[Screening for alpha1-antitrypsin deficiency using dried blood spot: Assessment of the first 20 months]. / Dépistage du déficit en alpha1-antitrypsine sur sang capillaire recueilli sur papier-filtre : bilan des 20 premiers mois.

INTRODUCTION: Alpha1-antitrypsin deficiency is a predisposing factor for pulmonary disease and under-diagnosis is a significant problem. The results of a targeted screening in patients with respiratory symptoms possibly indicative of severe deficiency are reported here. METHODS: Data were collected from March 2016 to October 2017 on patients who had a capillary blood sample collected during a consultation with a pulmonologist and sent to the laboratory for processing to determine alpha1-antitrypsin concentration, phenotype and possibly genotype. RESULTS: In 20 months, 3728 test kits were requested by 566 pulmonologists and 718 (19 %) specimens sent: among these, 708 were analyzable and 613 were accompanied by clinical information. Of the 708 samples, 70 % had no phenotype associated with quantitative alpha1- antitrypsin deficiency, 7 % had a phenotype associated with a severe deficiency and 23 % had a phenotype associated with an intermediate deficiency. One hundred and eight patients carried at least one PI*Z allele which is considered to be a risk factor for liver disease. CONCLUSIONS: The results of this targeted screening program for alpha1- antitrypsin deficiency using a dried capillary blood sample reflect improvement in early diagnosis of this deficiency in lung disease with good adherence of the pulmonologists to this awareness campaign.

An open-source framework for pulmonary fissure completeness assessment.

We present an open-source framework for pulmonary fissure completeness assessment. Fissure incompleteness has been shown to associate with emphysema treatment outcomes, motivating the development of tools that facilitate completeness estimation. Generally, the task of fissure completeness assessment requires accurate detection of fissures and definition of the boundary surfaces separating the lung lobes. The framework we describe acknowledges a) the modular nature of fissure detection and lung lobe segmentation (lobe boundary detection), and b) that methods to address these challenges are varied and continually developing. It is designed to be readily deployable on existing lung lobe segmentation and fissure detection data sets. The framework consists of multiple components: a flexible quality control module that enables rapid assessment of lung lobe segmentations, an interactive lobe segmentation tool exposed through 3D Slicer for handling challenging cases, a flexible fissure representation using particles-based sampling that can handle fissure feature-strength or binary fissure detection images, and a module that performs fissure completeness estimation using voxel counting and a novel surface area estimation approach. We demonstrate the usage of the proposed framework by deploying on 100 cases exhibiting various levels of fissure completeness. We compare the two completeness level approaches and also compare to visual reads. The code is available to the community via github as part of the Chest Imaging Platform and a 3D Slicer extension module.

Do We Need to Assess Quality-of-Life with Both the St George's Respiratory Questionnaire and the EuroQol 5-Dimension Questionnaire in a Clinical Study with an Economic Component: Insights from the REVOLENS Study in Severe Emphysema.

Introduction: The use of two quality-of-life questionnaires in a single clinical trial with an economic component can be challenging due to the associated workload in terms of data collection and an increased risk of missing data. The aim of our study was to determine whether the questionnaire chosen to measure health status, the St. George's Respiratory Questionnaire (SGRQ), could be administered on its own without adding the EuroQol five dimensions questionnaire (EQ-5D) for economic evaluation in emphysema studies. Materials and Methods: Data were prospectively collected during the REVOLENS trial assessing endobronchial coil treatment in severe emphysema. To quantify the association between the two questionnaires, correlations between the EQ-5D and the SGRQ were first tested and the concordance was then studied in order to know whether the two questionnaires were interchangeable. Finally, the Starkie et al algorithm predicting EQ-5D utility values from the SGRQ was used on REVOLENS's individual patient data. The Student's t-test, correlation and concordance between EQ-5D individual value (from the REVOLENS study) and predicted value (from the Starkie et al algorithm) were studied to test this algorithm. Results: Results showed a strong correlation but no concordance between the EQ-5D and the SGRQ, demonstrating that the two questionnaires are not interchangeable. Moreover, the algorithm predicting EQ-5D utilities from the SGRQ did not provide utility values comparable to those observed in the REVOLENS study. Indeed, our study demonstrated a strong correlation between predicted and individual EQ-5D values but no concordance. Conclusion: The use of both the EQ-5D and the SGRQ in a clinical study with an economic component is justified. Based on our results, the SGRQ should not be used to obtain a utility score to calculate the incremental cost-effectiveness ratio and conclude on the efficiency of an intervention in emphysema patients.

