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Wang Y, Chai L, Chen Y, Liu J, Wang Q, Zhang Q, Qiu Y, Li D, Chen H, Shen N, Shi X, Wang J, Xie X, Li M. Quantitative CT parameters correlate with lung function in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Front Surg 2023; 9:1066031. [PMID: 36684267 PMCID: PMC9845891 DOI: 10.3389/fsurg.2022.1066031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/14/2022] [Indexed: 01/06/2023] Open
Abstract
Objective This study aimed to analyze the correlation between quantitative computed tomography (CT) parameters and airflow obstruction in patients with COPD. Methods PubMed, Embase, Cochrane and Web of Knowledge were searched by two investigators from inception to July 2022, using a combination of pertinent items to discover articles that investigated the relationship between CT measurements and lung function parameters in patients with COPD. Five reviewers independently extracted data, and evaluated it for quality and bias. The correlation coefficient was calculated, and heterogeneity was explored. The following CT measurements were extracted: percentage of lung attenuation area <-950 Hounsfield Units (HU), mean lung density, percentage of airway wall area, air trapping index, and airway wall thickness. Two airflow obstruction parameters were extracted: forced expiratory volume in the first second as a percentage of prediction (FEV1%pred) and FEV1 divided by forced expiratory volume lung capacity. Results A total of 141 studies (25,214 participants) were identified, which 64 (6,341 participants) were suitable for our meta-analysis. Results from our analysis demonstrated that there was a significant correlation between quantitative CT parameters and lung function. The absolute pooled correlation coefficients ranged from 0.26 (95% CI, 0.18 to 0.33) to 0.70 (95% CI, 0.65 to 0.75) for inspiratory CT and 0.56 (95% CI, 0.51 to 0.60) to 0.74 (95% CI, 0.68 to 0.80) for expiratory CT. Conclusions Results from this analysis demonstrated that quantitative CT parameters are significantly correlated with lung function in patients with COPD. With recent advances in chest CT, we can evaluate morphological features in the lungs that cannot be obtained by other clinical indices, such as pulmonary function tests. Therefore, CT can provide a quantitative method to advance the development and testing of new interventions and therapies for patients with COPD.
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Huang X, Yin W, Shen M, Wang X, Ren T, Wang L, Liu M, Guo Y. Contributions of Emphysema and Functional Small Airway Disease on Intrapulmonary Vascular Volume in COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:1951-1961. [PMID: 36045693 PMCID: PMC9423118 DOI: 10.2147/copd.s368974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies have demonstrated that there is a certain correlation between emphysema and changes in pulmonary small blood vessels in patients with chronic obstructive pulmonary disease (COPD), but most of them were limited to the investigation of the inspiratory phase. The emphysema indicators need to be further optimized. Based on the parametric response mapping (PRM) method, this study aimed to investigate the effect of emphysema and functional small airway disease on intrapulmonary vascular volume (IPVV). Methods This retrospective study enrolled 63 healthy subjects and 47 COPD patients, who underwent both inspiratory and expiratory CT scans of the chest and pulmonary function tests (PFTs). Inspiratory and expiratory IPVV were measured by using an automatic pulmonary vessels integration segmentation approach, the ratio of emphysema volume (Emph%), functional small airway disease volume (fsAD%), and normal areas volume (Normal%) were quantified by the PRM method for biphasic CT scans. The participants were grouped according to PFTs. Analysis of variance (ANOVA) and Kruskal–Wallis H-test were used to analyze the differences in indicators between different groups. Then, Spearman’s rank correlation coefficients were used to analyze the correlation between Emph%, fsAD%, Normal%, PFTs, and IPVV. Finally, multiple linear regression was applied to analyze the effects of Emph% and fsAD% on IPVV. Results Differences were found in age, body mass index (BMI), smoking index, FEV1%, FEV1/forced vital capacity (FVC), expiratory IPVV, IPVV relative value, IPVV difference value, Emph%, fsAD%, and Normal% between the groups (P<0.05). A strong correlation was established between the outcomes of PFTs and quantitative CT indexes. Finally, the effect of Emph% was more significant than that of fsAD% on expiratory IPVV, IPVV difference value, and IPVV relative value. Conclusion IPVV may have a potential value in assessing COPD severity and is significantly affected by emphysema.
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Affiliation(s)
- Xiaoqi Huang
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Weiling Yin
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Min Shen
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Xionghui Wang
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Tao Ren
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Lei Wang
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Youmin Guo
- Department of Radiology, Yan'an University Affiliated Hospital, Yan'an, People's Republic of China
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Cao X, Gao X, Yu N, Shi M, Wei X, Huang X, Xu S, Pu J, Jin C, Guo Y. Potential Value of Expiratory CT in Quantitative Assessment of Pulmonary Vessels in COPD. Front Med (Lausanne) 2021; 8:761804. [PMID: 34722596 PMCID: PMC8551380 DOI: 10.3389/fmed.2021.761804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate the associations between intrapulmonary vascular volume (IPVV) depicted on inspiratory and expiratory CT scans and disease severity in COPD patients, and to determine which CT parameters can be used to predict IPVV. Methods: We retrospectively collected 89 CT examinations acquired on COPD patients from an available database. All subjects underwent both inspiratory and expiratory CT scans. We quantified the IPVV, airway wall thickness (WT), the percentage of the airway wall area (WA%), and the extent of emphysema (LAA%−950) using an available pulmonary image analysis tool. The underlying relationship between IPVV and COPD severity, which was defined as mild COPD (GOLD stage I and II) and severe COPD (GOLD stage III and IV), was analyzed using the Student's t-test (or Mann-Whitney U-test). The correlations of IPVV with pulmonary function tests (PFTs), LAA%−950, and airway parameters for the third to sixth generation bronchus were analyzed using the Pearson or Spearman's rank correlation coefficients and multiple stepwise regression. Results: In the subgroup with only inspiratory examinations, the correlation coefficients between IPVV and PFT measures were −0.215 ~ −0.292 (p < 0.05), the correlation coefficients between IPVV and WT3−6 were 0.233 ~ 0.557 (p < 0.05), and the correlation coefficient between IPVV and LAA%−950 were 0.238 ~ 0.409 (p < 0.05). In the subgroup with only expiratory scan, the correlation coefficients between IPVV and PFT measures were −0.238 ~ −0.360 (p < 0.05), the correlation coefficients between IPVV and WT3−6 were 0.260 ~ 0.566 (p < 0.05), and the correlation coefficient between IPVV and LAA%−950 were 0.241 ~ 0.362 (p < 0.05). The multiple stepwise regression analyses demonstrated that WT were independently associated with IPVV (P < 0.05). Conclusion: The expiratory CT scans can provide a more accurate assessment of COPD than the inspiratory CT scans, and the airway wall thickness maybe an independent predictor of pulmonary vascular alteration in patients with COPD.
