scholarly journals X-ray dark-field chest imaging for detection and quantification of emphysema in patients with chronic obstructive pulmonary disease: a diagnostic accuracy study

2021 ◽  
Vol 3 (11) ◽  
pp. e733-e744 ◽  
Author(s):  
Konstantin Willer ◽  
Alexander A Fingerle ◽  
Wolfgang Noichl ◽  
Fabio De Marco ◽  
Manuela Frank ◽  
...  
2021 ◽  
Author(s):  
Konstantin Willer ◽  
Alexander Fingerle ◽  
Wolfgang Noichl ◽  
Fabio De Marco ◽  
Manuela Frank ◽  
...  

SummaryBackgroundDiseases of the respiratory system are leading global causes of chronic morbidity and mortality. While advanced medical imaging technologies of today deliver detailed diagnostic information, a low-dose, fast, and inexpensive option for early detection and/or follow-ups is still lacking. Here, we report on the first human application of a novel modality, namely X-ray dark-field chest imaging, which might fill this gap. Enabling the assessment of microstructural changes in lung parenchyma, this technique presents a more sensitive alternative to conventional chest X-rays, and yet requires only a fraction of the dose applied in computed tomography (CT).MethodsFor this first clinical evaluation, we have built a novel dark-field chest X-ray system, which is also capable of simultaneously acquiring a conventional thorax radiograph (7 seconds, 0·035 mSv effective dose). Representing a major medical condition, we selected chronic obstructive pulmonary disease as study subject to obtain a first impression of potential diagnostic benefits relevant to humans. For a collective of 77 patients with different disease stages, X-ray dark-field- and CT-images were acquired and visually assessed by 5 readers. In addition, pulmonary function tests were performed for every patient. The individual data sets were evaluated in a statistical work-up using correlation testing, rank-based analysis of variance, and pair-wise post-hoc comparison.FindingsCompared to CT-based parameters (quantitative emphysema: ρ=–0·27, p=0·0893 and visual emphysema: ρ=–0·45, p=0·0028), the dark-field signal (ρ=0·62, p<0·0001) yields a stronger correlation with diffusion capacity in the evaluated collective. Emphysema assessment based on dark-field chest X-ray features yields consistent conclusions with findings from visual CT image interpretation and shows improved diagnostic performance in comparison to conventional clinical tests characterizing emphysema.InterpretationX-ray dark-field chest imaging allows the diagnosis of pulmonary emphysema as it provides relevant information representing the structural condition of lung parenchyma. Significant diagnostic benefits are also expected for other lung disorders.FundingEuropean Research Council, Royal Philips, Karlsruhe Nano Micro Facility.Research in contextEvidence before this studyWith a rising number of examinations in the last decades, X-rays play an indispensable role in clinical routine. Contrast formation in medical X-ray imaging such as radiography, fluoroscopy, and computed tomography is based on attenuation, which generally benefits from large differences in atomic number and/or mass density between involved materials. If these conditions are not prevalent, or the resolution of the imaging system is not sufficient, diagnostic capabilities are limited. However, attenuation is not the only physical effect X-rays are subjected to when penetrating matter. Variations in an object’s electron density lead to refraction and coherent small-angle scattering of incident X-rays. Phase-sensitive imaging techniques can detect these wave-optical phenomena, yielding additional object information. The dark-field signal, being a function of small-angle scattering, can provide structural information on the micron scale, generally below the resolution limit of the imaging system. Due to their very stringent requirements to X-ray source coherence, these techniques were originally limited to large-scale synchrotron facilities. The proposal of a three-grating interferometer in 2006, however, enabled the use of low-brilliance sources for X-ray phase-contrast imaging and thereby paved the way into the clinics. Such an apparatus elegantly allows the simultaneous acquisition of the conventional attenuation, differential phase-contrast, and novel dark-field signals. In a compact table-top system suitable for investigating murine disease models, numerous studies on pulmonary disorders such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pneumothorax, ventilator-associated lung injury, lung cancer, and pneumonia have been conducted and demonstrated a broad diagnostic value of the dark-field modality in particular. Adapting the system to enable imaging of the human body is a technical challenge due to limitations of the micrometer-fine, high aspect ratio grating structures in terms of fabricable size and performance at clinically relevant X-ray energies. The first evidences that these limitations are manageable were delivered in 2017 and 2018 by in-vivo porcine and human cadaver studies with an experimental prototype system.Added value of this studyWith this work we present the first X-ray dark-field chest images of human subjects in-vivo and demonstrate the method’s feasibility in a clinical surrounding. To enable this study, we have conceived, constructed, and commissioned a custom-built first demonstrator system suitable for patient use. This includes satisfying clinical demands regarding safety, usability, acquisition time, radiation dose, field of view, and image quality. This study marks the transition from investigating artificially induced disease models to evaluating the modality’s actual diagnostic performance in patients.Implications of all available evidenceOur findings indicate that X-ray dark-field radiography provides image-type information of the lungs’ underlying microstructure in humans. In view of the strong link between alveolar structure and the functional condition of the lung, this capability is highly relevant for respiratory medicine and might help to establish a better understanding of pulmonary disorders. With regard to early detection of COPD, which is generally accompanied by structural impairments of the lung, this novel technique might support resolving the prevalent under-diagnosis reported in literature. With an effective dose significantly lower (about a factor of hundred) compared to thorax computed tomography, dark-field radiography could be used as broadly deployed screening tool.


