Total Lung and Lobar Quantitative Assessment Based on Paired Inspiratory-Expiratory Chest CT in Healthy Adults:...

To provide the quantitative volumetric data of the total lung and lobes in inspiration and expiration from healthy adults, and to explore the value of paired inspiratory-expiratory chest CT scan in pulmonary ventilatory function and further explore the influence of each lobe on ventilation.

A total of 65 adults (29 males and 36 females) with normal clinical pulmonary function test (PFT) and paired inspiratory-expiratory chest CT scan were retrospectively enrolled. The inspiratory and expiratory volumetric indexes of the total lung (TL) and 5 lobes (left upper lobe [LUL], left lower lobe [LLL], right upper lobe [RUL], right middle lobe [RML], and right lower lobe [RLL]) were obtained by Philips IntelliSpace Portal image postprocessing workstation, including inspiratory lung volume (LV_in), expiratory lung volume (LV_ex), volume change (∆LV), and well-aerated lung volume (WAL, lung tissue with CT threshold between -950 and -750 HU in inspiratory scan). Spearman correlation analysis was used to explore the correlation between CT quantitative indexes of the total lung and ventilatory function indexes (including total lung capacity [TLC], residual volume [RV], and force vital capacity [FVC]). Multiple stepwise regression analysis was used to explore the influence of each lobe on ventilation.

At end-inspiratory phase, the LV_in-TL was 4664.6 (4282.7, 5916.2) mL, the WAL_TL was 4173 (3639.6, 5250.9) mL; both showed excellent correlation with TLC (LV_in-TL: r = 0.890, p < 0.001; WAL_TL: r = 0.879, p < 0.001). From multiple linear regression analysis with lobar CT indexes as variables, the LV_in and WAL of these two lobes, LLL and RUL, showed a significant relationship with TLC. At end-expiratory phase, the LV_ex-TL was 2325.2 (1969.7, 2722.5) mL with good correlation with RV (r = 0.811, p < 0.001), of which the LV_ex of RUL and RML had a significant relationship with RV. For the volumetric change within breathing, the ∆LV_TL was 2485.6 (2169.8, 3078.1) mL with good correlation with FVC (r = 0.719, p < 0.001), moreover, WAL_TL showed a better correlation with FVC (r = 0.817, p < 0.001) than that of ∆LV_TL. Likewise, there was also a strong association between ∆LV, WAL of these two lobes (LLL and RUL), and FVC.

The quantitative indexes derived from paired inspiratory-expiratory chest CT could reflect the clinical pulmonary ventilatory function, LLL, and RUL give greater impact on ventilation. Thus, the pulmonary functional evaluation needs to be more precise and not limited to the total lung level.