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Affiliation(s)
- Xianxian Cao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Diagnostic Imaging, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyan Gao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Medical Imaging Center, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Nan Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Meijuan Shi
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xia Wei
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoqi Huang
- Department of Radiology, The Affiliated Hospital of Yan'an University, Yan'an, China
| | - Shudi Xu
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiantao Pu
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Chenwang Jin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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4
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Wallat EM, Wuschner AE, Flakus MJ, Christensen GE, Reinhardt JM, Shanmuganayagam D, Bayouth JE. Radiation-induced airway changes and downstream ventilation decline in a swine model. Biomed Phys Eng Express 2021; 7:10.1088/2057-1976/ac3197. [PMID: 34670195 PMCID: PMC8785227 DOI: 10.1088/2057-1976/ac3197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/20/2021] [Indexed: 11/11/2022]
Abstract
Purpose.To investigate indirect radiation-induced changes in airways as precursors to atelectasis post radiation therapy (RT).Methods.Three Wisconsin Miniature Swine (WMSTM) underwent a research course of 60 Gy in 5 fractions delivered to a targeted airway/vessel in the inferior left lung. The right lung received a max point dose <5 Gy. Airway segmentation was performed on the pre- and three months post-RT maximum inhale phase of the four-dimensional (4D) computed tomography (CT) scans. Changes in luminal area (Ai) and square root of wall area (WA) for each airway were investigated. Changes in ventilation were assessed using the Jacobian ratio and were measured in three different regions: the inferior left lung <5 Gy (ILL), the superior left lung <5 Gy (SLL), and the contralateral right lung <5 Gy (RL).Results.Airways (n = 25) in the right lung for all swine showed no significant changes (p = 0.48) in Ai post-RT compared to pre-RT. Airways (n = 28) in the left lung of all swine were found to have a significant decrease (p < 0.001) in Ai post-RT compared to pre-RT, correlated (Pearson R = -0.97) with airway dose. Additionally,WAdecreased significantly (p < 0.001) with airway dose. Lastly, the Jacobian ratio of the ILL (0.883) was lower than that of the SLL (0.932) and the RL (0.955).Conclusions.This work shows that for the swine analyzed, there were significant correlations between Ai andWAchange with radiation dose. Additionally, there was a decrease in lung function in the regions of the lung supplied by the irradiated airways compared to the regions supplied by unirradiated airways. These results support the hypothesis that airway dose should be considered during treatment planning in order to potentially preserve functional lung and reduce lung toxicities.
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Affiliation(s)
- Eric M Wallat
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - Antonia E Wuschner
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - Mattison J Flakus
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - Gary E Christensen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA 52242, United States of America
- Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, United States of America
| | - Joseph M Reinhardt
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, United States of America
- Department of Radiology, University of Iowa, Iowa City, IA 52242, United States of America
| | - Dhanansayan Shanmuganayagam
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - John E Bayouth
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States of America
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Wu F, Chen L, Huang J, Fan W, Yang J, Zhang X, Jin Y, Yang F, Zheng C. Total Lung and Lobar Quantitative Assessment Based on Paired Inspiratory-Expiratory Chest CT in Healthy Adults: Correlation with Pulmonary Ventilatory Function. Diagnostics (Basel) 2021; 11:diagnostics11101791. [PMID: 34679488 PMCID: PMC8534441 DOI: 10.3390/diagnostics11101791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To provide the quantitative volumetric data of the total lung and lobes in inspiration and expiration from healthy adults, and to explore the value of paired inspiratory–expiratory chest CT scan in pulmonary ventilatory function and further explore the influence of each lobe on ventilation. Methods: A total of 65 adults (29 males and 36 females) with normal clinical pulmonary function test (PFT) and paired inspiratory–expiratory chest CT scan were retrospectively enrolled. The inspiratory and expiratory volumetric indexes of the total lung (TL) and 5 lobes (left upper lobe [LUL], left lower lobe [LLL], right upper lobe [RUL], right middle lobe [RML], and right lower lobe [RLL]) were obtained by Philips IntelliSpace Portal image postprocessing workstation, including inspiratory lung volume (LVin), expiratory lung volume (LVex), volume change (∆LV), and well-aerated lung volume (WAL, lung tissue with CT threshold between −950 and −750 HU in inspiratory scan). Spearman correlation analysis was used to explore the correlation between CT quantitative indexes of the total lung and ventilatory function indexes (including total lung capacity [TLC], residual volume [RV], and force vital capacity [FVC]). Multiple stepwise regression analysis was used to explore the influence of each lobe on ventilation. Results: At end-inspiratory phase, the LVin-TL was 4664.6 (4282.7, 5916.2) mL, the WALTL was 4173 (3639.6, 5250.9) mL; both showed excellent correlation with TLC (LVin-TL: r = 0.890, p < 0.001; WALTL: r = 0.879, p < 0.001). From multiple linear regression analysis with lobar CT indexes as variables, the LVin and WAL of these two lobes, LLL and RUL, showed a significant relationship with TLC. At end-expiratory phase, the LVex-TL was 2325.2 (1969.7, 2722.5) mL with good correlation with RV (r = 0.811, p < 0.001), of which the LVex of RUL and RML had a significant relationship with RV. For the volumetric change within breathing, the ∆LVTL was 2485.6 (2169.8, 3078.1) mL with good correlation with FVC (r = 0.719, p < 0.001), moreover, WALTL showed a better correlation with FVC (r = 0.817, p < 0.001) than that of ∆LVTL. Likewise, there was also a strong association between ∆LV, WAL of these two lobes (LLL and RUL), and FVC. Conclusions: The quantitative indexes derived from paired inspiratory–expiratory chest CT could reflect the clinical pulmonary ventilatory function, LLL, and RUL give greater impact on ventilation. Thus, the pulmonary functional evaluation needs to be more precise and not limited to the total lung level.