Clinical Features Of Women With COPD: Sex Differences In A Cross-Sectional Study In Spain ("The ESPIRAL-ES Study").

Aim: This cross-sectional multicenter study was performed aimed at describing the clinical characteristics of women with COPD attended in routine daily practice in Spain. Methods and results: Of a total of 1610 consecutive patients diagnosed with COPD recruited in primary care centers and pneumology services throughout Spain over a 90-day period, 17.9% (n=286) were women, with a median age of 62 years. Differences in COPD phenotypes by sex were statistically significant (P = 0.002). Males as compared with females showed a higher prevalence of non-exacerbator (47.9% vs 42.2%) and exacerbator with chronic bronchitis (22.9% vs 18.8%) phenotypes, whereas the ACOS phenotype was more common among females (21.7% vs 12.9%). The mean (SD) CAT score was similar in men than in women (20.8 [9.0] vs 21.2 [8.7], P = 0.481), as well as the impact of the disease on the quality of life according to CAT scores of <5 (no impact), 5-9 (low), 10-20 (medium), >20 (high), and >30 (very high). Sex-related differences according to smoking status were statistically significant (P < 0.001), with a higher percentage of men as compared with women in the groups of current smokers and ex-smokers; never-smokers were higher in women (9.1%) than in men (0.6%). The mean number of comorbidities was 2.01 (1.43) (95% CI 1.93-2.09) in males and 1.99 (1.42) (95% CI 1.83-2.16) (P = 0.930) in females, but cardiovascular diseases (hypertension, ischemic heart disease, chronic heart failure) were more frequent in men, whereas metabolic disorders (osteoporosis) were more frequent in women. Conclusion: This study highlights the impact of COPD in women and the importance of continuing sex-based research in tobacco-related respiratory diseases.

Survival associated with chronic obstructive pulmonary disease among SEER-Medicare beneficiaries with non-small-cell lung cancer.

Objective: We investigated the impact of preexisting COPD and its subtypes, chronic bronchitis and emphysema, on overall survival among Medicare enrollees diagnosed with non-small-cell lung cancer (NSCLC). Methods: Using SEER-Medicare data, we included patients ≥66 years of age diagnosed with NSCLC at any disease stage between 2006 and 2010 and continuously enrolled in Medicare Parts A and B in the 12 months prior to diagnosis. Preexisting COPD in patients with NSCLC were identified using ICD-9 codes. Kaplan-Meier method and log-rank tests were used to examine overall survival by COPD status and COPD subtype. Multivariable Cox proportional hazards models were fit to assess the risk of death after cancer diagnosis. Results: We identified 66,963 lung cancer patients. Of these, 22,497 (33.60%) had documented COPD before NSCLC diagnosis. For each stage of NSCLC, median survival was shorter in the COPD compared to the non-COPD group (Stage I: 692 days vs 1,130 days, P<0.0001; Stage II: 473 days vs 627 days, P<0.0001; Stage III: 224 days vs 229 days; P<0.0001; Stage IV: 106 days vs 112 days, P<0.0001). For COPD subtype, median survival for patients with preexisting chronic bronchitis was shorter compared to emphysema across all stages of NSCLC (Stage I: 672 days vs 811 days, P<0.0001; Stage II 582 days vs 445 days, P<0.0001; Stage III: 255 days vs 229 days, P<0.0001; Stage IV: 105 days vs 112 days, P<0.0001). In Cox proportional hazard model, COPD patients exhibited 11% increase in risk of death than non-COPD patients (HR: 1.11, 95%CI: 1.09-1.13). Conclusion: NSCLC patients with preexisting COPD had shorter survival with marked differences in early stages of lung cancer. Chronic bronchitis demonstrated a greater association with time to death than emphysema.

Assessment of emphysema severity as measured on three-dimensional computed tomography images for predicting respiratory complications after lung surgery.

