Abstract
BackgroundLittle has been reported on the feasibility of xenon-enhanced dual-energy computed tomography (Xe-DECT) in the visual and quantitative analysis of combined pulmonary fibrosis and emphysema (CPFE).ObjectivesWe compared CPFE with idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD), as well as correlation with parameters of pulmonary function tests (PFTs).MethodsStudied in 3 groups were 25 patients with CPFE, 25 with IPF without emphysema (IPF alone), 30 with COPD. Xe-DECT of the patients’ entire thorax was taken from apex to base after a patient’s single deep inspiration of 35% stable nonradioactive xenon. The differences in several parameters of PFTs and percentage of areas enhanced by xenon between 3 groups were compared and analyzed retrospectively.ResultsThe percentage of areas enhanced by xenon in both lungs were calculated as CPFE/IPF alone/COPD = 72.2 ± 15.1% / 82.2 ± 14.7% /45.2 ± 23.2%, respectively. In the entire patients, the percentage of areas enhanced by xenon showed significantly a positive correlation with FEV1/FVC (R = 0.558, P < 0.0001) and %FEV1, (R = 0.528, P < 0.0001) and a negative correlation with %RV (R = -0.594, P < 0.0001) and RV/TLC (R = -0.579, P < 0.0001). The percentage of areas enhanced by xenon in patients with CPFE showed significantly a negative correlation with RV/TLC (R = -0.529, P = 0.007). Xenon enhancement of CPFE indicated 3 different patterns such as upper predominant, diffuse, and multifocal defect. The percentage of areas enhanced by xenon in upper predominant defect pattern was significantly higher than that in diffuse defect and multifocal defect pattern among these 3 different patterns in CPFE.ConclusionThe percentage of areas enhanced by xenon demonstrated strong correlations with obstructive ventilation impairment. Therefore, we conclude that Xe-DECT may be useful for distinguishing emphysema lesion from fibrotic lesion in CPFE.
Highlights
Xenon-enhanced dual-energy computed tomography (Xe-DECT) has recently been found to be feasible to assess visualizing lung ventilation [1,2,3]
The percentage of areas enhanced by xenon in both lungs were calculated as combined pulmonary fibrosis and emphysema (CPFE)/idiopathic pulmonary fibrosis (IPF) alone/chronic obstructive pulmonary disease (COPD) = 72.2 ± 15.1% / 82.2 ± 14.7% /45.2 ± 23.2%, respectively
The percentage of areas enhanced by xenon showed significantly a positive correlation with forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) (R = 0.558, P < 0.0001) and %FEV1, (R = 0.528, P < 0.0001) and a negative correlation with %residual volume (RV) (R = -0.594, P < 0.0001) and RV/total lung capacity (TLC) (R = -0.579, P < 0.0001)
Summary
Xenon-enhanced dual-energy computed tomography (Xe-DECT) has recently been found to be feasible to assess visualizing lung ventilation [1,2,3]. This imaging technique has been proven to be safe without serious side effects in both children and adults. CPFE has been proposed as an important phenotype of pulmonary fibrosis, defined by the presence of emphysema in the upper lobes and fibrosis in the lower lobes predominant on chest high-resolution computed tomography (HRCT) [6]. Little has been reported on the feasibility of xenon-enhanced dual-energy computed tomography (Xe-DECT) in the visual and quantitative analysis of combined pulmonary fibrosis and emphysema (CPFE)
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