Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Visual and Quantitative Assessments of Regional Xenon-Ventilation Using Dual-Energy CT in Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome: A Comparison with Chronic Obstructive Pulmonary Disease

  • Hye Jeon Hwang (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sang Min Lee (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Joon Beom Seo (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jae Seung Lee (Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Namkug Kim (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sei Won Lee (Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yeon-Mok Oh (Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2019.12.12
  • Accepted : 2020.03.22
  • Published : 2020.09.01
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Abstract

Objective: To assess the regional ventilation in patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) using xenon-ventilation dual-energy CT (DECT), and to compare it to that in patients with COPD. Materials and Methods: Twenty-one patients with ACOS and 46 patients with COPD underwent xenon-ventilation DECT. The ventilation abnormalities were visually determined to be 1) peripheral wedge/diffuse defect, 2) diffuse heterogeneous defect, 3) lobar/segmental/subsegmental defect, and 4) no defect on xenon-ventilation maps. Emphysema index (EI), airway wall thickness (Pi10), and mean ventilation values in the whole lung, peripheral lung, and central lung areas were quantified and compared between the two groups using the Student's t test. Results: Most patients with ACOS showed the peripheral wedge/diffuse defect (n = 14, 66.7%), whereas patients with COPD commonly showed the diffuse heterogeneous defect and lobar/segmental/subsegmental defect (n = 21, 45.7% and n = 20, 43.5%, respectively). The prevalence of ventilation defect patterns showed significant intergroup differences (p < 0.001). The quantified ventilation values in the peripheral lung areas were significantly lower in patients with ACOS than in patients with COPD (p = 0.045). The quantified Pi10 was significantly higher in patients with ACOS than in patients with COPD (p = 0.041); however, EI was not significantly different between the two groups. Conclusion: The ventilation abnormalities on the visual and quantitative assessments of xenon-ventilation DECT differed between patients with ACOS and patients with COPD. Xenon-ventilation DECT may demonstrate the different physiologic changes of pulmonary ventilation in patients with ACOS and COPD.

Keywords

Acknowledgement

This study was funded by Bracco Imaging Korea, Seoul, South Korea.

