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Kantitatif Bilgisayarli Tomografinin Kronik Obstrüktif Akciğer Hastaliği Fenotipi Belirlemedeki Rolü

Yıl 2021, Cilt: 13 Sayı: 3, 97 - 103, 31.12.2021
https://doi.org/10.35514/mtd.2021.56

Öz

Amaç: Kronik obstrüktif akciğer hastalığı tanısı konmuş hastalarda, kantitatif toraks BT’nin KOAH fenotiplerinin belirlenmesindeki rolünü araştırmak.
Materyal ve Metod: Ocak 2007- Eylül 2013 tarihleri arasında Ufuk Üniversitesi Dr. Rıdvan Ege Hastanesi Göğüs Hastalıkları polikliniği/servisinde değerlendirilen 104 hasta ve 20 kontrol olgusu çalışmaya alındı. Hastaların spirometrik parametrelerine SFT kayıtlarından, toraks BT verilerine ise Radyoloji arşivinden ulaşıldı. Tüm toraks BT’lerin kantitatif incelemesi Radyoloji Anabilim Dalında belirlenen tek bir Radyoloji Uzmanı tarafından yapıldı. Görüntü Arşivleme ve İletişim sisteminden elde edilen toraks BT incelemeleri Radyoloji servisinde kullanılan iş istasyonuna yüklendi. Bu amaçla Adwanced Workstation 4.2 Sun Workstation kullanıldı.
Bulgular: Çalışmamızda sağ ve sol akciğer amfizem hacimleri ortalama değerleri sırasıyla 205,8 ± 303,3 ml ve 210,3 ± 363,8 ml olup kontrol grupları ile aralarında anlamlı bir fark bulundu (p<0,001). Olguların ROC analizinden elde edilen amfizem hacmi eşik değeri % 2,1 olarak alındığında, FEV1/FVC <%70’in altında olma durumunu tahmin etmedeki duyarlılığı %62,3, seçiciliği %94,4, pozitif prediktif değeri ise %98,5 olarak bulundu. Kronik bronşit ise direk bronş duvar kalınlığı ölçümleriyle bir cut-off belirlenemedi. Katılımcıların spirometri değerleri incelendiğinde kronik bronşitlilerin (n=39) FEV1, FEV1/FVC ve FEF 25-75 değerleri amfizemli olgularınkinden (n=65) anlamlı olarak yüksek bulunmuştur (p<0,05). Spirometri değerlerinden, YÇBT’deki amfizem yüzdesi ile en yüksek negatif korelasyon gösteren parametre FEV1/FVC idi (r=-0,539) (p<0,001). Diğer spirometri değerlerinin aksine FEV1/FVC ( % ) değeri ile bronş duvar kalınlığı arasında negatif korelasyon izlendi (r=-0,214) (p<0,05).
Sonuç: Kantitatif BT’de amfizem ve kronik bronşit varlığının fonksiyonel değerlendirme sonuçlarını öngördüğü ancak, yıllık atak sayısı ve semptom skorları açısından belirleyici olmadığı izlenmiştir. Ayrıca kantitatif BT’de amfizem hacmi eşik değeri %2,1 olarak bulundu. Radyolojik bulguların klinikle korelasyonu değerlendirilip fenotip belirlenmesi için ileri araştırmalara ihtiyaç vardır.
Anahtar kelimeler: Bilgisayarlı tomografi, KOAH, fenotip, spirometri

