulia Picozzi, Andrea Lopes Pegna, Eugenio Paci, Fabio Falaschi, Mario Mascalchi

Published in: European Radiology | Issue 1/2009

Abstract

We assessed with computed tomography (CT) densitometry the prevalence of emphysema in 266 (175 men and 91 women; mean age 64 ± 4 years) smokers and former smokers enrolled in the ITALUNG trial of lung cancer screening with low-dose thin-slice CT. Whole-lung volume and the relative area at −950 Hounsfield units (RA₉₅₀) and mean lung attenuation (MLA) in 1 of every 10 slices (mean, 24 slices per subject) were measured. Lung volume, MLA and RA950 significantly correlated each other and with age. Average RA950 >6.8% qualifying for emphysema was present in 71 (26.6%) of 266 subjects, with a higher prevalence in men than in women (30.3% vs 19.8%; p = 0.003). Only in smokers was a weak (r = 0.18; p = 0.05) correlation between RA950 and packs/year observed. In multiple regression analysis, the variability of RA950 (R2 = 0.24) or MLA (R2 = 0.34) was significantly, but weakly explained by age, lung volume and packs/year. Other factors besides smoking may also have a significant role in the etiopathogenesis of pulmonary emphysema.

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American Thoracic Society (1995) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 152:S77–S121

Dalal PU, Hansell DM (2006) High-resolution computed tomography of the lungs: the borderlands of normality. Eur Radiol 16:771–780PubMedCrossRef

Remy-Jardin M, Edme JL, Boulenguez C et al (2002) Longitudinal follow-up study of smoker’s lung with thin section CT in correlation with pulmonary function tests. Radiology 222:261–270PubMedCrossRef

Omori H, Nakashima R, Otsuka N et al (2006) Emphysema detected by lung cancer screening with low-dose spiral CT: prevalence, and correlation with smoking habits and pulmonary function in Japanese male subjects. Respirology 11:205–210PubMedCrossRef

Desai SR, Hansell DM, Walker A et al (2007) Quantification of emphysema: a composite physiologic index derived from CT estimation of disease extent. Eur Radiol 17:911–918PubMedCrossRef

Bakker HE, Stolk J, Putter H et al (2005) Variability in densitometric assessment of pulmonary emphysema with computed tomography. Invest Radiol 40:777–783PubMedCrossRef

Müller NL, Staples CA, Miller RR et al (1988) “Density mask”. An objective method to quantitate emphysema using computed tomography. Chest 99:782–787CrossRef

Kinsella M, Müller NL, Abboud RT (1990) Quantitation of emphysema by computed tomography using a “density mask” program and correlation with pulmonary function tests. Chest 97:315–321PubMedCrossRef

Gould GA, MacNee W, McLean A et al (1988) CT measurements of lung density in life can quantitate distal airspace enalrgement: an essential defining feature of human emphysema. Am Rev Respir Dis 137:380–392PubMed

10.

Bankier AA, De Maertelaer V, Keyzer C et al (1999) Pulmonary emphysema: subjective visual grading versus objective quantification with macroscopic morphometry and thin-section CT densitometry. Radiology 211:851–858PubMed

11.

Kauzcor HU, Hast J, Heussel CP et al (2002) CT attenuation of paired HRCT scans obtained at full inspiratory/expiratory position: comparison with pulmonary function tests. Eur Radiol 12:2757–2763

12.

Coxson HO (2007) Computed tomography and monitoring of emphysema. Eur Respir J 29:1075–1077PubMedCrossRef

13.

Ley-Zaporozhan J, Ley S, Kauzcor HU (2008) Morphological and functional imaging in COPD with CT and MRI: present and future. Eur Radiol 18:510–521PubMedCrossRef

14.

Wang Q, Takashima S, Wang JC et al (2001) Prevalence of emphysema in individuals who underwent screening CT for lung cancer in Nagano Prefecture of Japan. Respiration 68:352–356PubMedCrossRef

15.