References

  1. Gibson PG, Simpson JL. The overlap syndrome of asthma and COPD: what are its features and how important is it? Thorax 2009;64:728-735
  2. Hardin M, Cho M, McDonald ML, Beaty T, Ramsdell J, Bhatt S, et al. The clinical and genetic features of COPD-asthma overlap syndrome. Eur Respir J 2014;44:341-350
  3. Zeki AA, Schivo M, Chan A, Albertson TE, Louie S. The Asthma-COPD overlap syndrome: a common clinical problem in the elderly. J Allergy (Cairo) 2011;2011:861926
  4. 2015 asthma, COPD and asthma-COPD overlap syndrome (ACOS). Global Initiative for Asthma Web site. https://ginasthma.org/asthma-copd-and-asthma-copd-overlapsyndrome-acos/. Accessed Nov 2, 2017
  5. Kauppi P, Kupiainen H, Lindqvist A, Tammilehto L, Kilpelainen M, Kinnula VL, et al. Overlap syndrome of asthma and COPD predicts low quality of life. J Asthma 2011;48:279-285
  6. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2000;160:1683-1689
  7. Menezes AMB, Montes de Oca M, Perez-Padilla R, Nadeau G, Wehrmeister FC, Lopez-Varela MV, et al. Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma. Chest 2014;145:297-304
  8. Rhee CK, Yoon HK, Yoo KH, Kim YS, Lee SW, Park YB, et al. Medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease and asthma. COPD 2014;11:163-170
  9. Bakker ME, Putter H, Stolk J, Shaker SB, Piitulainen E, Russi EW, et al. Assessment of regional progression of pulmonary emphysema with CT densitometry. Chest 2008;134:931-937
  10. Kim SS, Seo JB, Lee HY, Nevrekar DV, Forssen AV, Crapo JD, et al. Chronic obstructive pulmonary disease: lobe-based visual assessment of volumetric CT by using standard images-Comparison with quantitative CT and pulmonary function test in the COPDGene study. Radiology 2013;266:626-635
  11. Mets OM, Murphy K, Zanen P, Gietema HA, Lammers JW, van Ginneken B, et al. The relationship between lung function impairment and quantitative computed tomography in chronic obstructive pulmonary disease. Eur Radiol 2012;22:120-128
  12. Park CS, Muller NL, Worthy SA, Kim JS, Awadh N, Fitzgerald M. Airway obstruction in asthmatic and healthy individuals: inspiratory and expiratory thin-section CT findings. Radiology 1997;203:361-367
  13. Chae EJ, Seo JB, Goo HW, Kim N, Song KS, Lee SD, et al. Xenon ventilation CT with a dual-energy technique of dual-source CT: initial experience. Radiology 2008;248:615-624
  14. Chae EJ, Seo JB, Lee J, Kim N, Goo HW, Lee HJ, et al. Xenon ventilation imaging using dual-energy computed tomography in asthmatics: initial experience. Invest Radiol 2010;45:354-361
  15. Hwang HJ, Seo JB, Lee SM, Kim N, Oh SY, Lee JS, et al. Assessment of regional xenon ventilation, perfusion, and ventilation-perfusion mismatch using dual-energy computed tomography in chronic obstructive pulmonary disease patients. Invest Radiol 2016;51:306-315
  16. Kim WW, Lee CH, Goo JM, Park SJ, Kim JH, Park EA, et al. Xenon-enhanced dual-energy CT of patients with asthma: dynamic ventilation changes after methacholine and salbutamol inhalation. AJR Am J Roentgenol 2012;199:975-981
  17. King GG, Farrow CE, Chapman DG. Dismantling the pathophysiology of asthma using imaging. Eur Respir Rev 2019;28:180111
  18. Sugino K, Kobayashi M, Nakamura Y, Gocho K, Ishida F, Isobe K, et al. Xenon-enhanced dual-energy CT imaging in combined pulmonary fibrosis and emphysema. PLoS One 2017;12:e0170289
  19. Cho YH, Lee SM, Seo JB, Kim N, Bae JP, Lee JS, et al. Quantitative assessment of pulmonary vascular alterations in chronic obstructive lung disease: associations with pulmonary function test and survival in the KOLD cohort. Eur J Radiol 2018;108:276-282
  20. Bergin C, Muller N, Nichols DM, Lillington G, Hogg JC, Mullen B, et al. The diagnosis of emphysema. A computed tomographic-pathologic correlation. Am Rev Respir Dis 1986;133:541-546
  21. Lee YK, Oh YM, Lee JH, Kim EK, Lee JH, Kim N, et al. Quantitative assessment of emphysema, air trapping, and airway thickening on computed tomography. Lung 2008;186:157-165
  22. Nakano Y, Sakai H, Muro S, Hirai T, Oku Y, Nishimura K, et al. Comparison of low attenuation areas on computed tomographic scans between inner and outer segments of the lung in patients with chronic obstructive pulmonary disease: incidence and contribution to lung function. Thorax 1999;54:384-389
