Assessment of lung volume collapsibility in chronic obstructive lung disease patients using CT

Abstract

Objective: To investigate the collapsibility of the lung and individual lobes in patients with COPD during inspiration/expiration and assess the association of whole lung and lobar volume changes with pulmonary function tests (PFTs) and disease severity.

Methods: PFT measures used were RV/TLC%, FEV1% predicted, FVC, FEV1/FVC%, DLco% predicted and GOLD category. A total of 360 paired inspiratory and expiratory CT examinations acquired in 180 subjects were analysed. Automated computerised algorithms were used to compute individual lobe and total lung volumes. Lung volume collapsibility was assessed quantitatively using the simple difference between CT computed inspiration (I) and expiration (E) volumes (I-E), and a relative measure of volume changes, (I-E)/I.

Results: Mean absolute collapsibility (I-E) decreased in all lung lobes with increasing disease severity defined by GOLD classification. Relative collapsibility (I-E)/I showed a similar trend. Upper lobes had lower volume collapsibility across all GOLD categories and lower lobes collectively had the largest volume collapsibility. Whole lung and left lower lobe collapsibility measures tended to have the highest correlations with PFT measures. Collapsibility of lung lobes and whole lung was also negatively correlated with the degree of air trapping between expiration and inspiration, as measured by mean lung density. All measured associations were statistically significant (P < 0.01).

Conclusion: Severity of COPD appears associated with increased collapsibility in the upper lobes, but change (decline) in collapsibility is faster in the lower lobes.

Key points: • Inspiratory and expiratory computed tomography allows assessment of lung collapsibility • Lobe volume collapsibility is significantly correlated with measures of lung function. • As COPD severity increases, collapsibility of individual lung lobes decreases. • Upper lobes exhibit more severe disease, while lower lobes decline faster.

Fig. 1

Examples of lobe segmentation results as outputted by the computerised scheme [–25]. The images (a)–(h) were obtained from a single COPD patient classified as category “none”. Images (i)–(p) were obtained from a single COPD patient classified as GOLD category 4. The top rows in both grids represent inspiratory imaging and the bottom rows represent the corresponding expiratory imaging. Axial views (in column 1), sagittal views (in column 2), coronal views (in column 3) and 3D views (in column 4), are shown. We note that changes in lobe volumes between inspiration and expiration are more pronounced visually in the non-COPD patient (none) than that in the patient with high severity of COPD (GOLD 4)

Fig. 2

Absolute lobe volume collapsibility for individual lobes across GOLD categories. The error bars denote standard deviations

Fig. 3

Relative lobe volume collapsibility for individual lobes across GOLD categories. The error bars denote standard deviations

Fig. 4

Selected scatter plots (a)–(d) showing the correlation between different pulmonary function measures and relative collapsibility

Fig. 4

Selected scatter plots (a)–(d) showing the correlation between different pulmonary function measures and relative collapsibility

Fig. 4

Selected scatter plots (a)–(d) showing the correlation between different pulmonary function measures and relative collapsibility

Fig. 4

Selected scatter plots (a)–(d) showing the correlation between different pulmonary function measures and relative collapsibility

Fig. 5

Relationship between the absolute lobe volume change and the CT-density change for each individual lobe. (a) RUL, (b) RML, (c) RLL, (d) LUL, and (e) LLL.

Fig. 5

Relationship between the absolute lobe volume change and the CT-density change for each individual lobe. (a) RUL, (b) RML, (c) RLL, (d) LUL, and (e) LLL.

Fig. 5

Relationship between the absolute lobe volume change and the CT-density change for each individual lobe. (a) RUL, (b) RML, (c) RLL, (d) LUL, and (e) LLL.

Fig. 5

Relationship between the absolute lobe volume change and the CT-density change for each individual lobe. (a) RUL, (b) RML, (c) RLL, (d) LUL, and (e) LLL.

Fig. 5

Relationship between the absolute lobe volume change and the CT-density change for each individual lobe. (a) RUL, (b) RML, (c) RLL, (d) LUL, and (e) LLL.