Background: Lung densitometry derived from computed tomographic images offers an opportunity to quantify emphysema non-invasively, but a pathological standard cannot be applied to validate its use in longitudinal monitoring studies. Consequently, forced expiratory volume in 1 second (FEV₁) remains the standard against which new methods must be judged. We related progression of densitometry (15th percentile point and voxel index, threshold −950 Hounsfield units) to disease stage and FEV₁ decline in two studies of subjects with α₁-antitrypsin deficiency (PiZ).

Methods: Consistency of progression, measured using densitometry and FEV₁, was assessed in relation to disease stage in a 2 year study of 74 subjects grouped according to the FEV₁ criteria employed in the GOLD guidelines. In the second study of a subgroup of subjects with extended data (n = 34), summary statistics were applied to measurements performed annually over 3 years and the rate of progression of densitometry was related to FEV₁ decline.

Results: The progression of percentile point was consistent across a wide spectrum of disease severity, but voxel index progression varied in association with disease stage (p = 0.004). In the second study, FEV₁ decline correlated with progression of lung densitometry (percentile point: r_S = 0.527, p = 0.001; voxel index: r_S = −0.398, p = 0.012).

Conclusions: 15th percentile point is a more consistent measure of lung density loss across a wide range of physiological impairment than voxel index. However, both methods are valid for use in longitudinal and interventional studies in which emphysema is the major outcome target.