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Affiliation(s)
- Feihong Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Leqing Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jia Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jinrong Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiaohui Zhang
- Clinical Science, Philips Healthcare, No. 718 Daning Rd., Jingan District, Shanghai 200233, China;
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China;
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (F.Y.); (C.Z.); Tel.: +86-027-8535-3238 (C.Z.)
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (F.Y.); (C.Z.); Tel.: +86-027-8535-3238 (C.Z.)
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Matsumoto S, Yamada Y, Yamada M, Chubachi S, Yokoyama Y, Matsuoka S, Tanabe A, Niijima Y, Murata M, Fukunaga K, Jinzaki M. Difference in the airway luminal area between the standing and supine positions using upright and conventional computed tomography. Clin Anat 2021; 34:1150-1156. [PMID: 34218460 DOI: 10.1002/ca.23763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/02/2021] [Accepted: 06/21/2021] [Indexed: 11/09/2022]
Abstract
No clinical studies to date have compared the airway luminal area between supine and standing positions. Our aim was therefore to compare the airway luminal area between these two positions on computed tomography (CT) and to determine its correlation with forced expiratory volume in 1 s (FEV1). Thirty-two asymptomatic volunteers underwent both conventional (supine position) and upright (standing position) CT during deep inspiration breath-holding. Pulmonary function tests were conducted on the same day. We measured the airway luminal area on CT in each position. Paired t-tests and Pearson's correlation coefficients were used for statistical analysis. The average luminal areas of the trachea, right and left main bronchi, and average third-generation airway were greater in the standing than the supine position by 3.4%, 6.1%, 5.5%, and 5.2%, respectively. The correlation coefficients between airway luminal areas and FEV1 tended to be higher in the standing than the supine position; this correlation was highest for the average third-generation airway (r = 0.70, P < 0.0001). The airway luminal areas of the trachea, bilateral main bronchi, and average third-generation airway were greater in the standing than the supine position. The average third-generation airway area in the standing position had the highest correlation with FEV1.
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Affiliation(s)
- Shunsuke Matsumoto
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shiho Matsuoka
- Department of Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Akiko Tanabe
- Department of Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Yuki Niijima
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Nishine H, Hiramoto T, Handa H, Inoue T, Wakahara K, Saka H, Miyazawa T, Mineshita M. Assessment of Extensive Airway Obstruction Using Point-by-Point Lateral Pressure Measurements during Bronchoscopy. Respiration 2021; 100:611-617. [PMID: 33946078 DOI: 10.1159/000515442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The positioning of the stent at the flow-limiting segment is crucial for patients with extensive airway obstruction to relieve dyspnea. However, CT and flow-volume curves cannot detect the area of maximal obstruction. OBJECTIVES The aim of this study is to physiologically evaluate extensive airway obstruction during interventional bronchoscopy. METHODS We prospectively measured point-by-point lateral airway pressure (Plat) at multiple points from the lower lobe bronchus to the upper trachea using a double-lumen catheter in 5 patients. The site of maximal obstruction was evaluated continuously to measure point-by-point Plat at multiple points when the airway catheter was withdrawn from the lower lobe bronchus to the upper trachea. RESULTS Remarkable pressure differences occurred at the site of maximal obstruction assessed by point-by-point Plat measurements. After initial stenting in 1 case, migration of the maximal obstruction to a nonstented segment of the weakened airway was seen with extensive stenosis from the trachea to the bronchi. In the second case, in addition to radiological analysis, point-by-point Plat measurements could identify the location of the maximal obstruction which contributed to dyspnea. CONCLUSIONS Point-by-point Plat measurement could be used to detect the site of maximal obstruction physiologically. Furthermore, Plat measurement could assess the need for additional procedures in real time in patients with extensive airway obstruction.
