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Authors Crossley D, Renton M, Khan M, Low EV, Turner AM
Received 1 June 2017
Accepted for publication 25 August 2017
Published 7 February 2018 Volume 2018:13 Pages 547—563
DOI https://doi.org/10.2147/COPD.S143066
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Charles Downs
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Background: The aim of the study was to assess the relationship between computed
tomography (CT) densitometry and routine clinical markers in patients with
chronic obstructive pulmonary disease (COPD) and alpha-1 anti-trypsin
deficiency (AATD).
Methods: Multiple databases were searched using a
combination of pertinent terms and those articles relating quantitatively
measured CT densitometry to clinical outcomes. Studies that used visual scoring
only were excluded, as were those measured in expiration only. A thorough
review of abstracts and full manuscripts was conducted by 2 reviewers; data
extraction and assessment of bias was conducted by 1 reviewer and the 4
reviewers independently assessed for quality. Pooled correlation coefficients
were calculated, and heterogeneity was explored.
Results: A total of 112 studies were identified, 82 being
suitable for meta-analysis. The most commonly used density threshold was −950
HU, and a significant association between CT density and all included clinical
parameters was demonstrated. There was marked heterogeneity between studies
secondary to large variety of disease severity within commonly included cohorts
and differences in CT acquisition parameters.
Conclusion: CT density shows a good relationship to clinically
relevant parameters; however, study heterogeneity and lack of longitudinal data
mean that it is difficult to compare studies or derive a minimal clinically
important difference. We recommend that international consensus is reached to
standardize CT conduct and analysis in future COPD and AATD studies.
Keywords: computed
tomography, CT, densitometry, emphysema, chronic obstructive pulmonary disease,
alpha-1 anti-trypsin deficiency