@article {1433745, title = {Assessment of pulmonary hypertension what CT and MRI can provide}, journal = {Acad Radiol}, volume = {18}, number = {4}, year = {2011}, month = {2011 Apr}, pages = {437-53}, abstract = {RATIONALES AND OBJECTIVES: Pulmonary hypertension (PH) is a life-threatening condition, characterized by elevated pulmonary arterial pressure, which is confirmed based on invasive right heart catheterization (RHC). Noninvasive examinations may support diagnosis of PH before proceeding to RHC and play an important role in management and treatment of the disease. Although echocardiography is considered a standard tool in diagnosis, recent advances have made computed tomography (CT) and magnetic resonance (MR) imaging promising tools, which may provide morphologic and functional information. In this article, we review image-based assessment of PH with a focus on CT and MR imaging. CONCLUSIONS: CT may provide useful morphologic information for depicting PH and seeking for underlying diseases. With the accumulated technological advancement, CT and MRI may provide practical tools for not only morphologic but also functional assessment of patients with PH.}, keywords = {Humans, Hypertension, Pulmonary, Image Enhancement, Magnetic Resonance Imaging, Tomography, X-Ray Computed}, issn = {1878-4046}, doi = {10.1016/j.acra.2011.01.003}, author = {Okajima, Yuka and Ohno, Yoshiharu and Washko, George R and Hatabu, Hiroto} } @article {1433742, title = {Azithromycin for prevention of exacerbations of COPD}, journal = {N Engl J Med}, volume = {365}, number = {8}, year = {2011}, month = {2011 Aug 25}, pages = {689-98}, abstract = {BACKGROUND: Acute exacerbations adversely affect patients with chronic obstructive pulmonary disease (COPD). Macrolide antibiotics benefit patients with a variety of inflammatory airway diseases. METHODS: We performed a randomized trial to determine whether azithromycin decreased the frequency of exacerbations in participants with COPD who had an increased risk of exacerbations but no hearing impairment, resting tachycardia, or apparent risk of prolongation of the corrected QT interval. RESULTS: A total of 1577 subjects were screened; 1142 (72\%) were randomly assigned to receive azithromycin, at a dose of 250 mg daily (570 participants), or placebo (572 participants) for 1 year in addition to their usual care. The rate of 1-year follow-up was 89\% in the azithromycin group and 90\% in the placebo group. The median time to the first exacerbation was 266 days (95\% confidence interval [CI], 227 to 313) among participants receiving azithromycin, as compared with 174 days (95\% CI, 143 to 215) among participants receiving placebo (P, keywords = {Aged, Anti-Bacterial Agents, Azithromycin, Bacterial Infections, Drug Resistance, Bacterial, Female, Humans, Macrolides, Male, Middle Aged, Nasopharynx, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Treatment Outcome}, issn = {1533-4406}, doi = {10.1056/NEJMoa1104623}, author = {Albert, Richard K and Connett, John and Bailey, William C and Casaburi, Richard and Cooper, J Allen D and Criner, Gerard J and Curtis, Jeffrey L and Dransfield, Mark T and Han, MeiLan K and Lazarus, Stephen C and Make, Barry and Marchetti, Nathaniel and Martinez, Fernando J and Madinger, Nancy E and McEvoy, Charlene and Niewoehner, Dennis E and Porsasz, Janos and Price, Connie S and Reilly, John and Scanlon, Paul D and Sciurba, Frank C and Scharf, Steven M and Washko, George R and Woodruff, Prescott G and Anthonisen, Nicholas R} } @article {1433741, title = {Chronic obstructive pulmonary disease exacerbations in the COPDGene study: associated radiologic phenotypes}, journal = {Radiology}, volume = {261}, number = {1}, year = {2011}, month = {2011 Oct}, pages = {274-82}, abstract = {PURPOSE: To test the hypothesis-given the increasing emphasis on quantitative computed tomographic (CT) phenotypes of chronic obstructive pulmonary disease (COPD)-that a relationship exists between COPD exacerbation frequency and quantitative CT measures of emphysema and airway disease. MATERIALS AND METHODS: This research protocol was approved by the institutional review board of each participating institution, and all participants provided written informed consent. One thousand two subjects who were enrolled in the COPDGene Study and met the GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria for COPD with quantitative CT analysis were included. Total lung emphysema percentage was measured by using the attenuation mask technique with a -950-HU threshold. An automated program measured the mean wall thickness and mean wall area percentage in six segmental bronchi. The frequency of COPD exacerbation in the prior year was determined by using a questionnaire. Statistical analysis was performed to examine the relationship of exacerbation frequency with lung function and quantitative CT measurements. RESULTS: In a multivariate analysis adjusted for lung function, bronchial wall thickness and total lung emphysema percentage were associated with COPD exacerbation frequency. Each 1-mm increase in bronchial wall thickness was associated with a 1.84-fold increase in annual exacerbation rate (P = .004). For patients with 35\% or greater total emphysema, each 5\% increase in emphysema was associated with a 1.18-fold increase in this rate (P = .047). CONCLUSION: Greater lung emphysema and airway wall thickness were associated with COPD exacerbations, independent of the severity of airflow obstruction. Quantitative CT can help identify subgroups of patients with COPD who experience exacerbations for targeted research and therapy development for individual phenotypes.