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Affiliation(s)
- Hiroki Nishine
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takehiko Hiramoto
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Handa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keiko Wakahara
- Division of Respirology, Department of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan
| | - Hideo Saka
- Departments of Respiratory Medicine and Medical Oncology, National Organization Nagoya Medical Center, Nagoya, Japan
| | - Teruomi Miyazawa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Chubachi S, Yamada Y, Yamada M, Yokoyama Y, Tanabe A, Matsuoka S, Niijima Y, Yamasawa W, Irie H, Murata M, Fukunaga K, Jinzaki M. Differences in airway lumen area between supine and upright computed tomography in patients with chronic obstructive pulmonary disease. Respir Res 2021; 22:95. [PMID: 33789651 PMCID: PMC8010787 DOI: 10.1186/s12931-021-01692-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND No clinical studies to date have compared the inspiratory and expiratory airway lumen area between supine and standing positions. Thus, the aims of this study were twofold: (1) to compare inspiratory and expiratory airway lumen area (IAA and EAA, respectively) on computed tomography (CT) among supine and standing positions; and (2) to investigate if IAA and EAA are associated with lung function abnormality in patients with chronic obstructive pulmonary disease (COPD). METHODS Forty-eight patients with COPD underwent both low-dose conventional (supine position) and upright CT (standing position) during inspiration and expiration breath-holds and a pulmonary function test (PFT) on the same day. We measured the IAA and EAA in each position. RESULTS For the trachea to the third-generation bronchi, the IAA was significantly larger in the standing position than in the supine position (4.1-4.9% increase, all p < 0.05). The EAA of all bronchi was significantly larger in the standing position than in the supine position (9.7-62.5% increases, all p < 0.001). The correlation coefficients of IAA in the standing position and forced expiratory volume in 1 s were slightly higher than those in the supine position. The correlation coefficients of EAA or EAA/IAA in the standing position and residual volume, and the inspiratory capacity/total lung capacity ratio were higher than those in the supine position. CONCLUSIONS Airway lumen areas were larger in the standing position than in the supine position. IAAs reflect airway obstruction, and EAAs reflect lung hyperinflation. Upright CT might reveal these abnormalities more precisely. Trial registration University Hospital Medical Information Network (UMIN 000026587), Registered 17 March 2017. URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000030456 .
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Affiliation(s)
- Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Akiko Tanabe
- Department of Clinical Laboratory, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Shiho Matsuoka
- Department of Clinical Laboratory, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Yuki Niijima
- Office of Radiation Technology, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Wakako Yamasawa
- Department of Laboratory Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Hidehiro Irie
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
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Nam BD, Ko S, Hwang JH. Quantitative evaluation of computed tomography findings in patients with bronchial asthma: prediction of therapeutic response. J Med Imaging Radiat Oncol 2021; 65:663-671. [PMID: 33724672 DOI: 10.1111/1754-9485.13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/19/2021] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To compare pretreatment quantitative CT parameters between patients with well-controlled and those with poorly controlled bronchial asthma after treatment. METHODS We retrospectively reviewed 785 patients with clinical diagnosis of bronchial asthma from January 2009 to April 2015. Of these, 43 patients underwent high-resolution CT and pulmonary function tests at initial diagnosis. According to the Global Initiative for Asthma (GINA) 2015 guidelines, the patients were classified into two groups (well-controlled (GINA1), n = 18; poorly controlled (GINA2 and GINA3), n = 25). Quantitative measurements for airways (total cross-sectional area (TA), lumen area (LA), wall area (WA) and wall area percentage (WA%)), air trapping and emphysema were performed on initial pretreatment CT scans. We compared CT measurements for airways between well-controlled and poorly controlled groups and also compared those between ever-smokers and never-smokers. The significant quantitative CT parameters were evaluated with multiple regression analysis. RESULTS The TA and the WA demonstrated significantly higher values in the poorly controlled than in the well-controlled patient group (TA in RB1 and LB1, each P < 0.05; WA in RB1 and RB8, each P < 0.05). Quantitative parameters for air trapping and emphysema did not show significant differences between the two patient groups. On multiple regression analysis, the TA and the WA were statistically significant in comparison of two patient groups with an adjustment for age, sex, body mass index and smoking history (each P < 0.05). Significantly higher values of the WA and the WA% were revealed in the asthmatics with smoking history comparing to non-smokers (P < 0.05). CONCLUSION Most of the quantitative CT measurements did not correlate significantly with clinical outcomes in patients with bronchial asthma. And, further research that supplements the limitations of this study is needed to support and validate the association between CT parameters and therapeutic response. This can be justified by the fact that a trend of higher values in airway measurements on initial pretreatment HRCT scan in the poorly controlled than in the well-controlled patient group.
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Affiliation(s)
- Bo Da Nam
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
| | - Sujin Ko
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
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Chae KJ, Jin GY, Choi J, Lee CH, Choi S, Choi H, Park J, Lin CL, Hoffman EA. Generation-based study of airway remodeling in smokers with normal-looking CT with normalization to control inter-subject variability. Eur J Radiol 2021; 138:109657. [PMID: 33773402 DOI: 10.1016/j.ejrad.2021.109657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/01/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE With the help of quantitative computed tomography (QCT), it is possible to identify smoking-associated airway remodeling. However, there is currently little information on whether QCT-based airway metrics are sensitive to early airway wall remodeling in subclinical phases of smoking-associated airway disease. This study aimed to evaluate a predictive model that normalized airway parameters and investigate structural airway alterations in smokers with normal-looking CT using the normalization scheme. METHODS In this retrospective analysis, 222 non-smokers (male 97, female 125) and 69 smokers (male 66, female 3) from January 2014 to December 2016 were included, and airway parameters were quantitatively analyzed. To control inter-subject variability, multiple linear regressions of tracheal wall thickness (WT), diameter (D), and luminal area (LA) were performed, adjusted for age, sex, and height. Using this normalization scheme, airway parameters with matched generation were compared between smokers and non-smokers. RESULTS Using the normalization scheme, it was possible to assess generation-based structural alterations of the airways in subclinical smokers. Smokers showed diffuse luminal narrowing of airways for most generations (P < 0.05, except 3rd generation), no change in wall thickness of the proximal bronchi (1st-3rd generation), and a thinning of distal airways (P <0.05, ≥4th generation). CONCLUSION QCT assessment for subclinical smokers can help identify minimal structural changes in airways induced by smoking.
