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CT densitometry in emphysema: a systematic review of its clinical utility

Authors Crossley D, Renton M, Khan M, Low EV, Turner AM

Received 1 June 2017

Accepted for publication 25 August 2017

Published 7 February 2018 Volume 2018:13 Pages 547—563

DOI https://doi.org/10.2147/COPD.S143066

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell


Diana Crossley,1 Mary Renton,1 Muhammad Khan,1 Emma V Low,1 Alice M Turner2

1Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; 2Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK

Background: The aim of the study was to assess the relationship between computed tomography (CT) densitometry and routine clinical markers in patients with chronic obstructive pulmonary disease (COPD) and alpha-1 anti-trypsin deficiency (AATD).
Methods: Multiple databases were searched using a combination of pertinent terms and those articles relating quantitatively measured CT densitometry to clinical outcomes. Studies that used visual scoring only were excluded, as were those measured in expiration only. A thorough review of abstracts and full manuscripts was conducted by 2 reviewers; data extraction and assessment of bias was conducted by 1 reviewer and the 4 reviewers independently assessed for quality. Pooled correlation coefficients were calculated, and heterogeneity was explored.
Results: A total of 112 studies were identified, 82 being suitable for meta-analysis. The most commonly used density threshold was −950 HU, and a significant association between CT density and all included clinical parameters was demonstrated. There was marked heterogeneity between studies secondary to large variety of disease severity within commonly included cohorts and differences in CT acquisition parameters.
Conclusion: CT density shows a good relationship to clinically relevant parameters; however, study heterogeneity and lack of longitudinal data mean that it is difficult to compare studies or derive a minimal clinically important difference. We recommend that international consensus is reached to standardize CT conduct and analysis in future COPD and AATD studies.

Keywords: computed tomography, CT, densitometry, emphysema, chronic obstructive pulmonary disease, alpha-1 anti-trypsin deficiency

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