}, keywords = {Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Phenotype, Pulmonary Disease, Chronic Obstructive, Severity of Illness Index, Tomography, X-Ray Computed}, issn = {1527-1315}, doi = {10.1148/radiol.11110173}, author = {Han, MeiLan K and Kazerooni, Ella A and Lynch, David A and Liu, Lyrica X and Murray, Susan and Curtis, Jeffrey L and Criner, Gerard J and Kim, Victor and Bowler, Russell P and Hanania, Nicola A and Anzueto, Antonio R and Make, Barry J and Hokanson, John E and Crapo, James D and Silverman, Edwin K and Martinez, Fernando J and Washko, George R} } @article {1433744, title = {Clinical and radiographic correlates of hypoxemia and oxygen therapy in the COPDGene study}, journal = {Respir Med}, volume = {105}, number = {8}, year = {2011}, month = {2011 Aug}, pages = {1211-21}, abstract = {BACKGROUND: Severe hypoxemia is a major complication of chronic obstructive pulmonary disease (COPD). Long-term oxygen therapy is beneficial in hypoxemic COPD patients. However, the clinical and radiographic predictors of hypoxemia and the use of oxygen therapy are not well described. This study aimed to find the correlates of resting hypoxemia and the pattern of oxygen use in moderate to severe COPD patients. METHODS: Subjects with GOLD stage II or higher COPD from the first 2500 COPDGene subjects were included in this analysis. All subjects were current or ex-smokers between ages 45 and 80. Severe resting hypoxemia was defined as room air oxygen saturation (SpO(2)) <=88\%. Use of supplemental oxygen therapy was determined by questionnaire. RESULTS: Eighty-two of 1060 COPD subjects (7.7\%) had severe resting hypoxemia. Twenty-one of the 82 (25.6\%) were not using continuous supplemental oxygen. Female sex, higher BMI, lower FEV(1), and enrollment in Denver were independent risk factors for hypoxemia; emphysema severity on quantitative chest CT scan did not predict hypoxemia. 132 of 971(13.6\%) subjects~without severe resting hypoxemia were using continuous supplemental oxygen. In~non-hypoxemic oxygen users, Denver recruitment, higher BMI, lower FEV(1), and more severe dyspnea were associated with the use of continuous oxygen. CONCLUSIONS: A large number of COPD patients without severe hypoxemia were using supplemental oxygen therapy and the pattern of oxygen use was affected by factors other than resting SpO(2) and emphysema severity. Longitudinal data will be required to reveal the effects of oxygen therapy in this subgroup. CLINICAL TRIAL REGISTRATION: http://clinicaltrials.gov (NCT00608764).}, keywords = {Aged, Aged, 80 and over, Female, Humans, Hypoxia, Male, Middle Aged, Oxygen Inhalation Therapy, Practice Guidelines as Topic, Pulmonary Disease, Chronic Obstructive, Quality of Life, Radiography, Rest, Risk Factors, Severity of Illness Index, Surveys and Questionnaires, Treatment Outcome}, issn = {1532-3064}, doi = {10.1016/j.rmed.2011.02.015}, author = {Kim, Deog Kyeom and Jacobson, Francine L and Washko, George R and Casaburi, Richard and Make, Barry J and Crapo, James D and Silverman, Edwin K and Hersh, Craig P} } @article {1433751, title = {Epidemiology, radiology, and genetics of nicotine dependence in COPD}, journal = {Respir Res}, volume = {12}, year = {2011}, month = {2011 Jan 13}, pages = {9}, abstract = {BACKGROUND: Cigarette smoking is the principal environmental risk factor for developing COPD, and nicotine dependence strongly influences smoking behavior. This study was performed to elucidate the relationship between nicotine dependence, genetic susceptibility to nicotine dependence, and volumetric CT findings in smokers. METHODS: Current smokers with COPD (GOLD stage >= 2) or normal spirometry were analyzed from the COPDGene Study, a prospective observational study. Nicotine dependence was determined by the Fagerstrom test for nicotine dependence (FTND). Volumetric CT acquisitions measuring the percent of emphysema on inspiratory CT (\% of lung , keywords = {Aged, Analysis of Variance, Case-Control Studies, Chi-Square Distribution, Female, Forced Expiratory Volume, Genetic Predisposition to Disease, Humans, Linear Models, Male, Middle Aged, Nerve Tissue Proteins, Phenotype, Polymorphism, Single Nucleotide, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Pulmonary Emphysema, Receptors, Nicotinic, Risk Assessment, Risk Factors, Severity of Illness Index, Smoking, Spirometry, Tobacco Use Disorder, Tomography, X-Ray Computed, United States}, issn = {1465-993X}, doi = {10.1186/1465-9921-12-9}, author = {Kim, Deog Kyeom and Hersh, Craig P and Washko, George R and Hokanson, John E and Lynch, David A and Newell, John D and Murphy, James R and Crapo, James D and Silverman, Edwin K} } @article {1433750, title = {Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system}, journal = {Gastrointest Endosc}, volume = {73}, number = {2}, year = {2011}, month = {2011 Feb}, pages = {315-21, 321.e1}, abstract = {BACKGROUND: Colonoscopy requires training and experience to ensure accuracy and safety. Currently, no objective, validated process exists to determine when an endoscopist has attained technical competence. Kinematics data describing movements of laparoscopic instruments have been used in surgical skill assessment to define expert surgical technique. We have developed a novel system to record kinematics data during colonoscopy and quantitatively assess colonoscopist performance. OBJECTIVE: To use kinematic analysis of colonoscopy to quantitatively assess endoscopic technical performance. DESIGN: Prospective cohort study. SETTING: Tertiary-care academic medical center. POPULATION: This study involved physicians who perform colonoscopy. INTERVENTION: Application of a kinematics data collection system to colonoscopy evaluation. MAIN OUTCOME MEASUREMENTS: Kinematics data, validated task load assessment instrument, and technical difficulty visual analog scale. RESULTS: All 13 participants completed the colonoscopy to the terminal ileum on the standard colon model. Attending physicians reached the terminal ileum quicker than fellows (median time, 150.19 seconds vs 299.86 seconds; p, keywords = {Biomechanical Phenomena, Clinical Competence, Colonoscopes, Colonoscopy, Equipment Design, Female, Humans, Internship and Residency, Male, Reproducibility