THE ROLE OF COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF CHOBLE (LITERATURE REVIEW)

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Abstract

Chronic obstructive pulmonary disease (COPD) is a common human disease. Further increase of morbidity rate is predicted in the nearest years. Early diagnosis of COPD is of topical importance, and computed tomography (CT) is generally accepted as the "gold" standard for its diagnosis. Therefore, this publication presents a literature review on CT diagnostics of COPD.

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Volume 04 Issue 04-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

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ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a common human disease. Further increase of morbidity rate is
predicted in the nearest years. Early diagnosis of COPD is of topical importance, and computed tomography (CT) is
generally accepted as the "gold" standard for its diagnosis. Therefore, this publication presents a literature review on
CT diagnostics of COPD.

KEYWORDS

Computed tomography, chronic obstructive pulmonary disease.

Research Article


THE ROLE OF COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF
CHOBLE (LITERATURE REVIEW)

Submission Date:

April 05, 2022,

Accepted Date:

April 15, 2022,

Published Date:

April 28, 2022 |

Crossref doi:

https://doi.org/10.37547/TAJMSPR/Volume04Issue04-01


Khamidov Obid Abdurakhmonovich

Head of Department, Faculty of Postgraduate Education, medical radiology, Uzbekistan

Zhuraev Kamoliddin Danabayevich

Assistant Department, Faculty of Postgraduate Education, medical radiology, Uzbekistan

Khamrokulov Munis Mukhsinovich

Clinical intern at the Department of Medical Radiology, Uzbekistan

Azimova Kamola Alisherovna

Clinical intern at the Department of Medical Radiology, Uzbekistan

Sayfiev Davron Dilshod Ugli

Clinical Resident of the Department of Medical Radiology, Uzbekistan

Journal

Website:

https://theamericanjou
rnals.com/index.php/ta
jmspr

Copyright:

Original

content from this work
may be used under the
terms of the creative
commons

attributes

4.0 licence.


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Volume 04 Issue 04-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

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VOLUME

04

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1-7

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(2020:

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Publisher:

The USA Journals

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a
chronic inflammatory disease with predominant
involvement of the distal airways, lung parenchyma
and emphysema, characterised by initially partially
reversible and eventually irreversible bronchial
obstruction. According to the American Thoracic
Society, COPD is a preventable and treatable disease
that restricts airflow in the airways.

One of the problems with the term 'chronic obstructive
pulmonary disease' is that it is interpreted in two ways.
Firstly, COPD is a term describing a group of diseases in
which the leading clinical syndrome is airway
obstruction (chronic obstructive pulmonary disease).
Secondly, the term "chronic obstructive pulmonary
disease" corresponds to an independent nosological
form. The term "COPD" is preferable to "chronic
bronchitis", because the disease does not involve the
pathological. The pathological process involves not
only the bronchi, but also without exception all the
functional and structural elements of the lung tissue
(alveolar tissue, vascular system, pleura, respiratory
muscles). Understanding and knowing the features of
this pathology makes "COPD" a term that describes the
disease more fully and profoundly.

COPD is one of the most common human diseases. The
incidence of the disease is predicted to increase further
in the coming years. Epidemiological data on morbidity
and mortality often underestimate the significance and
prevalence of COPD, as it is usually not diagnosed until
clinically significant and relatively severe stages of the
disease develop. About 600 million people in the world
currently suffer from chronic obstructive pulmonary
disease. According to epidemiological studies, the
global prevalence of COPD is ~ 10.1% (11.8% men and
8.5% women). Specifically, the cumulative prevalence

of COPD is 4.6% in the USA, 7.4% in Europe and 11.4% in
South-East Asia.

