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Assessment of the relationship between morphological emphysema phenotype and corresponding pulmonary perfusion pattern on a segmental level

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Abstract

Purpose

Distinct morphological emphysema phenotypes were assessed by CT to show characteristic perfusion defect patterns.

Material/Methods

Forty-one patients with severe emphysema (GOLD III/IV) underwent three-dimensional high resolution computed tomography (3D-HRCT) and contrast-enhanced magnetic resonance (MR) perfusion. 3D-HRCT data was visually analyzed for emphysema phenotyping and quantification by consensus of three experts in chest-radiology. The predominant phenotype per segment was categorized as normal, centrilobular, panlobular or paraseptal. Segmental lung perfusion was visually analyzed using six patterns of pulmonary perfusion (1-normal; 2-mild homogeneous reduction in perfusion; 3-heterogeneous perfusion without focal defects; 4-heterogeneous perfusion with focal defects; 5-heterogeneous absence of perfusion; 6-homogeneous absence of perfusion), with the extent of the defect given as a percentage.

Results

730 segments were evaluated. CT categorized 566 (78 %) as centrilobular, 159 (22 %) as panlobular and 5 (<1 %) as paraseptal with no normals. Scores with regards to MR perfusion patterns were: 1–0; 2–0; 3–28 (4 %); 4–425 (58 %); 5–169 (23 %); 6–108 (15 %).

The predominant perfusion pattern matched as follows: 70 % centrilobular emphysema - heterogeneous perfusion with focal defects (score 4); 42 % panlobular - homogeneous absence of perfusion (score 5); and 43 % panlobular - heterogeneous absence of perfusion (score 6).

Conclusion

MR pulmonary perfusion patterns correlate with the CT phenotype at a segmental level in patients with severe emphysema.

Key points

• MR perfusion patterns correlate with the CT phenotype in emphysema.

• Reduction of MR perfusion is associated with loss of lung parenchyma on CT

• Centrilobular emphysema shows heterogeneous perfusion reduction while panlobular emphysema shows loss of perfusion.

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Acknowledgments

The scientific guarantor of this publication is Prof. Hans-Ulrich Kauczor. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This work has been supported by the Competence Network on Asthma/COPD (ASCONET) through a grant and by the German Center for Lung Research (DZL) through grants from the Bundesministerium für Bildung und Forschung (BMBF) of the federal government of Germany (82DZL00401, 82DZL00402, 82DZL00404). Ravi Menezes kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, case–control study, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany

    Mark Bryant, Oliver Sedlaczek, Hans-Ulrich Kauczor & Julia Ley-Zaporozhan

  2. Department of Diagnostic and Interventional Radiology, Chirurgische Klinik Dr. Rinecker, Munich, Germany

    Sebastian Ley

  3. Department of Clinical Radiology, Ludwig Maximilians University, Munich, Germany

    Sebastian Ley & Julia Ley-Zaporozhan

  4. Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Amalienstr. 5, D-69126, Heidelberg, Germany

    Ralf Eberhardt & Felix Herth

  5. Medical Imaging, University of Toronto, Toronto, Canada

    Ravi Menezes

  6. Department of Radiology, German Cancer Research Center, Heidelberg, Germany

    Oliver Sedlaczek

  7. Translational Lung Research Center TLRC-H, Member of German Lung Research Center DZL, Heidelberg, Germany

    Mark Bryant, Ralf Eberhardt, Felix Herth, Oliver Sedlaczek & Hans-Ulrich Kauczor

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  1. Mark Bryant
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Correspondence to Julia Ley-Zaporozhan.

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Bryant, M., Ley, S., Eberhardt, R. et al. Assessment of the relationship between morphological emphysema phenotype and corresponding pulmonary perfusion pattern on a segmental level. Eur Radiol 25, 72–80 (2015). https://doi.org/10.1007/s00330-014-3385-5

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  • DOI: https://doi.org/10.1007/s00330-014-3385-5

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