OBJECTIVES: Emphysema is one of the main causes of respiratory complications in patients operated on for lung cancer. We have used three-dimensional computed tomography (3D CT) for surgical simulations, as well as for depicting emphysematous areas as low attenuation areas (LAAs) and visual scores based on the Goddard classification (Goddard score), which is a visual scale of the area of vascular disruption and LAA for each lung field. This study aimed to investigate the effectiveness of the 3D CT function for assessing emphysema severity and its association with respiratory complications. METHODS: The study included 504 lung cancer patients who had preoperative 3D CT from October 2010 to March 2015. Goddard score and LAA% (LAA/total lung volume) were measured using 3D CT data. The relationship between respiratory complications and independent variables was investigated. RESULTS: Postoperative respiratory complications were observed in 69 (13.6%) patients. The receiver operating characteristic curves for respiratory complications determined using the Goddard score and LAA% dichotomized at each cut-off level (1 and 0.7%, respectively) showed that the events were observed in 32% of the patients with a Goddard score ≥1 and in 25% of the patients with an LAA% ≥0.7. On multivariable analyses, the Goddard score was significantly correlated with postoperative respiratory complications (P < 0.001). CONCLUSIONS: Preoperative measurement of the Goddard score and LAA% using 3D CT in patients with lung cancer, particularly with the coexistence of emphysema, was beneficial for predicting postoperative respiratory complications.

When can computed tomography-fissure analysis replace Chartis collateral ventilation assessment in the prediction of patients with emphysema who might benefit from endobronchial valve therapy?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was when can computed tomography-fissure analysis replace Chartis collateral ventilation assessment in the prediction of patients with emphysema who might benefit from endobronchial valve therapy? Twelve papers were chosen to answer the question. The authors, date, journal, country of publication and study type; patient group studied; relevant outcomes and results of these papers were tabulated. Five studies retrospectively compared the prognostic value of 2 methods. They found that when computed tomography-fissure analysis showed an intact fissure more than 95%, both methods were equivalent in correctly predicting a positive response to valve therapy. Concordant results were found in two-thirds of patients, and the additional evaluation with Chartis did not confer a significant advantage. Yet the increasing cost and time to procedure, the different ranges of Chartis findings patterns not correlated with lung volume reduction and the unfeasibility of the measurements (reported in 6-17% of the most series) due to difficult anatomy are additional limitations for its use. Conversely, in patients with fissure integrity between 75% and 90%, Chartis assessment could improve the patient selection, because the computed tomography-fissure analysis alone is unable to predict a successful treatment. In this situation, Chartis had a 31% ability to predict those patients who can be successfully treated. In BeLieVer-HIfi Study, post hoc analysis revealed that the additional use of Chartis for patient selection significantly improved outcomes. Similarly, STELVIO, LIVE and IMPACT studies, where only patients with complete fissure and negative Chartis measurement were treated, showed significant benefits after valve treatment. Finally, in patients with fissure integrity below 75%, the negative predictive value for lobar atelectasis is 100%. Thus, in these patients, it could be futile even considering a Chartis assessment.

Assessment of regional emphysema, air-trapping and Xenon-ventilation using dual-energy computed tomography in chronic obstructive pulmonary disease patients.

OBJECTIVES: To compare the parenchymal attenuation change between inspiration/expiration CTs with dynamic ventilation change between xenon wash-in (WI) inspiration and wash-out (WO) expiration CTs. METHODS: 52 prospectively enrolled COPD patients underwent xenon ventilation dual-energy CT during WI and WO periods and pulmonary function tests (PFTs). The parenchymal attenuation parameters (emphysema index (EI), gas-trapping index (GTI) and air-trapping index (ATI)) and xenon ventilation parameters (xenon in WI (Xe-WI), xenon in WO (Xe-WO) and xenon dynamic (Xe-Dyna)) of whole lung and three divided areas (emphysema, hyperinflation and normal) were calculated on virtual non-contrast images and ventilation images. Pearson correlation, linear regression analysis and one-way ANOVA were performed. RESULTS: EI, GTI and ATI showed a significant correlation with Xe-WI, Xe-WO and Xe-Dyna (EI R = -.744, -.562, -.737; GTI R = -.621, -.442, -.629; ATI R = -.600, -.421, -.610, respectively, p < 0.01). All CT parameters showed significant correlation with PFTs except forced vital capacity (FVC). There was a significant difference in GTI, ATI and Xe-Dyna in each lung area (p < 0.01). CONCLUSIONS: The parenchymal attenuation change between inspiration/expiration CTs and xenon dynamic change between xenon WI- and WO-CTs correlate significantly. There are alterations in the dynamics of xenon ventilation between areas of emphysema. KEY POINTS: • The xenon ventilation change correlates with the parenchymal attenuation change. • The xenon ventilation change shows the difference between three lung areas. • The combination of attenuation and xenon can predict more accurate PFTs.

Low cost biological lung volume reduction therapy for advanced emphysema.