A large-scale international PLATINO study conducted in
5 Latin American countries showed a prevalence of
COPD ranging from 7.8% (men 11%, women 5.6%) in
Mexico to 19.7% (men 27.1%, women 14.5%) in Uruguay
(MenezesA.M. etal. 2005). The prevalence in
Kazakhstan was 64.4 per 100,000 population; in 2014,
it was 73.5. - 73.5, an increase of 9.1 over the previous
year. By regions, the highest rate of COPD morbidity is
registered in South Kazakhstan Oblast - 145.5 per 100
thousand population, the lowest rate of COPD
morbidity is registered in Aktobe oblast - 19.4 per 100
thousand population [13, 14]. Mortality from COPD is
constantly increasing, and according to the World
Health Organization (WHO) forecasts, by 2020, COPD
will occupy the fifth place in the world's population.
COPD will rank fifth among all causes of death. A study
published in TheLancetRespiratoryMedicine 2017
found that 3.2 million people died of COPD worldwide
in 2015, an increase of 11.9% since 1990. At the same
time, the standardised age-specific mortality rate
decreased by 41.9%, (from 37.7 to 45.1), due to
population growth and an ageing world population.
The main purpose of radiological examination of
patients with COPD is usually to rule out other diseases
or pathological conditions that may have similar clinical
manifestations or be combined with obstructive
disease. These include tuberculosis and lung cancer in
particular. The radiological examination of COPD
patients can be divided into two stages. The first is
aimed at the initial assessment of the thoracic organs
and usually involves the use of traditional radiography
- chest radiography in 2 projections (straight and right
lateral) with the patient upright, or fluoroscopy. Any of
these examinations are performed in almost all


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Volume 04 Issue 04-2022


The American Journal of Medical Sciences and Pharmaceutical Research
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VOLUME

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The USA Journals

patients with COPD at the stage of primary diagnosis
or during an acute episode of the disease. The second
stage consists of an in-depth study of the morphology
and function of the lung tissue and is aimed primarily at
detecting emphysema and bronchiectasis and
determining the type and extent of pathological
changes. Chest radiography is currently the routine
method of assessing the macrostructure and
anatomico-topographic condition of the pulmonary
tissue. However, the main manifestations of COPD,
such as pneumofibrosis and pulmonary emphysema,
can only be diagnosed by this method if they are
sufficiently widespread and pronounced. Other
imaging techniques such as ultrasound, radionuclide
and MRI are of limited value in the diagnosis of COPD.
However, the use of ventilatory perfusion scintigraphy
in static lung scintigraphy provides additional
scintigraphic criteria not only for limited, but also for
diffuse respiratory disease.

When considering a surgical procedure such as lung
volume reduction surgery, a chest CT scan is essential,
as the distribution of emphysema is one of the most
important factors in determining the indication for
surgery.

Early diagnosis of COPD is relevant, as it is not yet
known that there is a period in the development of
COPD, the timely diagnosis of which can radically affect
the course of the disease, i.e. to halt its progression .
Structural changes in the lung tissue far outstrip the
irreversible airway obstruction detected by external
respiratory function tests and estimated by statistical
averages of less than 80% of the proper values. In mild
COPD, no significant radiological changes are usually
detected on conventional chest film radiographs.
However, spirometry and clinical findings are not
considered to be abnormal in clinical stage zero chronic
obstructive pulmonary disease and therefore radiology

is more sensitive in detecting bronchial obstruction
than functional tests.

When patients in stage zero COPD are examined using
CT scanning, gross changes in the lung tissue are
detected. This raises the question of starting treatment
as early as possible. Computed tomography also helps
to rule out the presence of lung tumours, which are
much more likely to occur in chronically smokers than
in non-smokers. Computed tomography can detect
common congenital malformations in adults: cystic
lung,

lung

hypoplasia,

congenital

collateral

emphysema, bronchogenic cysts, bronchiectasias and
structural changes in lung tissue associated with other
lung diseases that may significantly affect the course of
COPD. COPD exacerbations are not to be forgotten. It
often requires not only additional therapy, but also
hospitalisation.

The

consequences

of

COPD

exacerbations

are

extremely

unfavourable:

acceleration of disease progression, deterioration of
patients' quality of life, and significant economic
losses. In exacerbations of COPD, radiological
examination is performed to rule out pneumonia or
lung abscess, as well as venous stasis and pulmonary
edema in left ventricular insufficiency. Currently, high-
resolution computed tomography (HRT) and its
modifications are considered the accepted gold
standard for the diagnosis of COPD, as confirmed by
numerous literature sources, which, unlike ICGG and
radiography, can detect pathognomonic symptoms of
COPD such as 'air traps', sabral tracheal deformity and
'tree in the kidney'.