2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Christoph Nowak ◽  
Noriane A. Sievi ◽  
Christian F. Clarenbach ◽  
Esther Irene Schwarz ◽  
Christian Schlatzer ◽  
...  

Psychological morbidity is common in chronic respiratory diseases. The diagnostic accuracy of the Hospital Anxiety and Depression Scale (HADS) and risk factors for comorbid depression in chronic obstructive pulmonary disease (COPD) are addressed. Consecutive COPD patients (GOLD stage I–IV, 40–75 years old) were enrolled in a multicentre, cross-sectional cohort study. Diagnosis of depression was ascertained through clinical records. Lung function, HADS score, 6-minute walking test (6-MWT), MRC dyspnoea score, and COPD Assessment Test (CAT) were evaluated. Two hundred fifty-nine COPD patients (mean age 62.5 years; 32% female; mean FEV1 48% predicted) were included. Patients diagnosed with depression (29/259; 11.2%) had significantly higher HADS-D and HADS-Total scores than nondepressed patients (median (quartiles) HADS-D 6 [4; 9] versus 4 [2; 7], median HADS-Total 14 [10; 20] versus 8 [5; 14]). Receiver-operating characteristic plots showed moderate accuracy for HADS-D, AUC 0.662 (95%CI 0.601–0.719), and HADS-Total, AUC 0.681 (95%CI 0.620–0.737), with optimal cut-off scores of >5 and >9, respectively. Sensitivity and specificity were 62.1% and 62.6% for HADS-D compared to 75.9% and 55.2% for HADS-Total. Age, comorbidities, sex, and lower airflow limitation predicted depression. The HADS exhibits low diagnostic accuracy for depression in COPD patients. Younger men with comorbidities are at increased risk for depression.


2018 ◽  
Vol 8 (4) ◽  
pp. 564-578
Author(s):  
Kelly Roberta Souza Andrade Caria ◽  
Fernanda Warken Rosa Camelier ◽  
Natasha Cordeiro ◽  
Airton Moreira ◽  
Bárbara Silva dos Santos ◽  
...  

INTRODUÇÃO: DPOC está associada a um processo inflamatório sistêmico que pode causar sarcopenia, redução da função e massa muscular, embora sua frequência e intensidade não seja completamente conhecida em portadores dessa enfermidade. OBJETIVO: descrever a prevalência e métodos de identificação da sarcopenia na DPOC através de uma revisão sistemática. MATERIAIS E MÉTODOS: Revisão sistemática utilizando a metodologia PICO e palavras-chave (Chronic Obstructive Pulmonary Disease, Sarcopenia). Foram incluídos estudos publicados que estimaram a prevalência de sarcopenia na DPOC. Excluídos aqueles cujo método não detalhou o diagnóstico da sarcopenia. RESULTADOS: A pesquisa resultou inicialmente em 897 artigos. Desses, 877 foram excluídos, sendo 20 selecionados (15 transversais, cinco longitudinais, um caso/controle). As amostras variaram de 57 a 2.582 participantes, a maioria (70%) conduzida em ambulatório. Um estudo foi de base populacional. A idade média foi de 66 anos. A prevalência de sarcopenia na DPOC variou (4,4% a 86,5%). Os métodos diagnósticos utilizados para determinar massa muscular foram o Dual X-ray Absorptiometry, a bioimpedância e as equações de referência. A força muscular foi estimada utilizando-se a preensão manual em dinamômetros portáteis ou a flexão/extensão do joelho através do dinamômetro isocinético. A capacidade funcional foi avaliada pelo teste de caminhada dos seis minutos ou através do teste de velocidade da marcha. CONCLUSÃO: A prevalência de sarcopenia na DPOC encontrada nos estudos (4,4 a 86,5%) é muito variável. Influenciada não somente pela característica do paciente, mas também pelo local, delineamento e método diagnóstico utilizado. Uma padronização de métodos parece ser necessária para se uniformizar condutas na literatura.