of Results}, issn = {1097-6779}, doi = {10.1016/j.gie.2010.09.005}, author = {Obstein, Keith L and Patil, Vaibhav D and Jayender, Jagadeesan and San Jos{\'e} Est{\'e}par, Ra{\'u}l and Spofford, Inbar S and Lengyel, Balazs I and Kirby G. Vosburgh and Thompson, Christopher C} } @article {1433743, title = {Family history is a risk factor for COPD}, journal = {Chest}, volume = {140}, number = {2}, year = {2011}, month = {2011 Aug}, pages = {343-350}, abstract = {BACKGROUND: Studies have shown that family history is a risk factor for COPD, but have not accounted for family history of smoking. Therefore, we sought to identify the effects of family history of smoking and family history of COPD on COPD susceptibility. METHODS: We compared 821 patients with COPD to 776 control smokers from the Genetic Epidemiology of COPD (COPDGene) Study. Questionnaires captured parental histories of smoking and COPD, as well as childhood environmental tobacco smoke (ETS) exposure. Socioeconomic status was defined by educational achievement. RESULTS: Parental history of smoking (85.5\% case patients, 82.9\% control subjects) was more common than parental history of COPD (43.0\% case patients, 30.8\% control subjects). In a logistic regression model, parental history of COPD (OR, 1.73; P < .0001) and educational level (OR, 0.48 for some college vs no college; P < .0001) were significant predictors of COPD, but parental history of smoking and childhood ETS exposure were not significant. The population-attributable risk from COPD family history was 18.6\%. Patients with COPD with a parental history had more severe disease, with lower lung function, worse quality of life, and more frequent exacerbations. There were nonsignificant trends for more severe emphysema and airway disease on quantitative chest CT scans. CONCLUSIONS: Family history of COPD is a strong risk factor for COPD, independent of family history of smoking, personal lifetime smoking, or childhood ETS exposure. Although further studies are required to identify genetic variants that influence COPD susceptibility, clinicians should question all smokers, especially those with known or suspected COPD, regarding COPD family history.}, keywords = {Female, Genetic Predisposition to Disease, Humans, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Risk Factors, Smoking, Tobacco Smoke Pollution}, issn = {1931-3543}, doi = {10.1378/chest.10-2761}, author = {Hersh, Craig P and Hokanson, John E and Lynch, David A and Washko, George R and Make, Barry J and Crapo, James D and Silverman, Edwin K} } @article {1433747, title = {Intrathoracic tracheal volume and collapsibility on inspiratory and end-expiratory ct scans correlations with lung volume and pulmonary function in 85 smokers}, journal = {Acad Radiol}, volume = {18}, number = {3}, year = {2011}, month = {2011 Mar}, pages = {299-305}, abstract = {RATIONALE AND OBJECTIVES: To evaluate the correlations of tracheal volume and collapsibility on inspiratory and end-expiratory computed tomography (CT) with lung volume and with lung function in smokers. MATERIALS AND METHODS: The institutional review board approved this study at each institution. 85 smokers (mean age 68, range 45-87 years; 40 females and 45 males) underwent pulmonary function tests and chest CT at full inspiration and end-expiration. On both scans, intrathoracic tracheal volume and lung volume were measured. Collapsibility of the trachea and the lung was expressed as expiratory/inspiratory (E/I) ratios of these volumes. Correlations of the tracheal measurements with the lung measurements and with lung function were evaluated by the linear regression analysis. RESULTS: Tracheal volume showed moderate or strong, positive correlations with lung volume on both inspiratory (r = 0.661, P < .0001) and end-expiratory (r = 0.749, P < .0001) scans. The E/I ratio of tracheal volume showed a strong, positive correlation with the E/I ratio of lung volume (r = 0.711, P < .0001). A weak, negative correlation was found between the E/I ratio of tracheal volume and the ratio of forced expiratory volume in the first second to forced vital capacity (r = -0.436, P < .0001). Also, a weak, positive correlation was observed between the E/I ratio of tracheal volume and the ratio of residual volume to total lung capacity (r = 0.253, P = .02). CONCLUSIONS: Tracheal volume and collapsibility, measured by inspiratory and end-expiratory CT scans, is related to lung volume and collapsibility. The highly collapsed trachea on end-expiratory CT does not indicate more severe airflow limitation or air-trapping in smokers.}, keywords = {Aged, Female, Humans, Lung, Male, Middle Aged, Organ Size, Respiratory Mechanics, Smoking, Statistics as Topic, Tidal Volume, Tomography, X-Ray Computed, Trachea}, issn = {1878-4046}, doi = {10.1016/j.acra.2010.11.005}, author = {Yamashiro, Tsuneo and San Jos{\'e} Est{\'e}par, Ra{\'u}l and Matsuoka, Shin and Bartholmai, Brian J and Ross, James C and Diaz, Alejandro and Murayama, Sadayuki and Silverman, Edwin K and Hatabu, Hiroto and Washko, George R} } @article {1433749, title = {Kurtosis and skewness of density histograms on inspiratory and expiratory CT scans in smokers}, journal = {COPD}, volume = {8}, number = {1}, year = {2011}, month = {2011 Feb}, pages = {13-20}, abstract = {The aim of this study is to evaluate the relationship between lung function and kurtosis or skewness of lung density histograms on computed tomography (CT) in smokers. Forty-six smokers (age range 46?81 years), enrolled in the Lung Tissue Research Consortium, underwent pulmonary function tests (PFT) and chest CT at full inspiration and full expiration. On both inspiratory and expiratory scans, kurtosis and skewness of the density histograms were automatically measured by open-source software. Correlations between CT measurements and lung function were evaluated by the linear regression analysis. Although no significant correlations were found