Nawa T, Nakagawa T, Kusano S et al (2002) Prevalence of emphysematous changes as shown by low-dose spiral CT screening images in 6144 healthy subjects. Nihon Kokyuki Gakkai Zasshi 40:468–472PubMed

16.

de Torres JP, Bastarrika G, Wisnivesky JP et al (2007) Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest. Chest 132:1932–1938PubMedCrossRef

17.

Dransfield MT, Washko GR, Foreman MG et al (2007) Gender differences in the severity of CT emphysema in COPD. Chest 132:464–470PubMedCrossRef

18.

Picozzi G, Paci E, Lopez Pegna A et al (2005) Screening of lung cancer with low dose spiral CT: results of a three year pilot study and design of the randomised controlled trial “Italung-CT”. Radiol Med (Turin) 109:17–26

19.

Aberle DR, Gamsu G, Henschke CI et al (2001) A consensus statement of the Society of Thoracic Radiology: screening for lung cancer with helical computed tomography. J Thoracic Imaging 16:65–68CrossRef

20.

Gevenois PA, de Maertelaer V, De Vuyst P et al (1995) Comparison of computed density and macroscopic morphometry in pulmonary empyhsema. Am J Resp Crit Care Med 152:653–657PubMed

21.

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

22.

Madani A, Zanen J, de Maertelaer V et al (2006) Pulmonary emphysema: objective quantification at multi-detector row CT: comparison with macroscopic and microscopic morphometry. Radiology 238:1036–1043PubMedCrossRef

23.

Orlandi I, Moroni C, Camiciottoli G et al (2005) Chronic obstructive pulmonary disease: thin-section CT measurement of airway wall thickness and lung attenuation. Radiology 234:604–610PubMedCrossRef

24.

Gevenois PA, Scillia P, de Maertelaer V et al (1996) The effects of age, sex, lung size, and hyperinflation on CT lung densitometry. AJR Am J Roentgenol 167:1169–1173PubMed

25.

Diciotti S, Petrolo L, Falchini M et al (2004) Neural network system for lung nodule detection in spiral CT images: preliminary results. In Book of Abstracts of the Mediterranean Conference on Medical and Biological Engineering, Ischia, Italy July 31-August 5

26.

Hu S, Hoffman EA, Reinhardt JM (2001) Automatic lung segmentation for accurate quantitation of volumetric X-ray CT images. IEEE Trans Med Imaging 20:490–498PubMedCrossRef

27.

Snider G, Kleinerman J, Thurlbeck WM et al (1985) The definition of emphysema: report of a National Heart, Lung and Blood Institute, Division of Lung Disease workshop. Am Rev Respir Dis 132:182–185

28.

Mannino DM (2002) COPD: epidemiology, prevalence, morbidity and mortality, and disease heterogeneity. Chest 121:121S–126SPubMedCrossRef

29.

Madani A, Keyzer C, Gevenois PA (2001) Quantitative computed tomography assessment of lung structure and function in pulmonary emphysema. Eur Respir J 18:720–730PubMedCrossRef

30.

Pauwels RA, Buist AS, Ma P et al (2001) Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: National Heart, Lung and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD); executive summary. Respir Care 46:798–825PubMed

31.

Lundbäck B, Lindberg A, Lindström M et al (2003) Not 15 but 50% of smokers develop COPD? Report from the Obstructive Lung Disease in Northern Sweden Studies. Respir Med 97:115–122PubMedCrossRef

32.

Siafakas NM, Tzortzaki EG (2002) Few smokers develop COPD. Why ? Respir Med 96:615–624CrossRef

33.

Boedeker KL, McNitt-Gray MF, Rogers SR et al (2004) Emphysema: effect of reconstruction algorithm on CT imaging measures. Radiology 232:295–301PubMedCrossRef

34.

Kemerink GJ, Kruize HH, Lamers RSJ et al (1996) Density resolution in quantitative computed tomography of foam and lung. Med Phys 23:1697–1708PubMedCrossRef

35.