2013 ◽  
Vol 26 (1) ◽  
pp. 71-78
Author(s):  
Gualberto Ruas ◽  
Gabriel Gomes Ribeiro ◽  
Juliane Moreira Naves ◽  
Mauricio Jamami

INTRODUCTION: The individual with chronic obstructive pulmonary disease (COPD) can experience a significant reduction of body composition, peripheral muscle dysfunction, resulting in a negative influence on functional capacity. OBJECTIVES: To analyze the influence of body composition assessed by dual-energy x-ray absorptiometry on functional capacity of patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Eleven male patients with COPD (COPDG), seven presenting moderate obstruction and four severe, and 11 sedentary male subjects (CG) were evaluated by dual-energy x-ray absorptiometry to assess their body composition. All subjects also performed the 6-minute walk test (6MWT) and Step Test (6MST) to assess their functional capacity. RESULTS: No significant differences were found between groups for anthropometric data such as age, weight, height and body mass index (BMI). However, the COPDG presented Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), FEV1/FVC ratio, Maximal Voluntary Ventilation (MVV), Walked Distance (WD) and Number of Steps (NS) significantly lower than the CG (p < 0.05, Student's t-test). The Body Bone Mass (BBM), BBM%, Lean Mass (LM), LM%, and Right Lower Limb (RLL) and Left Lower Limb (LLL) were significantly lower in the COPDG when compared with the CG, presenting statistically significant positive correlations with 6MWT's WD and 6MST's NS (p < 0.05, Pearson's test). CONCLUSION: We conclude that body composition is an important prognostic factor for patients with COPD, which reinforces the importance of assessing body composition by dual-energy absorptiometry since it has demonstrated with satisfactory accuracy in clinical practice. Moreover, it is a useful parameter for evaluation and reassessment in pulmonary rehabilitation programs.


2018 ◽  
Vol 19 (2) ◽  
pp. 114-118
Author(s):  
Md Khairul Islam ◽  
Fahima Sharmin Hossain ◽  
Mostofa Kamal Chowdhury ◽  
Prodip Kumar Biswas

Background: Osteoporosis is one of the most common systemic features of Chronic obstructive pulmonary disease (COPD). But there had been no data regarding osteoporosis in COPD patients in Bangladesh. Objectives: To determine the frequency of osteoporosis in COPD patients.Materials & Methods: This was a cross sectional observational study. COPD patients were recruited from Sarkari kormachari hospital. Patients were excluded if they had asthma, any disease affecting bones and calcium homeostasis or were receiving drugs related to bone metabolism. Demographic data were collected including age, smoking history, inhaled corticosteroid use, body mass index, treatment history hospital admission. Chest x-ray was done to exclude any infection or malignancy. Blood was obtained for complete blood count, renal function test, CRP. Bone mineral density (BMD; g/cm2) was conducted by using dual energy x-ray absorptiometry scan (DXA scan) at second to fourth lumbar spines (L2-4) and femoral neck.Results: The overall prevalence of osteoporosis according to the lowest T-score at either L2-4 or femoral neck were 56.7%. This is very high than other country. BMI and CRP were significantly associated with osteoporosis.Conclusion: The frequency of osteoporosis in Bangladeshi COPD patients was higher than others. Osteoporosis was associated with low BMI and high level of CRP.J MEDICINE JUL 2018; 19 (2) : 114-118


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