Destekleyen Kurum

Yok

Kaynakça

  • Kaynaklar 1. Han MK, Agusti A, Calverley PM, Celli BR, Criner G, Curtis JL, et al.Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med. 2010 Sep 1;182(5):598-604.
  • 2.Altın R. Kronik Obstriktif Akciğer Hastalığı’nda Klinik Özellikler. Türkiye Klinikleri Göğüs Hastalıkları Dergisi (2003); 1: 13-17.
  • 3.Miravitlles M, Calle M, Soler-Cataluña JJ. Clinical phenotypes of COPD: identification, definition and implications forguidelines. Arch Bronconeumol. 2012 Mar;48(3):86-98.
  • 4.Sakai N, Mishima M, Nishimura K et al. An automated method to assess the distribution of low attenuation areas on chest CT scans in chronic pulmonary emphysema patients. Chest 1994; 106:1319-25.
  • 5. Lakadamyalı H, Alpar S, Lakadamyalı h, Ertürk H, Kurt B. Kronik Ostrüktif Akciğer Hastalığında Yüksek rezolüsyonlu Bilgisayarlı Tomografi Bulguları ile Solunum Fonksiyon Testleri Arasındaki Korelasyon. Toraks Dergisi 2006; 7(1):17-22.
  • 6. GOLD Committee.Global Strategy for the diagnosis managemeny and prevention of COPD-revised 2013, Global Inıtiative for Chronic Obstructive Lung Disease (GOLD).Global Initiative for Chronic Obstructive Lung Disease website.http://www.goldcopd.org/guidelines-globalstrategy-for-diagnosis-management.html
  • 7. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scle as a measure of disability in patients withj chronic pulmonary disease. Thorax.1999; 54:581-586
  • 8. Jones PW, Harding G, Berry P,Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assesment Test. Eur Respir J . 2009 ; 34: 648-654.
  • 9. Brusasco V,Crapo R, Viegi G.Recommandations communes de l’ATS et de l’ERS sur les explarations fonctionnelles respiratoires (Coming together : the ATS/ERS consensuson clinical pulmonary function testing). Rev Mal Respir. 2007 Mar; 24 (3 Pt 2) :2S11-4
  • 10.Tylén U, Boijsen M, Ekberg-Jansson A, Bake B, Lofdahl CG. Emphysematous lesions and lung function in healthy smokers 60 years of age. Respir Med 2000; 94(1):38-43.
  • 11.Orlandi I, Moroni C, Camiciottoli G, Bartolucci M, Pistolesi M, Villari N, et al.Chronic obstructive pulmonary disease: thin-section CT measurement fairway wall thickness and lung attenuation. Radiology2005; 234(2):604.10.
  • 12. Burgel P-R et all. Clinical COPD phenotypes: a novelapproach using principal component and cluster analyses. Eur Respir J 2010; 36: 531–539
  • 13. Han MK, Kazerooni EA, Lynch DA, Liu LX, Murray S, Curtis JL, Criner GJ, Kim V, Bowler RP, Hanania NA, Anzueto AR, Make BJ, Hokanson JE, Crapo JD, Silverman EK, Martinez FJ, Washko GR (2011) Chronic obstructive pulmonary disease exacerbations in the COPD Gene Study: associated radiologic phenotypes. Radiology 261(1):274–282
  • 14. Boschetto P, Quintavalle S, Zeni E, Leprotti S, Potena A, Ballerin L, et al. Association between markers of emphysema and more severe obstructive chronic pulmonary disease. Thorax. 2006;61:1037–42.
  • 15.Barker B.L. and Brightling C.E.. Phenotyping the heterogeneity of chronic obstructive pulmonary disease. Clinical Science (2013) 124, 371–387
  • 16.Carolan BJ, Sutherland ER. Clinical phenotypes of chronic obstructive pulmonary disease and asthma: recent advances. J Allergy Clin Immunol. 2013 Mar; 131 (3):
  • 17.Xie X, P.A. de Jong, OudkerkM. , VliegenthartR., et all. Morphological measurements in computed tomography correlate with airflow obstruction in chronic obstructive pulmonary disease: systematic review and meta-analysis EurRadiol (2012) 22:2085–2093.
  • 18.Heussel C.P., HerthF. J. F., KappesJ., HantuschR., HartliebS., WeinheimerO., Kauczor H. U, Eberhardt R. Fully automatic quantitative as sessmentof emphysema in computed tomography: comparison with pulmonary function test ingand normal values. EurRadiol (2009) 19: 2391–2402
  • 19.Lee Y. K.,Oh Y.M., Lee J.H., Kim E. K. Quantitative Assessment of Emphysema, Air Trapping, and Airway Thickening on Computed Tomography. Lung (2008) 186:157–165.
  • 20.Bafadhel M, Umar I, BSc et all.The Role of CT Scanning in Multidimensional Phenotyping of COPD. Chest / 140 / 3 / September, 2011.
  • 21. Grydeland TB, Dirksen A, Coxson OH, Eagan TM, Thorsen E, Pillia SG, Sharma S, Eidwe GE, Gulsvik A, Bakke PS, Quantitative computed tomography measures of emphysema and airway wall thickness are related to respiratory symptoms. Amj Repir Crit Care Med. 2010 Feb 15; 181(4) :353-9.

