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Small pulmonary vascular alteration and acute exacerbations of COPD: quantitative computed tomography analysis

Authors Wang Z, Chen X, Liu K, Xie W, Wang H, Wei Y, Tang L, Zhu Y

Received 12 May 2016

Accepted for publication 2 July 2016

Published 22 August 2016 Volume 2016:11(1) Pages 1965—1971

DOI https://doi.org/10.2147/COPD.S112651

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Professor Hsiao-Chi Chuang

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell


Zhiyue Wang,1,* Xuesong Chen,2,* Kouying Liu,2 Weiping Xie,2 Hong Wang,2 Yongyue Wei,3 Lijun Tang,1 Yinsu Zhu1

1Department of Radiology, 2Department of Respiratory, The First Affiliated Hospital of Nanjing Medical University, 3Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China

*These authors contributed equally to this work

Abstract: The morphologic alterations of pulmonary small vessels measured by computed tomography (CT) have been used to evaluate chronic obstructive pulmonary disease (COPD). However, the relationship between small pulmonary vascular alteration and acute exacerbations of COPD (AECOPD) is not well understood. The aim of this study was to evaluate the cross-sectional area (CSA) of small pulmonary vessel alterations measured on CT images and investigate its relationship with the COPD severity staged by the degree of airflow limitation and the occurrence of AECOPD. We retrospectively reviewed CT scans, clinical characteristics, and pulmonary function test results of 153 patients with COPD. All the patients were divided into AECOPD and non-AECOPD group according to the COPD staging and pulmonary function test results. The percentages of the total CSA less than 5 mm2 and equal to 5–10 mm2 over the lung area (%CSA<5 and %CSA5–10, respectively) were measured. The %CSA<5 steadily decreased in relation to the increase of COPD severity. In addition, %CSA<5 of the AECOPD group was significantly lower than that of the non-AECOPD group (0.41±0.13 versus 0.68±0.18, P<0.001), and the optimal cutoff value was 0.56 (sensitivity, 0.863; specificity, 0.731). Therefore, small pulmonary vascular alteration, as measured by %CSA<5, could indicate not only the degree of COPD severity, but also the occurrence of AECOPD.

Keywords: acute exacerbation of chronic obstructive pulmonary disease, computed tomography, cross-sectional area of small pulmonary vessels

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