between inspiratory kurtosis or skewness and PFT results, expiratory kurtosis significantly correlated with the following: the percentage of predicted value of forced expiratory volume in the first second (FEV(1)), the ratio of FEV(1) to forced vital capacity (FVC), and the ratio of residual volume (RV) to total lung capacity (TLC) (FEV(1)\%predicted, R = -0.581, p < 0.001; FEV(1)/FVC, R = -0.612, p < 0.001; RV/TLC, R = 0.613, p < 0.001, respectively). Similarly, expiratory skewness showed significant correlations with PFT results (FEV(1)\%predicted, R = -0.584, p < 0.001; FEV(1)/FVC, R = -0.619, p < 0.001; RV/TLC, R = 0.585, p < 0.001, respectively). Also, the expiratory/inspiratory (E/I) ratios of kurtosis and skewness significantly correlated with FEV(1)\%predicted (p < 0.001), FEV(1)/FVC (p < 0.001), RV/TLC (p < 0.001), and the percentage of predicted value of diffusing capacity for carbon monoxide (kurtosis E/I ratio, p = 0.001; skewness E/I ratio, p = 0.03, respectively). We conclude therefore that expiratory values and the E/I ratios of kurtosis and skewness of CT densitometry reflect airflow limitation and air-trapping. Higher kurtosis or skewness on expiratory CT scan indicates more severe conditions in smokers.}, keywords = {Aged, Aged, 80 and over, Data Interpretation, Statistical, Female, Forced Expiratory Volume, Humans, Lung, Lung Diseases, Male, Middle Aged, Normal Distribution, Pulmonary Diffusing Capacity, Pulmonary Disease, Chronic Obstructive, Residual Volume, Smoking, Tomography, X-Ray Computed, Total Lung Capacity, Vital Capacity}, issn = {1541-2563}, doi = {10.3109/15412555.2010.541537}, author = {Yamashiro, Tsuneo and Matsuoka, Shin and San Jos{\'e} Est{\'e}par, Ra{\'u}l and Bartholmai, Brian J and Diaz, Alejandro and Ross, James C and Murayama, Sadayuki and Silverman, Edwin K and Hatabu, Hiroto and Washko, George R} } @article {1433746, title = {Lung volumes and emphysema in smokers with interstitial lung abnormalities}, journal = {N Engl J Med}, volume = {364}, number = {10}, year = {2011}, month = {2011 Mar 10}, pages = {897-906}, abstract = {BACKGROUND: Cigarette smoking is associated with emphysema and radiographic interstitial lung abnormalities. The degree to which interstitial lung abnormalities are associated with reduced total lung capacity and the extent of emphysema is not known. METHODS: We looked for interstitial lung abnormalities in 2416 (96\%) of 2508 high-resolution computed tomographic (HRCT) scans of the lung obtained from a cohort of smokers. We used linear and logistic regression to evaluate the associations between interstitial lung abnormalities and HRCT measurements of total lung capacity and emphysema. RESULTS: Interstitial lung abnormalities were present in 194 (8\%) of the 2416 HRCT scans evaluated. In statistical models adjusting for relevant covariates, interstitial lung abnormalities were associated with reduced total lung capacity (-0.444 liters; 95\% confidence interval [CI], -0.596 to -0.292; P, keywords = {Cohort Studies, Humans, Linear Models, Logistic Models, Lung, Lung Diseases, Interstitial, Pulmonary Disease, Chronic Obstructive, Pulmonary Emphysema, Pulmonary Fibrosis, Smoking, Spirometry, Tomography, X-Ray Computed, Total Lung Capacity}, issn = {1533-4406}, doi = {10.1056/NEJMoa1007285}, author = {Washko, George R and Hunninghake, Gary M and Fernandez, Isis E and Nishino, Mizuki and Okajima, Yuka and Yamashiro, Tsuneo and Ross, James C and San Jos{\'e} Est{\'e}par, Ra{\'u}l and Lynch, David A and Brehm, John M and Andriole, Katherine P and Diaz, Alejandro A and Khorasani, Ramin and D{\textquoteright}Aco, Katherine and Sciurba, Frank C and Silverman, Edwin K and Hatabu, Hiroto and Rosas, Ivan O} } @article {1433753, title = {Probabilistic elastography: estimating lung elasticity}, journal = {Inf Process Med Imaging}, volume = {22}, year = {2011}, month = {2011}, pages = {699-710}, abstract = {We formulate registration-based elastography in a probabilistic framework and apply it to study lung elasticity in the presence of emphysematous and fibrotic tissue. The elasticity calculations are based on a Finite Element discretization of a linear elastic biomechanical model. We marginalize over the boundary conditions (deformation) of the biomechanical model to determine the posterior distribution over elasticity parameters. Image similarity is included in the likelihood, an elastic prior is included to constrain the boundary conditions, while a Markov model is used to spatially smooth the inhomogeneous elasticity. We use a Markov Chain Monte Carlo (MCMC) technique to characterize the posterior distribution over elasticity from which we extract the most probable elasticity as well as the uncertainty of this estimate. Even though registration-based lung elastography with inhomogeneous elasticity is challenging due the problem{\textquoteright}s highly underdetermined nature and the sparse image information available in lung CT, we show promising preliminary results on estimating lung elasticity contrast in the presence of emphysematous and fibrotic tissue.