Quantitative Computed Tomography Assessment of Respiratory Muscles in Male Patients Diagnosed with Emphysema

Ji-Yeon Han; Ki-Nam Lee; Eun-Ju Kang; Jin Wook Baek

doi:10.3348/jksr.2018.78.6.371

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Han, Lee, Kang, and Baek: Quantitative Computed Tomography Assessment of Respiratory Muscles in Male Patients Diagnosed with Emphysema

Original Article

J Korean Soc Radiol 2018;78(6):371-379.

Published online: 20 January 2018

DOI: https://doi.org/10.3348/jksr.2018.78.6.371

Quantitative Computed Tomography Assessment of Respiratory Muscles in Male Patients Diagnosed with Emphysema

Ji-Yeon Han, MD¹, Ki-Nam Lee, MD^2,^∗, Eun-Ju Kang, MD², Jin Wook Baek, MD³

¹Department of Radiology, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea

²Department of Radiology, Dong-A University Hospital, Busan, Korea

³Department of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea

^∗Corresponding author: Ki-Nam Lee, MD Department of Radiology, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea. Tel. 82-51-240-5367 Fax. 82-51-253-4931 E-mail: gnlee@dau.ac.kr

Received 4 September 2017 Revised 27 November 2017 Accepted 15 February 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to accurately evaluate the significance and correlation between the clinical severity and the morphologic feature of respiratory muscles in patients with emphysema as noted using computed tomography (CT).

Materials and Methods

The cross sectional area (CSA) and attenuation of respiratory muscles in the patients with emphysema (n = 71) were subsequently retrospectively reviewed. The clinical severity for the patients was determined by the value of the actual forced expiratory volume in 1 second/forced vital capacity at the pulmonary function test (PFT). The correlation between the CT measurements with visual assessment of emphysema (VAE), and the PFT values were completed and recorded. The multiple linear regression analysis of each CT measurement on the VAE and PFT values was used to determine the most affective parameters among the recorded and identified CT measurements.

Results

The CSA of the pectoralis major (p = 0.002) and subsequently the serratus anterior (p = 0.011) were found to be lower in patients with emphysema than as compared to those in the control group. The CSA and the attenuation of respiratory muscles remained significant for its relation for the VAE and PFT values. As noted, both the VAE and PFT values were mostly contributed by the CSA and attenuation of serratus anterior and attenuation of diaphragm crus among all respiratory muscles.

Conclusion

The CT measurement of the patient's respiratory muscles may reflect clinical and visual severity in the patients with emphysema.

Keywords: Index terms Pulmonary Disease, Chronic Obstructive Emphysema Multidetector Computed Tomography Respiratory Muscles Diaphragm

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Fig. 1.

Sample CT scans used to measure cross sectional area of respiratory muscles. A. The cross sectional area of PM (red) and PN (blue) are measured at the level of the claviculomanubrial joint. B. The cross sectional area of ITC (purple), SA (green), and LD (yellow) are measured at the level of right inferior pulmonary vein. C. The cross sectional area of DC (orange) is measured at the retrocrural area at the level of origin of the celiac trunk. DC = diaphragm crus, ITC = intercostalis, LD = latissimus dorsi, PM = pectoralis major, PN = pectoralis minor, SA = serratus anterior

Fig. 2.

Correlation of CT measurements of serratus anterior according to visual assessment of emphysema (A, B) and FEV₁/FVC (C, D). FEV₁/FVC = forced expiratory volume in 1 second/forced vital capacity

Table 1.

Characteristics of 71 Male Patients with Emphysema

Total patient number	71
Age (years)	69.6 ± 10.2
BMI (kg/m²)	21.7 ± 3.3
GOLD stage
Normal	12
Mild	14
Moderate	16
Severe	22
Very severe	7
VAE^∗
0% (6 point)	0
1–5% (7–11 point)	1
6–25% (12–17 point)	17
26–50% (18–23 point)	37
51–75% (24–29 point)	14
> 75% (30–36 point)	2

Data are presented as mean ± standard deviation. ∗The visual extent of emphysema for the whole lung was expressed by averaging the sum of six-point scale scores of six lobes. BMI = body mass index, GOLD = Global Initiative for Obstructive Lung Disease, VAE = visual assessment of emphysema

Table 2.