The frequency of detection of these symptoms,
according to different sources, ranges from 25% to 75%.
However, the role of CT in the radiological diagnosis of
chronic obstructive pulmonary disease is still unclear
and is debated by many scientists. The clinical


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indications for CTPR in chronic obstructive pulmonary
disease are:

1.

Detection and staging of COPD, taking into
account the history of the disease (smoking
history, occupational inhalation exposures to the
lungs, frequent pneumonia in childhood).

2.

Diagnosis of possible lung complications, in
particular

pneumonia,

spontaneous

pneumothorax, various lung tumours, etc.

3.

When planning surgery on thoracic organs,
including lung transplantation.

Computed tomography in patients with COPD allows
the structure of the lung tissue and the condition of the
small bronchi to be assessed. For this purpose, CTBT is
used, which can be a variant of stepwise scanning or
performed in spiral mode on MSCT machines [15, 38].
CTVR can serve as a non-invasive method of detecting
morphological changes in the lungs in the early stages
of COPD, which enables to prescribe adequate
treatment in time and to judge the effectiveness of the
therapy. According to the results, almost half of the
examined patients with COPD (43.8%) showed no lung
changes, while CTVR revealed these changes.

According to M.V. Khrupenkova-Piven's data on COPD,
sensitivity, specificity, and prognostic predictive
indices of CTBP significantly exceed those of
conventional chest radiography, which suggests that
CTBP is a more informative technique for detection and
differential diagnosis of COPD, especially in the early
stages of the disease The sensitivity of CTBP method is
88.7% and specificity 95.4% that is significantly higher
than that of conventional radiography (11.3% and 65.5%,
respectively) [37]. According to Trishina N.N. (2009) CT
sensitivity in diagnostics of COPD is 90.3%, and for CTVR
95.2%. Specificity is 84.3% and 89.5%, and accuracy is
87.5% and 94.9% respectively. However, a number of
authors have noted disadvantages of CTVR in the

diagnosis of COPD. For example, a study by K.
Kurashima et al. (2005) showed that CTVR has a rather
high sensitivity and low specificity in the diagnosis of
COPD. Pulmonary emphysema was not detected by
CTVR in 18.6% of patients with COPD .

CTVR clarifies the localisation of the most airy areas in
the lungs. The densitometric density of normal lung
tissue ranges from -600 to -900 Ni. In emphysema, this
figure rises to -900l-1000 Ni. In addition, comparison of
the densitometric values of adjacent lung areas during
inspiration and exhalation helps to identify not only
overinflated but also poorly ventilated areas.
Aspiratory-expiratory CTVR is. Aspiratory-exhalation
CTVR combined with spirometry can determine the
extent of emphysema, while expiratory CTVR can
reflect airflow limitation and pulmonary hyperinflation.
Pulmonary hyperinflation is an increase in lung volume
at the end of spontaneous exhalation. Expiratory CTVR
allows a better assessment of airway conduction to
areas of the lung containing air traps.

Sections obtained during full exhalation are more
functionally informative than those obtained during
full exhalation. The most informative for density
estimation are lung areas at the level of tracheal
bifurcation (95%) and aortic arch (93%), to a lesser
extent - in the basal areas (83%). According to M.V.
Khrupenkova-Pivenvramkova, COPD develops at least
2 parallel pathological processes (emphysema and
obliterating bronchiolitis) having different symptoms
at CTBP. In COPD, obliterating bronchiolitis is
combined

with

infectious

bronchitis

and/or

bronchiolitis, often with emphysema, creating a
characteristic, often pathognomonic CT picture. In
addition, she believes that CTBP should be the method
of choice in the diagnosis of chronic obstructive
pulmonary disease, as compensated forms of COPD
can have normal functional test values and at the same


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time have CT signs of chronic obstructive pulmonary
disease. The clinical significance of the changes
detected may vary. This is due to the fact that COPD
patients have a combination of functional changes in
external

respiration

resulting

from

bronchial

obstruction, morphological changes typical of
emphysema, and pathological changes in the bronchial
tree characteristic of chronic bronchitis.

