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P93 ‘copd: ct thorax – friend or foe’: clinical utility of ct thorax in diagnosing comorbidities

Introduction Chronic obstructive pulmonary disease (COPD) is associated with several pulmonary and extra-pulmonary comorbidities. Comorbidities have a significant impact on health, healthcare services, and mortality in COPD patients, who have, on average,≥4 additional diseases.1 Earlier detection and treatment will lead to better patient outcomes. This study aims to demonstrate the added value of non-contrast CT Thorax in revealing previously unreported co-morbidities. Our hypothesis is CT Thorax is often requested in COPD patients primarily for co-existing lung disease however extra-pulmonary comorbidities are often under requested and under reported. Methods Setting Tertiary cardio thoracic centre Study design Retrospective review 1000 non-contrast CT thorax scans in COPD patients. Using a pre-formed list of co-morbidities (listed below), images were reviewed by a single operator. Pulmonary bronchiectasis, infection, lung cancer, ILD Extra-pulmonary Coronary artery calcification, Pulmonary artery diameter, hiatus hernia, vertebral fractures. Corresponding Diagnoses Ischaemic heart disease, Pulmonary artery hypertension, Gastroesophageal reflux disease and Osteoporosis Results 1000 CT chest scans were reviewed. Here is analysis from first 227 scans. Common reasons for requesting imaging: lung transplant assessment (29%), excluding bronchiectasis(18%), acute exacerbation of COPD(12%) and LVRS assessment. Retrospective analysis of 227 CT Thorax scans showed a total of 450 pulmonary (138) and extra pulmonary (312) findings. (figure 1) Pulmonary findings Bronchiectasis: 40% (90/227), lung nodules: 6% (13/227) of which new cancer diagnoses were 23% (3/13), Consolidation 4% (9/227), Small airway changes 3% (7/227), Interstitial lung changes:6% (14/227), Pleural plaques 2% (5/227). Extra pulmonary findings Hiatus hernia: 18.5% (42/227), Vertebral fractures: 17% (39/227), Enlarged Pulmonary artery diameter (more than or equal to 29 mm): 38% (87/227), Coronary artery plaques: 55% (124/227). Abstract P93 Figure 1 Pie charts showing extra pulmonary (a) and pulmonary findings (b) on retrospective analysis of 227 CT scans. Summary Preliminary analysis indicates a high incidence of potentially treatable extra pulmonary comorbidities. Incidence of co-existing radiological bronchiectasis is 40%. Conclusions To our knowledge this is the first report quantifying the added value of non-contrast CT Thorax in the assessment of COPD patients. Our recommendation is that a list of imaging diagnoses linked to well recognised COPD comorbidities should be part of the standard work up in the assessment of COPD patients undergoing CT Thorax. Reference Martinez CH, Miguel DJ, Mannino DM. Defining COPD-related comorbidities, 2004–2014. J COPD F.2014;1(1):51–63.