}, keywords = {Data Interpretation, Statistical, Elastic Modulus, Elasticity Imaging Techniques, Emphysema, Humans, Lung, Pulmonary Fibrosis, Radiography}, issn = {1011-2499}, author = {Risholm, Petter and Ross, James and Washko, George R and Wells, William M} } @article {1433748, title = {Randomized trial of zileuton for treatment of COPD exacerbations requiring hospitalization}, journal = {COPD}, volume = {8}, number = {1}, year = {2011}, month = {2011 Feb}, pages = {21-9}, abstract = {RATIONALE: Leukotrienes have been implicated in the pathogenesis of acute exacerbations of COPD, but leukotriene modifiers have not been studied as a possible therapy for exacerbations. OBJECTIVE: We sought to test the safety and efficacy of adding oral zileuton (a 5-lipoxygenase inhibitor) to usual treatment for acute exacerbations of COPD requiring hospitalization. METHODS: Randomized double-blind, placebo-controlled, parallel group study of zileuton 600 mg orally, 4 times daily versus placebo for 14 days starting within 12 hours of hospital admission for COPD exacerbation. Primary outcome measure was hospital length of stay; secondary outcomes included treatment failure and biomarkers of leukotriene production. MAIN FINDINGS: Sixty subjects were randomized to zileuton and 59 to placebo (the study was stopped short of enrollment goals because of slow recruitment). There was no difference in hospital length of stay (3.75 +/- 2.19 vs. 3.86 +/- 3.06 days for zileuton vs. placebo, p = 0.39) or treatment failure (23\% vs. 27\% for zileuton vs. placebo, p = 0.63) despite a decline in urinary LTE(4) levels in the zileuton-treated group as compared to placebo at 24 hours (change in natural log-transformed ng/mg creatinine -1.38 +/- 1.19 vs. 0.14 +/- 1.51, p < 0.0001) and 72 hours (-1.32 +/- 2.08 vs. 0.26 +/- 1.93, p, keywords = {Aged, Biomarkers, Double-Blind Method, Drug Administration Schedule, Female, Hospitalization, Humans, Hydroxyurea, Length of Stay, Leukotriene B4, Leukotriene E4, Lipoxygenase Inhibitors, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Treatment Failure, Treatment Outcome}, issn = {1541-2563}, doi = {10.3109/15412555.2010.540273}, author = {Woodruff, Prescott G and Albert, Richard K and Bailey, William C and Casaburi, Richard and Connett, John E and Cooper, John A D and Criner, Gerard J and Curtis, Jeffrey L and Dransfield, Mark T and Han, MeiLan K and Harnden, Sarah M and Kim, Victor and Marchetti, Nathaniel and Martinez, Fernando J and McEvoy, Charlene E and Niewoehner, Dennis E and Reilly, John J and Rice, Kathryn and Scanlon, Paul D and Scharf, Steven M and Sciurba, Frank C and Washko, George R and Lazarus, Stephen C} } @article {1433752, title = {The relationship between small pulmonary vascular alteration and aortic atherosclerosis in chronic obstructive pulmonary disease: quantitative CT analysis}, journal = {Acad Radiol}, volume = {18}, number = {1}, year = {2011}, month = {2011 Jan}, pages = {40-6}, abstract = {RATIONALE AND OBJECTIVES: The relationship between chronic obstructive pulmonary disease (COPD) and atherosclerosis has been suggested; this association may relate to systemic inflammation and endothelial dysfunction, which can lead to alteration of small pulmonary vessels. The relationship between atherosclerosis and small pulmonary vessel alteration, however, has not been assessed in COPD patients. We tested the hypothesis that the severity of thoracic aortic calcification measured by computed tomography (CT) would be associated with the total cross-sectional area of small pulmonary vessels (CSA) on CT images. MATERIALS AND METHODS: The study was approved by the institutional review board and was Health Insurance Portability and Accountability Act-compliant. Informed consent was waived. For 51 COPD patients enrolled in the National Heart, Lung, and Blood Institute Lung Tissue Research Consortium, we calculated the percentage of total CSAs of less than 5 mm{\texttwosuperior} for the total lung area (\%CSA, keywords = {Aged, Aged, 80 and over, Aortic Diseases, Arteriosclerosis, Female, Humans, Lung, Male, Middle Aged, Pulmonary Artery, Pulmonary Disease, Chronic Obstructive, Retrospective Studies, Severity of Illness Index, Tomography, X-Ray Computed}, issn = {1878-4046}, doi = {10.1016/j.acra.2010.08.013}, author = {Matsuoka, Shin and Yamashiro, Tsuneo and Diaz, Alejandro and San Jos{\'e} Est{\'e}par, Ra{\'u}l and Ross, James C and Silverman, Edwin K and Kobayashi, Yasuyuki and Dransfield, Mark T and Bartholmai, Brian J and Hatabu, Hiroto and Washko, George R} } @article {473261, title = {Airway Extraction In Inspiratory Volumetric CT Using Scale-Space Particles}, journal = {American journal of respiratory and critical care medicineAmerican journal of respiratory and critical care medicine}, volume = {183}, year = {2011}, month = {Jun 17}, pages = {A4611}, author = {San Jose Est{\'e}par, Ra{\'u}l and Ross, James C and Kindlmann, Gordon L and Diaz, Alejandro A and Silverman, Edwin K and Washko, George R and COPDGene investigators} } @article {473296, title = {Epidemiology, radiology, and genetics of nicotine dependence in COPD.}, journal = {Respiratory researchRespiratory research}, volume = {12}, year = {2011}, pages = {9}, abstract = {BACKGROUND: Cigarette smoking is the principal environmental risk factor for developing COPD, and nicotine dependence strongly influences smoking behavior. This study was performed to elucidate the relationship between nicotine dependence, genetic susceptibility to nicotine dependence, and volumetric CT findings in smokers. METHODS: Current smokers with COPD (GOLD stage \>/= 2) or normal spirometry were analyzed from the COPDGene Study, a prospective observational study. Nicotine dependence was determined by the Fagerstrom test for nicotine dependence (FTND). Volumetric CT acquisitions measuring the percent of emphysema on inspiratory CT (\% of lung \<-950 HU) and gas trapping on expiratory CT (\% of lung \<-856 HU) were obtained. Genotypes for two SNPs in the CHRNA3/5 region (rs8034191, rs1051730) previously associated with nicotine dependence and COPD were analyzed for association to COPD and nicotine dependence phenotypes. RESULTS: Among 842 currently smoking subjects (335 COPD cases and 507 controls), 329 subjects (39.1\%) showed high nicotine dependence. Subjects with high nicotine dependence had greater cumulative and current amounts of smoking. However, emphysema severity was negatively correlated with the FTND score in controls (rho = -0.19, p \< .0001) as well as in COPD cases (rho = -0.18, p = 0.0008). Lower FTND score, male gender, lower body mass index, and lower FEV1 were independent risk factors for emphysema severity in COPD cases. Both CHRNA3/5 SNPs were associated with FTND in current smokers. An association of genetic variants in CHRNA3/5 with severity of emphysema was only found in former smokers, but not in current smokers. CONCLUSIONS: Nicotine dependence was a negative predictor for emphysema on CT in COPD and control smokers. Increased inflammation in more highly addicted current smokers could influence the CT lung density distribution, which may influence genetic association studies of emphysema phenotypes.