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  • 1
    Keywords: THIN-SECTION CT ; INFANTS ; CHILDREN ; asthma ; LUNG-DISEASE ; cystic fibrosis ; SCORING SYSTEMS ; DIMENSIONS ; airway dimensions ; airway disease ; CHEST RADIOGRAPH ; chronic obstructive pulmonary disease ; FLOW LIMITATION ; quantitative computed tomography ; WALL THICKNESS
    Abstract: Purpose: To evaluate the fully automatic quantification of airway dimensions on chest multidetector computed tomography (MDCT) performed in cystic fibrosis (CF) patients. Airflow indices including predicted forced expiratory volume in 1 second (FEV1%) were used to study the impact on regional lung function. Materials and Methods: MDCT data of patients with CF (14 children and 23 adults) and of control patients (11 children and 22 adults) were used to compute total diameter (TD), lumen area (LA), and wall thickness (WT) using dedicated software. Pulmonary function testing including FEV1% was performed in parallel and correlated with MDCT parameters in a generation-based analysis. Results: TD was largely increased in CF patients (third-generation to fourth-generation airways in children, first to ninth in adults; P 〈 0.05). LA remained unchanged, but WT was also larger in CF compared with controls (third generation to sixth generation in children, first to eleventh in adults; P 〈 0.05). In adult CF patients significant negative correlations for TD, LA, and WT with FEV1% were found for intermediate airways (fifth to seventh generation; r = -0.7 to -0.9) but not in pediatric CF patients and controls. Conclusions: Automatic airway analysis succeeded in quantifying specific pathologies such as airway dilatation and wall thickening in CF patients at different ages. Moreover, our results indicate a shift in main airflow resistance to intermediate airways in cases of chronic CF. The objective computational parameters TD, LA, and WT should be considered for assessment and follow-up of CF airway disease
    Type of Publication: Journal article published
    PubMed ID: 23222199
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  • 2
    Abstract: A 22-year-old man on postoperative day 1 after open reduction with internal fixation of a distal fibula fracture presented with hemoptysis and increased oxygen demand. X-ray and contrast-enhanced computed tomography revealed bilateral patchy opacities and mediastinal emphysema. After bronchoscopy and bronchoalveolar lavage, a diagnosis of alveolar hemorrhage was made. The medical history revealed regular abuse of marihuana and cocaine.
    Type of Publication: Journal article published
    PubMed ID: 22349534
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  • 3
    Keywords: BLOOD ; Germany ; LUNG ; SPIRAL CT ; VOLUME ; DISEASE ; POPULATION ; HEART ; TIME ; PATIENT ; BLOOD-FLOW ; blood flow ; FLOW ; MRI ; MAGNETIC-RESONANCE ; magnetic resonance imaging ; AGE ; arteries ; PARAMETERS ; HYPERTENSION ; HEALTHY ; PULMONARY ; VELOCITY ; fibrosis ; PH ; HEALTHY-VOLUNTEERS ; CHRONIC THROMBOEMBOLISM ; CYSTIC-FIBROSIS ; ARTERIAL ; PULMONARY-ARTERIES ; early development ; bronchosystemic shunt ; cystic fibrosis
    Abstract: Cystic fibrosis (CF) leads to disabling lung disease and pulmonary hypertension (PH). The goal of this study was to assess the hemodynamics in the systemic and pulmonary arterial circulation of patients with CF using MRI. Ten patients with CF and 15 healthy volunteers were examined (1.5-T MRI). Phase-contrast flow measurements were assessed in the ascending aorta, pulmonary trunc, and the left and right pulmonary arteries (PA), resulting in the following parameters: peak velocity (PV) (centimeters per second) velocity rise gradient (VRG), time to PV (milliseconds), and the average area (centimeters squared). The blood flow ratio between the right and left lungs and the bronchosystemic shunt were calculated. For the ascending aorta and pulmonary trunc no parameter was significantly different between both populations. In the right PA a significantly lower PV (p=0.001) and VRG (p=0.02) was found. In the left PA there was a significantly (p=0.007) lower PV but no significant (p=0.07) difference between the VRG. The areas of the right (p=0.08) and left (p=0.5) PA were not significantly enlarged. For the volunteers a linear increase of PV in both PA was found with age, while it decreased in patients with CF. The blood flow distribution (right/left lung) showed no significant (p=0.7) difference between the groups. There was a significantly (p 〈 0.001) higher bronchosystemic shunt volume in patients with CF (1.3 l/min) than in volunteers (0.1 l/min). Magnetic resonance based flow measurements in the right and left PA showed first indications for early development of PH. The significant increase in bronchosystemic shunt volume might be indicative fo the extent of parenchymal changes
