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Study Touts Lung CT As Predictor Of Mortality

January 22, 2013
Written by: , Filed in: Chest Radiology, Diagnostic Imaging
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The use of CT for lung evaluation got another boost last week. A study published online in the American Journal of Respiratory and Critical Care Medicine found that the severity of emphysema, as measured by CT, was a good predictor of mortality—from all causes—among current or former smokers. That held true regardless of whether the subjects suffered from chronic obstructive pulmonary disease.

Ane Johannessen, PhD, a postdoctoral researcher at the Centre for Clinical Research at Haukeland University Hospital in Bergen, Norway, led a multinational team of researchers. They used CT to scan the lungs of 947 subjects who were or had been smokers, classifying the severity of emphysema as low, medium, or high according to the percentage of low-attenuation areas in the lungs.

During the eight-year study period, 4 percent of the group with low-severity emphysema died, compared with 18 percent of the group with medium-severity emphysema and 44 percent of the group with high-severity emphysema. When adjusted for sex, case/control status, forced expiratory volume in one second, COPD status, age, body mass index, smoking status, age of smoking onset, pack years, and inflation level, the participants with medium or high emphysema severity lived 19 fewer months than those with mild disease.

“Our main metric for quite a while has been the degree of lung function impairment,” said David M. Mannino, MD, professor and chair of the Department of Preventive Medicine and Environmental Health at the University of Kentucky College of Public Health. “Although that is good, it really doesn’t capture everything.”

Dr. Mannino has investigated the relationship between lung function and mortality but was not involved with the study by Johannessen and colleagues. He was quoted by Medscape Medical News.

He predicted:

Over the next year or so, there’s going to be a growing conversation about the need for CT-based lung cancer screening for people who have a smoking history.

Momentum for that has already been building, as we’ve been reporting, most recently last August. “There’s good evidence now that CT scans can detect early lung cancer that actually leads to a survival advantage,” Dr. Mannino said. “If that becomes more common, it becomes relatively easy to implement, when screening for lung cancer, to run an algorithm that would give you the proportion of low-attenuation area.”

Well, maybe not yet “relatively easy.” Medscape Medical News also quotes Barry J. Make, MD, co-director of the COPD Program at National Jewish Health and professor at the University of Colorado Denver School of Medicine, regarding the state of the technology:

“The current CT scanners, the equipment that takes the image and processes it, do not have the software embedded in the scanner to measure the amount of emphysema.”

We suspect upgrades will be forthcoming soon.

Related seminar: Cardiovascular and Pulmonary Imaging

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