  23. Grydeland TB, Dirksen A, Coxson HO, Pillai SG, Sharma S, Eide GE, et al. Quantitative computed tomography: emphysema and airway wall thickness by sex, age and smoking. Eur Respir J 2009;34:858-865
  24. Cho YH, Seo JB, Kim N, Lee HJ, Hwang HJ, Kim EY, et al. Comparison of a new integral-based half-band method for CT measurement of peripheral airways in COPD with a conventional full-width half-maximum method using both phantom and clinical CT images. J Comput Assist Tomogr 2015;39:428-436
  25. Park HJ, Lee SM, Choe J, Lee SM, Kim N, Lee JS, et al. Prediction of treatment response in patients with chronic obstructive pulmonary disease by determination of airway dimensions with baseline computed tomography. Korean J Radiol 2019;20:304-312
  26. Cukic V, Begic A. Potential role of lung ventilation scintigraphy in the assessment of COPD. Acta Inform Med 2014;22:170-173
  27. de Lange EE, Altes TA, Patrie JT, Battiston JJ, Juersivich AP, Mugler JP 3rd, et al. Changes in regional airflow obstruction over time in the lungs of patients with asthma: evaluation with 3 He MR imaging. Radiology 2009;250:567-575
  28. Kirby M, Mathew L, Wheatley A, Santyr GE, McCormack DG, Parraga G. Chronic obstructive pulmonary disease: longitudinal hyperpolarized 3 He MR imaging. Radiology 2010;256:280-289
  29. Ohno Y, Iwasawa T, Seo JB, Koyama H, Takahashi H, Oh YM, et al. Oxygen-enhanced magnetic resonance imaging versus computed tomography: multicenter study for clinical stage classification of smoking-related chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008;177:1095-1102
  30. Stavngaard T, Sogaard LV, Mortensen J, Hanson LG, Schmiedeskamp J, Berthelsen AK, et al. Hyperpolarized 3 He MRI and 81mKr SPECT in chronic obstructive pulmonary disease. Eur J Nucl Med Mol Imaging 2005;32:448-457
  31. Suga K, Nishigauchi K, Kume N, Koike S, Takano K, Tokuda O, et al. Dynamic pulmonary SPECT of xenon-133 gas washout. J Nucl Med 1996;37:807-814
  32. Tzeng YS, Hoffman E, Cook-Granroth J, Gereige J, Mansour J, Washko G, et al. Investigation of hyperpolarized 3 He magnetic resonance imaging utility in examining human airway diameter behavior in asthma through comparison with high-resolution computed tomography. Acad Radiol 2008;15:799-808
  33. Lee SW, Lee SM, Shin SY, Park TS, Oh SY, Kim N, et al. Improvement in ventilation-perfusion mismatch after bronchoscopic lung volume reduction: quantitative image analysis. Radiology 2017;285:250-260
  34. Altes TA, Powers PL, Knight-Scott J, Rakes G, Platts-Mills TA, de Lange EE, et al. Hyperpolarized 3 He MR lung ventilation imaging in asthmatics: preliminary findings. J Magn Reson Imaging 2001;13:378-384
  35. Farah CS, King GG, Brown NJ, Downie SR, Kermode JA, Hardaker KM, et al. The role of the small airways in the clinical expression of asthma in adults. J Allergy Clin Immunol 2012;129:381-387.e1
  36. Gao Y, Zhai X, Li K, Zhang H, Wang Y, Lu Y, et al. Asthma COPD overlap syndrome on CT densitometry: a distinct phenotype from COPD. COPD 2016;13:471-476
  37. Suzuki T, Tada Y, Kawata N, Matsuura Y, Ikari J, Kasahara Y, et al. Clinical, physiological, and radiological features of asthma-chronic obstructive pulmonary disease overlap syndrome. Int J Chron Obstruct Pulmon Dis 2015;10:947-954
  38. Kosciuch J, Krenke R, Gorska K, Zukowska M, Maskey-Warzechowska M, Chazan R. Airway dimensions in asthma and COPD in high resolution computed tomography: can we see the difference? Respir Care 2013;58:1335-1342
  39. Kaushik SS, Cleveland ZI, Cofer GP, Metz G, Beaver D, Nouls J, et al. Diffusion-weighted hyperpolarized 129Xe MRI in healthy volunteers and subjects with chronic obstructive pulmonary disease. Magn Reson Med 2011;65:1154-1165
  40. Kirby M, Svenningsen S, Owrangi A, Wheatley A, Farag A, Ouriadov A, et al. Hyperpolarized 3 He and 129Xe MR imaging in healthy volunteers and patients with chronic obstructive pulmonary disease. Radiology 2012;265:600-610
  41. Jung JW, Kwon JW, Kim TW, Lee SH, Kim KM, Kang HR, et al. New insight into the assessment of asthma using xenon ventilation computed tomography. Ann Allergy Asthma Immunol 2013;111:90-95.e2
  42. Lee CW, Seo JB, Lee Y, Chae EJ, Kim N, Lee HJ, et al. A pilot trial on pulmonary emphysema quantification and perfusion mapping in a single-step using contrast-enhanced dual-energy computed tomography. Invest Radiol 2012;47:92-97