Total Lung and Lobar Quantitative Assessment Based on Paired Inspiratory-Expiratory Chest CT in Healthy Adults: Correlation with Pulmonary Ventilatory Function

Objective: To provide the quantitative volumetric data of the total lung and lobes in inspiration and expiration from healthy adults, and to explore the value of paired inspiratory-expiratory chest CT scan in pulmonary ventilatory function and further explore the influence of each lobe on ventilation. Methods: A total of 65 adults (29 males and 36 females) with normal clinical pulmonary function test (PFT) and paired inspiratory-expiratory chest CT scan were retrospectively enrolled. The inspiratory and expiratory volumetric indexes of the total lung (TL) and 5 lobes (left upper lobe [LUL], left lower lobe [LLL], right upper lobe [RUL], right middle lobe [RML], and right lower lobe [RLL]) were obtained by Philips IntelliSpace Portal image postprocessing workstation, including inspiratory lung volume (LVin), expiratory lung volume (LVex), volume change ( increment LV), and well-aerated lung volume (WAL, lung tissue with CT threshold between -950 and -750 HU in inspiratory scan). Spearman correlation analysis was used to explore the correlation between CT quantitative indexes of the total lung and ventilatory function indexes (including total lung capacity [TLC], residual volume [RV], and force vital capacity [FVC]). Multiple stepwise regression analysis was used to explore the influence of each lobe on ventilation. Results: At end-inspiratory phase, the LVin-TL was 4664.6 (4282.7, 5916.2) mL, the WAL(TL) was 4173 (3639.6, 5250.9) mL; both showed excellent correlation with TLC (LVin-TL: r = 0.890, p < 0.001; WAL(TL): r = 0.879, p < 0.001). From multiple linear regression analysis with lobar CT indexes as variables, the LVin and WAL of these two lobes, LLL and RUL, showed a significant relationship with TLC. At end-expiratory phase, the LVex-TL was 2325.2 (1969.7, 2722.5) mL with good correlation with RV (r = 0.811, p < 0.001), of which the LVex of RUL and RML had a significant relationship with RV. For the volumetric change within breathing, the increment LVTL was 2485.6 (2169.8, 3078.1) mL with good correlation with FVC (r = 0.719, p < 0.001), moreover, WAL(TL) showed a better correlation with FVC (r = 0.817, p < 0.001) than that of increment LVTL. Likewise, there was also a strong association between increment LV, WAL of these two lobes (LLL and RUL), and FVC. Conclusions: The quantitative indexes derived from paired inspiratory-expiratory chest CT could reflect the clinical pulmonary ventilatory function, LLL, and RUL give greater impact on ventilation. Thus, the pulmonary functional evaluation needs to be more precise and not limited to the total lung level.

Automated summary

This study aimed to provide quantitative volumetric data of the total lung and lobes in inspiration and expiration from healthy adults using paired inspiratory-expiratory chest CT scans. The results showed that LLL and RUL had a significant impact on ventilation, emphasizing the need for more precise pulmonary functional evaluation beyond the total lung level.