By G. L. Snider (auth.), P. M. A. Calverley, N. B. Pride (eds.)
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Those using quantitative CT scans to identify and assess the severity of emphysema must still take into account whether a decrease in density is due to hyperinflation or true emphysema, and what are age-related normal values. Changes in mean values are likely to reflect panacinar emphysema whereas the focal lesions of CAE can only be identified by careful examination of frequency distributions of density measurement or qualitative assessment in the identification of individual lesions . 7) rather than actual quantitative measurements.
There is no proof that such damage to alveolar walls is a necessary stage in the development of either CAE or P AE. Such evidence of destruction may identify a pathogenetic mechanism and fulfil the definition of emphysema. It does not reflect outcome, the severity of emphysema, and therefore is unlikely to correlate with any functional variable. 8 EMPHYSEMA AND CT ASSESSMENT (SEE ALSO CHAPTER 14) In 1978 Thurlbeck and Simon  described criteria for the diagnosis of emphysema using the chest radiograph.
M. (1967) The internal surface area of non-emphysematous lungs. Am. Rev. Respir. , 95, 765-73. 40. , Lamb, D. J. (1991) A new automated technique for the assessment of emphysema on histological sections. J. Clin. , 44, 1007-11. 41. A. s. (1982) Morphometry, Arnold, London. 42. , McLean, A. et al. (1988) CT measurements of lung density in life can quantitate distal air space enlargement - an essential defining feature of human emphysema. Am. Rev. Respir. , 137, 380-92. 43. , Gillooly, M. et al. (1992) Microscopic and macroscopic meas- 32 Pathology 44.