    Type of Publication: Journal article published
    PubMed ID: 15761712
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  • 4
    Keywords: Germany ; LUNG ; chest ; CT ; FOLLOW-UP ; imaging ; INFORMATION ; SYSTEM ; TOOL ; DEATH ; POPULATION ; computed tomography ; RESOLUTION ; PATIENT ; IMPACT ; CONTRAST ; MRI ; MAGNETIC-RESONANCE ; magnetic resonance imaging ; COMPUTED-TOMOGRAPHY ; CHILDREN ; LUNG PERFUSION ; ADULTS ; PHASE ; cystic fibrosis
    Abstract: Cystic fibrosis (CF) is the most frequent inherited disorder leading to premature death in the Caucasian population. As life expectancy is limited by pulmonary complications, repeated imaging [chest X-ray, multislice high-resolution computed tomography (MS-HRCT)] is required in the follow-up. Magnetic resonance imaging (MRI) of the lung parenchyma is a promising new diagnostic tool. Its value for imaging lung changes caused by CF compared with CT is demonstrated. MRI performs well when compared with CT, which serves as the gold standard. Its lack in spatial resolution is obvious, but advantages in contrast and functional assessment compensate for this limitation. Thus, MRI is a reasonable alternative for imaging the CF lung and should be introduced as a radiation-free modality for follow-up studies in CF patients. For further evaluation of the impact of MRI, systematic studies comparing MRI and conventional imaging modalities are necessary. Furthermore, the value of the additional functional MRI (fMRI) information has to be studied, and a scoring system for the morphological and functional aspect of MRI has to be established
    Type of Publication: Journal article published
    PubMed ID: 16941092
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  • 5
    Keywords: evaluation ; Germany ; LUNG ; chest ; CT ; FOLLOW-UP ; imaging ; DISEASE ; EXPOSURE ; computed tomography ; NUCLEAR-MEDICINE ; radiation ; PATIENT ; MRI ; magnetic resonance ; MAGNETIC-RESONANCE ; magnetic resonance imaging ; AGE ; DAMAGE ; tomography ; COMPUTED-TOMOGRAPHY ; CHILDREN ; nuclear medicine ; COMPLICATIONS ; LUNG PERFUSION ; radiology ; ADULTS ; LIFE ; CHEST-X-RAY ; CYSTIC-FIBROSIS ; RADIATION-EXPOSURE ; methods ; NUCLEAR ; USA ; correlation ; cystic fibrosis ; female ; Male ; MEDICINE ; multidetector computed tomography ; - ; comparison ; RESONANCE ; MDCT ; chest x-ray ; cystic fibrosis (CF) ; morphologic MRI ; RADIOGRAPH ; SCORING SYSTEMS
    Abstract: Objectives: As pulmonary complications are life limiting in patients with cystic fibrosis (CF), repeated chest imaging [chest x-ray, computed tomography (CT)] is needed for follow up. With the continuously rising life expectancy of CF patients, magnetic resonance imaging (MRI) as a radiation-free imaging modality might become more and more attractive. The goal of this study was to prospectively assess the value of MRI for evaluation of morphologic pulmonary CF-changes in comparison to established imaging modalities. Materials and Methods: Thirty-one CF patients (19 female, 12 male; mean age 16.7 years) with stable lung disease were examined by MRI: HASTE, coronal/transversal (TR/TE/alpha/TA: infinite/28 ms/180 degrees/18 s), multi-detector computed tomography (MDCT) (30 patients): 120 kV, dose modulated mAs, and chest x-ray (21 patients). Image evaluation: random order, 4 chest radiologists in consensus; chest x-ray: modified Chrispin-Norman score; CT and MRI: modified Helbich score. The maximal attainable score for chest x-ray was 34, for MRI and CT 25. Median scores, Pearson correlation coefficients, Bland-Altman plots, and concordance of MRI to CT on a lobar and segmental basis were calculated. Results: The median MRI and MDCT scores were 13 (min 3, max 20) respectively 13.5 (min 0, max 20). The median chest x-ray score was 14 (min 5, max 32). Pearson correlation coefficients: MRI/CT = 0.80, P 〈 0.0001; MRI/chest x-ray = 0.63, P 〈 0.0018; chest x-ray/CT = 0.75, P 〈 0.0001. The median lobe related concordance was 80% for bronchiectasis, 77% for mucus plugging, 93%, for sacculation/abscesses, and 100% for collapse/consolidation. Conclusions: Morphologic MRI of the lung in CF patients demonstrates comparable results to MDCT and chest x-ray. Because radiation exposure is an issue in CF patients, MRI might have the ability to be used as an appropriate alternative method for pulmonary imaging