An aspiration-expiratory CT scan provides important
diagnostic information. It allows the quantification of
emphysema. Sections taken during full exhalation are
more functionally informative than those taken during
full exhalation. Equally importantly, the CT scan allows
the degree of ballooning of any part of the lung to be
judged. The changes between inspiration and
exhalation serve as an index of regional ventilation. A
series of slices determines the condition of all parts of
the bronchial tree, reveals peri-ribronchial infiltrates,
presence

of

broncho-

and

bronchioloectasis,

vasoconstriction in oligemic areas. Peripheral parts of
the lung fields deserve special attention. In case of
pathological changes of small bronchi and transition of
process to bronchioles, small striations and branching
structures, tubular shadows, small foci are detected
here. In some cases an expiratory obstruction
syndrome (so-called "air traps") is detected, when the
area of the swollen lung does not disappear or diminish
in density on exhalation. In the preclinical stage (risk of
disease onset), CTBG reveals thickening of bronchial
walls and bronchioles, sometimes widening of their
lumen (broncho- and bronchioloectases), often local,
not sharply expressed signs of expiratory trapping
(mainly during exhalation examination) CT allows to
assess functional features not only of lobes and
segments, but also separate lobules of lung CTBG
allows to differentiate degrees of COPD severity, but
not initial manifestations of disease. In areas of
impaired bronchial patency, equal in volume to

individual lobules, sometimes segments and even
lobes, the study reveals areas of increased airiness - "air
traps" - on exhalation. "An 'air trap' is a retention of
stored gas in any part of the lungs during the
exhalation phase.

On high-resolution CT, air-trap regions appear as areas
of lower density than normal parenchyma and are
usually localised within a secondary lobule, segment,
lobe or the whole lung, being more clearly visualised on
exhalation. The 'air trap' symptom is seen on an
expiratory CT scan in cases where the patency of the
small bronchi is compromised. This is more
characteristic of obstructive changes in general, and is
not specific for COPD. Emphysema is characterised by
an abnormal increase in air-containing spaces distal to
the terminal bronchioles in the absence of overt
fibrosis in the lung tissue. Emphysema is usually
classified into three main types according to the
predominant localisation of areas of destruction:
centrilobular, panlobular and paraseptal. In the early
stages of development, these forms of emphysema
can be distinguished with confidence by CTVR. In the
final stages of the disease, they are difficult or
impossible to distinguish, not only on CT scan, but also
on morphological examination.

The detection of signs of emphysema on CTVR and the
exclusion of symptoms of interstitial lung disease
complete the diagnostic process. Crucially, it is not
necessary to perform a lung biopsy in these cases.
Appearance of small foci inside secondary lobules on
the background of some intra lobular interstitial
pattern enhancement is called in scientific literature as
symptoms of "tree with swollen kidneys" or "toy men"
and morphologically correspond to manifestations of
obliterating bronchiolitis of various etiology.


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VOLUME

04

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SJIF

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FACTOR

(2020:

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64

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(2022:

6.

319

)

OCLC

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METADATA

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7.569















































Publisher:

The USA Journals

CONCLUSIONS

Thus, among current methods of radiological diagnosis
of COPD, CTBP has a special place, especially when
using

its

functional

(inspiratory-expiratory)

modification

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Azimov M. I., Shomurodov K.E. A technique for
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Akhme Dov Alisher Astanovich, Rizayev Jasur
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Sadikov

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Abdujamilevich, Turayev Alimjan Bakhriddnovich.
(2021). The State of Periodontal Tissues in Athletes
Engaged in Cyclic Sports. Annals of the Romanian
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ticle/view/102