BACKGROUND: Bronchoscopic lung volume reduction (BLVR), using biological agents, is one of the new alternatives to lung volume reduction surgery. OBJECTIVES: To evaluate efficacy and safety of biological BLVR using low cost agents including autologous blood and fibrin glue. METHODS: Enrolled patients were divided into two groups: group A (seven patients) in which autologous blood was used and group B (eight patients) in which fibrin glue was used. The agents were injected through a triple lumen balloon catheter via fiberoptic bronchoscope. Changes in high resolution computerized tomography (HRCT) volumetry, pulmonary function tests, symptoms, and exercise capacity were evaluated at 12 weeks postprocedure as well as for complications. RESULTS: In group A, at 12 weeks postprocedure, there was significant improvement in the mean value of HRCT volumetry and residual volume/total lung capacity (% predicted) (P-value: <0.001 and 0.038, respectively). In group B, there was significant improvement in the mean value of HRCT volumetry and (residual volume/total lung capacity % predicted) (P-value: 0.005 and 0.004, respectively). All patients tolerated the procedure with no mortality. CONCLUSION: BLVR using autologous blood and locally prepared fibrin glue is a promising method for therapy of advanced emphysema in term of efficacy, safety as well as cost effectiveness.

European Non-Communicable Respiratory Disease Research, 2002-13: Bibliometric Study of Outputs and Funding.

This study was conducted in order to map European research in chronic respiratory diseases (CRDs). It was intended to assist the European Commission and other research funders to identify gaps and overlaps in their portfolios, and to suggest ways in which they could improve the effectiveness of their support and increase the impact of the research on patient care and on the reduction of the incidence of the CRDs. Articles and reviews were identified in the Web of Science on research in six non-communicable respiratory diseases that were published in 2002-13 from 31 European countries. They represented only 0.8% of biomedical research output but these diseases accounted for 4.7% of the European disease burden, as measured by Disability-Adjusted Life Years (DALYs), so the sub-field is seriously under-researched. Europe is prominent in the sub-field and published 56% of the world total, with the UK the most productive and publishing more than France and Italy, the next two countries, combined. Asthma and Chronic Obstructive Pulmonary Disease (COPD) were the diseases with the most publications and the highest citation rates. They also received the most funding, with around two acknowledgments per paper (in 2009-13), whereas cystic fibrosis and emphysema averaged only one. Just over 37% of papers had no specific funding and depended on institutional support from universities and hospitals.

COMPARATIVE ASSESSMENT OF THORACOSCOPY AND DESTRUCTION OF PULMONARY BULLAS COMBINED WITH PLEURODESIS AND PLEURECTOMY.

The article presents the results of thoracoscopic surgeries in case of bullous emphysema of the lung in 88 patients. The patients have been divided into 2 groups according to the method of treatment: 1) destruction of pulmonary bullas and pleurodesis using diathermic electrocoagulation (42 people); 2) destruction of pulmonary bullas and subtotal pleurectomy (47 people). The operative periods weren't statistically differentiated in patient's groups. The volume of hemorrhage and exudation period from the pleural cavity were significantly higher in patient's group, where patients underwent pleurectomy. However, lung spreading terms and ending of air leakage, periods of drains removal from the pleural cavity, hospital stay and rate of pneumothorax recurrence were considerably smaller in the group without application of pleurodesis.

Influence of pulmonary emphysema on COPD assessment test-oriented categorization in GOLD document.

BACKGROUND: The COPD assessment test (CAT) score is a key component of the multifactorial assessment of COPD in the Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines of 2014. Nevertheless, little is known regarding the differences among COPD categories in terms of clinical parameters such as pulmonary function or radiological findings. Thus, our aims in this study were to evaluate the associations between CAT scores and pulmonary clinical parameters, and to investigate factors that could discriminate between a "less symptomatic group" (categories A and C) and a "more symptomatic group" (categories B and D) among stable COPD patients. METHODS: We enrolled 200 outpatients at Chiba University Hospital. Study subjects were assessed by CAT, pulmonary function testing, and multidetector computed tomography (MDCT). We assessed possible correlations between these indices. RESULTS: CAT scores were negatively correlated with percentage of the forced expiratory volume in 1 second predicted value (FEV1 %predicted) and percentage of the diffusing capacity for carbon monoxide per liter of lung volume predicted value (DLCO/VA [%predicted]) results and positively correlated with low attenuation volume percentage (LAV%) and residual volume to total lung capacity ratios (RV/TLC). In the "more symptomatic group" (category B or D), the mean DLCO/VA (%predicted) was significantly lower and the mean LAV% and RV/TLC was significantly higher than those in the "less symptomatic group" (category A or C), respectively. Interestingly, those in category B had higher mean LAV% compared to those in category C. CONCLUSION: CAT scores were significantly correlated with pulmonary function parameters and emphysematous changes on MDCT. The new GOLD classification system would be a step toward a phenotypic approach, especially taking into account the degree of emphysema and hyperinflation.

