Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characteristic of small airway inflammation, obstruction, and emphysema. It is well known that spirometry alone cannot differentiate each separate component. Computed tomography (CT) is widely used to determine the extent of emphysema and small airway involvement in COPD. Compared with the pulmonary function test, small airway CT phenotypes can accurately reflect disease severity in patients with COPD, which is conducive to improving the prognosis of this disease. CT measurement of central airway morphology has been applied in clinical, epidemiologic, and genetic investigations as an inference of the presence and severity of small airway disease. This review will focus on presenting the current knowledge and methodologies in chest CT that aid in identifying discrete COPD phenotypes.
Airway Obstruction ; Humans ; Phenotype ; Pulmonary Disease, Chronic Obstructive/diagnostic imaging* ; Pulmonary Emphysema/diagnostic imaging* ; Tomography, X-Ray Computed

BACKGROUNDThe relationship between chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) remains largely unknown. This study aimed to explore the association of COPD with CAD, especially with multi-vessel disease (VD).

METHODSThe data of 354 patients who underwent multi-detector computed tomography (MDCT) for suspected CAD were analyzed. Luminal narrowing was defined as at least one lesion 50% or greater stenosis. The analysis of serum biochemistry profile and spirometry were performed on all eligible patients, and the diagnosis of COPD was defined as the criteria of Global Initiative for Chronic Obstructive Lung Disease.

RESULTSPatients with CAD had a significantly higher complication of COPD than those without CAD (11.8% vs. 3.7%, P < 0.001). Comparing with patients without COPD, those with COPD were more likely to have multi-VD, proportion of smoking and high C-reactive protein (CRP) (P < 0.001). Multivariate Logistic regression analysis revealed that the multi-VD was significantly correlated with COPD (P=0.012) and CRP (P=0.015).

CONCLUSIONSThere was a high complication of COPD in patients with CAD, and COPD may be a critical risk factor for CAD, especially for multi-VD. CAD and COPD were closely associated and the interplay of systemic inflammation might in part explain the relationship between them.

Coronary Artery Disease ; complications ; diagnostic imaging ; metabolism ; Humans ; Pulmonary Disease, Chronic Obstructive ; complications ; diagnostic imaging ; metabolism ; Radiography ; Risk Factors

OBJECTIVETo explore the characteristics of vibration response imaging (VRI) in chronic obstructive pulmonary disease (COPD).

METHODSSixty-three COPD patients received lung function test (LFT) and VRI examination before and after inhalation of bronchodilator. As the control group, 66 healthy volunteers received LFT and VRI examinations. We defined VRI results as quantitative lung data (QLD), crack counts, and image grade.

RESULTSThe results of control group were: QLD of right lung (45.1 +/- 5.9%), mean crack counts 0.1, and mean image grade 0.9. After inhalation of bronchodilator, the VRI results of COPD group were: QLD of right lung (51.0 +/- 12.1)%, mean crack counts 2.7, and image grade 4.2 +/- 1.9. The results between control group and COPD group were significantly different (P < 0.01). The VRI results were similar before and after inhalation of bronchodilator in COPD group (P > 0.05). After inhalation of bronchodilator, there was a linear relationship between VRI image grade and FEV1% (r = 0.31, P = 0.01). The model of the linear regression was: y = 63.85 -2.95 x (y: 100 x FEV1%, x: VRI image grade).

CONCLUSIONSThe VRI results differ between COPD patients and healthy people. The VRI results are stable after inhalation of bronchodilator in COPD patients, which may be helpful in the diagnosis of COPD. The VRI image grade after inhalation of bronchodilator is useful to assess the degree of obstruction.

Adult ; Aged ; Diagnostic Imaging ; methods ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; Vibration

OBJECTIVETo investigate the imaging and hemodynamical features of pulmonary artery branches in chronic obstructive pulmonary disease (COPD) with pulmonary artery hypertension (PAH).

METHODSCT pulmonary angiography (CTPA) with ECG-gating was performed in 13 patients with clinical diagnosed COPD and 25 normal subjects. The thin-slice multiple plane reconstruction in systole and diastole phase was conducted, which in turn was used to generate the InSpace reconstructed images with reference frame of the main pulmonary artery and the first two grades branches, the contour of the branches was depicted. On the base of coordinates, the GAMBIT was used to generate nodes and furthermore meshes, then the software Fluent was used for numerical calculation and flow simulation. The velocity and pressure changes in the main pulmonary artery and the first two grades branches during different periods of cardiac cycle were observed in both groups.

RESULTCTPA showed that the diameter of the main pulmonary before bifurcate and proximal of the first two branches was larger in systole period than that in diastole period. The diameter of the second segmental artery of right upper lobe was larger during diastole period. The length of the main pulmonary and the first two branches showed no significant difference in both diastole and systole periods. There was no significant difference in length of pulmonary arteries between COPD and normal groups. The main pulmonary to distal right pulmonary artery appeared larger in diastole period. Compared with normal, in COPD group several arteries increased in diameter including proximal and distal of the proximal right pulmonary artery and the proximal right pulmonary artery during systole and diastole periods. In systole period only the diameter of the main pulmonary before bifurcate got larger and the back basic segmental artery of both lower lobe show smaller than normal. The flow condition analysis in COPD and normal groups suggested higher pressure in pulmonary arteries during systole period than that in diastole period, both groups showed high pressure area below the branching point. In COPD patients the right lower lobe artery endured the most significant pressure fall during the two periods and high pressure distributed larger area than normal. Flow velocity in main branch was faster than lower grade branches and that in systole period was faster than that in diastole period. The trend of diffusion of high pressure area was more prominent in diastole period than normal and the influence more prominent.

