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Evaluation of spirometry-gated computed tomography to measure lung volumes in emphysema patients

Jens T. Bakker, Karin Klooster, Jan Bouwman, Gert Jan Pelgrim, Rozemarijn Vliegenthart, Dirk-Jan Slebos
ERJ Open Research 2022 8: 00492-2021; DOI: 10.1183/23120541.00492-2021
Jens T. Bakker
1University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
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  • For correspondence: j.t.bakker@umcg.nl
Karin Klooster
1University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
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Jan Bouwman
1University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
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Gert Jan Pelgrim
2University of Groningen, University Medical Center Groningen, Dept of Radiology, Groningen, The Netherlands
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Rozemarijn Vliegenthart
2University of Groningen, University Medical Center Groningen, Dept of Radiology, Groningen, The Netherlands
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Dirk-Jan Slebos
1University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
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  • FIGURE 1
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    FIGURE 1

    a) Sagittal slice of lungs during complete expiration. b) Graph plotting volume against time. The red plot is an example of what the pneumotachograph measured during the expiration manoeuvre, first tidal breathing for approximately 30 s followed by a maximum expiration (residual volume level) with a breath hold (plateau in the curve) for a few seconds. During the breath hold, the expiration scan was acquired. The green plot is an example of what the pneumotachograph measures during the inspiration manoeuvre, first tidal breathing for approximately 30 s followed by a maximum inspiration (total lung capacity level) with a breath hold for a few seconds. During the breath hold, the inspiration scan was acquired. c) Sagittal slice of the lungs during complete inspiration.

  • FIGURE 2
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    FIGURE 2

    Comparison of the means of computed tomography (CT) to body plethysmography measurements. Grey bars represent CT-derived measurements, while white bars represent body plethysmography-derived measurements. a) Comparison of total lung capacity (TLC), b) comparison of residual volume (RV), c) comparison of % RV/TLC and d) comparison of emphysema scores at −950 HU. All comparisons are significant. Error bars represent 1 sd.

  • FIGURE 3
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    FIGURE 3

    Bland–Altman plots comparing computed tomography (CT) and body plethysmography-derived analogous measurements. a) Total lung capacity (TLC) gated, b) TLC non-gated, c) TLC % predicted gated and d) TLC % predicted non-gated. The continuous lines indicate the mean difference between CT and body plethysmography, the outer dashed lines indicate the 95% confidence intervals in the differences between CT and body plethysmography, and the difference between these is the difference in limits of agreement (ΔLoA). The finer dashed lines in the middle of the figures indicate the linear regression signifying the proportional bias.

  • FIGURE 4
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    FIGURE 4

    Bland–Altman plots comparing Computed tomography (CT) and body plethysmography-derived analogous measurements. a) Residual volume (RV) gated, b) RV non-gated, c) RV % predicted gated and d) RV % predicted non-gated. The continuous lines indicate the mean difference between CT and body plethysmography, the outer dashed lines indicate the 95% confidence intervals in the differences between CT and body plethysmography, and the difference between these is the difference in limits of agreement (ΔLoA). The finer dashed lines in the middle of the figures indicate the linear regression signifying the proportional bias.

  • FIGURE 5
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    FIGURE 5

    Figures show association of computed tomography (CT) with body plethysmography-derived analogous measurements. a) Total lung capacity (TLC) gated, b) TLC non-gated, c) residual volume (RV) gated and d) RV non-gated. All correlations are significant (p<0.001). The dashed lines indicate the line for identity and the continuous lines show the functions derived by linear regression.

Tables

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  • TABLE 1

    Baseline characteristics

    CharacteristicsGatedNon-gatedp-value
    Subjects n100100
    Female/male %68/3273/270.535#
    Age years62±762±80.918
    BMI kg·m−223.6±4.124.7±4.20.124
    GOLD 2/3/43/37/603/43/540.723#
    Spirometry
     FEV1 L0.81±0.270.79±0.240.464
     FEV1 % predicted29±929±90.923
     FVC L2.73±0.772.53±0.780.074
     FVC % predicted76±1572±180.107
     FEV1/FVC %30±632±60.067
     VC L2.98±0.732.90±0.810.416
    Body plethysmography
     TLC L7.64±1.457.36±1.470.169
     TLC % predicted134±13132±130.352
     RV L4.64±1.094.45±1.040.206
     RV % predicted217±39212±400.408
     RV/TLC %60.6±7.360.4±7.50.884
    Computed tomography
     Emphysema score −950 HU %34.3±9.131.7±9.70.044
     TLC L7.37±1.456.78±1.480.005
     TLC % predicted129±12122±14<0.001
     RV L4.94±1.105.14±1.290.227
     RV % predicted231±39245±480.024
     RV/TLC %67.2±8.476.2±11.7<0.001

    Table contains information, mean±sd and a p-value based on an independent t-test, for the studied population. The population is divided into two groups, gated (n=100) and non-gated (n=100). All CT-derived values are significantly different between groups, except for RV. Bold denotes a significant p-value (p<0.05). BMI: body mass index; GOLD: Global Initiative for Chronic Obstructive Lung Disease; FEV1: forced expiratory flow in 1 s; FVC: forced vital capacity; VC: vital capacity; TLC: total lung capacity; RV: residual volume. #: the test applied was the Fisher's exact test.

    Supplementary Materials

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    • Supplementary Material

      Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

      Supplementary material 00492-2021.SUPPLEMENT

      Supplementary material ONLINE_SUPPLEMENT_SETUP_GATING

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    Evaluation of spirometry-gated computed tomography to measure lung volumes in emphysema patients
    Jens T. Bakker, Karin Klooster, Jan Bouwman, Gert Jan Pelgrim, Rozemarijn Vliegenthart, Dirk-Jan Slebos
    ERJ Open Research Jan 2022, 8 (1) 00492-2021; DOI: 10.1183/23120541.00492-2021

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    Evaluation of spirometry-gated computed tomography to measure lung volumes in emphysema patients
    Jens T. Bakker, Karin Klooster, Jan Bouwman, Gert Jan Pelgrim, Rozemarijn Vliegenthart, Dirk-Jan Slebos
    ERJ Open Research Jan 2022, 8 (1) 00492-2021; DOI: 10.1183/23120541.00492-2021
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