The effect of comorbidities on COPD assessment: a pilot study.

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) frequently suffer from comorbidities. COPD severity may be evaluated by the Global initiative for chronic Obstructive Lung Disease (GOLD) combined risk assessment score (GOLD score). Spirometry, body plethysmography, diffusing capacity of the lung for carbon monoxide (DLCO), and high-resolution computed tomography (HR-CT) measure lung function and elucidate pulmonary pathology. This study assesses associations between GOLD score and measurements of lung function in COPD patients with and without (≤1) comorbidities. It evaluates whether the presence of comorbidities influences evaluation by GOLD score of COPD severity, and questions whether GOLD score describes morbidity rather than COPD severity. METHODS: In this prospective study, 106 patients with stable COPD were included. Patients treated for lung cancer were excluded. Demographics, oxygen saturation (SpO2), modified Medical Research Council Dyspnea Scale, COPD exacerbations, and comorbidities were recorded. Body plethysmography and DLCO were measured, and HR-CT performed and evaluated for emphysema and airways disease. COPD severity was stratified by the GOLD score. Correlation analyses: 1) GOLD score, 2) emphysema grade, and 3) airways disease and lung function parameters, described by: forced expiratory volume in the first second in percent of expected value (FEV1%), inspiratory capacity (IC%), total lung volume (TLC%), IC/TLC, and SpO2. Correlation analyses between subgroups and hierarchical cluster analysis were performed. RESULTS: Significant associations were found between GOLD score and both emphysema grade (correlation coefficients [cc]: -0.2, P=0.03) and lung function parameters (cc: -0.5 to -0.7, P-values all <0.001) weakened in patients with >1 comorbidity (cc: -0.4 to -0.5, P-values all 0.001). Significant differences between subgroups were found in GOLD score and both FEV1% (cc: -0.2, P=0.02) and IC/TLC (cc: -0.2, P=0.02). Comorbidities were associated with GOLD score and composite measures in hierarchical cluster analysis. CONCLUSION: The presence of comorbidities influences the relationship between GOLD score and lung function measurements. GOLD score may be more representative of morbidity than of COPD severity.

The COPD assessment test correlates well with the computed tomography measurements in COPD patients in China.

BACKGROUND: The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a validated simple instrument to assess health status, and it correlates well with the severity of airway obstruction in COPD patients. However, little is known about the relationships between CAT scores and quantitative computed tomography (CT) measurements of emphysema and airway wall thickness in COPD patients in the People's Republic of China. METHODS: One hundred and twelve participants including 63 COPD patients and 49 normal control subjects were recruited. All participants were examined with high-resolution CT to get the measurements of emphysema (percentage of pixels below -950 HU [%LAA-950]) and airway wall thickness (wall area percentage and the ratio of airway wall thickness to total diameter). Meanwhile, they completed the CAT and modified Medical Research Council questionnaire independently. RESULTS: Significantly higher CAT scores and CT measurements were found in COPD patients compared with normal control subjects (P<0.05), and there was a tendency of higher CAT scores and CT measurements with increasing disease severity measured by GOLD staging system. Positive correlations were found between CAT scores and CT measurements (P<0.01). Using multiple linear stepwise regression, CAT score =-46.38+0.778× (wall area percentage) +0.203× (%LAA-950) (P<0.001). Meanwhile, CAT scores and CT measurements in COPD patients all positively correlated with the modified Medical Research Council grades and negatively correlated with FEV1% (P<0.01). CONCLUSION: CAT scores correlate well with the quantitative CT measurements in COPD patients, which may provide an imaging evidence that the structural changes of the lungs in this disease are associated with the health status measured by CAT.

MR Quantitative Equilibrium Signal Mapping: A Reliable Alternative to CT in the Assessment of Emphysema in Patients with Chronic Obstructive Pulmonary Disease.

