Computed Tomography Measure of Lung at Risk and Lung Function Decline in Chronic Obstructive Pulmonary Disease

Surya P Bhatt; Sandeep Bodduluri; Eric A Hoffman; John D Newell Jr; Jessica C Sieren; Mark T Dransfield; Joseph M Reinhardt; COPDGene Investigators

doi:10.1164/rccm.201701-0050OC

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Computed Tomography Measure of Lung at Risk and Lung Function Decline in Chronic Obstructive Pulmonary Disease

Journal article

Open access

Peer reviewed

Computed Tomography Measure of Lung at Risk and Lung Function Decline in Chronic Obstructive Pulmonary Disease

Surya P Bhatt, Sandeep Bodduluri, Eric A Hoffman, John D Newell Jr, Jessica C Sieren, Mark T Dransfield, Joseph M Reinhardt and COPDGene Investigators

American journal of respiratory and critical care medicine, Vol.196(5), pp.569-576

09/01/2017

DOI: 10.1164/rccm.201701-0050OC

PMCID: PMC5620667

PMID: 28481639

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https://doi.org/10.1164/rccm.201701-0050OCView

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Abstract

The rate of decline of lung function is greater than age-related change in a substantial proportion of patients with chronic obstructive pulmonary disease, even after smoking cessation. Regions of the lung adjacent to emphysematous areas are subject to abnormal stretch during respiration, and this biomechanical stress likely influences emphysema initiation and progression. To assess whether quantifying this penumbra of lung at risk would predict FEV decline. We analyzed paired inspiratory-expiratory computed tomography images at baseline of 680 subjects participating in a large multicenter study (COPDGene) over approximately 5 years. By matching inspiratory and expiratory images voxel by voxel using image registration, we calculated the Jacobian determinant, a measure of local lung expansion and contraction with respiration. We measured the distance between each normal voxel to the nearest emphysematous voxel, and quantified the percentage of normal voxels within each millimeter distance from emphysematous voxels as mechanically affected lung (MAL). Multivariable regression analyses were performed to assess the relationship between the Jacobian determinant, MAL, and FEV decline. The mean (SD) rate of decline in FEV was 39.0 (58.6) ml/yr. There was a progressive decrease in the mean Jacobian determinant of both emphysematous and normal voxels with increasing disease stage (P < 0.001). On multivariable analyses, the mean Jacobian determinant of normal voxels within 2 mm of emphysematous voxels (MAL ) was significantly associated with FEV decline. In mild-moderate disease, for participants at or above the median MAL (threshold, 36.9%), the mean decline in FEV was 56.4 (68.0) ml/yr versus 43.2 (59.9) ml/yr for those below the median (P = 0.044). Areas of normal-appearing lung are mechanically influenced by emphysematous areas and this lung at risk is associated with lung function decline. Clinical trial registered with www.clinicaltrials.gov (NCT00608764).

Aged

Aged, 80 and over

Disease Progression

Female

Forced Expiratory Volume - physiology

Humans

Lung - diagnostic imaging

Lung - physiopathology

Male

Middle Aged

Pulmonary Disease, Chronic Obstructive - diagnostic imaging

Pulmonary Disease, Chronic Obstructive - physiopathology

Respiratory Function Tests - statistics & numerical data

Tomography, X-Ray Computed

Details

Title: Subtitle: Computed Tomography Measure of Lung at Risk and Lung Function Decline in Chronic Obstructive Pulmonary Disease
Creators: Surya P Bhatt - University of Alabama at Birmingham
Sandeep Bodduluri - University of Alabama at Birmingham
Eric A Hoffman - University of Iowa
John D Newell Jr - University of Iowa
Jessica C Sieren - University of Iowa
Mark T Dransfield - University of Alabama at Birmingham
Joseph M Reinhardt - University of Iowa
COPDGene Investigators
Resource Type: Journal article
Publication Details: American journal of respiratory and critical care medicine, Vol.196(5), pp.569-576
DOI: 10.1164/rccm.201701-0050OC
PMID: 28481639
PMCID: PMC5620667
NLM abbreviation: Am J Respir Crit Care Med
ISSN: 1073-449X
eISSN: 1535-4970
Grant note: P30 ES005605 / NIEHS NIH HHS U01 HL089856 / NHLBI NIH HHS U01 HL089897 / NHLBI NIH HHS K23 HL133438 / NHLBI NIH HHS R01 HL089856 / NHLBI NIH HHS S10 OD018526 / NIH HHS R01 HL089897 / NHLBI NIH HHS R01 HL079406 / NHLBI NIH HHS R01 HL112986 / NHLBI NIH HHS P30 DK054759 / NIDDK NIH HHS
Language: English
Date published: 09/01/2017
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
Record Identifier: 9984197147102771

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