Emphysema: definition, imaging, and quantification.

This review will discuss imaging of the chest in patients with pulmonary emphysema. Imaging findings must be related to the structure of the lung because emphysema is defined in anatomic terms. Accordingly, we first review the anatomic definitions of emphysema and its consequences and then review the imaging findings, with emphasis on CT, in patients with this disease. The more severe the morphologic emphysema, the more likely a radiographic diagnosis will be made, no matter what criteria are used. The criterion of arterial deficiency is specific but insensitive. The criteria used to assess overinflation are sensitive but not specific. CT can be used for both qualitative and quantitative assessment of emphysema. The presence and extent of emphysema can be determined by visual assessment of areas of abnormally low attenuation or by objective quantification based on the attenuation values. Statistically significant correlations between emphysema and CT findings have been shown in numerous studies, but mild morphologic emphysema may be missed by CT, and occasionally CT scans give false-positive findings. In patients with moderate to severe emphysema, the severity of emphysema is underestimated on the basis of CT findings by a factor of approximately three when compared directly with results of pathologic examination of lung specimens. In spite of these limitations, CT is the best way of recognizing emphysema in living patients and probably has a significant role in recognizing localized emphysema that is amenable to surgical treatment.

[1]  B. Strickland,et al.  Computed tomography in the assessment of bullous lung disease. , 1984, British journal of diseases of the chest.

[2]  G Gamsu,et al.  High-resolution CT diagnosis of emphysema in symptomatic patients with normal chest radiographs and isolated low diffusing capacity. , 1992, Radiology.

[3]  W. Thurlbeck,et al.  Chronic Airflow Obstruction in Lung Disease , 1977 .

[4]  P. Pratt,et al.  ROENTGENOLOGIC CRITERIA FOR THE RECOGNITION OF NONSYMPTOMATIC PULMONARY EMPHYSEMA. CORRELATION BETWEEN ROENTGENOLOGIC FINDINGS AND PULMONARY PATHOLOGY. , 2015, The American review of respiratory disease.

[5]  P. Pratt,et al.  Correlation of postmortem function and structure in normal and emphysematous lungs. , 1961, The American review of respiratory disease.

[6]  F. Millard,et al.  CORRELATION BETWEEN RADIOLOGICAL DIAGNOSIS AND STRUCTURAL LUNG CHANGES IN EMPHYSEMA. , 1964, Clinical radiology.

[7]  H Nishitani,et al.  The diagnosis of mild emphysema. Correlation of computed tomography and pathology scores. , 1990, The American review of respiratory disease.

[8]  N. Müller,et al.  Panacinar Emphysema: CT and Pathologic Findings , 1993, Journal of computer assisted tomography.

[9]  S. Sutinen,et al.  Accuracy of postmortem radiography of excised air-inflated human lungs in assessment of pulmonary emphysema. , 1982, Thorax.

[10]  W M Thurlbeck,et al.  Radiographic appearance of the chest in emphysema. , 1978, AJR. American journal of roentgenology.

[11]  R. Ryder,et al.  A study of interobserver variation in the assessment of the amount of pulmonary emphysema in paper-mounted whole lung sections. , 1969, The American review of respiratory disease.

[12]  J. Hogg,et al.  Exponential analysis of the pressure-volume curve. Correlation with mean linear intercept and emphysema in human lungs. , 1988, The American review of respiratory disease.

[13]  Thurlbeck Wm The incidence of pulmonary emphysema, with observations on the relative incidence and spatial distribution of various types of emphysema. , 1963 .

[14]  T. Petty,et al.  Radial traction and small airways disease in excised human lungs. , 2015, The American review of respiratory disease.

[15]  W. Thurlbeck,et al.  A comparative study of the severity of emphysema in necropsy populations in three different countries. , 1974, The American review of respiratory disease.

[16]  W. Thurlbeck,et al.  Collagen and elastin in human pulmonary emphysema. , 1993, The American review of respiratory disease.