The role of quantitative computed tomography in determining the phenotype of chronic obstructive pulmonary disease

Yıl 2021, Cilt: 13 Sayı: 3, 97 - 103, 31.12.2021
https://doi.org/10.35514/mtd.2021.56

Öz

Backround: To assess the role of quantitative thorax computerized tomography (CT) in determining phenotypes of chronic obstructuve pulmonary disease (COPD).
Material and Methods: 104 patients admitted /consulted to Chest Diseases outpatient clinic/ ward in University Hospital and 20 healthy controls were enrolled in this study between January 2007 and September 2013. The spirometry values were obtained from Spirometry Lung Function Test registry and thorax CT scans were obtained from archive of Radiology department. The quantitative evaluation of CTs were performed by the same radiologist. The torax CT imagings obtained from the Picture archiving and Communication System were loaded to the work station of Radiology. Advanced Workstation 4.2 Sun Workstation was applied.
Results: The emphysema mean volumes of the right and the left lung - evaluated were 205,8 ± 303,3 ml and 210,3 ± 363,8 ml, and significant difference was determined between the groups (p<0,001). The threshold for emphysema volume was detected as 2,1%; sensitivity, specifity anpositive predictive value to predict FEV1/FVC ≤ 70 was 62,3%, 94,4% 98,5% respectively. No cut-off value was determined for chronic bronchitis with bronchial diameter measurements. Besides, FEV1, FEV1/FVC and FEF 25-75 values of the patients with chronic bronchitis were significantly higher than the patients with emphysema (p<0,05). The FEV1/ FVC value has the strongest negative correlation with emphysema percentage value of the High Resolution CT (r= -0, 539) (p<0,001). FEV1/FVC had also negative correlation with bronchial wall diameter (r=-0,214) (p<0,05).
Conclusion: In quantitative CT the presence of emphysema and chronic bronchitis predicted the results of functional evaluation, but was not determinative in annual attack number and symptom scores. The cut-off value was found as 2,1% on quantitative CT for volume of empysema. Further studies are required in order to correlate the clinical state with radiological findings and determine the phenotype.
Keywords: Computed tomography, COPD, phenotype, spirometry

