Search

Chronic obstructive pulmonary disease (COPD) is frequently associated with coronary artery disease (CAD). When considering computed tomography (CT) for COPD phenotyping, coronary vessel wall calcification would be a potential marker of cardiac disease. However, non-ECG gated scans as used in COPD monitoring do not comply with established quantitative approaches using ECG-triggered CT and the Agatston score. We studied the diagnostic potential of Agatston scores from non-triggered scans for cardiac disease. The study population was a sub-group of the COPD cohort COSYCONET that underwent CT scanning in addition to comprehensive clinical assessments, echocardiographic data and physician-based diagnoses of comorbidities. Agatston scores from non-contrast enhanced, non-triggered CT were used to identify a cut-off value for CAD via ROC analysis. 399 patients were included (152 female, mean age 66.0 ± 8.2 y). In terms of CAD, an Agatston score ≥1500 AU performed best (AUC 0.765; 95% CI: 0.700, 0.831) and was superior to the conventional cut-off value (400 AU). Using this value for defining groups, there were differences (p lt; 0.05) in lung function, left atrial diameter and left ventricular end-systolic diameter as well as CT-determined central airway wall thickness pointing towards a bronchitis phenotype. In multivariate analysis, BMI, hyperlipidemia, arterial hypertension, GOLD D (p lt; 0.05) but particularly Agatston score ≥1500 AU (Odds ratio 10.5; 95% CI: 4.8; 22.6)) were predictors of CAD. We conclude that in COPD patients, Agatston scores derived from non-ECG gated CT showed a much higher cut-off value (1500 AU) for actionable coronary artery disease than the score derived from ECG-triggered CT in cardiology patients.

Background: Bronchiectasis is known to be associated with COPD. We studied which degree of radiological alterations was associated with clinical signs of bronchiectasis in COPD. Methods: Visit 4 data (GOLD grades 1-4) of the COSYCONET cohort was analysed. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0-2), resulting in a total score of 0-12. We also included data from disease-specific questionnaires, medication, and lung function. Results: 1176 patients were included (mean age 67.3y, 61.1% males), among them 38 (3.2%) with patient-reported physicians’ diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). 429 patients had CT scans, with any signs of bronchiectasis in 46.6%, less than 50% bronchiectasis in ≤2 lobes in 18.6%, in 3-4 lobes in 10.0%, in 5-6 lobes in 15.9%, and more than 50% bronchiectasis in at least 1 lobe in 2.1%. Scores ≥4 were linked to elevated FRC/RV. Links to sputum production, composition (n=105) or inflammatory indices were borderline or absent. Triple therapy was associated with symptoms, but not radiological signs of bronchiectasis. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally ≥5. AA1D was associated with radiological signs of bronchiectasis and only borderline with the clinical diagnosis. Conclusion: Clinical diagnosis and radiological signs of bronchiectasis showed only weak correlations in COPD patients. For a significant correspondence to symptoms and diagnosis, a threshold CT score implying radiological alterations in several lobes was needed, which was about one third of the maximum score.

Introduction: Morphologic changes in the COPD lung also affect the lung vasculature. Most insights stem from pathologic examinations of end-stage disease and there is only limited data for milder COPD. Aims: To analyse the lung vasculature from thoracic CT images in a large cohort of patients with different grades of chronic airway obstruction from GOLD 0 (only symptoms) to GOLD 1&2 (FEV1≥50%) and GOLD 3&4 ( Methods: The COSYCONET study acquired CT images in inspiration and expiration. An algorithm identified the lung vessels with diameters of 2-10mm and labelled them as arteries and veins. All segmentations were inspected by a radiologist to exclude failed results. Morphologic readouts were analysed with respect to GOLD stage. Results: Normalized inspiratory vessel volume decreased with disease severity (p Conclusion: Vessel morphology changes with severity of chronic airway obstruction and may reflect interactions between lung volume, loss of elasticity, and intrathoracic pressure.

