ObjectivesTo determine the improvement of emphysema quantification with density correction and to determine the optimal site to use for air density correction on volumetric computed tomography (CT). MethodsSeventy-eight CT scans of COPD patients (GOLD II–IV, smoking history 39.2±25.3 pack-years) were obtained from several single-vendor 16-MDCT scanners. After density measurement of aorta, tracheal- and external air, volumetric CT density correction was conducted (two reference values: air, −1000HU/blood, +50HU). Using in-house software, emphysema index (EI) and mean lung density (MLD) were calculated. Differences in air densities, MLD and EI prior to and after density correction were evaluated (paired t-test). Correlation between those parameters and FEV1 and FEV1/FVC were compared (age- and sex adjusted partial correlation analysis). ResultsMeasured densities (HU) of tracheal- and external air differed significantly (−990±14, −1016±9, P<0.001). MLD and EI on original CT data, after density correction using tracheal- and external air also differed significantly (MLD: −874.9±27.6 vs. −882.3±24.9 vs. −860.5±26.6; EI: 16.8±13.4 vs. 21.1±14.5 vs. 9.7±10.5, respectively, P<0.001). The correlation coefficients between CT quantification indices and FEV1, and FEV1/FVC increased after density correction. The tracheal air correction showed better results than the external air correction. ConclusionDensity correction of volumetric CT data can improve correlations of emphysema quantification and PFT.