Relationships between diffusing capacity for carbon monoxide (DLCO), and quantitative computed tomography measurements and visual assessment for chronic obstructive pulmonary disease

• Quantitative CT measurements significantly correlated with DLCO/VA.
• 15th percentile HU had the strongest correlation with DLCO/VA.
• Visual scoring of emphysema had independent significant correlations with DLCO/VA.

PurposeTo evaluate the relationships between DLCO, and Quantitative CT (QCT) measurements and visual assessment of pulmonary emphysema and to test the relative roles of visual and quantitative assessment of emphysema.Materials and methodsThe subjects included 199 current and former cigarette smokers from the COPDGene cohort who underwent inspiratory and expiratory CT and also had diffusing capacity for carbon monoxide corrected for alveolar volume (DLCO/VA). Quantitative CT measurements included % low attenuation areas (%LAA−950ins = voxels ≤−950 Hounsfield unit (HU), % LAA−910ins, and % LAA−856ins), mean CT attenuation and 15th percentile HU value on inspiratory CT, and %LAA−856exp (voxels ≤−856 HU on expiratory CT). The extent of emphysema was visually assessed using a 5-point grading system. Univariate and multiple variable linear regression analyses were employed to evaluate the correlations between DLCO/VA and QCT parameters and visual extent of emphysema.ResultsThe DLCO/VA correlated most strongly with 15th percentile HU (R2 = 0.440, p < 0.001) closely followed by % LAA−950ins (R2 = 0.417, p < 0.001) and visual extent of emphysema (R2 = 0.411, p < 0.001). Multiple variable analysis showed that visual extent of emphysema and 15th percentile HU were independent significant predictors of DLCO/VA at an R2 of 0.599.Conclusions15th percentile HU seems the best parameter to represent the respiratory condition of COPD. Visual and Quantitative CT assessment of emphysema provide complementary information to QCT analysis.