Automatic Emphysema Detection using Weakly Labeled HRCT Lung Images

A method for automatically quantifying emphysema regions using High-Resolution Computed Tomography (HRCT) scans of patients with chronic obstructive pulmonary disease (COPD) that does not require manually annotated scans for training is presented. HRCT scans of controls and of COPD patients with diverse disease severity are acquired at two different centers. Textural features from co-occurrence matrices and Gaussian filter banks are used to characterize the lung parenchyma in the scans. Two robust versions of multiple instance learning (MIL) classifiers, miSVM and MILES, are investigated. The classifiers are trained with the weak labels extracted from the forced expiratory volume in one minute (FEV$_1$) and diffusing capacity of the lungs for carbon monoxide (DLCO). At test time, the classifiers output a patient label indicating overall COPD diagnosis and local labels indicating the presence of emphysema. The classifier performance is compared with manual annotations by two radiologists, a classical density based method, and pulmonary function tests (PFTs). The miSVM classifier performed better than MILES on both patient and emphysema classification. The classifier has a stronger correlation with PFT than the density based method, the percentage of emphysema in the intersection of annotations from both radiologists, and the percentage of emphysema annotated by one of the radiologists. The correlation between the classifier and the PFT is only outperformed by the second radiologist. The method is therefore promising for facilitating assessment of emphysema and reducing inter-observer variability.Comment: Accepted at PLoS ON

New insights on COPD imaging via CT and MRI

Multidetector-row computed tomography (MDCT) can be used to quantify morphological features and investigate structure/function relationship in COPD. This approach allows a phenotypical definition of COPD patients, and might improve our understanding of disease pathogenesis and suggest new therapeutical options. In recent years, magnetic resonance imaging (MRI) has also become potentially suitable for the assessment of ventilation, perfusion and respiratory mechanics. This review focuses on the established clinical applications of CT, and novel CT and MRI techniques, which may prove valuable in evaluating the structural and functional damage in COPD

Manifold learning of COPD

Analysis of CT scans for studying Chronic Obstructive Pulmonary Disease (COPD) is generally limited to mean scores of disease extent. However, the evolution of local pulmonary damage may vary between patients with discordant effects on lung physiology. This limits the explanatory power of mean values in clinical studies. We present local disease and deformation distributions to address this limitation. The disease distribution aims to quantify two aspects of parenchymal damage: locally diffuse/dense disease and global homogeneity/heterogeneity. The deformation distribution links parenchymal damage to local volume change. These distributions are exploited to quantify inter-patient differences. We used manifold learning to model variations of these distributions in 743 patients from the COPDGene study. We applied manifold fusion to combine distinct aspects of COPD into a single model. We demonstrated the utility of the distributions by comparing associations between learned embeddings and measures of severity. We also illustrated the potential to identify trajectories of disease progression in a manifold space of COPD

Quantitative computed tomography (CT) assessment of emphysema in patients with severe chronic obstructive pulmonary disease (COPD) and its correlation with age, sex, pulmonary function tests, BMI, smoking, and biomass exposure

Background: To evaluate the role of HRCT in quantifying emphysema in severe COPD patients and to study the variations in the pattern of emphysema in relation to age, sex, FEV1, smoking index, biomass exposure, and BMI. Material/Methods: Automatic lung segmentation of HRCT scans in 41 severe COPD patients (GOLD stage III or more) was done using an emphysema protocol. The extent of emphysema was assessed using the density mask method with a threshold of -950 HU (%LAA-950). The percentage of emphysema in each lung lobe and both lungs was correlated with 6 parameters - age, sex, BMI, smoking index, biomass exposure, and FEV1. Results: Smoking resulted in homogenously distributed emphysema regardless of the severity of smoking. BMI was inversely correlated with the extent of emphysema. A significant association was found between the percentage of emphysema in the right lower lobe and BMI (P=0.015), between biomass exposure and the percentage of emphysema in RUL, RLL, and both lungs (P values of 0.024, 0.016, and 0.036, respectively). The extent of emphysema was disproportionately low compared to the amount of obstruction on PFTs, indicating an airway predominant variety of COPD with significant biomass exposure. Conclusions: Smoking is associated with a relatively homogenous distribution of emphysema with no regional predilection. Biomass exposure produces predominantly right-sided emphysema. BMI decreases with increasing levels of emphysema in the right lower lobe. These risk factors of emphysema patterns are helpful in deciding on the management, including surgical options

Regional lung function and heterogeneity of specific gas volume in healthy and emphysematous subjects.

The aim of our study was to study regional lung function by standard computed tomography (CT) and characterise regional variations of density and specific gas volume (SVg) between different lung volumes. We studied 10 healthy and 10 severely emphysematous subjects. Corresponding CT images taken at high and low lung volumes were registered by optical flow to obtain two-dimensional maps of pixel-by-pixel differences of density (ΔHU) and SVg (ΔSVg) at slice levels near the aortic arch, carina and top diaphragm. In healthy subjects, ΔHU was higher at all levels (p<0.001) with higher variability expressed as interquartile range (p<0.001), largely due to its differences between dorsal and ventral regions. In patients, median ΔSVg values were 3.2 times lower than healthy volunteers (p<0.001), while heterogeneity of ΔSVg maps, expressed as quartile coefficient of variation, was 5.4 times higher (p<0.001). In all patients, there were areas with negative values of ΔSVg. In conclusion, ΔSVg is uniform in healthy lungs and minimally influenced by gravity. The significant ΔSVg heterogeneity observed in emphysema allows identification of areas of alveolar destruction and gas trapping and suggests that ΔSVg maps provide useful information for evaluation and planning of emerging treatments that target trapped gas for removal

Airway dimensions in COPD:relationships with clinical variables

SummaryBackgroundCOPD patients have varying degrees of airways disease and emphysema. CT scanning can differentiate these pathological subtypes. We evaluated airway dimensions and emphysema severity with low dose CT scanning in COPD patients to determine relationships with clinical features of the disease.MethodsFifty six patients with COPD had a low dose thoracic CT scan. Airways were analysed using novel software as either proximal (1st and 2nd generation) or distal (3rd to 6th generation); the extent of emphysema was assessed as the percentage of pixels less than −950 Hounsfield units. CT measures were related to clinical features of COPD.ResultsThicker walls in the proximal airways were associated with clinical features that may represent a bronchitic phenotype (MRC Bronchitis Score; β = 0.20, p = 0.003, Frequent Exacerbations; β = 0.14, p = 0.017, Total St George’s Score; β = 0.50, p = 0.001 and body mass index [BMI]; β = 0.26, p = 0.049); these associations were independent of emphysema. BMI was negatively correlated with the degree of emphysema (β = −0.41, p = 0.001). Airway wall thickness was negatively correlated with CT measured emphysema for both proximal and more distal airways (r = −0.30, p = 0.025 and r = −0.32, p = 0.015).ConclusionsCT measured airway dimensions are associated with several clinical measures of COPD; these are related to a bronchitic phenotype and the effect is independent of emphysema