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Affiliation(s)
- Kum Ju Chae
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
| | - Jiwoong Choi
- Department of Internal Medicine, School of Medicine, University of Kansas, Kansas City, KS, USA; Department of Bioengineering, University of Kansas, Lawrence, KS, USA
| | - Chang Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul, South Korea
| | - Sanghun Choi
- School of Mechanical Engineering, Kyungpook National University, Daegu, South Korea
| | - Hyemi Choi
- Department of Statistics and Institute of Applied Statistics, Jeonbuk National University, Jeonju, Jeonbuk, South Korea
| | - Jeongjae Park
- Department of Statistics, Regional Cardiocerebrovascular Center, Wonkwang University School of Medicine, Iksan, Jeonbuk, South Korea
| | - Ching-Long Lin
- Department of Radiology & Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
| | - Eric A Hoffman
- Department of Radiology & Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
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Gawlitza J, Henzler T, Trinkmann F, Nekolla E, Haubenreisser H, Brix G. COPD Imaging on a 3rd Generation Dual-Source CT: Acquisition of Paired Inspiratory-Expiratory Chest Scans at an Overall Reduced Radiation Risk. Diagnostics (Basel) 2020; 10:E1106. [PMID: 33352939 PMCID: PMC7765937 DOI: 10.3390/diagnostics10121106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023] Open
Abstract
As stated by the Fleischner Society, an additional computed tomography (CT) scan in expiration is beneficial in patients with chronic obstructive pulmonary disease (COPD). It was thus the aim of this study to evaluate the radiation risk of a state-of-the-art paired inspiratory-expiratory chest scan compared to inspiration-only examinations. Radiation doses to 28 organs were determined for 824 COPD patients undergoing routine chest examinations at three different CT systems-a conventional multi-slice CT (MSCT), a 2nd generation (2nd-DSCT), and 3rd generation dual-source CT (3rd-DSCT). Patients examined at the 3rd-DSCT received a paired inspiratory-expiratory scan. Organ doses, effective doses, and lifetime attributable cancer risks (LAR) were calculated. All organ and effective doses were significantly lower for the paired inspiratory-expiratory protocol (effective doses: 4.3 ± 1.5 mSv (MSCT), 3.0 ± 1.2 mSv (2nd-DSCT), and 2.0 ± 0.8 mSv (3rd-DSCT)). Accordingly, LAR was lowest for the paired protocol with an estimate of 0.025 % and 0.013% for female and male patients (50 years) respectively. Image quality was not compromised. Paired inspiratory-expiratory scans can be acquired on 3rd-DSCT systems at substantially lower dose and risk levels when compared to inspiration-only scans at conventional CT systems, offering promising prospects for improved COPD diagnosis.
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Affiliation(s)
- Joshua Gawlitza
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, 66424 Homburg, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68159 Mannheim, Germany;
| | - Frederik Trinkmann
- Pulmonology and Critical Care Medicine, Thoraxklinik at University Hospital Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), 69115 Heidelberg, Germany;
- Department of Biomedical Informatics of the Heinrich-Lanz-Center, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 69115 Heidelberg, Germany
| | - Elke Nekolla
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, 91465 Neuherberg, Germany; (E.N.); (G.B.)
| | | | - Gunnar Brix
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, 91465 Neuherberg, Germany; (E.N.); (G.B.)
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12
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Nagatani Y, Yoshigoe M, Tsukagoshi S, Ushio N, Ohashi K, Nitta N, Kimoto T, Uranishi A, Sato S, Mayumi M, Yamashiro T, Moriya H, Murata K, Watanabe Y. Peripheral bronchial luminal conspicuity on dynamic-ventilation computed tomography: association with radiation doses and temporal resolution by using an ex vivo porcine lung phantom. Acta Radiol 2020; 61:1608-1617. [PMID: 32212830 DOI: 10.1177/0284185120911186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is still unclear which image reconstruction algorithm is appropriate for peripheral bronchial luminal conspicuity (PBLC) on dynamic-ventilation computed tomography (DVCT). PURPOSE To assess the influence of radiation doses and temporal resolution (TR) on the association between movement velocity (MV) and PBLC on DVCT. MATERIAL AND METHODS An ex vivo porcine lung phantom with simulated respiratory movement was scanned by 320-row CT at 240 mA and 10 mA. Peak and dip CT density and luminal area adjusted by values at end-inspiration (CTDpeak and CTDdip, luminal area ratio [LAR]) for PBLC and MVs were measured and visual scores (VS) were obtained at 12 measurement points on 13 frame images obtained at half and full reconstructions (TR 340 and 190 ms) during expiration. Size-specific dose estimate (SSDE) was applied to presume radiation dose. VS, CTDpeak, CTDdip, LAR, and their cross-correlation coefficients with MV (CCC) were compared among four methods with combinations of two reconstruction algorithms and two doses. RESULTS The dose at 10 mA was presumed as 26 mA by SSDE for standard proportion adults. VS, CTDdip, CTDpeak, and LAR with half reconstruction at 10 mA (2.52 ± 0.59, 1.016 ± 0.221, 0.948 ± 0.103, and 0.990 ± 0.527) were similar to those at 240 mA except for VS, and different from those with full reconstruction at both doses (2.24 ± 0.85, 0.830 ± 0.209, 0.986 ± 0.065, and 1.012 ± 0.438 at 240 mA) (P < 0.05). CCC for CTDdip with half reconstruction (-0.024 ± 0.552) at 10 mA was higher compared with full reconstruction (-0.503 ± 0.291) (P < 0.05). CONCLUSION PBLC with half reconstruction at 10 mA was comparable to that at 240 mA and better than those with full reconstruction on DVCT.
