Subtyping emphysematous COPD by respiratory volume change distributions on CT

Hiroshi Shima, Naoya Tanabe, Akira Oguma, Kaoruko Shimizu, Shizuo Kaji, Kunihiko Terada, Tsuyoshi Oguma, Takeshi Kubo, Masaru Suzuki, Hironi Makita, Atsuyasu Sato, Masaharu Nishimura, Susumu Sato, Satoshi Konno, Toyohiro Hirai

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Background There is considerable heterogeneity among patients with emphysematous chronic obstructive pulmonary disease (COPD). We hypothesised that in addition to emphysema severity, ventilation distribution in emphysematous regions would be associated with clinical-physiological impairments in these patients. Objective To evaluate whether the discordance between respiratory volume change distributions (from expiration to inspiration) in emphysematous and non-emphysematous regions affects COPD outcomes using two cohorts. Methods Emphysema was quantified using a low attenuation volume percentage on inspiratory CT (iLAV%). Local respiratory volume changes were calculated using non-rigidly registered expiratory/inspiratory CT. The Ventilation Discordance Index (VDI) represented the log-transformed Wasserstein distance quantifying discordance between respiratory volume change distributions in emphysematous and non-emphysematous regions. Results Patients with COPD in the first cohort (n=221) were classified into minimal emphysema (iLAV% <10%; n=113) and established emphysema with high VDI and low VDI groups (n=46 and 62, respectively). Forced expiratory volume in 1 s (FEV 1) was lower in the low VDI group than in the other groups, with no difference between the high VDI and minimal emphysema groups. Higher iLAV%, more severe airway disease and hyperventilated emphysematous regions in the upper-middle lobes were independently associated with lower VDI. The second cohort analyses (n=93) confirmed these findings and showed greater annual FEV 1 decline and higher mortality in the low VDI group than in the high VDI group independent of iLAV% and airway disease on CT. Conclusion Lower VDI is associated with severe airflow limitation and higher mortality independent of emphysema severity and airway morphological changes in patients with emphysematous COPD.

Original languageEnglish
Pages (from-to)344-353
Number of pages10
Issue number4
Publication statusPublished - Apr 1 2023

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine


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