}, author = {Kim, Deog Kyeom and Hersh, Craig P and Washko, George R and Hokanson, John E and Lynch, David A and Newell, John D and Murphy, James R and Crapo, James D and Silverman, Edwin K and COPDGene investigators} } @article {473281, title = {Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system.}, journal = {Gastrointestinal endoscopyGastrointestinal endoscopy}, volume = {73}, year = {2011}, month = {Mar}, pages = {315-21, 321.e1}, abstract = {BACKGROUND:Colonoscopy requires training and experience to ensure accuracy and safety. Currently, no objective, validated process exists to determine when an endoscopist has attained technical competence. Kinematics data describing movements of laparoscopic instruments have been used in surgical skill assessment to define expert surgical technique. We have developed a novel system to record kinematics data during colonoscopy and quantitatively assess colonoscopist performance.OBJECTIVE:To use kinematic analysis of colonoscopy to quantitatively assess endoscopic technical performance.DESIGN:Prospective cohort study.SETTING:Tertiary-care academic medical center.POPULATION:This study involved physicians who perform colonoscopy.INTERVENTION:Application of a kinematics data collection system to colonoscopy evaluation.MAIN OUTCOME MEASUREMENTS:Kinematics data, validated task load assessment instrument, and technical difficulty visual analog scale.RESULTS:All 13 participants completed the colonoscopy to the terminal ileum on the standard colon model. Attending physicians reached the terminal ileum quicker than fellows (median time, 150.19 seconds vs 299.86 seconds; p\<.01) with reduced path lengths for all 4 sensors, decreased flex (1.75 m vs 3.14 m; P=.03), smaller tip angulation, reduced absolute roll, and lower curvature of the endoscope. With performance of attending physicians serving as the expert reference standard, the mean kinematic score increased by 19.89 for each decrease in postgraduate year (P\<.01). Overall, fellows experienced greater mental, physical, and temporal demand than did attending physicians.LIMITATION:Small cohort size.CONCLUSION:Kinematic data and score calculation appear useful in the evaluation of colonoscopy technical skill levels. The kinematic score appears to consistently vary by year of training. Because this assessment is nonsubjective, it may be an improvement over current methods for determination of competence. Ongoing studies are establishing benchmarks and characteristic profiles of skill groups based on kinematics data.}, author = {Obstein, Keith L and Patil, Vaibhav D and Jayender, Jagadeesan and San Jose Est{\'e}par, Ra{\'u}l and Spofford, Inbar S and Lengyel, Balazs I and Kirby G. Vosburgh and Thompson, Christopher C} } @article {473291, title = {Image Registered Gastroscopic Ultrasound (IRGUS) in human subjects: a pilot study to assess feasibility}, journal = {EndoscopyEndoscopy}, volume = {43}, year = {2011}, pages = {394-399}, abstract = {BACKGROUND AND STUDY AIMS: Endoscopic ultrasound (EUS) is a complex procedure due to the subtleties of ultrasound interpretation, the small field of observation, and the uncertainty of probe position and orientation. Animal studies demonstrated that Image Registered Gastroscopic Ultrasound (IRGUS) is feasible and may be superior to conventional EUS in efficiency and image interpretation. This study explores whether these attributes of IRGUS will be evident in human subjects, with the aim of assessing the feasibility, effectiveness, and efficiency of IRGUS in patients with suspected pancreatic lesions. PATIENTS AND METHODS: This was a prospective feasibility study at a tertiary care academic medical center in human patients with pancreatic lesions on computed tomography (CT) scan. Patients who were scheduled to undergo conventional EUS were randomly chosen to undergo their procedure with IRGUS. Main outcome measures included feasibility, ease of use, system function, validated task load (TLX) assessment instrument, and IRGUS experience questionnaire. RESULTS: Five patients underwent IRGUS without complication. Localization of pancreatic lesions was accomplished efficiently and accurately (TLX temporal demand 3.7 \%; TLX effort 8.6 \%). Image synchronization and registration was accomplished in real time without procedure delay. The mean assessment score for endoscopist experience with IRGUS was positive (66.6 {\textpm} 29.4). Real-time display of CT images in the EUS plane and echoendoscope orientation were the most beneficial characteristics. CONCLUSIONS: IRGUS appears feasible and safe in human subjects, and efficient and accurate at identification of probe position and image interpretation. IRGUS has the potential to broaden the adoption of EUS techniques and shorten EUS learning curves. Clinical studies comparing IRGUS with conventional EUS are ongoing.}, author = {Obstein L, K and San Jose Est{\'e}par, Ra{\'u}l and J Jayender and Patil D, V and Spofford S, I and Ryan B, M and Lengyel I, B and R Shams and Vosburgh G, K and Thompson, CC} } @article {473271, title = {Intrathoracic tracheal volume and collapsibility on inspiratory and end-expiratory ct scans correlations with lung volume and pulmonary function in 85 smokers.}, journal = {Academic RadiologyAcademic Radiology}, volume = {18}, year = {2011}, month = {Apr}, pages = {299-305}, abstract = {RATIONALE AND OBJECTIVES:To evaluate the correlations of tracheal volume and collapsibility on inspiratory and end-expiratory computed tomography (CT) with lung volume and with lung function in smokers.MATERIALS AND METHODS:The institutional review board approved this study at each institution. 