Disproportionate contribution of right middle lobe to emphysema and gas trapping on computed tomography.

<h4>Rationale</h4>Given that the diagnosis of chronic obstructive pulmonary disease (COPD) relies on demonstrating airflow limitation by spirometry, which is known to be poorly sensitive to early disease, and to regional differences in emphysema, we sought to evaluate individual lobar co...

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Autores principales:	Surya P Bhatt, Jessica C Sieren, John D Newell, Alejandro P Comellas, Eric A Hoffman
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f3173b0dbe1c49f1bcbe0fa778941b0d
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spelling	oai:doaj.org-article:f3173b0dbe1c49f1bcbe0fa778941b0d2021-11-25T06:07:27ZDisproportionate contribution of right middle lobe to emphysema and gas trapping on computed tomography.1932-620310.1371/journal.pone.0102807https://doaj.org/article/f3173b0dbe1c49f1bcbe0fa778941b0d2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25054539/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Rationale</h4>Given that the diagnosis of chronic obstructive pulmonary disease (COPD) relies on demonstrating airflow limitation by spirometry, which is known to be poorly sensitive to early disease, and to regional differences in emphysema, we sought to evaluate individual lobar contributions to global spirometric measures.<h4>Methods</h4>Subjects with COPD were compared with smokers without airflow obstruction, and non-smokers. Emphysema (% low attenuation area, LAAinsp<-950 HU, at end-inspiration) and gas trapping (%LAAexp<-856 HU at end-expiration) on CT were quantified using density mask analyses for the whole lung and for individual lobes, and distribution across lobes and strength of correlation with spirometry were compared.<h4>Results</h4>The right middle lobe had the highest %LAAinsp<-950 HU in smokers and controls, and the highest %LAAexp<-856 HU in all three groups. While RML contributed to emphysema and gas trapping disproportionately to its relatively small size, it also showed the least correlation with spirometry. There was no change in correlation of whole lung CT metrics with spirometry when the middle lobe was excluded from analyses. Similarly, RML had the highest %LAAexp<-856 HU while having the least correlation with spirometry.<h4>Conclusions</h4>Because of the right middle lobe's disproportionate contribution to CT-based emphysema measurements, and low contribution to spirometry, longitudinal studies of emphysema progression may benefit from independent analysis of the middle lobe in whole lung quantitative CT assessments. Our findings may also have implications for heterogeneity assessments and target lobe selection for lung volume reduction.<h4>Clinical trial registration</h4>ClinicalTrials.gov NCT00608764.Surya P BhattJessica C SierenJohn D NewellAlejandro P ComellasEric A HoffmanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 7, p e102807 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Surya P Bhatt Jessica C Sieren John D Newell Alejandro P Comellas Eric A Hoffman Disproportionate contribution of right middle lobe to emphysema and gas trapping on computed tomography.
description	<h4>Rationale</h4>Given that the diagnosis of chronic obstructive pulmonary disease (COPD) relies on demonstrating airflow limitation by spirometry, which is known to be poorly sensitive to early disease, and to regional differences in emphysema, we sought to evaluate individual lobar contributions to global spirometric measures.<h4>Methods</h4>Subjects with COPD were compared with smokers without airflow obstruction, and non-smokers. Emphysema (% low attenuation area, LAAinsp<-950 HU, at end-inspiration) and gas trapping (%LAAexp<-856 HU at end-expiration) on CT were quantified using density mask analyses for the whole lung and for individual lobes, and distribution across lobes and strength of correlation with spirometry were compared.<h4>Results</h4>The right middle lobe had the highest %LAAinsp<-950 HU in smokers and controls, and the highest %LAAexp<-856 HU in all three groups. While RML contributed to emphysema and gas trapping disproportionately to its relatively small size, it also showed the least correlation with spirometry. There was no change in correlation of whole lung CT metrics with spirometry when the middle lobe was excluded from analyses. Similarly, RML had the highest %LAAexp<-856 HU while having the least correlation with spirometry.<h4>Conclusions</h4>Because of the right middle lobe's disproportionate contribution to CT-based emphysema measurements, and low contribution to spirometry, longitudinal studies of emphysema progression may benefit from independent analysis of the middle lobe in whole lung quantitative CT assessments. Our findings may also have implications for heterogeneity assessments and target lobe selection for lung volume reduction.<h4>Clinical trial registration</h4>ClinicalTrials.gov NCT00608764.
format	article
author	Surya P Bhatt Jessica C Sieren John D Newell Alejandro P Comellas Eric A Hoffman
author_facet	Surya P Bhatt Jessica C Sieren John D Newell Alejandro P Comellas Eric A Hoffman
author_sort	Surya P Bhatt
title	Disproportionate contribution of right middle lobe to emphysema and gas trapping on computed tomography.
title_short	Disproportionate contribution of right middle lobe to emphysema and gas trapping on computed tomography.
title_full	Disproportionate contribution of right middle lobe to emphysema and gas trapping on computed tomography.
title_fullStr	Disproportionate contribution of right middle lobe to emphysema and gas trapping on computed tomography.
title_full_unstemmed	Disproportionate contribution of right middle lobe to emphysema and gas trapping on computed tomography.
title_sort	disproportionate contribution of right middle lobe to emphysema and gas trapping on computed tomography.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/f3173b0dbe1c49f1bcbe0fa778941b0d
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Disproportionate contribution of right middle lobe to emphysema and gas trapping on computed tomography.

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