ABSTRACT
I. Introduction 431
II. Detection of Emphysema by Chest Radiograph 432
III. Quantification of Emphysema from Pathologic Specimens 432
IV. CT Methodology for Detecting Emphysema 433
V. Relationship Between CT Detected Emphysema and
Pathologically Defined Emphysema 434
VI. Relationship Between CT Detected Emphysema and
Pulmonary Function 436
VII. Role of CT in LVRS 436
VIII. Prediction of Outcome 437
A. Presence of Emphysema 437
B. Emphysema Distribution-Craniocaudal 438
C. Emphysema Distribution-Novel Methodologies 444
IX. CT Volumes as an Outcome or Correlate with Outcomes 445
X. Conclusion 446
References 446
I. Introduction
Over 11 million people in the United States were estimated to have chronic
obstructive pulmonary disease (COPD) in the year 2000 (1). Approximately
9.4 million patients have chronic bronchitis and 3.1 million patients have emphy-
sema (1). In the United States, COPD is the fourth leading cause of death and the
leading pulmonary cause of death (1). Worldwide, COPD is expected to rank fifth
in terms of morbidity and mortality by the year 2020 (2). Recent reviews have
defined the current pharmacological and nonpharmacological therapies in
COPD (3). Unfortunately, despite medical advances, significant limitation in
quality of life persists. As such, much effort has been devoted to the identification
of surgical options for selected patients, including lung volume reduction surgery
(LVRS) (4). LVRS has been identified as a viable treatment for selected patients
with advanced emphysema (5). An understanding of imaging for emphysema is
crucial to understand the appropriate role of LVRS in selected patients.
