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Reimagining emphysema for a computational age
  1. Joseph Jacob1,2
  1. 1 Department of Respiratory Medicine, University College London, London, UK
  2. 2 Satsuma Lab, Centre for Medical Image Computing, University College London, London, UK
  1. Correspondence to Dr Joseph Jacob, Satsuma Lab, Centre for Medical Imaging and Computing, University College London, London, WC1E 6BT, UK; j.jacob{at}

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Emphysema remains an enigma. Visual classification of emphysema on CT imaging has remained unchanged for over 30 years and essentially constitutes the identification of three disease patterns: centrilobular,1 2 paraseptal3 or panlobular4 emphysema. This classification originates from anatomical descriptions dating from the 1950s specifying the location of airspace destruction within the acinus or lobule and the proximity of emphysema to the visceral pleura. The extrapolation of histopathological scale features of damage5 6 to the clinical CT scale was a key milestone in the early years of lung CT interpretation.

Yet, when considering emphysema and its role in disease pathogenesis and progression, one is led to wonder what has been lost by only considering emphysema in terms of three anatomical patterns. Centrilobular emphysema can itself comprise a range of imaging phenotypes, from frank destruction of an entire secondary pulmonary lobule to subtle reductions in peribronchiolar lung density that may be easily missed at first glance. While visual evaluation has focused on measuring emphysema extent, could we be inadequately capturing emphysema severity?

The advent of computer analysis of lung CT imaging dramatically improved the ability with which emphysema extent could be quantified using density masks7 or parametric response maps.8 Computer tools typically evaluate the entirety of the lungs in discretised small voxel volume units. While valuable information pertaining to the co-ordinates and morphology of emphysema and …

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  • Contributors JJ would also like to thank Prof John R Hurst and Dr Stijn E Verleden for their review and comments on the manuscript.

  • Funding This research was funded in whole or in part by the Wellcome Trust (209553/Z/17/Z). For the purpose of open access, the author has applied a CC-BY public copyright licence to any author accepted manuscript version arising from this submission. JJ was also supported by the NIHR UCLH Biomedical Research Centre.

  • Competing interests JJ declares fees from Boehringer Ingelheim, F. Hoffmann-La Roche, GlaxoSmithKline, NHSX and Takeda. Grant Funding from GlaxoSmithKline, Wellcome Trust and Microsoft Research. Patents: UK patent application numbers 2113765.8 and GB2211487.0.

  • Provenance and peer review Commissioned; externally peer reviewed.

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