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Affiliation(s)
- Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Makoto Yoshigoe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | | | - Noritoshi Ushio
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kohei Ohashi
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tatsuya Kimoto
- Center for Medical Research and Development, Canon Medical Systems, Otawara, Tochigi, Japan
| | - Ayumi Uranishi
- CT System Division, Canon Medical Systems, Otawara, Tochigi, Japan
| | - Shigetaka Sato
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masayuki Mayumi
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima, Fukushima, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Zhang H, Qian X, Liu ZH, Gong Y. The value of bronchial and cavity contraction rates in differentiating benign and malignant pulmonary cavities. BMC Pulm Med 2020; 20:208. [PMID: 32762669 PMCID: PMC7409678 DOI: 10.1186/s12890-020-01238-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study aimed to assess the value of bronchial and cavity contraction percentages in differentiating benign and malignant pulmonary cavities. METHODS Forty-two patients with pulmonary cavities were scanned by dual-phase computed tomography (CT). Then, the cavity and bronchial contraction percentages were respectively measured, the differences between the benign and malignant cavities were compared, and the best diagnostic critical point for differentiating benign and malignant cavities was obtained through the receiver operator characteristic (ROC) curve of the diagnostic test. RESULTS The contraction percentage of the bronchial end with benign cavities was significantly higher than that of the bronchial end with malignant cavities (P < 0.001). The contraction percentage was significantly higher in the benign group than in the malignant group (P < 0.001). The ROC analysis revealed that the sensitivity and specificity of the bronchial contraction percentage was 90.50 and 86.40%, respectively, while the sensitivity and specificity of the cavity contraction percentage was 90.50 and 90.90%, respectively. CONCLUSION The dual-phase CT scanning of the bronchial and cavity contraction percentage can distinguish between benign and malignant cavities.
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Affiliation(s)
- Hua Zhang
- Department of Radiology, the Third Affiliated Hospital of Nanchang University (also known as the First Hospital of Nanchang), No.128 Xiangshan north road, Donghu district, Nanchang, 330008, China.
| | - Xia Qian
- Department of Radiology, the Third Affiliated Hospital of Nanchang University (also known as the First Hospital of Nanchang), No.128 Xiangshan north road, Donghu district, Nanchang, 330008, China
| | - Zheng-Hua Liu
- Department of Radiology, the Third Affiliated Hospital of Nanchang University (also known as the First Hospital of Nanchang), No.128 Xiangshan north road, Donghu district, Nanchang, 330008, China
| | - Yi Gong
- Department of Radiology, the Third Affiliated Hospital of Nanchang University (also known as the First Hospital of Nanchang), No.128 Xiangshan north road, Donghu district, Nanchang, 330008, China
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Automatic bronchial segmentation on ultra-HRCT scans: advantage of the 1024-matrix size with 0.25-mm slice thickness reconstruction. Jpn J Radiol 2020; 38:953-959. [PMID: 32562178 DOI: 10.1007/s11604-020-01000-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/05/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the advantages of ultra-high-resolution computed tomography (U-HRCT) for automatic bronchial segmentation. MATERIALS AND METHODS This retrospective study was approved by the Institutional Review Board, and written informed consent was waived. Thirty-three consecutive patients who underwent chest CT by a U-HRCT scanner were enrolled. In each patient, CT data were reconstructed by two different protocols: 512 × 512 matrix with 0.5-mm slice thickness (conventional HRCT mode) and 1024 × 1024 matrix with 0.25-mm slice thickness (U-HRCT mode). We used a research workstation to compare the two CT modes with regard to the numbers and total lengths of the automatically segmented bronchi. RESULTS Significantly greater numbers and longer lengths of peripheral bronchi were segmented in the U-HRCT mode than in the conventional HRCT mode (P < 0.001, for fifth- to eighth-generation bronchi). For example, the mean numbers and total lengths of the sixth-generation bronchi were 81 and 1048 mm in the U-HRCT mode and 59 and 538 mm in the conventional HRCT mode. CONCLUSIONS The U-HRCT mode greatly improves automatic airway segmentation for the more peripheral bronchi, compared with the conventional HRCT mode. This advantage can be applied to routine clinical care, such as virtual bronchoscopy and automatic lung segmentation.
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Matsushita S, Yamashiro T, Matsuoka S, Yagihashi K, Nakajima Y. The Association Between Bronchial Wall CT Attenuation and Spirometry in Patients with Bronchial Asthma. Acad Radiol 2019; 26:960-966. [PMID: 30377058 DOI: 10.1016/j.acra.2018.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVE The purpose of this study was to evaluate the correlation between generation-based bronchial wall attenuation on thin-section computed tomography (CT) scans and airflow limitation in patients with bronchial asthma. MATERIALS AND METHODS This study included 28 bronchial asthma patients (13 men, 15 women; age range, 23-89 years) who underwent both chest CT and spirometry. On CT, the mean values of peak wall attenuation, wall area percentage, and luminal area were measured in the segmental, subsegmental, and sub-subsegmental bronchi of the right B1 and B10 bronchi. Correlations of the CT measurements with forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), percent predicted forced expiratory flow at 25%-75% of the FVC (%pred forced expiratory flow25-75), and percent predicted peak flow rate were evaluated with Spearman's rank correlation test. RESULTS The peak wall attenuation of each generation of segmental bronchi significantly correlated with the forced expiratory volume in 1 second/FVC (B1 segmental, ρ = -0.683, p < 0.0001; B1 subsegmental, ρ = -0.875, p < 0.0001; B1 sub-subsegmental, ρ = -0.926, p < 0.0001; B10 segmental, ρ = -0.811, p < 0.0001; B10 subsegmental, ρ = -0.903, p < 0.0001; B10 sub-subsegmental ρ = -0.950, p < 0.0001). Similar correlations were found between the peak wall attenuation and %pred forced expiratory flow 25-75 or percent predicted peak flow rate. Overall, the correlation coefficients were relatively high in the more peripheral bronchial generations. In all measurements, the coefficients of the peak wall attenuations were higher than those of the wall area percentage and luminal area. CONCLUSION Peak attenuation of the bronchial wall, particularly in the peripheral bronchi, measured on CT is a good biomarker for the severity of bronchial asthma.
