Micro-CT uncovers emphysema missed by clinical CT in 30% of patients

Micro-CT detects emphysematous changes in 30% of patients with non-elevated low attenuation area (≤5%) on clinical CT; missed cases concentrate in ever-smokers, pre-COPD, and mild COPD; micro-CT mean linear intercept correlates with histology (r=0.84).

• In 89 patients (never-smokers, ever-smokers, pre-COPD, mild-to-severe COPD) undergoing spirometry and clinical CT before lung surgery, micro-CT mean linear intercept (MLI) correlated strongly with histological MLI (r=0.84, p<0.001).
• Clinical CT low attenuation area percentage correlated with micro-CT MLI (r=0.83, p<0.001), but 30% of patients with LAA ≤5% had elevated MLI, with undetected prevalence 22% in ever-smokers, 26% in pre-COPD, and 23% in mild COPD.
• The automated micro-CT MLI method is less labour-intensive than existing techniques and reveals limitations of LAA thresholding on clinical CT for subtle emphysema.

Automated summary

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