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DJuraev, A. M., & Khalimov, R. J. (2020). New
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Dzhuraev, A., Usmanov, Sh., Rakhmatullaev, H., &
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Ilkhomovna, K. M., Eriyigitovich, I. S., &
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Khodjieva D. T., Khaydarova D. K., Khaydarov N. K.
Complex evaluation of clinical and instrumental
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Khodjieva D. T., Khaydarova D. K. Clinical and
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Хушвакова Н.Ж., Хамракулова Н.О., Очилов Т.М.
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Хамракулова Н.О., Хушвакова Н.Ж. и др.
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антисептического раствора у больных с
гнойным

средним

отитом

на

фоне

хронического

лейкоза

//Российская

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Sadriddin Sayfullaevich Pulatov. (2022). Efficacy of
ipidacrine in the recovery period of ischaemic
stroke. World Bulletin of Public Health, 7, 28-32.


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7

Volume 04 Issue 04-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

04

Pages:

1-7

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

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Tukhtarov B.E., Comparative assessment of the
biological value of average daily diets in
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2010, 2, 65–67.

References

Azimov M. I., Shomurodov K.E. A technique for Cleft Palate Repair. Journal of research in health science. Vol. 1, No. 2, 2018, pp. 56-59.

Akhme Dov Alisher Astanovich, Rizayev Jasur Alimdjanovich, Sadikov Abdushukur Abdujamilevich, Turayev Alimjan Bakhriddnovich. (2021). The State of Periodontal Tissues in Athletes Engaged in Cyclic Sports. Annals of the Romanian Society for Cell Biology, 235–241. Retrieved from https://www.annalsofrscb.ro/index.php/journal/article/view/102

DJuraev, A. M., & Khalimov, R. J. (2020). New methods for surgical treatment of perthes disease in children. International Journal of Psychosocial Rehabilitation, 24(2), 301-307.

Dzhuraev, A., Usmanov, Sh., Rakhmatullaev, H., & Khalimov, R. (2021). Our experience with surgical treatment of congenital elevation of the scapula in young children. Medicine and Innovations, 1(4), 37-44.

С Гаффоров, А Ахмедов, Научные взгляды на этиопатогенез, лечение и профилактику некариозных поражений тканей зубов (обзор литературы) , stomatologiya: № 2(75) (2019)

Khodjieva D.T., Pulatov S.S., Khaidarova D.K. All about hemorrhagic stroke in elderly and senile persons (own observations) // Science of Young People (Eruditio Juvenium). 2015. №3. С. 87-96.

MI Kamalova, S Khaminov, B Eshboltaeva Morphometric features of bronchial epithelium development in rabbits in postnatal ontogenesis

Shomurodov. K.E. Features of cytokine balance in gingival fluid at odontogenicphlegmon of maxillofacial area. // Doctor-aspirant 2010.-42 Vol.-No.5.1.-P.187-192;

Ilkhomovna, K. M., Eriyigitovich, I. S., & Kadyrovich, K. N. (2020). Morphological Features Of Microvascular Tissue Of The Brain At Hemorrhagic Stroke. The American Journal of Medical Sciences and Pharmaceutical Research, 2(10), 53-59. https://doi.org/10.37547/TAJMSPR/Volume02Issue10-08

Khodjieva D. T., Khaydarova D. K., Khaydarov N. K. Complex evaluation of clinical and instrumental data for justification of optive treatment activites in patients with resistant forms of epilepsy. American Journal of Research. USA. № 11-12, 2018. C.186-193.

Khodjieva D. T., Khaydarova D. K. Clinical and neuroph clinical and neurophysiological ch ogical characteristics of teristics of post-insular cognitive disorders and issues of therapy optimization. Central Asian Journal of Pediatrics. Dec.2019. P 82-86

Хушвакова Н.Ж., Хамракулова Н.О., Очилов Т.М. Анализ результатов больных с хроническим одонтогенными верхнечелюстными синуситами //Научный обозреватель. 2019. С. 33-36.

Хамракулова Н.О., Хушвакова Н.Ж. и др. Применение озона и местного антисептического раствора у больных с гнойным средним отитом на фоне хронического лейкоза //Российская оториноларингология. 2012. С. 178.

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