Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis - Comparison of different quantitative evaluations and pulmonary function test

Purpose: The aim of the study was to use three-dimensional high-resolution CT scan data sets in inspiration and expiration for the quantitative evaluation of emphysema. Using an advanced dedicated semiautomatic analysis tool, the functional inspiratory/expiratory shifts of emphysema volume and clusters were quantified. The pulmonary function test (PFT) served as the clinical gold standard. Materials and methods: Thirty-one patients (9 women and 22 men; mean [+/- SD] age, 60 +/- 8 years) who had severe emphysema due to COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] class III and IV) were included in the study. All patients underwent paired inspiratory/expiratory multidetector CT scans (slice thickness, 1/0.8 nun) and pulmonary function tests (PFrs). CT scan data were analyzed with self-written emphysema detection solftware. It provides lung volume (LV), emphysema volume (EV), emphysema index (EI), and four clusters of emphysema with different volumes (from 2, 8, 65, and 120 mm(3)). These results were correlated with total lung capacity (TLC), intrathoracic gas volume (ITGV), and residual volume (RV) derived from PFT results. Results: Inspiratory LV correlated with TLC (r = 0.9), expiratory LV with ITGV (r = 0.87), and RV (r = 0.83). Expiratory EV correlated better with ITGV (r = 0.88) and RV (r = 0.93) than with inspiratory EV (r = 0.83 and 0.88, respectively). The mean inspiratory Ell was 54 +/- 13%, and it decreased to 43 +/- 15% in expiration. However, the individuals showed a broad spectrum of changes of El (mean, 11%; range, 1 to 28%), and no differences in inspiratory/expiratory El and changes in El or LV were found between GOLD III and GOLD IV patients. In expiration, there was a change from the large emphysema cluster (-37%) to the intermediate cluster (+15%) and small cluster (+13% and +11%, respectively). The change of volume of the large emphysema cluster after expiration correlated well with the changes in LV (r = 0.9), EV (r = 0.99), El (r = 0.85), and MLD (r = 0.76). Conclusion: Emphysema volumes measured from expiratory MDCT scans better reflect PFT abnormalities in patients with severe emphysema than those from inspiratory scans. Volumettic cluster analysis provided deeper insights into the local hyperinflation and expiratory obstruction of large emphysematous clusters.