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Affiliation(s)
- Shoichiro Matsushita
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa 216-8511, Japan.
| | - Tsuneo Yamashiro
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa 216-8511, Japan; Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Shin Matsuoka
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Kunihiro Yagihashi
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Yasuo Nakajima
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa 216-8511, Japan
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Karayama M, Inui N, Yasui H, Kono M, Hozumi H, Suzuki Y, Furuhashi K, Hashimoto D, Enomoto N, Fujisawa T, Nakamura Y, Watanabe H, Suda T. Clinical features of three-dimensional computed tomography-based radiologic phenotypes of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:1333-1342. [PMID: 31296985 PMCID: PMC6598936 DOI: 10.2147/copd.s207267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/30/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose The diagnosis and severity of chronic obstructive pulmonary disease (COPD) are defined by airflow limitation using spirometry. However, COPD has diverse clinical features, and several phenotypes based on non-spirometric data have been investigated. To identify novel phenotypes of COPD using radiologic data obtained by three-dimensional computed tomography (3D-CT). Patients and methods The inner luminal area and wall thickness of third- to sixth-generation bronchi and the percentage of the low-attenuation area (less than −950 HU) of the lungs were measured using 3D-CT in patients with COPD. Using the radiologic data, hierarchical clustering was performed. Respiratory reactance and resistance were measured to evaluate functional differences among the clusters. Results Four clusters were identified among 167 patients with COPD: Cluster I, mild emphysema with severe airway changes, severe airflow limitation, and high exacerbation risk; Cluster II, mild emphysema with moderate airway changes, mild airflow limitation, and mild dyspnea; Cluster III, severe emphysema with moderate airway changes, severe airflow limitation, and increased dyspnea; and Cluster IV, moderate emphysema with mild airway changes, mild airflow limitation, low exacerbation risk, and mild dyspnea. Cluster I had the highest respiratory resistance among the four clusters. Clusters I and III had higher respiratory reactance than Clusters II and IV. Conclusions The 3D-CT-based radiologic phenotypes were associated with the clinical features of COPD. Measurement of respiratory resistance and reactance may help to identify phenotypic differences.
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Affiliation(s)
- Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan.,Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Masato Kono
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Dai Hashimoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Hiroshi Watanabe
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
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Physiological and morphological differences of airways between COPD and asthma-COPD overlap. Sci Rep 2019; 9:7818. [PMID: 31127165 PMCID: PMC6534606 DOI: 10.1038/s41598-019-44345-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/14/2019] [Indexed: 01/12/2023] Open
Abstract
Overlap of asthma and COPD has attracted attention recently. We aimed to clarify physiological and morphological differences of the airways between COPD and asthma–COPD overlap (ACO). Respiratory resistance and reactance and three-dimensional computed tomography data were evaluated in 167 patients with COPD. Among them, 43 patients who fulfilled the diagnosis of asthma were defined as having ACO. Among 124 patients with COPD without ACO, 86 with a comparable smoking history and airflow limitation as those with ACO were selected using propensity score matching (matched COPD). The intraluminal area (Ai) and wall thickness (WT) of third- to sixth-generation bronchi were measured and adjusted by body surface area (BSA; Ai/BSA and WT/√BSA, respectively). Patients with ACO had higher respiratory resistance and reactance during tidal breathing, but a smaller gap between the inspiratory and expiratory phases, compared with matched patients with COPD. Patients with ACO had a greater WT/√BSA in third- to fourth-generation bronchi, smaller Ai/BSA in fifth- to sixth-generation bronchi, and less emphysematous changes than did matched patients with COPD. Even when patients with ACO and those with COPD have a comparable smoking history and fixed airflow limitation, they have different physiological and morphological features of the airways.
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Gawlitza J, Sturm T, Spohrer K, Henzler T, Akin I, Schönberg S, Borggrefe M, Haubenreisser H, Trinkmann F. Predicting Pulmonary Function Testing from Quantified Computed Tomography Using Machine Learning Algorithms in Patients with COPD. Diagnostics (Basel) 2019; 9:diagnostics9010033. [PMID: 30901865 PMCID: PMC6468377 DOI: 10.3390/diagnostics9010033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction: Quantitative computed tomography (qCT) is an emergent technique for diagnostics and research in patients with chronic obstructive pulmonary disease (COPD). qCT parameters demonstrate a correlation with pulmonary function tests and symptoms. However, qCT only provides anatomical, not functional, information. We evaluated five distinct, partial-machine learning-based mathematical models to predict lung function parameters from qCT values in comparison with pulmonary function tests. Methods: 75 patients with diagnosed COPD underwent body plethysmography and a dose-optimized qCT examination on a third-generation, dual-source CT with inspiration and expiration. Delta values (inspiration—expiration) were calculated afterwards. Four parameters were quantified: mean lung density, lung volume low-attenuated volume, and full width at half maximum. Five models were evaluated for best prediction: average prediction, median prediction, k-nearest neighbours (kNN), gradient boosting, and multilayer perceptron. Results: The lowest mean relative error (MRE) was calculated for the kNN model with 16%. Similar low MREs were found for polynomial regression as well as gradient boosting-based prediction. Other models led to higher MREs and thereby worse predictive performance. Beyond the sole MRE, distinct differences in prediction performance, dependent on the initial dataset (expiration, inspiration, delta), were found. Conclusion: Different, partially machine learning-based models allow the prediction of lung function values from static qCT parameters within a reasonable margin of error. Therefore, qCT parameters may contain more information than we currently utilize and can potentially augment standard functional lung testing.
