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Asynchrony in respiratory movements between the pulmonary lobes in patients with COPD: continuous measurement of lung density by 4-dimensional dynamic-ventilation CT

Authors Yamashiro T, Moriya H, Matsuoka S, Nagatani Y, Tsubakimoto M, Tsuchiya N, Murayama S

Received 22 April 2017

Accepted for publication 24 June 2017

Published 20 July 2017 Volume 2017:12 Pages 2101—2109

DOI https://doi.org/10.2147/COPD.S140247

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Supplementary Video 2: The dynamic-ventilation computed tomography of non-COPD smoker (left) and COPD patients (right). Notes: Respiratory movements of the lung are smaller in COPD patient than in non-COPD smoker. In the axial plane of COPD patient, a p

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Tsuneo Yamashiro,1 Hiroshi Moriya,2 Shin Matsuoka,3 Yukihiro Nagatani,4 Maho Tsubakimoto,1 Nanae Tsuchiya,1 Sadayuki Murayama1

On behalf of the ACTIve Study Group

1Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan; 2Department of Radiology, Ohara General Hospital, Fukushima-City, Fukushima, Japan; 3Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan; 4Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan

Purpose: Four-dimensional dynamic-ventilation CT imaging demonstrates continuous movement of the lung. The aim of this study was to assess the correlation between interlobar synchrony in lung density and spirometric values in COPD patients and smokers, by measuring the continuous changes in lung density during respiration on the dynamic-ventilation CT.
Materials and methods: Thirty-two smokers, including ten with COPD, underwent dynamic-ventilation CT during free breathing. CT data were continuously reconstructed every 0.5 sec. Mean lung density (MLD) of the five lobes (right upper [RU], right middle [RM], right lower [RL], left upper [LU], and left lower [LL]) was continuously measured by commercially available software using a fixed volume of volume of interest which was placed and tracked on a single designated point in each lobe. Concordance between the MLD time curves of six pairs of lung lobes (RU-RL, RU-RM, RM-RL, LU-LL, RU-LU, and RL-LL lobes) was expressed by cross-correlation coefficients. The relationship between these cross-correlation coefficients and the forced expiratory volume in one second/forced vital capacity (FEV1.0/FVC) values was assessed by Spearman rank correlation analysis.
Results: In all six pairs of the pulmonary lobes, the cross-correlation coefficients of the two MLD curves were significantly positively correlated with FEV1.0/FVC (ρ =0.60–0.73, P<0.001). The mean value of the six coefficients strongly correlated with FEV1.0/FVC (ρ =0.80, P<0.0001).
Conclusion: The synchrony of respiratory movements between the pulmonary lobes is limited or lost in patients with more severe airflow limitation.

Keywords: computed tomography, chronic obstructive pulmonary disease, emphysema, airflow limitation, mean lung density

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