Journal article
The Use of CT Densitometry for the Assessment of Emphysema in Clinical Trials: A Position Paper from the Fleischner Society
American journal of respiratory and critical care medicine, Vol.211(5), pp.709-728
05/2025
DOI: 10.1164/rccm.202410-2012SO
PMCID: PMC12091028
PMID: 40126404
Abstract
Emphysema's significant morbidity and mortality underscore the need for reliable outcome metrics in clinical trials. However, commonly accepted COPD outcome measures do not adequately capture emphysema severity or progression. Computed tomography (CT) metrics have been validated as accurate indicators of pathological emphysema and predictors of COPD progression, exacerbations, and mortality. This Position Paper reviews the evidence supporting CT densitometry as a biomarker for emphysema, establishes implementation standards, and highlights areas for future research. A systematic literature review addressed three key questions: whether CT densitometry can be used as a diagnostic biomarker of emphysema, whether CT densitometry can be used as prognostic biomarker, and whether longitudinal change in densitometry can be used as a disease progression monitoring biomarker. Emphysema metrics, such as the percentage of low attenuation areas (LAA
), are validated, highly reproducible diagnostic and prognostic biomarkers. Volume-adjusted lung density is recommended for disease monitoring. Both metrics demonstrate a scan-rescan intra-class correlation coefficient of 0.99 with proper technique. The paper also discusses relevant CT physics, techniques, and sources of variation, including technical factors, physiological changes, and software analysis. Key recommendations for clinical trials include using standardized CT techniques, proper subject selection, and longitudinal evaluation with volume-adjusted lung density.
Details
- Title: Subtitle
- The Use of CT Densitometry for the Assessment of Emphysema in Clinical Trials: A Position Paper from the Fleischner Society
- Creators
- Raúl San José EstéparR Graham Barr - Columbia UniversitySean B Fain - University of IowaPhilippe A Grenier - Hôpital FochEric A Hoffman - University of IowaStephen M Humphries - National Jewish HealthMiranda Kirby - Toronto Metropolitan UniversityNancy Obuchowski - Cleveland ClinicChristopher J Ryerson - University of British ColumbiaJoon Beom Seo - Asan Medical CenterRuth Tal-Singer - TalSi Translational Medicine Consulting, LLC, Media, Pennsylvania, United StatesSamuel Y Ash - South Shore HospitalAlexander A Bankier - UMass Memorial Medical CenterJames Crapo - National Jewish HealthMeiLan Han - Michigan MedicineLiz Kellermeyer - National Jewish HealthJonathan Goldin - University of California, Los AngelesCynthia H McCollough - Mayo ClinicJohn D Newell Jr - University of Iowa, Radiology, Iowa City, Iowa, United StatesBruce E Miller - COPD FoundationLars H Nordenmark - AstraZeneca (Sweden)Martine Remy-Jardin - University Hospital Center of Lille, Department of Thoracic Imaging, Lille, FranceMathias Prokop - Radboud University Medical CenterYoshiharu Ohno - Fujita Health UniversityEdwin K Silverman - Brigham and Women's HospitalCharlie Strange - Medical University of South CarolinaGeorge R Washko - Brigham and Women's HospitalDavid A Lynch - National Jewish Health
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.211(5), pp.709-728
- DOI
- 10.1164/rccm.202410-2012SO
- PMID
- 40126404
- PMCID
- PMC12091028
- NLM abbreviation
- Am J Respir Crit Care Med
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Publisher
- AMER THORACIC SOC
- Grant note
- NHLBI: 1R01HL149877
Supported by NHLBI grant 1R01HL149877 (R.S.J.E.).
- Language
- English
- Electronic publication date
- 03/24/2025
- Date published
- 05/2025
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Electrical and Computer Engineering; Health, Sport, and Human Physiology ; Internal Medicine
- Record Identifier
- 9984802507802771
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