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Comparative Study
. 2020;99(7):598-605.
doi: 10.1159/000507265. Epub 2020 Jul 8.

Differences in Lung and Lobe Volumes between Supine and Standing Positions Scanned with Conventional and Newly Developed 320-Detector-Row Upright CT: Intra-Individual Comparison

Yoshitake Yamada  1 , Minoru Yamada  2 , Yoichi Yokoyama  2 , Akiko Tanabe  3 , Shiho Matsuoka  3 , Yuki Niijima  4 , Keiichi Narita  2 , Takehiro Nakahara  2 , Mitsuru Murata  5 , Koichi Fukunaga  6 , Shotaro Chubachi  6 , Masahiro Jinzaki  2
Affiliations
Comparative Study

Differences in Lung and Lobe Volumes between Supine and Standing Positions Scanned with Conventional and Newly Developed 320-Detector-Row Upright CT: Intra-Individual Comparison

Yoshitake Yamada et al. Respiration. 2020.

Abstract

Background: No clinical studies to date have compared unilateral lung or lobe volumes between the supine and standing positions.

Objectives: To compare lung/lobe volumes on computed tomography (CT) between these two positions and evaluate the correlation between the total lung volume and total lung capacity (TLC) on pulmonary function tests (PFTs).

Methods: Thirty-two asymptomatic volunteers underwent both conventional CT (supine position) and upright CT (standing position), during deep inspiration breath-hold, and PFTs on the same day. We measured lung/lobe volumes on CT in each position. Paired t tests were used for statistical analysis.

Results: The volumes of the total lung (10.9% increase), right lung (10.3% increase), right upper lobe (8.6% increase), right lower lobe (14.6% increase), left lung (11.6% increase), left upper lobe (7.1% increase), and left lower lobe (16.0% increase) were significantly greater in the standing position than in the supine position (all p < 0.0001). The right middle lobe volume was similar between the two positions (p = 0.16). Intraclass correlation coefficients for agreement between total lung volumes on CT in the supine/standing positions and the TLC on PFT were 0.891/0.938, respectively.

Conclusions: While the volumes of the bilateral upper and lower lobes and bilateral lungs were significantly greater in the standing than in the supine position, with lower lobes showing larger changes, the right middle lobe volume did not change significantly between positions. The total lung volume on upright CT in the standing position was more similar to TLC on PFT than that in the supine position.

Keywords: Lung volume measurements; Multidetector computed tomography; Posture; Standing position; Thorax.

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Conflict of interest statement

M.J. has received a grant from Canon Medical Systems. However, Canon Medical Systems was not involved in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, and approval of the manuscript. The remaining authors have no conflicts of interest to declare (Y. Yamada, M.Y., Y. Yokoyama, A.T., S.M., Y.N., K.N., T.N., M.M., K.F., and S.C.).

Figures

Fig. 1
Fig. 1
Conventional CT examination in the supine position (a) and upright CT examination in the standing position (b). a Conventional CT was performed with the subject's arms down during deep inspiration breath-hold. b Upright CT was also performed with the subject's arms down during deep inspiration breath-hold. The upright CT system allows up-and-down movement of a transverse 320-detector-row gantry. For safety during upright CT scanning, an acrylic wall encircling the body was added to prevent falls, with a pinch prevention mechanism and contact interlock control mechanism. Furthermore, to stabilize patients while standing, a back-support pole, 2.3-m long and made of carbon, was included; it was mounted between the floor and the top of the system. The mounting position could be adjusted based on the subject's bodily dimensions or the scan conditions. To support patients who are frail or elderly, a Velcro band can be attached to the pole and loosely wrapped around a patient's body. In this study, the subjects were healthy volunteers; thus, we did not use the Velcro band.
Fig. 2
Fig. 2
Representative segmentation and lung/lobe volume measurement in a 44-year-old male: axial (a), sagittal (b), and coronal (c) images, and volume rendering images (d) taken in the supine and standing positions. Yellow is the right upper lobe, blue is the right middle lobe, green is the right lower lobe, pink is the left upper lobe, and purple is the left lower lobe. The volumes of the total (bilateral) lungs in the supine vs. standing positions in this subject were 5,148.0 vs. 5,670.2 mL, respectively (10.1% increase); right lung, 2,738.8 vs. 2,972.3 mL (8.5% increase); right upper lobe, 959.4 vs. 1,024.6 mL (6.8% increase); right middle lobe, 514.1 vs. 537.2 mL (4.5% increase); right lower lobe, 1,265.3 vs. 1,410.6 mL (11.5% increase); left lung, 2,409.2 vs. 2,697.9 mL (12.0% increase); left upper lobe, 1,226.4 vs. 1,329.0 mL (8.4% increase); and left lower lobe, 1,182.8 vs. 1,368.9 mL (15.7% increase).
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