85 smokers (mean age 68, range 45-87 years; 40 females and 45 males) underwent pulmonary function tests and chest CT at full inspiration and end-expiration. On both scans, intrathoracic tracheal volume and lung volume were measured. Collapsibility of the trachea and the lung was expressed as expiratory/inspiratory (E/I) ratios of these volumes. Correlations of the tracheal measurements with the lung measurements and with lung function were evaluated by the linear regression analysis.RESULTS:Tracheal volume showed moderate or strong, positive correlations with lung volume on both inspiratory (r = 0.661, P \< .0001) and end-expiratory (r = 0.749, P \< .0001) scans. The E/I ratio of tracheal volume showed a strong, positive correlation with the E/I ratio of lung volume (r = 0.711, P \< .0001). A weak, negative correlation was found between the E/I ratio of tracheal volume and the ratio of forced expiratory volume in the first second to forced vital capacity (r = -0.436, P \< .0001). Also, a weak, positive correlation was observed between the E/I ratio of tracheal volume and the ratio of residual volume to total lung capacity (r = 0.253, P = .02).CONCLUSIONS:Tracheal volume and collapsibility, measured by inspiratory and end-expiratory CT scans, is related to lung volume and collapsibility. The highly collapsed trachea on end-expiratory CT does not indicate more severe airflow limitation or air-trapping in smokers.}, author = {Yamashiro, Tsuneo and San Jose Est{\'e}par, Ra{\'u}l and Matsuoka, Shin and Bartholmai, Brian J and Ross, James C and Diaz, Alejandro and Murayama, Sadayuki and Silverman, Edwin K and Hatabu, Hiroto and Washko, George R} } @article {473276, title = {Kurtosis and skewness of density histograms on inspiratory and expiratory CT scans in smokers.}, journal = {COPDCOPD}, volume = {8}, year = {2011}, month = {Mar}, pages = {13-20}, abstract = {The aim of this study is to evaluate the relationship between lung function and kurtosis or skewness of lung density histograms on computed tomography (CT) in smokers. Forty-six smokers (age range 46?81 years), enrolled in the Lung Tissue Research Consortium, underwent pulmonary function tests (PFT) and chest CT at full inspiration and full expiration. On both inspiratory and expiratory scans, kurtosis and skewness of the density histograms were automatically measured by open-source software. Correlations between CT measurements and lung function were evaluated by the linear regression analysis. Although no significant correlations were found between inspiratory kurtosis or skewness and PFT results, expiratory kurtosis significantly correlated with the following: the percentage of predicted value of forced expiratory volume in the first second (FEV(1)), the ratio of FEV(1) to forced vital capacity (FVC), and the ratio of residual volume (RV) to total lung capacity (TLC) (FEV(1)\%predicted, R = -0.581, p \< 0.001; FEV(1)/FVC, R = -0.612, p \< 0.001; RV/TLC, R = 0.613, p \< 0.001, respectively). Similarly, expiratory skewness showed significant correlations with PFT results (FEV(1)\%predicted, R = -0.584, p \< 0.001; FEV(1)/FVC, R = -0.619, p \< 0.001; RV/TLC, R = 0.585, p \< 0.001, respectively). Also, the expiratory/inspiratory (E/I) ratios of kurtosis and skewness significantly correlated with FEV(1)\%predicted (p \< 0.001), FEV(1)/FVC (p \< 0.001), RV/TLC (p \< 0.001), and the percentage of predicted value of diffusing capacity for carbon monoxide (kurtosis E/I ratio, p = 0.001; skewness E/I ratio, p = 0.03, respectively). We conclude therefore that expiratory values and the E/I ratios of kurtosis and skewness of CT densitometry reflect airflow limitation and air-trapping. Higher kurtosis or skewness on expiratory CT scan indicates more severe conditions in smokers.}, author = {Yamashiro, Tsuneo and Matsuoka, Shin and San Jose Est{\'e}par, Ra{\'u}l and Bartholmai, Brian J and Diaz, Alejandro and Ross, James C and Murayama, Sadayuki and Silverman, Edwin K and Hatabu, Hiroto and Washko, George R} } @article {473266, title = {Lung volumes and emphysema in smokers with interstitial lung abnormalities.}, journal = {The New England journal of medicineThe New England journal of medicine}, volume = {364}, year = {2011}, month = {Apr 10}, pages = {897-906}, abstract = {BACKGROUND: Cigarette smoking is associated with emphysema and radiographic interstitial lung abnormalities. The degree to which interstitial lung abnormalities are associated with reduced total lung capacity and the extent of emphysema is not known. METHODS: We looked for interstitial lung abnormalities in 2416 (96\%) of 2508 high-resolution computed tomographic (HRCT) scans of the lung obtained from a cohort of smokers. We used linear and logistic regression to evaluate the associations between interstitial lung abnormalities and HRCT measurements of total lung capacity and emphysema. RESULTS: Interstitial lung abnormalities were present in 194 (8\%) of the 2416 HRCT scans evaluated. In statistical models adjusting for relevant covariates, interstitial lung abnormalities were associated with reduced total lung capacity (-0.444 liters; 95\% confidence interval [CI], -0.596 to -0.292; P\<0.001) and a lower percentage of emphysema defined by lung-attenuation thresholds of -950 Hounsfield units (-3\%; 95\% CI, -4 to -2; P\<0.001) and -910 Hounsfield units (-10\%; 95\% CI, -12 to -8; P\<0.001). As compared with participants without interstitial lung abnormalities, those with abnormalities were more likely to have a restrictive lung deficit (total lung capacity \<80\% of the predicted value; odds ratio, 2.3; 95\% CI, 1.4 to 3.7; P\<0.001) and were less likely to meet the diagnostic criteria for chronic obstructive pulmonary disease (COPD) (odds ratio, 0.53; 95\% CI, 0.37 to 0.76; P\<0.001). The effect of interstitial lung abnormalities on total lung capacity and emphysema was dependent on COPD status (P\<0.02 for the interactions). Interstitial lung abnormalities were positively associated with both greater exposure to tobacco smoke and current smoking. CONCLUSIONS: In smokers, interstitial lung abnormalities--which were present on about 1 of every 12 HRCT scans--were associated with reduced total lung capacity and a lesser amount of emphysema. (Funded by the National Institutes of Health and the Parker B. Francis Foundation; ClinicalTrials.gov number, NCT00608764.).