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Original Research: COPD |

Diffusing Capacity for Carbon Monoxide Correlates Best With Tissue Volume From Quantitative CT Scanning AnalysisQuantitative Chest CT Scan Analysis in COPD

Igor Barjaktarevic, MD; Steven Springmeyer, MD; Xavier Gonzalez, MD; William Sirokman, BS; Harvey O. Coxson, PhD; Christopher B. Cooper, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Barjaktarevic and Cooper), Department of Medicine, and Department of Physiology (Dr Cooper), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Spiration, Inc (Drs Springmeyer and Gonzalez and Mr Sirokman), Redmond, WA; and Department of Radiology (Dr Coxson), UBC James Hogg Research Centre, Vancouver General Hospital, Vancouver, BC, Canada.

CORRESPONDENCE TO: Christopher B. Cooper, MD, FCCP, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, 37-131 CHS, Los Angeles, CA 90095; e-mail: ccooper@mednet.ucla.edu


FUNDING/SUPPORT: This study was supported by Spiration Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1485-1493. doi:10.1378/chest.14-1693
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BACKGROUND:  Quantitative analysis of high-resolution chest CT scan (QCT) is an established method for determining the severity and distribution of lung parenchymal destruction in patients with emphysema. Diffusing capacity of the lung for carbon monoxide (Dlco) is a traditional physiologic measure of emphysema severity and is probably influenced more by destruction of the alveolar capillary bed than by membrane diffusion per se. We reasoned that Dlco should correlate with tissue volume from QCT.

METHODS:  A total of 460 patients with upper-lobe-predominant emphysema were enrolled in the study. The mean (SD) of percent predicted values for FEV1, total lung capacity, and Dlco were 30.6% (8.0%), 129.5% (18.1%), and 6.7% (13.1%), respectively. QCT was performed using custom software; the relationship between Dlco and various metrics from QCT were evaluated using Pearson correlation coefficients.

RESULTS:  On average, whole-body plethysmography volumes were higher by 841 mL compared with QCT-calculated total lung volume. However, there was a strong correlation between these measurements (r = 0.824, P < .0001). Dlco correlated with total lung volume (r = 0.314, P < .0001), total tissue volume (r = 0.498, P < .0001), and percentage of lung with low density (−950 Hounsfield units) (r = −0.337, P < .0001).

CONCLUSIONS:  In patients with severe emphysema, Dlco correlates best with total tissue volume, supporting the hypothesis that pulmonary capillary blood volume is the main determinant of Dlco in the human lung. The relationships between Dlco and various anatomic metrics of lung parenchymal destruction from QCT inform our understanding of the relationship between structure and function of the human lung.

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