Quantitative CT Analysis in Patients with Pulmonary Emphysema: Do Calculated Differences Between Full Inspiration and Expiration Correlate with Lung Function?

Abstract

Purpose: The aim of this retrospective study was to evaluate correlations between parameters of quantitative computed tomography (QCT) analysis, especially the 15th percentile of lung attenuation (P15), and parameters of clinical tests in a large group of patients with pulmonary emphysema.

Patients and methods: One hundred and seventy-two patients with pulmonary emphysema and chronic obstructive pulmonary disease (COPD) global initiative for chronic obstructive lung disease (GOLD) stage 3 or 4 were assessed by nonenhanced thin-section CT scans in full inspiratory and expiratory breath-hold, pulmonary function test (PFT), a 6-minute walk test (6MWT), and quality of life questionnaires (SGRQ and CAT). QCT parameters included total lung volume (TLV), total emphysema score (TES), and P15, all measured at inspiration (IN) and expiration (EX). Differences between inspiration and expiration were calculated for TLV (TLV_Diff), TES (TES_Diff), and P15 (P15_Diff). Spearman correlation analysis was performed.

Results: CT-measured lung volume in inspiration (TLV_IN) correlated strongly with spirometry-measured total lung capacity (TLC) (r=0.81, p<0.001) and moderately to strongly with residual volume (RV), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV₁)/FVC (r=0.60, 0.56, and -0.49, each p<0.001). Lung volume in expiration (TLV_EX) correlated moderately to strongly with TLC, RV and FEV₁/FVC ratio (r=0.75, 0.66, and -0.43, each p<0.001). TES and P15 showed stronger correlations with the carbon monoxide transfer coefficient (KCO%) (r= -0.42, 0.44, both p<0.001), when measured during expiration. P15_Diff correlated moderately with KCO% and carbon monoxide diffusing capacity (DLCO%) (r= 0.41, 0.40, both p<0.001). The 6MWT and most QCT parameters showed significant differences between COPD GOLD 3 and 4 groups.

Conclusion: Our results suggest that QCT can help predict the severity of lung function decrease in patients with pulmonary emphysema and COPD GOLD 3 or 4. Some QCT parameters, including P15_EX and P15_Diff, correlated moderately to strongly with parameters of pulmonary function tests.

Keywords: chronic obstructive pulmonary disease; pulmonary emphysema; pulmonary function test; quantitative CT.