Thin-Section CT Detection of Emphysema Associated With Bronchiectasis and Correlation With Pulmonary Function Tests

doi:10.1378/chest.109.2.360

Chest

Volume 109, Issue 2, February 1996, Pages 360-365

https://doi.org/10.1378/chest.109.2.360 Get rights and content

Purpose

To evaluate, on thin-section CT scans, the prevalence of emphysema in patients with bronchiectasis and to correlate the results of thin-section CT scans with the results of pulmonary function tests, in order to question whether there was a particular functional test profile in this group of patients.

Patients and methods

This is a retrospective study including 90 patients having both thin-section CT scans and pulmonary function tests for bronchiectasis. A CT scoring system was established for assessing the airway disease by the severity and extent of bronchiectasis and by the extent of emphysema. CT scans were reviewed independently by two reviewers and final interpretation was obtained by consensus. Results of thin-section CT scans were correlated with results of pulmonary function tests, including FEV₁ and FEV₁/FVC to assess air-way obstruction, total lung capacity and residual volume to assess air trapping, and diffusing capacity for carbon monoxide/alveolar volume (Dco/VA).

Results

CT evidence of emphysema, which was noted in 45% of the patients (n=41), was mainly localized in the same bronchopulmonary segments as bronchiectasis. The presence of emphysema was in relation to the extent and to the severity of bronchiectasis. Only eight patients with CT evidence of emphysema had functional evidence of emphysema (20%). When comparing the group of patients with CT evidence of emphysema with the group of patients with no CT evidence of emphysema, the group of patients with CT evidence of emphysema had significantly higher airflow obstruction and air trapping, had significantly lesser value of diffusing capacity, but with no decreased gas transfer (Dco/VA >80%).

Conclusion

Our series suggests that there is a high prevalence of emphysema in patients with bronchiectasis. Emphysema that was not suggested using pulmonary function tests in most of the cases could explain in part the higher airway obstruction observed in the group of patients with CT evidence of emphysema. This study could support the suggestive notion that emphysema, which was mainly localized in bronchiectatic lobes, could be due to the inflammatory airway process.

Section snippets

Patients

We conducted a retrospective study. The patients included in this study were identified by using a computer-generated list of all thoracic thin-section CT studies performed at our institution from 1987 to 1993. All patients who were referred to our institution for suspicion of bronchiectasis had thin-section CT scans. CT scans of patients who were referred for bronchiectasis were obtained for reinterpretation by two radiologists. The medical records of these patients, including pulmonary

RESULTS

CT evidence of emphysema was noted in 41 of the 90 patients (45%). Among these 41 patients, emphysema was mainly localized in the same BP segments as bronchiectasis (score A, 76%; score B, 5%; score C, 19%; score D, 0%) (FIGURE 1, FIGURE 2, FIGURE 3).

Relation between the presence of emphysema and the extent of bronchiectasis was highly significant (χ²=32;p<10⁻⁵) and relation between the presence of emphysema and the severity of bronchiectasis was significant (χ²=17;p<^10–3) (Table 2). There was

DISCUSSION

The use of high-resolution CT (HRCT) in the evaluation of bronchiectasis and emphysema, in vivo, has been clearly demonstrated.6, 8, 13 The comparison of preoperative thin-section CT and pathologic findings in resected specimens has demonstrated that thin-section CT depicts bronchiectasis in most of the cases.¹⁴ Because of its cross-sectional nature and its high-contrast resolution, HRCT has been proved to be the most accurate method available for detection of mild emphysema,8, 13, 15, 16 and

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: revision accepted September 6.

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Chest

Clinical Investigations: COPD/REHABThin-Section CT Detection of Emphysema Associated With Bronchiectasis and Correlation With Pulmonary Function Tests

Purpose

Patients and methods

Results

Conclusion

Section snippets

Patients

RESULTS

DISCUSSION

Clin Radiol

Radiol Clin North Am

Chest

Chest

Clin Radiol

Am J Med

Chest

Clin Chest Med

Hum Pathol

Roentgenographic diagnosis of bronchiectasis: an analysis of 112 cases

Acta Radiol

The segmental and lobular physiology and pathology of the lung

J Thorac Surg

Computed tomography of bronchiectasis

J Comput Assist Tomogr

Bronchiectasis: assessment by thin section CT

Radiology

Bronchiectasis: CT evaluation

AJR

The diagnosis of emphysema: a computed tomographic-pathologic correlation

Am Rev Respir Dis

Cystic fibrosis: scoring system with thin-section CT

Radiology

Reference spirometric values using techniques and equipment that meet ATS recommendations

Am Rev Respir Dis

Single breath diffusing capacity in a representative sample of the population of Michigan, a large industrial state: predicted values, lower limits of normal, and frequencies of abnormality by smoking history

Am Rev Respir Dis

The definition of emphysema: report of a National Heart, Lung, and Blood Institute, Division of Lung Diseases workshop

Am Rev Respir Dis

Clinical Investigations: COPD/REHAB
Thin-Section CT Detection of Emphysema Associated With Bronchiectasis and Correlation With Pulmonary Function Tests