Journal List > J Korean Soc Radiol > v.78(6) > 1095546

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

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.

References

1. Orozco-Levi M. Structure and function of the respiratory muscles in patients with COPD: impairment or adaptation? Eur Respir J Suppl. 2003; 46:41s–51s.
crossref
2. Levine S, Kaiser L, Leferovich J, Tikunov B. Cellular adaptations in the diaphragm in chronic obstructive pulmonary disease. N Engl J Med. 1997; 337:1799–1806.
crossref
3. Levine S, Gregory C, Nguyen T, Shrager J, Kaiser L, Rubinstein N, et al. Bioenergetic adaptation of individual human diaphragmatic myofibers to severe COPD. J Appl Physiol. 2002; 92:1205–1213.
4. Mercadier JJ, Schwartz K, Schiaffino S, Wisnewsky C, Ausoni S, Heimburger M, et al. Myosin heavy chain gene expression changes in the diaphragm of patients with chronic lung hyperinflation. Am J Physiol. 1998; 274:L527–L534.
5. Similowski T, Yan S, Gauthier AP, Macklem PT, Bellemare F. Contractile properties of the human diaphragm during chronic hyperinflation. N Engl J Med. 1991; 325:917–923.
crossref
6. Arora NS, Rochester DF. COPD and human diaphragm muscle dimensions. Chest. 1987; 91:719–724.
crossref
7. Steele RH, Heard BE. Size of the diaphragm in chronic bronchitis. Thorax. 1973; 28:55–60.
crossref
8. Ishikawa S, Hayes JA. Functional morphometry of the diaphragm in patients with chronic obstructive lung disease. Amer Rev Resp Dis. 1973; 108:135–138.
9. McDonald ML, Diaz AA, Ross JC, San Jose Estepar R, Zhou L, Regan EA, et al. Quantitative computed tomography measures of pectoralis muscle area and disease severity in chronic obstructive pulmonary disease. a cross-sectional study. Ann Am Thorac Soc. 2014; 11:326–334.
crossref
10. Park MJ, Cho JM, Jeon KN, Bae KS, Kim HC, Choi DS, et al. Mass and fat infiltration of intercostal muscles measured by CT histogram analysis and their correlations with COPD severity. Acad Radiol. 2014; 21:711–717.
crossref
11. Huang YS, Hsu HH, Chen JY, Tai MH, Jaw FS, Chang YC. Quantitative computed tomography of pulmonary emphysema and ventricular function in chronic obstructive pulmonary disease patients with pulmonary hypertension. Korean J Radiol. 2014; 15:871–877.
crossref
12. Yoon SH, Goo JM, Jung J, Hong H, Park EA, Lee CH, et al. Computer-aided classification of visual ventilation patterns in patients with chronic obstructive pulmonary disease at two-phase xenon-enhanced CT. Korean J Radiol. 2014; 15:386–396.
crossref
13. Lynch DA, Austin JH, Hogg JC, Grenier PA, Kauczor HU, Bankier AA, et al. CT-definable subtypes of chronic obstructive pulmonary disease: a statement of the Fleischner Society. Radiology. 2015; 277:192–205.
crossref
14. Smith BM, Austin JH, Newell JD Jr, D'Souza BM, Rozensh-tein A, Hoffman EA, et al. Pulmonary emphysema subtypes on computed tomography: the MESA COPD study. Am J Med. 2014; 127:94. .e7–23.
crossref
15. Nakayama Y, Awai K, Funama Y, Hatemura M, Imuta M, Nakaura T, et al. Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. Radiology. 2005; 237:945–951.
crossref
16. Rho M, Spitznagle T, Van Dillen L, Maheswari V, Oza S, Prather H. Gender differences on ultrasound imaging of lateral abdominal muscle thickness in asymptomatic adults: a pilot study. PM R. 2013; 5:374–380.
crossref
17. Sharp JT, Danon J, Druz WS, Goldberg NB, Fishman H, Mach-nach W. Respiratory muscle function in patients with chronic obstructive pulmonary disease: its relationship to disability and to respiratory therapy. Am Rev Respir Dis. 1974; 110:154–168.
18. Rochester DF, Braun NM. Determinants of maximal inspiratory pressure in chronic obstructive pulmonary disease. Am Rev Respir Dis. 1985; 132:42–47.
19. Cassart M, Pettiaux N, Gevenois PA, Paiva M, Estenne M. Effect of chronic hyperinflation on diaphragm length and surface area. Am J Respir Crit Care Med. 1997; 156:504–508.
crossref
20. Kim SS, Seo JB, Lee HY, Nevrekar DV, Forssen AV, Crapo JD, et al. Chronic obstructive pulmonary disease: lobe-based visual assessment of volumetric CT by using standard images–comparison with quantitative CT and pulmonary function test in the COPDGene study. Radiology. 2013; 266:626–635.
crossref
21. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J. 2009; 33:1165–1185.
crossref
22. Caron MA, Debigaré R, Dekhuijzen PN, Maltais F. Comparative assessment of the quadriceps and the diaphragm in patients with COPD. J Appl Physiol. 2009; 107:952–961.
crossref
23. Nishimura Y, Tsutsumi M, Nakata H, Tsunenari T, Maeda H, Yokoyama M. Relationship between respiratory muscle strength and lean body mass in men with COPD. Chest. 1995; 107:1232–1236.
crossref
24. Fabbri LM, Rabe KF. From COPD to chronic systemic inflammatory syndrome? Lancet. 2007; 370:797–799.
crossref
25. Cannon DT, Grout SL, May CA, Strom SD, Wyckoff KG, Cipriani DJ, et al. Recruitment of the serratus anterior as an accessory muscle of ventilation during graded exercise. J Physiol Sci. 2007; 57:127–131.
crossref
26. Cho YH, Seo JB, Lee SM, Lee SM, Choe J, Lee D, et al. Quantitative CT imaging in chronic obstructive pulmonary disease: review of current status and future challenges. J Korean Soc Radiol. 2018; 78:1–12.
crossref

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
jksr-78-371f1.tif
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
jksr-78-371f2.tif
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

TOOLS
Similar articles