[17]  M. Cosio,et al.  Destructive index: a measurement of lung parenchymal destruction in smokers. , 2015, The American review of respiratory disease.

[18]  A. E. Anderson,et al.  Relative dimensions of bronchioles and parenchymal spaces in lungs from normal subjects and emphysematous patients. , 1962, The American journal of medicine.

[19]  Boren Hg Alveolar fenestrae. Relationship to the pathology and pathogenesis of pulmonary emphysema. , 1962 .

[20]  J. F. Wade,et al.  Physiologic evaluation of bullous emphysema. , 1991, Chest.

[21]  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.

[22]  W. Thurlbeck,et al.  The "destructive index" in nonemphysematous and emphysematous lungs. Morphologic observations and correlation with function. , 1989, The American review of respiratory disease.

[23]  A. Woolcock,et al.  Correlation between the function and structure of the lung in smokers. , 1979, The American review of respiratory disease.

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

[25]  P. Paré,et al.  The diagnosis of emphysema. A computed tomographic-pathologic correlation. , 1986, The American review of respiratory disease.

[26]  E. Gaensler,et al.  Patient work-up for bullectomy , 1986, Journal of thoracic imaging.

[27]  N. Müller,et al.  Comparison of single breath carbon monoxide diffusing capacity and pressure-volume curves in detecting emphysema. , 1990, The American review of respiratory disease.

[28]  C Nahmias,et al.  Automated in vivo quantification of emphysema. , 1993, Radiology.

[29]  D. Stowell,et al.  The accuracy of the roentgenologic diagnosis of chronic pulmonary emphysema. , 1966, The American review of respiratory disease.

[30]  W. MacNee,et al.  Relation between distal airspace size, bronchiolar attachments, and lung function. , 1993, Thorax.

[31]  W. Thurlbeck,et al.  Alveolar attachments in emphysema of human lungs. , 1991, The American review of respiratory disease.

[32]  R H Hruban,et al.  High resolution computed tomography of inflation-fixed lungs. Pathologic-radiologic correlation of centrilobular emphysema. , 1987, The American review of respiratory disease.

[33]  R. G. Fraser,et al.  A COMPARISON BETWEEN CLINICAL, ROENTGENOLOGIC, FUNCTIONAL AND MORPHOLOGIC CRITERIA IN CHRONIC BRONCHITIS, EMPHYSEMA, ASTHMA AND BRONCHIECTASIS , 1970 .

[34]  M. Cosio,et al.  Loss of alveolar attachments in smokers. A morphometric correlate of lung function impairment. , 1985, The American review of respiratory disease.

[35]  W M Thurlbeck,et al.  A comparison of three methods of measuring emphysema. , 1970, Human pathology.

[36]  M. Dunnill Evaluation of a Simple Method of Sampling the Lung for Quantitative Histological Analysis , 1964, Thorax.

[37]  N J Morrison,et al.  Quantitation of emphysema by computed tomography using a "density mask" program and correlation with pulmonary function tests. , 1990, Chest.

[38]  R R Miller,et al.  CT in the qualitative assessment of emphysema , 1986, Journal of thoracic imaging.

[39]  M. Dunnill Quantitative Methods in the Study of Pulmonary Pathology , 1962, Thorax.

[40]  J. Tienari,et al.  Diagnosis of emphysema on chest radiographs. , 1984, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[41]  D. Lamb,et al.  Microscopic emphysema in relation to age and smoking habit. , 1993, Thorax.

[42]  D. Lamb,et al.  Airspace size in lungs of lifelong non-smokers: effect of age and sex. , 1993, Thorax.

[43]  J. Gough,et al.  The Centrilobular Form of Hypertrophic Emphysema and its Relation to Chronic Bronchitis , 1957, Thorax.

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

[45]  W. Webb High-resolution CT of the lung parenchyma. , 1989, Radiologic clinics of North America.

[46]  J. Gough,et al.  Thin sections of entire organs mounted on paper. , 1957, Harvey lectures.