PURPOSE: To compare magnetic resonance (MR) quantitative equilibrium signal (qS0) mapping with quantitative computed tomography (CT) in the estimation of emphysema in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Written informed consent of the original study permitted future reanalysis of data. This study was a retrospective analysis of data from an institutional review board-approved study. Twenty-four patients with COPD and 12 healthy patients who did not smoke underwent spirometry and two separate 1.5-T MR imaging examinations. All patients with COPD underwent additional chest CT. Lung MR qS0 maps were generated from MR images obtained with multiple inversion times by fitting the inversion recovery signal equation. Mean, 15th percentile, and standard deviation of whole-lung qS0 and relative lung area with a qS0 value below 0.20 (RA0.20) were measured and compared between groups with an unpaired t test. Reproducibility between two examinations was tested with intraclass correlation coefficients (ICCs), and their associations with spirometry and CT measurements of 15th percentile attenuation (PA15) and relative lung area with attenuation below -950 HU (RA-950) were assessed with the Pearson correlation coefficient. RESULTS: Whole-lung mean qS0 and 15th percentile of qS0 were significantly lower, whereas RA0.20 and standard deviation of qS0 were significantly higher in patients with COPD than in healthy control subjects (P = .014, P = .002, P = .005, and P < .001, respectively). Whole-lung mean qS0, the 15th percentile of qS0, and RA0.20 strongly correlated with RA-950 (r = -0.78, r = -0.81, and r = 0.86, respectively; P < .001) and PA15 (r = 0.78, r = 0.79, and r = -0.71, respectively; P < .001) and moderately correlated with the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (r = 0.63, r = 0.67, and r = -0.60, respectively; P < .001) and percentage predicted FEV1 (r = 0.54, r = 0.62, and r = -0.56, respectively; P ≤ .001). Good reproducibility of qS0 readouts was found in both groups (ICC range, 0.89-0.98). CONCLUSION: Lung MR qS0 mapping may be a reliable noncontrast nonradiation alternative to CT in the assessment of emphysema in patients with COPD.

[ULTRASONIC ASSESSMENT OF DIAPHRAGM CONDITION OF THE PATIENTS, WHO PASSED THE SELECTION FOR LUNG VOLUME REDUCTION SURGERY].

The article showed the results of ultrasonic assessment of topographic and functional diaphragm indices in patients with severe diffuse emphysema. They passed the selection for lung volume reduction surgery. The comparison of diaphragm indices was presented in patients with diffuse emphysema and control group of healthy volunteers. Dynamics of diaphragm condition was studied after surgical treatment. There wasn't noted any statistical difference of diaphragm topographic indices as compared with the control group. There wasn't shown a correlation between respiratory function indices and functional diaphragm indices, but it was noted a positive tendency in characteristics during quiet breathing.

Assessment of the relationship between morphological emphysema phenotype and corresponding pulmonary perfusion pattern on a segmental level.

PURPOSE: Distinct morphological emphysema phenotypes were assessed by CT to show characteristic perfusion defect patterns. MATERIAL/METHODS: Forty-one patients with severe emphysema (GOLD III/IV) underwent three-dimensional high resolution computed tomography (3D-HRCT) and contrast-enhanced magnetic resonance (MR) perfusion. 3D-HRCT data was visually analyzed for emphysema phenotyping and quantification by consensus of three experts in chest-radiology. The predominant phenotype per segment was categorized as normal, centrilobular, panlobular or paraseptal. Segmental lung perfusion was visually analyzed using six patterns of pulmonary perfusion (1-normal; 2-mild homogeneous reduction in perfusion; 3-heterogeneous perfusion without focal defects; 4-heterogeneous perfusion with focal defects; 5-heterogeneous absence of perfusion; 6-homogeneous absence of perfusion), with the extent of the defect given as a percentage. RESULTS: 730 segments were evaluated. CT categorized 566 (78%) as centrilobular, 159 (22%) as panlobular and 5 (<1%) as paraseptal with no normals. Scores with regards to MR perfusion patterns were: 1-0; 2-0; 3-28 (4%); 4-425 (58%); 5-169 (23%); 6-108 (15%). The predominant perfusion pattern matched as follows: 70 % centrilobular emphysema - heterogeneous perfusion with focal defects (score 4); 42% panlobular--homogeneous absence of perfusion (score 5); and 43% panlobular--heterogeneous absence of perfusion (score 6). CONCLUSION: MR pulmonary perfusion patterns correlate with the CT phenotype at a segmental level in patients with severe emphysema. KEY POINTS: • MR perfusion patterns correlate with the CT phenotype in emphysema. • Reduction of MR perfusion is associated with loss of lung parenchyma on CT • Centrilobular emphysema shows heterogeneous perfusion reduction while panlobular emphysema shows loss of perfusion.