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Affiliation(s)
- Joshua Gawlitza
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Timo Sturm
- Department of General Management and Information Systems, University of Mannheim, 68131 Mannheim, Germany.
| | - Kai Spohrer
- Department of General Management and Information Systems, University of Mannheim, 68131 Mannheim, Germany.
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Ibrahim Akin
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
- DZHK (German Center for Cardiovascular Research), partner site, 68167 Mannheim, Germany.
| | - Stefan Schönberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Martin Borggrefe
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
- DZHK (German Center for Cardiovascular Research), partner site, 68167 Mannheim, Germany.
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Frederik Trinkmann
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
- Department of Biomedical Informatics of the Heinrich-Lanz-Center, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Bossé Y. The Strain on Airway Smooth Muscle During a Deep Inspiration to Total Lung Capacity. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2019; 2:0108021-1080221. [PMID: 32328568 PMCID: PMC7164505 DOI: 10.1115/1.4042309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/06/2018] [Indexed: 02/05/2023]
Abstract
The deep inspiration (DI) maneuver entices a great deal of interest because of its ability to temporarily ease the flow of air into the lungs. This salutary effect of a DI is proposed to be mediated, at least partially, by momentarily increasing the operating length of airway smooth muscle (ASM). Concerningly, this premise is largely derived from a growing body of in vitro studies investigating the effect of stretching ASM by different magnitudes on its contractility. The relevance of these in vitro findings remains uncertain, as the real range of strains ASM undergoes in vivo during a DI is somewhat elusive. In order to understand the regulation of ASM contractility by a DI and to infer on its putative contribution to the bronchodilator effect of a DI, it is imperative that in vitro studies incorporate levels of strains that are physiologically relevant. This review summarizes the methods that may be used in vivo in humans to estimate the strain experienced by ASM during a DI from functional residual capacity (FRC) to total lung capacity (TLC). The strengths and limitations of each method, as well as the potential confounders, are also discussed. A rough estimated range of ASM strains is provided for the purpose of guiding future in vitro studies that aim at quantifying the regulatory effect of DI on ASM contractility. However, it is emphasized that, owing to the many limitations and confounders, more studies will be needed to reach conclusive statements.
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Affiliation(s)
- Ynuk Bossé
- Université Laval, Faculty of Medicine, Department of Medicine, IUCPQ, M2694, Pavillon Mallet, Chemin Sainte-Foy, Québec, QC G1V 4G5, Canada e-mail:
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20
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Lusk CM, Wenzlaff AS, Watza D, Sieren JC, Robinette N, Walworth G, Petrich M, Neslund-Dudas C, Flynn MJ, Song T, Spizarny D, Simoff MJ, Soubani AO, Gadgeel S, Schwartz AG. Quantitative Imaging Markers of Lung Function in a Smoking Population Distinguish COPD Subgroups with Differential Lung Cancer Risk. Cancer Epidemiol Biomarkers Prev 2019; 28:724-730. [PMID: 30642838 DOI: 10.1158/1055-9965.epi-18-0886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/30/2018] [Accepted: 12/12/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition with respect to onset, progression, and response to therapy. Incorporating clinical- and imaging-based features to refine COPD phenotypes provides valuable information beyond that obtained from traditional clinical evaluations. We characterized the spectrum of COPD-related phenotypes in a sample of former and current smokers and evaluated how these subgroups differ with respect to sociodemographic characteristics, COPD-related comorbidities, and subsequent risk of lung cancer. METHODS White (N = 659) and African American (N = 520) male and female participants without lung cancer (controls) in the INHALE study who completed a chest CT scan, interview, and spirometry test were used to define distinct COPD-related subgroups based on hierarchical clustering. Seven variables were used to define clusters: pack years, quit years, FEV1/FVC, % predicted FEV1, and from quantitative CT (qCT) imaging, % emphysema, % air trapping, and mean lung density ratio. Cluster definitions were then applied to INHALE lung cancer cases (N = 576) to evaluate lung cancer risk. RESULTS Five clusters were identified that differed significantly with respect to sociodemographic (e.g., race, age) and clinical (e.g., BMI, limitations due to breathing difficulties) characteristics. Increased risk of lung cancer was associated with increasingly detrimental lung function clusters (when ordered from most detrimental to least detrimental). CONCLUSIONS Measures of lung function vary considerably among smokers and are not fully explained by smoking intensity. IMPACT Combining clinical (spirometry) and radiologic (qCT) measures of COPD defines a spectrum of lung disease that predicts lung cancer risk differentially among patient clusters.
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Affiliation(s)
- Christine M Lusk
- Karmanos Cancer Institute, Detroit, Michigan.,Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan
| | - Angela S Wenzlaff
- Karmanos Cancer Institute, Detroit, Michigan.,Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan
| | - Donovan Watza
- Karmanos Cancer Institute, Detroit, Michigan.,Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan
| | - Jessica C Sieren
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Natasha Robinette
- Department of Radiology, Karmanos Cancer Institute, Detroit, Michigan
| | - Garrett Walworth
- Department of Radiology, Karmanos Cancer Institute, Detroit, Michigan
| | - Michael Petrich
- Department of Radiology, