Repeatability of quantitative CT indexes of emphysema in patients evaluated for lung volume reduction surgery.

PURPOSE To evaluate the repeatability of quantitative computed tomographic (CT) indexes of emphysema and the effect of spirometric gating of lung volume during CT in candidates for lung volume reduction surgery (LVRS). MATERIALS AND METHODS Initial and same-day repeat routine inspiratory spiral chest CT studies were performed in 29 LVRS candidates (group 1, routine study vs repeat study). In a separate cohort of 29 LVRS candidates, spiral chest CT studies were performed both without and with spirometric gating by using a spirometer to trigger scanning at 90% of vital capacity (group 2, spirometric gating study). In each study, Pearson and intraclass correlation coefficients were calculated to determine the agreement between multiple pairs of whole-lung quantitative CT indexes of emphysema, and mean values were compared with two-tailed paired t tests. RESULTS Pearson and intraclass correlation coefficients were high for all quantitative CT indexes (all > or = 0.92). No significant differences were found between mean values of quantitative CT indexes in group 1. Variation in quantitative CT results was small but more prominent in group 2 than in group 1. The variation in quantitative CT results was primarily related to differences in lung volume (r(2) as great as 0.83). CONCLUSION Repeatability of quantitative CT test results in LVRS candidates is high and unlikely to improve by using spirometric gating.

[1]  H. Sostman,et al.  Radiologic evaluation of emphysema in patients with chronic obstructive pulmonary disease. Chest radiography versus high resolution computed tomography. , 1995, American journal of respiratory and critical care medicine.

[2]  F. Sciurba,et al.  Changes in lung volume and volume of emphysema after unilateral lung reduction surgery: analysis with CT lung densitometry. , 1996, Radiology.

[3]  J. Best,et al.  DIAGNOSIS OF PULMONARY EMPHYSEMA BY COMPUTERISED TOMOGRAPHY , 1984, The Lancet.

[4]  W A Kalender,et al.  Measurement of pulmonary parenchymal attenuation: use of spirometric gating with quantitative CT. , 1990, Radiology.

[5]  J. V. van Engelshoven,et al.  Chronic obstructive pulmonary disease: evaluation with spirometrically controlled CT lung densitometry. , 1994, Radiology.

[6]  K P Whittall,et al.  Preoperative severity of emphysema predictive of improvement after lung volume reduction surgery: use of CT morphometry. , 2000, Chest.

[7]  R M Slone,et al.  Pulmonary emphysema: comparison of preoperative quantitative CT and physiologic index values with clinical outcome after lung-volume reduction surgery. , 1997, Radiology.

[8]  R. Yusen,et al.  Evaluation of patients with emphysema for lung volume reduction surgery. Washington University Emphysema Surgery Group. , 1996, Seminars in thoracic and cardiovascular surgery.

[9]  N. Müller,et al.  "Density mask". An objective method to quantitate emphysema using computed tomography. , 1988, Chest.

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

[11]  J D Newell,et al.  Quantitative chest computed tomography as a means of predicting exercise performance in severe emphysema. , 1995, Academic radiology.

[12]  R M Slone,et al.  Patients with emphysema: quantitative CT analysis before and after lung volume reduction surgery. Work in progress. , 1997, Radiology.

[13]  G. Patterson,et al.  Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema. , 1996, The Journal of thoracic and cardiovascular surgery.

[14]  K. Osann,et al.  Patient selection criteria for lung volume reduction surgery. , 1997, The Journal of thoracic and cardiovascular surgery.

[15]  L Kreel,et al.  Pulmonary tissue attenuation with computed tomography: comparison of inspiration and expiration scans. , 1979, Journal of computer assisted tomography.

[16]  R M Slone,et al.  Patient selection for lung volume reduction surgery: An objective model based on prior clinical decisions and quantitative CT analysis. , 2000, Chest.

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

[18]  T. Pilgram,et al.  Lung volume reduction surgery: comparison of preoperative radiologic features and clinical outcome. , 1997, Radiology.

[19]  J. Best,et al.  CT measurements of lung density in life can quantitate distal airspace enlargement--an essential defining feature of human emphysema. , 1988, The American review of respiratory disease.

[20]  I K Mun,et al.  Lung volumes before and after lung volume reduction surgery: quantitative CT analysis. , 1998, American journal of respiratory and critical care medicine.