Although some of the associations between chronic obstructive pulmonary disease (COPD) and atherosclerosis are based on shared risk factors such as smoking, recent epidemiological evidence suggests that COPD is a risk factor for vascular disease due to systemic inflammation. The present study assessed the hypothesis that disease severity (as expressed by the GOLD stage) independently predicts the extent of vascular calcifications. A total of 160 smokers diagnosed with COPD (GOLD I–IV, 40 subjects of each GOLD stage) and 40 smokers at risk (GOLD 0; median age of 60 years old; Q1:56;Q3:65; 135 males and 65 females) underwent non-contrast, non-electrocardiography synchronized chest computerised tomography. The volume of thoracic aortic calcifications was quantified semi-automatically within a region from T1 through T12. Multiparametric associations with GOLD stage, smoking history, sex, age, body mass index and emphysema index were evaluated using generalized linear regression analysis. Thoracic aortic calcifications were highly prevalent in this cohort (187/200 subjects, 709 (Q1:109;Q3:2163) mm3). Analysis of variance on ranks demonstrated a significant difference in calcium between different GOLD-stages as well as patients at risk of COPD (F=36.8, P

To longitudinally investigate smoking cessation-related changes of quantitative computed tomography (QCT)–based airway metrics in a group of heavy smokers. CT scans were acquired in a lung cancer screening population over 4 years at 12-month intervals in 284 long-term ex-smokers (ES), 405 continuously active smokers (CS), and 31 subjects who quitted smoking within 2 years after baseline CT (recent quitters, RQ). Total diameter (TD), lumen area (LA), and wall percentage (WP) of 1st–8th generation airways were computed using airway analysis software. Inter-group comparison was performed using Mann-Whitney U test or Student’s t test (two groups), and ANOVA or ANOVA on ranks with Dunn’s multiple comparison test (more than two groups), while Fisher’s exact test or chi-squared test was used for categorical data. Multiple linear regression was used for multivariable analysis. At any time, TD and LA were significantly higher in ES than CS, for example, in 5th–8th generation airways at baseline with 6.24 mm vs. 5.93 mm (p

Die MRT der Lunge entwickelt sich zu einer ernstzunehmenden dritten Saule der Thoraxdiagnostik neben dem Thoraxrontgen und der Computertomographie (CT). Ihr Wert in der padiatrischen Lungendiagnostik oder fur den wissenschaftlichen Einsatz, insbesondere wenn eine Strahlenexposition vermieden werden soll, ist unbestritten. Von allen Indikationen stellt die Diagnostik interstitieller Lungenerkrankungen die groste Herausforderung dar. Zusammenfassung des aktuellen Stands zu Moglichkeiten und Perspektiven der MRT fur die Diagnostik interstitieller Lungenerkrankungen. Zusammenfassung einer aktuellen Literaturrecherche und Bewertung der Ergebnisse vor dem Hintergrund eigener Erfahrungen mit der Lungen-MRT. Allein aufgrund der geringeren Detailauflosung und der deutlich groseren Anfalligkeit fur Artefakte ist die MRT der CT bei der Diagnostik interstitieller Lungenerkrankungen („interstitial lung diseases“, ILD) bei feinen Mustern (feinnetzige Fibrose, Mikronoduli) unterlegen, kann aber grobere Fibrosen (Honigwabenmuster) detektieren. Zudem wurde an kleinen Fallgruppen gezeigt, dass die MRT diagnostisch wertvolle Informationen zur regionalen Lungenfunktion (Ventilation, Perfusion, mechanische Eigenschaften) und Entzundungsaktivitat (natives Signal, Kontrastmitteldynamik) liefern kann. Aktuell kann die morphologische Lungen-MRT erganzend zur kardialen Diagnostik bei Sarkoidose fur die umfassende kardiothorakale Bildgebung in einer Sitzung oder fur Verlaufsbeobachtungen eingesetzt werden. Wenn sich die Moglichkeiten der MRT-basierten Lungenfunktionsdiagnostik und Beurteilung der Entzundungsaktivitat klinisch robust umsetzen lassen, ist von einer deutlichen Erweiterung des Anwendungsspektrums auszugehen.