CT Measurements of Respiratory Muscles

	Emphysema (n = 71)	Control (n = 24)	p-Value
Age (years)	69.6 ± 10.2	68.8 ± 13.3	0.249
BMI (kg/m²)	21.7 ± 3.3	20.5 ± 3.3	0.383
Height (m)	1.66 ± 0.06	1.69 ± 0.07	0.108^∗
CSA (cm²)
Pectoralis major	21.9 ± 5.9	26.5 ± 6.8	0.002^∗
Pectoralis minor	7.7 ± 2.1	7.9 ± 2.2	0.566
Intercostal	1.0 (0.2–3.2)	0.8 (0.3–2.3)	0.155^†
Serratus anterior	12.1 ± 5.0	15.4 ± 5.8	0.011^∗
Latissimus dorsi	11.7 (3.1–23.6)	13.0 (6.0–24.7)	0.136^†
Diaphragm crus	2.7 ± 1.0	2.8 ± 1.3	0.644
Attenuation
Pectoralis major	47.4 ± 10.3	45.1 ± 8.0	0.736
Pectoralis minor	45.9 ± 8.6	44.4 ± 6.4	0.149
Intercostal	2.3 ± 14.7	2.6 ± 17.4	0.320
Serratus anterior	39.8 (9.5–59.8)	42.3 (25.5–59)	0.300^†
Latissimus dorsi	27.0 (−14.5–52.5)	31.0 (−0.2–51.5)	0.222^†
Diaphragm crus	32.2 ± 10.6	35.8 ± 7.8	0.138

Data are presented as mean ± standard deviation. ∗Significative p-values.

^† If Mann-Whitney U test was performed, data were presented as median with range in parentheses. BMI = body mass index, CSA = cross sectional area

Table 3.

Repeatability of CT Measurements of Respiratory Muscles

Respiratory Muscles	Intraclass Correlation Coefficient
	Intraobserver		Interobserver
	CSA	Attenuation	CSA	Attenuation
Pectoralis major	0.853	0.900	0.713	0.853
Pectoralis minor	0.822	0.811	0.795	0.781
Intercostalis	0.751	0.852	0.651	0.809
Serratus anterior	0.944	0.882	0.929	0.823
Latissimus dorsi	0.867	0.913	0.848	0.901
Diaphragm crus	0.732	0.683	0.683	0.683

CSA = cross sectional area

Table 4.

Pearson Correlation Coefficient (r) between CT Measurements and FEV₁/FVC

Variables	VAE (p-Value)	FEV₁/FVC (p-Value)
CSA
Pectoralis major	–0.210 (0.078)	–0.052 (0.227)
Pectoralis minor	–0.144 (0.232)	–0.105 (0.904)
Intercostalis	–0.245 (0.040)^∗	–0.064 (0.613)
Serratus anterior	–0.389 (0.001)^∗	–0.390 (0.001)^∗
Latissimus dorsi	–0.343 (0.003)^∗	–0.285 (0.022)^∗
Diaphragm crus	–0.138 (0.250)	–0.083 (0.513)
Attenuation
Pectoralis major	–0.330 (0.005)	0.207 (0.098)
Pectoralis minor	–0.408 (< 0.001)^∗	0.271 (0.029)^∗
Intercostalis	–0.328 (0.005)^∗	0.210 (0.094)
Serratus anterior	–0.376 (0.001)^∗	0.334 (0.007)^∗
Latissimus dorsi	–0.138 (0.251)	0.155 (0.217)
Diaphragm crus	–0.329 (0.005)^∗	0.376 (0.002)^∗

^∗ Correlation coefficient with significative p-values. CSA = cross sectional area, FEV₁/FVC = forced expiratory volume in 1 sec-ond/forced vital capacity, VAE = visual assessment of emphysema

Table 5.

Relationship of CT Measurements of Respiratory Muscles to VAE and FEV₁/FVC in Patients with Emphysema, Respectively

Respiratory Muscles	VAE				FEV₁/FVC
	CSA		Attenuation		CSA		Attenuation
	β	p-Value	β	p-Value	β	p-Value	β	p-Value
Simple regression
Pectoralis major	–0.202 cm²	0.247	–0.130	0.007^∗	0.229 cm²	0.629	0.256	0.238
Pectoralis minor	–0.048 cm²	0.863	–0.192	0.001^∗	–0.408 cm²	0.736	0.428	0.083
Intercostalis	–1.197 cm²	0.220	–0.092	0.004^∗	0.911 cm²	0.836	0.211	0.142
Serratus anterior	–0.333 cm²	0.004^∗	–0.172	< 0.001^∗	1.444 cm²	0.004^∗	0.524	0.013^∗
Latissimus dorsi	–0.321 cm²	0.026^∗	–0.044	0.195	1.262 cm²	0.047^∗	0.134	0.360
Diaphragm crus	–0.154 cm²	0.770	–0.115	0.014^∗	0.661 cm²	0.771	0.551	0.007^∗
Stepwise multiple regression
Serratus anterior	–0.312 cm²	0.001^∗	–0.122	0.046^∗	1.760 cm²	< 0.001^∗	0.419	0.040^∗
Diaphragm crus	–	–	–0.111	0.012^∗	–	–	0.492	0.012^∗
Pectoralis minor	–	–	–0.164	0.014^∗	–	–	–	–

^∗ Significative p-values. CSA = cross sectional area, FEV₁/FVC = forced expiratory volume in 1 second/forced vital capacity, VAE = visual assessment of emphysema

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