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Monitoring of Smoking-induced Emphysema with CT in a Lung Cancer Screening Setting: Detection of Real Increase in Extent of Emphysema¹

¹ From the Departments of Radiology (H.A.G., M.P.) and Pulmonology (J.W.J.L.) and Image Sciences Institute (A.M.S., B.v.G.), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; and Department of Pulmonology, Erasmus Medical Center, Rotterdam, the Netherlands (R.J.v.K.). Received August 2, 2006; revision requested October 4; revision received October 31; accepted December 6; final version accepted January 26, 2007. Address correspondence to H.A.G. (e-mail: h.gietema{at}umcutrecht.nl).

View larger version (155K): [in this window] [in a new window] [Download PPT slide]   Figure 1: CT scan of phantom used to monitor CT numbers during the study. The phantom consisted of a foam body, 320 mm in diameter, and two free spaces of 80 mm in diameter each. One of the free spaces was filled with plastic, whereas the other contained only air.

View larger version (132K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Coronal (a) baseline and (b) repeat scans in a 56-year-old man show areas with attenuation below –910 HU. The computer program divides the lungs into three equal volumes shown in red, yellow, and green and provides the total low-attenuation volume. Total lung volume was 5965 mL on the baseline scan and 6350 mL on the repeat scan.

View larger version (85K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Coronal (a) baseline and (b) repeat scans in a 56-year-old man show areas with attenuation below –910 HU. The computer program divides the lungs into three equal volumes shown in red, yellow, and green and provides the total low-attenuation volume. Total lung volume was 5965 mL on the baseline scan and 6350 mL on the repeat scan.

View larger version (9K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Bland-Altman plots for ESs at (a) –910 HU, (b) –930 HU, and (c) –950 HU. The x-axes show the means of ESs on the baseline and repeat scans; the y-axes show ESs on the baseline scan subtracted from ESs on the repeat scan, expressed as percentage of total lung volume. The mean differences are shown with a solid line; the limits of agreement are shown with dashed lines. An increase in ES above the upper limit of agreement or a decrease below the lower limit of agreement has a 95% likelihood to be a real progression or regression of emphysema.

View larger version (8K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Bland-Altman plots for ESs at (a) –910 HU, (b) –930 HU, and (c) –950 HU. The x-axes show the means of ESs on the baseline and repeat scans; the y-axes show ESs on the baseline scan subtracted from ESs on the repeat scan, expressed as percentage of total lung volume. The mean differences are shown with a solid line; the limits of agreement are shown with dashed lines. An increase in ES above the upper limit of agreement or a decrease below the lower limit of agreement has a 95% likelihood to be a real progression or regression of emphysema.

View larger version (7K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: Bland-Altman plots for ESs at (a) –910 HU, (b) –930 HU, and (c) –950 HU. The x-axes show the means of ESs on the baseline and repeat scans; the y-axes show ESs on the baseline scan subtracted from ESs on the repeat scan, expressed as percentage of total lung volume. The mean differences are shown with a solid line; the limits of agreement are shown with dashed lines. An increase in ES above the upper limit of agreement or a decrease below the lower limit of agreement has a 95% likelihood to be a real progression or regression of emphysema.

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 4: Correlation between lung volumes on the baseline scans and lung volumes on repeat scans. Equal volumes are demonstrated by the solid line. No systematic difference between lung volume on baseline scan and that on repeat scan could be demonstrated.

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 5a: Correlation between the difference between inspiration level on repeat scans (volume 2) after logarithmic transformation and inspiration level on baseline scans (volume 1) after logarithmic transformation and difference in ESs between repeat scans and baseline scans at (a) –910 HU, (b) –930 HU, and (c) –950 HU. Significant but low to moderate correlations could be demonstrated.

View larger version (8K): [in this window] [in a new window] [Download PPT slide]   Figure 5b: Correlation between the difference between inspiration level on repeat scans (volume 2) after logarithmic transformation and inspiration level on baseline scans (volume 1) after logarithmic transformation and difference in ESs between repeat scans and baseline scans at (a) –910 HU, (b) –930 HU, and (c) –950 HU. Significant but low to moderate correlations could be demonstrated.

View larger version (9K): [in this window] [in a new window] [Download PPT slide]   Figure 5c: Correlation between the difference between inspiration level on repeat scans (volume 2) after logarithmic transformation and inspiration level on baseline scans (volume 1) after logarithmic transformation and difference in ESs between repeat scans and baseline scans at (a) –910 HU, (b) –930 HU, and (c) –950 HU. Significant but low to moderate correlations could be demonstrated.