Vikgren J, Friman O, Borga M et al (2005) Detection of mild emphysema by computed tomography density measurements. Acta Radiol 46:237–245PubMedCrossRef

36.

Gierada DS, Pilgram TK, Whiting BR et al (2007) Comparison of standard- and low-radiation-dose CT for quantification of emphysema. AJR Am J Roentgenol 188:42–47PubMedCrossRef

37.

Madani A, de Maertelaer V, Zanen J et al (2007) Pulmonary emphysema: radiation dose and section thickness at multidetector CT quantification: comparison with macroscopic and microscopic morphometry. Radiology 243:250–257PubMedCrossRef

38.

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. J Comput Assist Tomogr 30:460–468PubMedCrossRef

39.

Clark KD, Wardrobe-Wong N, Elliot JJ et al (2001) Patterns of lung disease in a “normal” smoking population: are emphysema and airflow obstruction found together? Chest 120:743–747PubMedCrossRef

40.

Spaggiari E, Zompatori M, Verduri A et al (2005) Early smoking-induced lung lesions in asymptomatic subjects. Correlations between high resolution dynamic CT and pulmonary function testing. Radiol Med (Turin) 109:27–39

41.

Gillooly M, Lamb D (1993) Microscopic emphysema in relation to age and smoking habit. Thorax 48:491–495PubMedCrossRef

42.

Tylén U, Boijsen M, Ekberg-Jansson A et al (2000) Emphysematous lesions and lung function in healthy smokers 60 years of age. Respir Med 94:38–43PubMedCrossRef

43.

Sashidhar K, Gulati M, Gupta D et al (2002) Emphysema in heavy smokers with normal chest radiography. Detection and quantification by HRCT. Acta Radiol 43:60–65PubMed

44.

Altman DG, Royston P (2006) The cost of dichotomising continuous variables. BMJ 332:1080PubMedCrossRef

45.

Gillooly M, Lamb D (1993) Airspace size in lungs of lifelong non-smokers: effect of age and sex. Thorax 48:39–43PubMedCrossRef

46.

Brozek J (1960) Age differences in residual lung volume and vital capacity of normal individuals. J Gerontol 15:155–160PubMed

47.

Silverman EK, Chapman HA, Drazen JM et al (1998) Genetic epidemiology of severe, early-onset chronic obstructive pulmonary disease. Risk to relatives for airflow obstruction and chronic bronchitis. Am J Respir Crit Care Med 157:1770–1778PubMed

48.

McCloskey SC, Patel BD, Hinchliffe SJ et al (2001) Siblings of patients with severe chronic obstructive pulmonary disease have a significant risk of airflow obstruction. Am J Respir Crit Care Med 164:1419–1424PubMed

49.

Mishima M, Itoh H, Sakai H et al (1999) Optimized scanning conditions of high resolution CT in the follow-up of pulmonary emphysema. J Comput Assist Tomogr 23:380–384PubMedCrossRef

50.

American Thoracic Society (1995) Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 152:1107–1136

51.

American Thoracic Society (1995) Single-breath carbon monoxide diffusing capacity (transfer factor): recommendations for a standard technique. Am J Respir Crit Care Med 152:2185–2198

Title: Prevalence and correlates of pulmonary emphysema in smokers and former smokers. A densitometric study of participants in the ITALUNG trial
Authors: Gianna Camiciottoli
Edoardo Cavigli
Luca Grassi
Stefano Diciotti
Ilaria Orlandi
Marco Zappa
Giulia Picozzi
Andrea Lopes Pegna
Eugenio Paci
Fabio Falaschi
Mario Mascalchi
Publication date: 01-01-2009
Publisher: Springer-Verlag
Published in: European Radiology / Issue 1/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-1131-6

At a glance: The STEP trials

Springer Medicine

Prevalence and correlates of pulmonary emphysema in smokers and former smokers. A densitometric study of participants in the ITALUNG trial

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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