Impact of the spirometric definition on comorbidities in chronic obstructive pulmonary disease. Meteran Howraman,Thomsen Simon Francis,Miller Martin R,Hjelmborg Jacob,Sigsgaard Torben,Backer Vibeke Respiratory medicine BACKGROUND:Little is known about how the spirometric definition of airway obstruction affects the association between COPD and comorbidities and whether these associations might be due to genetic predisposition. AIM:1) To examine the impact of the spirometric definition on the associations between COPD and its comorbidities and 2) To examine whether these associations can be explained by shared genetic or environmental factors. METHODS:11,458 twins, aged 40-80 years, from the Danish Twin Registry were recruited who completed a questionnaire on medical history, life style factors and had a clinical examination. COPD was defined by respiratory symptoms (RS) plus airway obstruction according to either GOLD (FR-COPD) or ERS/ATS guidelines (LLN-COPD). Self-reported physician diagnoses were used to identify comorbidities. RESULTS:The mean age of participants was 58.4 years ±SD 9.7, mean BMI was 26.6 kg/m ± SD 4.4, 52% were female and the prevalence of LLN2.5-COPD and FR-COPD was 2.5% and 6.3%, respectively. Among eight major comorbidities, multivariate logistic regression showed COPD was only associated with heart failure, whereas RS alone were associated with 6 out of 8 comorbidities after Bonferroni-correction. There was an increased risk of heart failure, ischemic heart disease, depression and pulmonary embolism in twin individuals with RS compared with the co-twin without RS. CONCLUSIONS:COPD was only associated with an increased risk of heart failure. Discordant COPD-individuals (FR-COPD+/LLN5-COPD-) were at increased risk of heart failure. Sub-analyses showed that RS, but not airway obstruction were associated with an increased risk of comorbidities. 10.1016/j.rmed.2021.106399

Pulmonary Functional Imaging: Part 2-State-of-the-Art Clinical Applications and Opportunities for Improved Patient Care. Radiology Pulmonary functional imaging may be defined as the regional quantification of lung function by using primarily CT, MRI, and nuclear medicine techniques. The distribution of pulmonary physiologic parameters, including ventilation, perfusion, gas exchange, and biomechanics, can be noninvasively mapped and measured throughout the lungs. This information is not accessible by using conventional pulmonary function tests, which measure total lung function without viewing the regional distribution. The latter is important because of the heterogeneous distribution of virtually all lung disorders. Moreover, techniques such as hyperpolarized xenon 129 and helium 3 MRI can probe lung physiologic structure and microstructure at the level of the alveolar-air and alveolar-red blood cell interface, which is well beyond the spatial resolution of other clinical methods. The opportunities, challenges, and current stage of clinical deployment of pulmonary functional imaging are reviewed, including applications to chronic obstructive pulmonary disease, asthma, interstitial lung disease, pulmonary embolism, and pulmonary hypertension. Among the challenges to the deployment of pulmonary functional imaging in routine clinical practice are the need for further validation, establishment of normal values, standardization of imaging acquisition and analysis, and evidence of patient outcomes benefit. When these challenges are addressed, it is anticipated that pulmonary functional imaging will have an expanding role in the evaluation and management of patients with lung disease. 10.1148/radiol.2021204033

Advances for Pulmonary Functional Imaging: Dual-Energy Computed Tomography for Pulmonary Functional Imaging. Diagnostics (Basel, Switzerland) Dual-energy computed tomography (DECT) can improve the differentiation of material by using two different X-ray energy spectra, and may provide new imaging techniques to diagnostic radiology to overcome the limitations of conventional CT in characterizing tissue. Some techniques have used dual-energy imaging, which mainly includes dual-sourced, rapid kVp switching, dual-layer detectors, and split-filter imaging. In iodine images, images of the lung's perfused blood volume (PBV) based on DECT have been applied in patients with pulmonary embolism to obtain both images of the PE occluding the pulmonary artery and the consequent perfusion defects in the lung's parenchyma. PBV images of the lung also have the potential to indicate the severity of PE, including chronic thromboembolic pulmonary hypertension. Virtual monochromatic imaging can improve the accuracy of diagnosing pulmonary vascular diseases by optimizing kiloelectronvolt settings for various purposes. Iodine images also could provide a new approach in the area of thoracic oncology, for example, for the characterization of pulmonary nodules and mediastinal lymph nodes. DECT-based lung ventilation imaging is also available with noble gases with high atomic numbers, such as xenon, which is similar to iodine. A ventilation map of the lung can be used to image various pulmonary diseases such as chronic obstructive pulmonary disease. 10.3390/diagnostics13132295