Learning objectives
Brief overview of the epidemiological,
clinical and imagiologic characteristics of emphysema.
Description and illustration ofa subjective grading system for the distribution's pattern ofemphysema and of its radiologic and clinical practical utility.
Background
Pulmonary emphysema is an abnormal permanent enlargement of the airspaces distal to the terminal bronchioles,
accompanied by destruction of the alveolar wall and without obvious fibrosis.
Pulmonary emphysema is part of the chronic obstructive pulmonary disease (COPD) spectrum and encompasses a number of entities and morphological patterns,
of which the most important subtypes are centrilobular (most common),
panlobular and paraseptal.
Epidemiologically speaking,
approximately 210 million people are affected worldwide,
leading to 3 million annual deaths,
total.
It is predominantly a disease of middle to late...
Findings and procedure details
Advances in CT scanning and specifically designed software now allow precise assessment of the extent of emphysema - emphysema index.Areas of the lung with a density below a given threshold (commonly -950 HU) are designated as emphysematous.
In addition,
the technology can be used to assess the distribution of emphysematous disease,
an approach that has been utilised in assessing patients for (and in the outcomes of) lung volume reduction surgery and also in monitoring changes in emphysema longitudinally in AAT-deficient patients.
There are physiologic differences...
Conclusion
In addition to the emphysema index,
regional heterogeneity of emphysema contributes to impairment of pulmonary function.
Combined emphysema index and heterogeneity index better represent the airflow limitation component among patients’ impaired function.
Assessing the regional heterogeneity of emphysema using a visual scoring system is a very useful tool,
with comparable results to an objective computerized system,
allowing an accurate assessment of the impairment of pulmonary function on patients with this diagnosis.
References
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Bankier AA,
Maertelaer VD,
Keyzer C,
Gevenois PA.
Pulmonary Emphysema: Subjective Visual Grading versus Objective Quantification with Macroscopic Morphometry and Thin-Section CT Densitometry.
Radiology 1999; 211:851–858.
Sciurba FC,
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A Randomized Study of Endobronchial Valves for Advanced Emphysema.
N Engl J...