    Type of Publication: Journal article published
    PubMed ID: 17984769
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  • 6
    Keywords: CT ; MICE ; PATHOGENESIS ; MANAGEMENT ; LUNG-DISEASE ; QUANTITATIVE ASSESSMENT ; EPITHELIAL NA+ CHANNEL ; COPD ; Scoring system ; AIRWAY SURFACE LIQUID
    Abstract: Background: Histopathological studies on lung specimens from patients with cystic fibrosis (CF) and recent results from a mouse model indicate that emphysema may contribute to CF lung disease. However, little is known about the relevance of emphysema in patients with CF. In the present study, we used computationally generated density masks based on multidetector computed tomography (MDCT) of the chest for non-invasive characterization and quantification of emphysema in CF. Methods: Volumetric MDCT scans were acquired in parallel to pulmonary function testing in 41 patients with CF (median age 20.1 years; range 7-66 years) and 21 non-CF controls (median age 30.4 years; range 4-68 years), and subjected to dedicated software. The lung was segmented, low attenuation volumes below a threshold of -950 Hounsfield units were assigned to emphysema volume (EV), and the emphysema index was computed (EI). Results were correlated with forced expiratory volume in 1 s percent predicted (FEV1%), residual volume (RV), and RV/total lung capacity (RV/TLC). Results: We show that EV was increased in CF (457 +/- 530 ml) compared to non-CF controls (78 +/- 90 ml) (P〈0.01). EI was also increased in CF (7.7 +/- 7.5%) compared to the control group (1.2 +/- 1.4%) (P〈0.05). EI correlated inversely with FEV1% (r(s)=-0.66), and directly with RV (r(s)=0.69) and RV/TLC (r(s)=0.47) in patients with CF (P〈0.007), but not in non-CF controls. Emphysema in CF was detected from early adolescence (similar to 13 years) and increased with age (r(s)=0.67, P〈0.001). Conclusions: Our results indicate that early onset emphysema detected by densitometry on chest MDCT is a characteristic pathology that contributes to airflow limitation and may serve as a novel endpoint for monitoring lung disease in CF.
    Type of Publication: Journal article published
    PubMed ID: 23991177
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  • 7
    ISSN: 1432-1440
    Keywords: Emphysema ; Alveolar macrophage ; Elastase ; Smoking
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Current concepts of pathomechanisms leading to acquired emphysema suggest that alveolar macrophages (AM) activated by cigarette smoking may cause an elastase/antielastase imbalance localized to the microenvironment formed by phagocytes and lung tissue. A functional cell assay was used to evaluate the cell-associated elastinolytic activity of AM. AM were obtained by bronchoalveolar lavage from patients with emphysema and from patients with non obstructive chronic pulmonary diseases (non-COPD) and cultured under serum-free conditions in direct contact with 3H-labeled elastin particles. Elastinolytic activity was calculated from the released radioactivity in culture supernatants and expressed as micrograms of 3H-elastin degraded × 10−5 AM × 72 h−1. AM of patients with emphysema had significantly higher elastinolytic activity compared to that of non-COPD patients (median: 10.8 versus 4.1 μg; P 〈 0.01). Further differentiation of patients revealed the lowest median activity in sarcoidosis (2.3 μg). In respect to smoking habits there was a major difference between smokers with and those without emphysema; AM of smokers with emphysema degraded more than twice the amount of elastin than smokers in the non-COPD group (median:11 versus 3.9 μg, P = 0.01). From these data we conclude that AM-derived elastinolytic proteases may be involved in the destruction of lung elastin, which is thought to be the key event occurring in the pathogenesis of pulmonary emphysema.
    Type of Medium: Electronic Resource
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