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Erschienen in:
01.01.2015 | Chest
Assessment of the relationship between morphological emphysema phenotype and corresponding pulmonary perfusion pattern on a segmental level
Erschienen in: European Radiology | Ausgabe 1/2015
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Purpose
Distinct morphological emphysema phenotypes were assessed by CT to show characteristic perfusion defect patterns.
Material/Methods
Forty-one patients with severe emphysema (GOLD III/IV) underwent three-dimensional high resolution computed tomography (3D-HRCT) and contrast-enhanced magnetic resonance (MR) perfusion. 3D-HRCT data was visually analyzed for emphysema phenotyping and quantification by consensus of three experts in chest-radiology. The predominant phenotype per segment was categorized as normal, centrilobular, panlobular or paraseptal. Segmental lung perfusion was visually analyzed using six patterns of pulmonary perfusion (1-normal; 2-mild homogeneous reduction in perfusion; 3-heterogeneous perfusion without focal defects; 4-heterogeneous perfusion with focal defects; 5-heterogeneous absence of perfusion; 6-homogeneous absence of perfusion), with the extent of the defect given as a percentage.
Results
730 segments were evaluated. CT categorized 566 (78 %) as centrilobular, 159 (22 %) as panlobular and 5 (<1 %) as paraseptal with no normals. Scores with regards to MR perfusion patterns were: 1–0; 2–0; 3–28 (4 %); 4–425 (58 %); 5–169 (23 %); 6–108 (15 %).
The predominant perfusion pattern matched as follows: 70 % centrilobular emphysema - heterogeneous perfusion with focal defects (score 4); 42 % panlobular - homogeneous absence of perfusion (score 5); and 43 % panlobular - heterogeneous absence of perfusion (score 6).
Conclusion
MR pulmonary perfusion patterns correlate with the CT phenotype at a segmental level in patients with severe emphysema.
Key points
• MR perfusion patterns correlate with the CT phenotype in emphysema.
• Reduction of MR perfusion is associated with loss of lung parenchyma on CT
• Centrilobular emphysema shows heterogeneous perfusion reduction while panlobular emphysema shows loss of perfusion.