Functional Impairment in Emphysema: Contribution of Airway Abnormalities and Distribution of Parenchymal Disease
Zelena A. Aziz1,
Athol U. Wells2,
Sujal R. Desai3,
Stephen M. Ellis4,
Amanda E. Walker5,
Sharyn MacDonald6 and
David M. Hansell1
1 Department of Radiology, Royal Brompton Hospital, Sydney St., London SW3 6NP,
England.
2 Interstitial Lung Disease Unit, Royal Brompton Hospital, London,
England.
3 Department Of Radiology, King'S College Hospital, London, England.
4 Department of Radiology, The London Chest Hospital, London, England.
5 Department of Radiology, St. Mary's Hospital, London, England.
6 Department of Radiology, Christchurch Hospital, Auckland, New Zealand.
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Fig. 1 —High-resolution CT image in 76-year-old man with emphysema
and bronchial wall thickening within right lower lobe that was scored as grade
1 by both radiologists (bronchial dilatation score, grade 1; bronchiectasis
score, grade 2).
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Fig. 2A —45-year-old man with emphysema. High-resolution CT images
show examples of scoring uniformity of emphysematous destruction at level of
aortic arch (A), carina (B), and 2 cm above level of aortic arch
(C). Overall heterogeneity score given by both observers was 1.5
(difference between medians of three best and worst sections).
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Fig. 2B —45-year-old man with emphysema. High-resolution CT images
show examples of scoring uniformity of emphysematous destruction at level of
aortic arch (A), carina (B), and 2 cm above level of aortic arch
(C). Overall heterogeneity score given by both observers was 1.5
(difference between medians of three best and worst sections).
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Fig. 2C —45-year-old man with emphysema. High-resolution CT images
show examples of scoring uniformity of emphysematous destruction at level of
aortic arch (A), carina (B), and 2 cm above level of aortic arch
(C). Overall heterogeneity score given by both observers was 1.5
(difference between medians of three best and worst sections).
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Fig. 3 —High-resolution CT image in 68-year-old woman illustrates
division of each lung into core and rind regions. Extent of emphysema is
greater in core region of lung when compared with rind, or peripheral,
region.
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Fig. 4 —High-resolution CT image of 42-year-old man shows islands of
normal or near-normal lung adjacent to areas of emphysematous destruction.
This case was therefore scored as grade 3 with contiguous area of normal or
near-normal lung estimated at 35% and 45% by two observers, respectively.
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Fig. 5A —51-year-old man with emphysema who was outlier in our study.
High-resolution CT images show degree of outflow obstruction is not mirrored
by extent of emphysema. Note bronchial wall thickening in upper (A) and
lower (B) lobes.
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Fig. 5B —51-year-old man with emphysema who was outlier in our study.
High-resolution CT images show degree of outflow obstruction is not mirrored
by extent of emphysema. Note bronchial wall thickening in upper (A) and
lower (B) lobes.
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Copyright © 2005 by the American Roentgen Ray Society.
