What is the role of CT scanning in the assessment of emphysema?

Updated: Mar 13, 2019
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Answer

CT scanning of the chest, especially high-resolution CT (HRCT), has a much greater sensitivity and specificity than those of plain chest radiography in diagnosing and assessing the severity of emphysema (see the images below). [16]  HRCT is useful in the workup of smokers with new-onset or progressive dyspnea. The severity of emphysematous change may be underestimated on conventional radiography, whereas HRCT depicts combined fibrosis and emphysema. [17] Patients with these conditions may have relatively normal lung volumes and spirometric results, but they may have severe dyspnea and a reduced diffusing capacity. In healthy nonsmokers aged 19-40 years, a maximum of 0.35% of the area of emphysema can be detected by means of CT quantification. [18]

 

CT can depict surgically treatable areas of bullous disease that are not evident on plain chest radiography. CT is also useful in predicting the outcome of surgery. HRCT may be useful in diagnosing subclinical or mild emphysema, and HRCT can be used to differentiate the pathologic types of emphysema. However, CT scanning is not yet used to routinely evaluate patients with COPD. Instead, it is reserved for patients in whom the diagnosis is in doubt, to look for coexistent pathologies, and to assess their suitability for surgical intervention. [6, 19, 20, 21, 22, 23, 24, 25, 26, 27]

High-resolution CT (HRCT) in a patient after viral High-resolution CT (HRCT) in a patient after viral bronchiolitis obliterans demonstrates areas of airtrapping, which is predominant in the inferior lobes and associated with bronchiectasis in the left lower lobe. Note that the decreased attenuation caused by the airtrapping can simulate emphysema (Corrêa da Silva, 2001).
Pediatric high-resolution CT (HRCT) shows a hyperi Pediatric high-resolution CT (HRCT) shows a hyperinflated right lung with large pulmonary bullae due to congenital lobar emphysema (Corrêa da Silva, 2001).
High-resolution CT (HRCT) demonstrates areas of ce High-resolution CT (HRCT) demonstrates areas of centriacinar emphysema. Note the low attenuation areas without walls due to destruction of the alveoli septae centrally in the acini. Red element shows the size of a normal acinus (Corrêa da Silva, 2001).
High-resolution CT (HRCT) shows large bullae in bo High-resolution CT (HRCT) shows large bullae in both inferior lobes due to uniform enlargement and destruction of the alveoli walls causing distortion of the pulmonary architecture (Corrêa da Silva, 2001).

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