Image reconstruction affects computer tomographic assessment of lung hyperinflation.

OBJECTIVES: Lung hyperinflation may be assessed by computed tomography (CT). As shown for patients with emphysema, however, CT image reconstruction affects quantification of hyperinflation. We studied the impact of reconstruction parameters on hyperinflation measurements in mechanically ventilated (MV) patients. DESIGN: Observational analysis. SETTING: A University hospital-affiliated research Unit. PATIENTS: The patients were MV patients with injured (n = 5) or normal lungs (n = 6), and spontaneously breathing patients (n = 5). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Eight image series involving 3, 5, 7, and 10 mm slices and standard and sharp filters were reconstructed from identical CT raw data. Hyperinflated (V(hyper)), normally (V(normal)), poorly (V(poor)), and nonaerated (V(non)) volumes were calculated by densitometry as percentage of total lung volume (V(total)). V(hyper) obtained with the sharp filter systematically exceeded that with the standard filter showing a median (interquartile range) increment of 138 (62-272) ml corresponding to approximately 4% of V(total). In contrast, sharp filtering minimally affected the other subvolumes (V(normal), V(poor), V(non), and V(total)). Decreasing slice thickness also increased V(hyper) significantly. When changing from 10 to 3 mm thickness, V(hyper) increased by a median value of 107 (49-252) ml in parallel with a small and inconsistent increment in V(non) of 12 (7-16) ml. CONCLUSIONS: Reconstruction parameters significantly affect quantitative CT assessment of V(hyper) in MV patients. Our observations suggest that sharp filters are inappropriate for this purpose. Thin slices combined with standard filters and more appropriate thresholds (e.g., -950 HU in normal lungs) might improve the detection of V(hyper). Different studies on V(hyper) can only be compared if identical reconstruction parameters were used.