Strain Analysis in Patients at High-Risk for COPD Using Four-Dimensional Dynamic-Ventilation CT

Purpose: To quantitatively identify abnormal lung motion in chronic obstructive pulmonary disease (COPD) using strain analysis, and further clarify the potential differences of deformation in COPD with different severity of airflow limitation. Materials and Methods: Totally, 53 patients at high-risk for COPD were enrolled in this study. All CT examinations were performed on a 320-row MDCT scanner, and strain measurement based on dynamic-ventilation CT data was performed with a computational fluid dynamics analysis software (Micro Vec V3.6.2). The strain-related parameters derived from the whole expiration phase ( PSmax-all, PSmean-all, Speedmax-all ), the first 2s of expiration phase ( PSmax2s, PSmean2s, Speedmax2s ) were divided respectively by the changes in lung volume to adjust for the degree of expiration. Spearman rank correlation analysis was used to evaluate associations between the strain-related parameters and various spirometric parameters. Comparisons of the strain-related parameters between COPD and non-COPD patients, between GOLD I (mild airflow restriction) and GOLD II–IV (moderate to severe airflow restriction) were made using the Mann–Whitney U -test. Receiver-operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of the strain-related parameters for COPD. P < 0.05 was considered statistically significant. Results: Strain-related parameters demonstrated positive correlations with spirometric parameters ( ρ =0.275∼ 0.687, P < 0.05), suggesting that heterogeneity in lung motion was related to abnormal spirometric results. Strain-related parameters can quantitatively distinguish COPD from non-COPD patients with moderate diagnostic significance with the AUC values ranged from 0.821 to 0.894. Furthermore, parameters of the whole expiration phase ( PSmax-all, Speedmax-al l ) demonstrated significant differences ( P =0.005; P =0.04) between COPD patients with mild and moderate to severe airflow limitation. Conclusion: Strain-related parameters derived from dynamic-ventilation CT data covering the whole lung associated with lung function changes in COPD, reflecting the severity of airflow limitation in some degree, even though its utility in severe COPD patients remains to be investigated. Keywords: strain analysis, dynamic-ventilation CT, chronic obstructive pulmonary disease, computed tomography, CT, airflow limitation