}, author = {Washko, George R and Hunninghake, Gary M and Fernandez, Isis E and Nishino, Mizuki and Okajima, Yuka and Yamashiro, Tsuneo and Ross, James C and San Jose Est{\'e}par, Ra{\'u}l and Lynch, David A and Brehm, John M and Andriole, Katherine P and Diaz, Alejandro A and Khorasani, Ramin and D\'Aco, Katherine and Sciurba, Frank C and Silverman, Edwin K and Hatabu, Hiroto and Rosas, Ivan O and COPDGene investigators} } @article {473286, title = {The relationship between small pulmonary vascular alteration and aortic atherosclerosis in chronic obstructive pulmonary disease: quantitative CT analysis.}, journal = {Academic RadiologyAcademic Radiology}, volume = {18}, year = {2011}, month = {Feb}, pages = {40-46}, abstract = {RATIONALE AND OBJECTIVES: The relationship between chronic obstructive pulmonary disease (COPD) and atherosclerosis has been suggested; this association may relate to systemic inflammation and endothelial dysfunction, which can lead to alteration of small pulmonary vessels. The relationship between atherosclerosis and small pulmonary vessel alteration, however, has not been assessed in COPD patients. We tested the hypothesis that the severity of thoracic aortic calcification measured by computed tomography (CT) would be associated with the total cross-sectional area of small pulmonary vessels (CSA) on CT images. MATERIALS AND METHODS: The study was approved by the institutional review board and was Health Insurance Portability and Accountability Act-compliant. Informed consent was waived. For 51 COPD patients enrolled in the National Heart, Lung, and Blood Institute Lung Tissue Research Consortium, we calculated the percentage of total CSAs of less than 5 mm(2) for the total lung area (\%CSA\<5). Thoracic aortic calcification, quantified by modified Agatston score, was measured. The correlations between thoracic aortic calcification score and \%CSA\<5, pulmonary function, and extent of emphysema were evaluated. Multiple linear regression analysis using aortic calcification score as the dependent outcome was also performed. RESULTS: The \%CSA\<5 had a significant negative correlation with the thoracic aortic calcification score (r = -0.566, P \< .0001). Multiple linear regression analysis showed significant correlation between the aortic calcification score and \%CSA\<5 (P \< .0001) independent of age, pack-years, extent of emphysema, and FEV1\%. CONCLUSIONS: Atherosclerosis, assessed by aortic calcification, is associated with the small pulmonary vascular alteration in COPD. Systemic inflammation and endothelial dysfunction may cause the close relationship between atherosclerosis and small pulmonary vessel alteration.}, author = {Matsuoka, Shin and Yamashiro, Tsuneo and Diaz, Alejandro and San Jose Est{\'e}par, Ra{\'u}l and Ross, James C and Silverman, Edwin K and Kobayashi, Yasuyuki and Dransfield, Mark T and Bartholmai, Brian J and Hatabu, Hiroto and Washko, George R} } @article {444381, title = {Gender differences of airway dimensions in anatomically matched sites on CT in smokers}, journal = {COPD}, volume = {8}, number = {4}, year = {2011}, month = {2011 Aug}, pages = {285-92}, abstract = {RATIONALE AND OBJECTIVES: There are limited data on, and controversies regarding gender differences in the airway dimensions of smokers. Multi-detector CT (MDCT) images were analyzed to examine whether gender could explain differences in airway dimensions of anatomically matched airways in smokers. MATERIALS AND METHODS: We used VIDA imaging software to analyze MDCT scans from 2047 smokers (M:F, 1021:1026) from the COPDGene{\textregistered} cohort. The airway dimensions were analyzed from segmental to subsubsegmental bronchi. We compared the differences of luminal area, inner diameter, wall thickness, wall area percentage (WA\%) for each airway between men and women, and multiple linear regression including covariates (age, gender, body sizes, and other relevant confounding factors) was used to determine the predictors of each airway dimensions. RESULTS: Lumen area, internal diameter and wall thickness were smaller for women than men in all measured airway (18.4 vs 22.5 mm(2) for segmental bronchial lumen area, 10.4 vs 12.5 mm(2) for subsegmental bronchi, 6.5 vs 7.7 mm(2) for subsubsegmental bronchi, respectively p < 0.001). However, women had greater WA\% in subsegmental and subsubsegmental bronchi. In multivariate regression, gender remained one of the most significant predictors of WA\%, lumen area, inner diameter and wall thickness. CONCLUSION: Women smokers have higher WA\%, but lower luminal area, internal diameter and airway thickness in anatomically matched airways as measured by CT scan than do male smokers. This difference may explain, in part, gender differences in the prevalence of COPD and airflow limitation.}, keywords = {Aged, Bronchography, Chi-Square Distribution, Female, Humans, Male, Pulmonary Disease, Chronic Obstructive, Radiographic Image Interpretation, Computer-Assisted, Regression Analysis, Respiratory Function Tests, Sex Factors, Smoking, Tomography, X-Ray Computed}, issn = {1541-2563}, doi = {10.3109/15412555.2011.586658}, author = {Kim, Yu-Il and Schroeder, Joyce and Lynch, David and Newell, John and Make, Barry and Friedlander, Adam and San Jos{\'e} Est{\'e}par, Ra{\'u}l and Hanania, Nicola A and Washko, George and Murphy, James R and Wilson, Carla and Hokanson, John E and Zach, Jordan and Butterfield, Kiel and Bowler, Russell P and Bowler, Russell P} }