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Identifying the heterogeneity of COPD by V/P SPECT : A new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease

Bajc, M. LU ; Chen, Y.; Wang, J.; Li, X. Y.; Shen, W. M.; Wang, C. Z.; Huang, H; Lindqvist, A. and He, X. Y. (2017) In International Journal of COPD 12. p.1579-1587
Abstract

Introduction: Airway obstruction and possible concomitant pulmonary diseases in COPD cannot be identified conventionally with any single diagnostic tool. We aimed to diagnose and grade COPD severity and identify pulmonary comorbidities associated with COPD with ventilation/perfusion single-photon emission computed tomography (V/P SPECT) using Technegas as the functional ventilation imaging agent. Methods: 94 COPD patients (aged 43–86 years, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I–IV) were examined with V/P SPECT and spirometry. Ventilation and perfusion defects were analyzed blindly according to the European guidelines. Penetration grade of Technegas in V SPECT measured the degree of obstructive small... (More)

Introduction: Airway obstruction and possible concomitant pulmonary diseases in COPD cannot be identified conventionally with any single diagnostic tool. We aimed to diagnose and grade COPD severity and identify pulmonary comorbidities associated with COPD with ventilation/perfusion single-photon emission computed tomography (V/P SPECT) using Technegas as the functional ventilation imaging agent. Methods: 94 COPD patients (aged 43–86 years, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I–IV) were examined with V/P SPECT and spirometry. Ventilation and perfusion defects were analyzed blindly according to the European guidelines. Penetration grade of Technegas in V SPECT measured the degree of obstructive small airways disease. Total preserved lung function and penetration grade of Technegas in V SPECT were assessed by V/P SPECT and compared to GOLD stages and spirometry. Results: Signs of small airway obstruction in the ventilation SPECT images were found in 92 patients. Emphysema was identified in 81 patients. Two patients had no signs of COPD, but both of them had a pulmonary embolism, and in one of them we also suspected a lung tumor. The penetration grade of Technegas in V SPECT and total preserved lung function correlated significantly to GOLD stages (r=0.63 and -0.60, respectively, P<0.0001). V/P SPECT identified pulmonary embolism in 30 patients (32%). A pattern typical for heart failure was present in 26 patients (28%). Parenchymal changes typical for pneumonia or lung tumor were present in several cases. Conclusion: V/P SPECT, using Technegas as the functional ventilation imaging agent, is a new tool to diagnose COPD and to grade its severity. Additionally, it revealed heterogeneity of COPD caused by pulmonary comorbidities. The characteristics of these comorbidities suggest their significant impact in clarifying symptoms, and also their influence on the prognosis.

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author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
COPD, Imaging interpretation criteria, Pulmonary comorbidities, Technegas, V/P SPECT
in
International Journal of COPD
volume
12
pages
9 pages
publisher
Dove Press
external identifiers
  • scopus:85020207474
ISSN
1176-9106
DOI
language
English
LU publication?
no
id
3faf059a-1b7f-4ba4-a3db-74939fbf894f
date added to LUP
2017-08-21 10:04:23
date last changed
2018-05-29 09:23:39
@article{3faf059a-1b7f-4ba4-a3db-74939fbf894f,
  abstract     = {<p>Introduction: Airway obstruction and possible concomitant pulmonary diseases in COPD cannot be identified conventionally with any single diagnostic tool. We aimed to diagnose and grade COPD severity and identify pulmonary comorbidities associated with COPD with ventilation/perfusion single-photon emission computed tomography (V/P SPECT) using Technegas as the functional ventilation imaging agent. Methods: 94 COPD patients (aged 43–86 years, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I–IV) were examined with V/P SPECT and spirometry. Ventilation and perfusion defects were analyzed blindly according to the European guidelines. Penetration grade of Technegas in V SPECT measured the degree of obstructive small airways disease. Total preserved lung function and penetration grade of Technegas in V SPECT were assessed by V/P SPECT and compared to GOLD stages and spirometry. Results: Signs of small airway obstruction in the ventilation SPECT images were found in 92 patients. Emphysema was identified in 81 patients. Two patients had no signs of COPD, but both of them had a pulmonary embolism, and in one of them we also suspected a lung tumor. The penetration grade of Technegas in V SPECT and total preserved lung function correlated significantly to GOLD stages (r=0.63 and -0.60, respectively, P&lt;0.0001). V/P SPECT identified pulmonary embolism in 30 patients (32%). A pattern typical for heart failure was present in 26 patients (28%). Parenchymal changes typical for pneumonia or lung tumor were present in several cases. Conclusion: V/P SPECT, using Technegas as the functional ventilation imaging agent, is a new tool to diagnose COPD and to grade its severity. Additionally, it revealed heterogeneity of COPD caused by pulmonary comorbidities. The characteristics of these comorbidities suggest their significant impact in clarifying symptoms, and also their influence on the prognosis.</p>},
  author       = {Bajc, M. and Chen, Y. and Wang, J. and Li, X. Y. and Shen, W. M. and Wang, C. Z. and Huang, H and Lindqvist, A. and He, X. Y.},
  issn         = {1176-9106},
  keyword      = {COPD,Imaging interpretation criteria,Pulmonary comorbidities,Technegas,V/P SPECT},
  language     = {eng},
  month        = {05},
  pages        = {1579--1587},
  publisher    = {Dove Press},
  series       = {International Journal of COPD},
  title        = {Identifying the heterogeneity of COPD by V/P SPECT : A new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease},
  url          = {http://dx.doi.org/},
  volume       = {12},
  year         = {2017},
}