Journal of Intensive Care Medicine

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Image reconstruction affects computer tomographic assessment of lung hyperinflation

Andreas W. Reske, Harald Busse, Marcelo B. P. Amato, Matthias Jaekel, Thomas Kahn, Peter Schwarzkopf, Dierk Schreiter, Udo Gottschaldt, Matthias Seiwerts
Original
Volume 34, Issue 11 / November , 2008

Pages 2044 - 2053

Abstract

Objectives

Lung hyperinflation may be assessed by computed tomography (CT). As shown for patients with emphysema, however, CT image reconstruction affects quantification of hyperinflation. We studied the impact of reconstruction parameters on hyperinflation measurements in mechanically ventilated (MV) patients.

Design

Observational analysis.

Setting

A University hospital-affiliated research Unit.

Patients

The patients were MV patients with injured (n = 5) or normal lungs (n = 6), and spontaneously breathing patients (n = 5).

Interventions

None.

Measurements and results

Eight image series involving 3, 5, 7, and 10 mm slices and standard and sharp filters were reconstructed from identical CT raw data. Hyperinflated (Vhyper), normally (Vnormal), poorly (Vpoor), and nonaerated (Vnon) volumes were calculated by densitometry as percentage of total lung volume (Vtotal). Vhyper obtained with the sharp filter systematically exceeded that with the standard filter showing a median (interquartile range) increment of 138 (62–272) ml corresponding to approximately 4% of Vtotal. In contrast, sharp filtering minimally affected the other subvolumes (Vnormal, Vpoor, Vnon, and Vtotal). Decreasing slice thickness also increased Vhyper significantly. When changing from 10 to 3 mm thickness, Vhyper increased by a median value of 107 (49–252) ml in parallel with a small and inconsistent increment in Vnon of 12 (7–16) ml.

Conclusions

Reconstruction parameters significantly affect quantitative CT assessment of Vhyper in MV patients. Our observations suggest that sharp filters are inappropriate for this purpose. Thin slices combined with standard filters and more appropriate thresholds (e.g., −950 HU in normal lungs) might improve the detection of Vhyper. Different studies on Vhyper can only be compared if identical reconstruction parameters were used.

Keywords

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