Kaynakça

  • Kaynaklar 1. Han MK, Agusti A, Calverley PM, Celli BR, Criner G, Curtis JL, et al.Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med. 2010 Sep 1;182(5):598-604.
  • 2.Altın R. Kronik Obstriktif Akciğer Hastalığı’nda Klinik Özellikler. Türkiye Klinikleri Göğüs Hastalıkları Dergisi (2003); 1: 13-17.
  • 3.Miravitlles M, Calle M, Soler-Cataluña JJ. Clinical phenotypes of COPD: identification, definition and implications forguidelines. Arch Bronconeumol. 2012 Mar;48(3):86-98.
  • 4.Sakai N, Mishima M, Nishimura K et al. An automated method to assess the distribution of low attenuation areas on chest CT scans in chronic pulmonary emphysema patients. Chest 1994; 106:1319-25.
  • 5. Lakadamyalı H, Alpar S, Lakadamyalı h, Ertürk H, Kurt B. Kronik Ostrüktif Akciğer Hastalığında Yüksek rezolüsyonlu Bilgisayarlı Tomografi Bulguları ile Solunum Fonksiyon Testleri Arasındaki Korelasyon. Toraks Dergisi 2006; 7(1):17-22.
  • 6. GOLD Committee.Global Strategy for the diagnosis managemeny and prevention of COPD-revised 2013, Global Inıtiative for Chronic Obstructive Lung Disease (GOLD).Global Initiative for Chronic Obstructive Lung Disease website.http://www.goldcopd.org/guidelines-globalstrategy-for-diagnosis-management.html
  • 7. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scle as a measure of disability in patients withj chronic pulmonary disease. Thorax.1999; 54:581-586
  • 8. Jones PW, Harding G, Berry P,Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assesment Test. Eur Respir J . 2009 ; 34: 648-654.
  • 9. Brusasco V,Crapo R, Viegi G.Recommandations communes de l’ATS et de l’ERS sur les explarations fonctionnelles respiratoires (Coming together : the ATS/ERS consensuson clinical pulmonary function testing). Rev Mal Respir. 2007 Mar; 24 (3 Pt 2) :2S11-4
  • 10.Tylén U, Boijsen M, Ekberg-Jansson A, Bake B, Lofdahl CG. Emphysematous lesions and lung function in healthy smokers 60 years of age. Respir Med 2000; 94(1):38-43.
  • 11.Orlandi I, Moroni C, Camiciottoli G, Bartolucci M, Pistolesi M, Villari N, et al.Chronic obstructive pulmonary disease: thin-section CT measurement fairway wall thickness and lung attenuation. Radiology2005; 234(2):604.10.
  • 12. Burgel P-R et all. Clinical COPD phenotypes: a novelapproach using principal component and cluster analyses. Eur Respir J 2010; 36: 531–539
  • 13. Han MK, Kazerooni EA, Lynch DA, Liu LX, Murray S, Curtis JL, Criner GJ, Kim V, Bowler RP, Hanania NA, Anzueto AR, Make BJ, Hokanson JE, Crapo JD, Silverman EK, Martinez FJ, Washko GR (2011) Chronic obstructive pulmonary disease exacerbations in the COPD Gene Study: associated radiologic phenotypes. Radiology 261(1):274–282
  • 14. Boschetto P, Quintavalle S, Zeni E, Leprotti S, Potena A, Ballerin L, et al. Association between markers of emphysema and more severe obstructive chronic pulmonary disease. Thorax. 2006;61:1037–42.
  • 15.Barker B.L. and Brightling C.E.. Phenotyping the heterogeneity of chronic obstructive pulmonary disease. Clinical Science (2013) 124, 371–387
  • 16.Carolan BJ, Sutherland ER. Clinical phenotypes of chronic obstructive pulmonary disease and asthma: recent advances. J Allergy Clin Immunol. 2013 Mar; 131 (3):
  • 17.Xie X, P.A. de Jong, OudkerkM. , VliegenthartR., et all. Morphological measurements in computed tomography correlate with airflow obstruction in chronic obstructive pulmonary disease: systematic review and meta-analysis EurRadiol (2012) 22:2085–2093.
  • 18.Heussel C.P., HerthF. J. F., KappesJ., HantuschR., HartliebS., WeinheimerO., Kauczor H. U, Eberhardt R. Fully automatic quantitative as sessmentof emphysema in computed tomography: comparison with pulmonary function test ingand normal values. EurRadiol (2009) 19: 2391–2402
  • 19.Lee Y. K.,Oh Y.M., Lee J.H., Kim E. K. Quantitative Assessment of Emphysema, Air Trapping, and Airway Thickening on Computed Tomography. Lung (2008) 186:157–165.
  • 20.Bafadhel M, Umar I, BSc et all.The Role of CT Scanning in Multidimensional Phenotyping of COPD. Chest / 140 / 3 / September, 2011.
  • 21. Grydeland TB, Dirksen A, Coxson OH, Eagan TM, Thorsen E, Pillia SG, Sharma S, Eidwe GE, Gulsvik A, Bakke PS, Quantitative computed tomography measures of emphysema and airway wall thickness are related to respiratory symptoms. Amj Repir Crit Care Med. 2010 Feb 15; 181(4) :353-9.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Sümeyye Alparslan Bekir 0000-0002-3542-8133

Gökçe Kaan Ataç Bu kişi benim 0000-0002-4145-8275

Evrim Akpınar 0000-0001-9040-9309

Esra Büyük 0000-0001-8568-7523

Sinem Güngör 0000-0002-1163-125X

Eylem Tunçay 0000-0002-5046-1943

Meral Gülhan Bu kişi benim 0000-0002-8169-570X

Yayımlanma Tarihi 31 Aralık 2021
Gönderilme Tarihi 22 Ekim 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 13 Sayı: 3

Kaynak Göster

Vancouver Alparslan Bekir S, Ataç GK, Akpınar E, Büyük E, Güngör S, Tunçay E, Gülhan M. Kantitatif Bilgisayarli Tomografinin Kronik Obstrüktif Akciğer Hastaliği Fenotipi Belirlemedeki Rolü. Maltepe tıp derg. 2021;13(3):97-103.