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Asbestos-induced and Smoking-related Disease: Apportioning Pulmonary Function Deficit by Using Thin-Section CT¹

¹ From the Department of Radiology, Hammersmith Hospital, London, England (S.J.C.); Department of Radiology (D.M.H., M.B.R.) and Interstitial Lung Disease Unit (A.J.N.T., A.U.W.), Royal Brompton Hospital, Emmanuel Kaye Building, Manresa Rd, London, SW6 LR6, England; Center for Respiratory Research, University College London, London, England (Y.C.G.L.); Departments of Medicine and Public Health, University of Western Australia, Perth, Australia (A.W.M.); Department of Respiratory Medicine, Middlemore Hospital and University of Auckland, Auckland, New Zealand (P.S.); and Department of Respiratory Medicine, the London Chest Hospital, London, England (R.M.R.). Received July 12, 2005; revision requested September 21; revision received February 16, 2006; accepted March 21; final version accepted April 3. Y.C.G.L. supported by a Wellcome Advanced Fellowship. Address correspondence to A.U.W. (e-mail: a.wells{at}rbh.nthames.nhs.uk).

Purpose: To retrospectively correlate the extent of individual diseases seen at thin-section computed tomography (CT) with pulmonary function in an initial group of patients with asbestos-related parenchymal disease (asbestosis) and to test these findings in a subsequent group of patients whose CT scans were retrospectively identified.

Materials and Methods: This retrospective study had Institutional Review Board approval; informed consent was not required. The study included 133 individuals who had been exposed to asbestos. In the initial study group (81 patients; 79 men, two women; median age, 67 years), two observers used a CT scoring system to quantify the extent of pulmonary fibrosis, diffuse pleural thickening, small-airways disease, and emphysema. Multivariate equations were formulated by using independent CT variables to predict changes in total lung capacity (TLC) and carbon monoxide diffusing capacity (DLCO). The validity of these equations was then tested in a subsequent group of patients (52 patients; all men; median age, 60 years).

Results: At thin-section CT, the extent of asbestos-induced pleuropulmonary disease and emphysema correlated significantly with physiologic impairment (P < .001). Combined CT variables predicted 58% and 57% of the variability in TLC and DLCO, respectively, despite considerable variation in the proportion of coexisting pathologic conditions. When predictive equations with CT variables derived from the initial study group were applied to the subsequent study group, predicted TLC ( = 0.75, P < .001) and DLCO ( = 0.64, P < .001) correlated strongly with measured values.

Conclusion: The proposed CT system provides a semiquantitative method for assessing the relative contribution of asbestos-induced pleuropulmonary disease and smoking-related emphysema to functional impairment.

© RSNA, 2006