The population of patients suffering from chronic obstructive pulmonary disease (COPD) and asthma is heterogeneous, complicating therapy management and scientific analysis. Owing to the rapid technical improvements in imaging techniques in the past years, research has succeeded in gaining further insights into the different manifestations of obstructive pulmonary disease. Whereas the main parameters for differentiation and categorization of the disease in the past were pulmonary function tests and pathologic examinations, computed tomography (CT) has now made it possible to visualize alterations in the airway and parenchymal architecture induced by COPD in vivo and in unprecedented detail. The visual differentiation of COPD is currently given by the two major radiologic phenotypes, namely the airway predominant and the emphysema predominant type of COPD. Further objective and reliable categorization and classification of the different manifestations via computer-aided analysis of pulmonary CT examinations is an important goal of recent research in pulmonary imaging. While much innovation and improvement have already been made, finding a conclusive system of parameters that allow for a reliable and quantitative classification of the different imaging features of COPD remains a task to be completed. In this chapter we provide a fundamental insight into the particular imaging patterns and provide a technical basis for the use of CT in COPD. Furthermore, we illustrate the current state-of-the-art technologies in imaging analysis and the results of recent research in typecasting COPD with clinical correlation.

Background Hemoptysis can be an acute medical emergency, which can be localized angiographically and controlled by therapeutic intervention. Purpose To evaluate the effectiveness and safety of bronchial artery embolization, and including follow-up in patients with hemoptysis. Material and Methods Thirty-five vascular interventions were performed in 28 patients (nine women and 19 men, mean age 42 years, age range 20–82 years) treated for hemoptysis between January 1998 and October 2008. Underlying diseases were cystic fibrosis ( n = 9), lung cancer ( n = 6), chronic inflammatory disease ( n = 4), bronchiectasis ( n = 3), chronic obstructive pulmonary disease ( n = 2), and other ( n = 4). Bronchial artery embolization was performed using particles. Patients were followed up for a median of 23 months (range 1 month to 8 years). Results Bronchial artery embolization was technically successful in all patients (bleeding halted within 24 hours). Recurrent bleeding occurred in four patients with cystic fibrosis (14%) at one, 16, 19 and 48 months, respectively. Within this subset, multirecurrence bleeding occurred in one patient with cystic fibrosis. Cumulative patient survival rate was 74% at eight years. No patient died due to hemoptysis but due to underlying disease. Conclusion Bronchial artery embolization was highly effective in patients with hemoptysis. It may help to avoid surgery in patients who are poor candidates for surgery. Should hemoptysis recur in these patients, repeated embolization can be performed.

Background: Relationship between comorbidities and lung disorder could depend on the type of lung disorder (parenchymal vs airway). Aim: Determine whether CT scans available from clinical routine assessments can be made comparable for developing a prediction function to estimate the probability of lung disorder types from functional data. Methods: Within the COSYCONET cohort study, 2,741 patients with COPD were recruited in 30 study centers. Assessments included spirometry, body plethysmography and diffusing capacity for CO. CT scans from 24 centres were evaluated regarding the type of lung disorder. Using logistic/linear regression analyses, associations between categorical/continuous measures of CTs and lung function were assessed. Results: 342 CT scans could be used in patients of categories GOLD 0-IV (mean (SD) age 65 (8) y; 34% female; 8% GOLD 0; 40% I/II; 52% III/IV). Regarding the binary emphysema score, FEV1/FVC, TLCO%pred, TLC%pred, specific airway resistance sRaw and absolute FEV1 were identified as predictors, resulting in 76% of patients correctly categorized (sensitivity for emphysema 78%). Analyses of the continuous scores lung density, 15-percentile of density and emphysema index were consistent with these findings. Conclusion: Results indicate that rather heterogeneous chest CT scans can be brought to a level of comparability that is sufficient to reveal meaningful associations between emphysema scoring and functional parameters. The functions will be used to investigate the impact of the type of lung disorder in the total COPD cohort. Competence Network Asthma/COPD funded by German Federal Ministry of Education and Research.