Assessment of the relationship between lung parenchymal destruction and impaired pulmonary perfusion on a lobar level in patients with emphysema.

PURPOSE To assess the relationship between lung parenchymal destruction and impaired pulmonary perfusion on a lobar level using CT and MRI in patients with emphysema. MATERIAL AND METHODS Forty-five patients with severe emphysema (GOLD III and IV) underwent inspiratory 3D-HRCT and contrast-enhanced MR-perfusion (1.5T; 3.5mmx1.9mmx4mm). 3D-HRCT data was analyzed using a software for detection and visualization of emphysema. Emphysema was categorized in four clusters with different volumes and presented as overlay on the CT. CT and lung perfusion were visually analyzed for three lobes on each side using a four-point-score to grade the abnormalities on CT (1: predominantly small emphysema-clusters to 4: >75% large emphysema-clusters) and MRI (1: normal perfusion to 4: no perfusion). RESULTS A total of 270 lobes were evaluated. At CT, the score was 1 for 9 lobes, 2 for 43, 3 for 77, and 4 for 141 lobes. At MRI, the score was 1 for 13 lobes, 2 for 45, 3 for 92, and 4 for 120 lobes. Matching of lung parenchymal destruction and reduced perfusion was found in 213 lobes (weighted kappa=0.8). The score was higher on CT in 44, and higher on MRI in 13 lobes. CONCLUSION 3D-HRCT and 3D MR-perfusion show a high lobar agreement between parenchymal destruction and reduction of perfusion in patients with severe emphysema.

[1]  J. West,et al.  Ventilation-perfusion inequality in chronic obstructive pulmonary disease. , 1977, The Journal of clinical investigation.

[2]  Michael Bock,et al.  Regional lung perfusion: assessment with partially parallel three-dimensional MR imaging. , 2004, Radiology.

[3]  G. Liljestrand,et al.  Observations on the Pulmonary Arterial Blood Pressure in the Cat , 1946 .

[4]  P. Aspelin,et al.  Visual classification of emphysema heterogeneity compared with objective measurements: HRCT vs spiral CT in candidates for lung volume reduction surgery , 2002, European Radiology.

[5]  Roland Werthschützky,et al.  Automated CT image evaluation of the lung: a morphology-based concept , 2001, IEEE Transactions on Medical Imaging.

[6]  E. Russi,et al.  Role of lung perfusion scintigraphy in relation to chest computed tomography and pulmonary function in the evaluation of candidates for lung volume reduction surgery. , 1999, American journal of respiratory and critical care medicine.

[7]  K. Sandek,et al.  Relationship between lung function, ventilation-perfusion inequality and extent of emphysema as assessed by high-resolution computed tomography. , 2002, Respiratory medicine.

[8]  Jonathan G Goldin,et al.  Quantitative CT of the lung. , 2002, Radiologic clinics of North America.

[9]  Manfred Thelen,et al.  Vollautomatische Detektion und Quantifizierung des Lungenemphysems in Dünnschicht-MD-CT des Thorax durch eine neue, speziell entwickelte Software , 2004 .

[10]  G. Prisk,et al.  Inhomogeneity of ventilation leads to unpredictable errors in measured D LCO , 2005, Respiratory Physiology & Neurobiology.

[11]  E. Kazerooni.  Radiologic evaluation of emphysema for lung volume reduction surgery. , 1999, Clinics in chest medicine.

[12]  R. Crapo,et al.  Single-breath carbon monoxide diffusing capacity. , 2001, Clinics in chest medicine.

[13]  P. Aspelin,et al.  Visual grading of emphysema severity in candidates for lung volume reduction surgery. Comparison between HRCT, spiral CT and "density-masked" images. , 2002, Acta radiologica.

[14]  H. Hatabu,et al.  Value of Volumetric Data Acquisition in Expiratory High-Resolution Computed Tomography of the Lung , 2004, Journal of computer assisted tomography.

[15]  J. Bishop.  Cardiovascular complications of chronic bronchitis and emphysema. , 1973, The Medical clinics of North America.

[16]  P. Aspelin,et al.  Visual grading of emphysema severity in candidates for lung volume reduction surgery: Comparison between HRCT, spiral CT and “density-masked” images , 2002 .

[17]  Y. Ohno,et al.  Dynamic perfusion MRI versus perfusion scintigraphy: prediction of postoperative lung function in patients with lung cancer. , 2004, AJR. American journal of roentgenology.