CONCLUSIONThe distal part of right pulmonary artery to lower lobe artery may be affected earlier when the pulmonary pressure increased. It is feasible to study the changes of flow condition in pulmonary artery branches though the combination of CTPA image and relevant software.

Adult ; Angiography ; methods ; Case-Control Studies ; Humans ; Hypertension, Pulmonary ; etiology ; physiopathology ; Middle Aged ; Pulmonary Artery ; diagnostic imaging ; physiopathology ; Pulmonary Disease, Chronic Obstructive ; complications ; physiopathology ; Tomography, Spiral Computed

OBJECTIVE: Few studies have prospectively evaluated the diagnostic accuracy and temporal impact of ultrasound in the emergency department (ED) in a randomized manner. In this study, we aimed to perform a randomized, standard therapy controlled evaluation of the diagnostic accuracy and temporal impact of a standardized ultrasound strategy, versus standard care, in patients presenting to the ED with acute dyspnea.METHODS: The patients underwent a standardized ultrasound examination that was blinded to the team caring for the patient. Ultrasound results remained blinded in patients randomized to the treating team but were unblinded in the interventional cohort. Scans were performed by trained emergency physicians. The gold standard diagnosis (GSDx) was determined by two physicians blinded to the ultrasound results. The same two physicians reviewed all data >30 days after the index visit.RESULTS: Fifty-nine randomized patients were enrolled. The mean±standard deviation age was 54.4±11 years, and 37 (62%) were male. The most common GSDx was acute heart failure with reduced ejection fraction in 13 (28.3%) patients and airway diseases such as acute exacerbation of asthma or chronic obstructive pulmonary disease in 10 (21.7%). ED diagnostic accuracy, as compared to the GSDx, was 76% in the ultrasound cohort and 79% in the standard care cohort (P=0.796). Compared with the standard care cohort, the final diagnosis was obtained much faster in the ultrasound cohort (mean±standard deviation: 12±3.2 minutes vs. 270 minutes, P<0.001).CONCLUSION: A standardized ultrasound approach is equally accurate, but enables faster ED diagnosis of acute dyspnea than standard care.
Asthma ; Cohort Studies ; Diagnosis ; Diagnostic Imaging ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Heart Failure ; Humans ; Male ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; Ultrasonography

OBJECTIVE: To explore the value of 64 slice spiral CT (SCT) low-dose chest scanning at full inspiration and full expiration for lung density measurement in assessing the pulmonary function in patients with chronic obstructive pulmonary disease (COPD). METHODS: Totally 36 COPD patients (the COPD group) underwent pulmonary function tests (PFT) and were essentially verified COPD; 30 healthy people (the control group) were selected whose 64 slice SCT chest scanning was normal. The 2 groups underwent chest 64 slice SCT low-dose scanning at full inspiration and full expiration. After the scanning, the lung was measured by CT Pulmo software. The lung was divided into 3 regions by scanning layers. We measured and calculated the density indexes of each region (including the upper, middle, lower field, and the total lung) of the 2 groups. All density indexes were lung density at full inspiration and full expiration (Din, Dex), density difference (Dex-Din), density ratio (Dex/ Din), density variation percentage (Din-Dex)/Din. All patients underwent PFT and 64 slice SCT within 3 days, whose pulmonary function was tested by Master Lab ( Jaeger, Germany). The indexes were the percentage of actual value and expected value of forced expiratory volume at the first second (FEV1%) and the ratio of first second forced expiratory volume to forced vital capacity (FEV1/FVC). Then we compared with the CT indexes between the COPD group and the control group. The relevant indicators of lung densities were analyzed in comparison with the indicators of FEV1% and FEV1/FVC by Pearson correlation analysis. RESULTS: The density indexes of each region and total lung, and the Din in the control group and the COPD group were compared. The difference between them was statistically significant (P<0.05). The difference among other indexes was also statistically significant (P<0.01). Excellent correlation was found between Dex, Dex-Din, Dex/ Din and (Din-Dex)/ Din indexes with FEV1% and FEV1/FVC (r=0.566, 0.686, 0.568, 0.580, -0.565, -0.598, 0.565 and 0.598; P<0.01) CONCLUSION Sixty-four slice SCT low-dose two-phase scanning density indexes are closely related to the indicators (FEV1% and FEV1/FVC) of clinical lung function tests, which can be used to evaluate the lung function in COPD patients conventiently and accurately.
Aged ; Aged, 80 and over ; Case-Control Studies ; Densitometry ; methods ; Female ; Humans ; Lung ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; diagnostic imaging ; physiopathology ; Respiratory Function Tests ; Tomography, Spiral Computed

Adult ; Age Factors ; Aged ; Chronic Disease ; Electrocardiography ; Female ; Humans ; Lung Diseases, Obstructive ; diagnostic imaging ; etiology ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Emphysema ; etiology ; Radiography ; Respiratory Function Tests ; Sex Factors ; Smoking