[18]  K. Cederlund,et al.  Lung perfusion scintigraphy prior to lung volume reduction surgery. , 2003, Acta radiologica.

[19]  T. Jones,et al.  Regional structure-function correlations in chronic obstructive lung disease measured with positron emission tomography. , 1992, Thorax.

[20]  C. Fink,et al.  Kontrastmittelverstärkte 3D-MR-Perfusion der Lunge: Einsatz paralleler Bildgebungstechniken bei gesunden Probanden , 2004 .

[21]  H. Kauczor,et al.  Respiratory lumenal change of the pharynx and trachea in normal subjects and COPD patients: assessment by cine-MRI , 2004, European Radiology.

[22]  K. K. Gast,et al.  Reformatierungen als Lösungsansatz für die Problematik der unterschiedlichen Schichtführung beim Vergleich von 3He-MRT und HR-CT der Lunge , 2003 .

[23]  H. Mal,et al.  Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. , 2005, Chest.

[24]  P De Vuyst,et al.  Comparison of computed density and macroscopic morphometry in pulmonary emphysema. , 1995, American journal of respiratory and critical care medicine.

[25]  B. Bake,et al.  Quantitative analysis of inhomogeneity in ventilation SPET , 2001, European Journal of Nuclear Medicine.

[26]  A A Bankier,et al.  Pulmonary emphysema: subjective visual grading versus objective quantification with macroscopic morphometry and thin-section CT densitometry. , 1999, Radiology.

[27]  T. Gildea,et al.  A multicenter trial of an intrabronchial valve for treatment of severe emphysema. , 2007, Journal of Thoracic and Cardiovascular Surgery.

[28]  N. Morrell,et al.  Collateral ventilation and gas exchange in emphysema. , 1994, American journal of respiratory and critical care medicine.

[29]  D. Hansell,et al.  Bronchoscopic volume reduction with valve implants in patients with severe emphysema. , 2003, The Lancet.

[30]  Hans-Ulrich Kauczor,et al.  Assessment of Differential Pulmonary Blood Flow Using Perfusion Magnetic Resonance Imaging: Comparison With Radionuclide Perfusion Scintigraphy , 2006, Investigative radiology.

[31]  Jenny Vikgren,et al.  Regional ventilation and distribution of emphysema – a quantitative comparison , 2004, Clinical physiology and functional imaging.

[32]  L Battolla,et al.  Relationship between extent of pulmonary emphysema by high-resolution computed tomography and lung elastic recoil in patients with chronic obstructive pulmonary disease. , 2001, American journal of respiratory and critical care medicine.

[33]  Martin Requardt,et al.  Time-Resolved Contrast-Enhanced Three-Dimensional Magnetic Resonance Angiography of the Chest: Combination of Parallel Imaging With View Sharing (TREAT) , 2005, Investigative radiology.

[34]  Y. Nagasaka,et al.  Correlation among the Indices of High-Resolution Computed Tomography, Pulmonary Function Tests, Pulmonary Perfusion Scans and Exercise Tolerance in Cases of Chronic Pulmonary Emphysema , 2002, Respiration.

[35]  T. Gildea,et al.  Lung volume reduction surgery in patients with emphysema and alpha-1 antitrypsin deficiency. , 2007, The Annals of thoracic surgery.

[36]  N J Morrison,et al.  Pulmonary capillary blood volume in emphysema. , 1990, The American review of respiratory disease.

[37]  J. Gurney,et al.  Pathophysiology of obstructive airways disease. , 1998, Radiologic clinics of North America.

[38]  Sharyn MacDonald,et al.  Functional impairment in emphysema: contribution of airway abnormalities and distribution of parenchymal disease. , 2005, AJR. American journal of roentgenology.

[39]  J C Yernault,et al.  Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. , 1995, The European respiratory journal.

[40]  D. Hui,et al.  Early results of endoscopic lung volume reduction for emphysema. , 2004, The Journal of thoracic and cardiovascular surgery.

[41]  Hans-Ulrich Kauczor,et al.  Effect of Inspiratory and Expiratory Breathhold on Pulmonary Perfusion: Assessment by Pulmonary Perfusion Magnetic Resonance Imaging , 2005, Investigative radiology.

[42]  Balthasar Eberle,et al.  Functional analysis in single-lung transplant recipients: a comparative study of high-resolution CT, 3He-MRI, and pulmonary function tests. , 2004, Chest.

[43]  Hans-Ulrich Kauczor,et al.  Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis: comparison of different quantitative evaluations and pulmonary function test. , 2005, Chest.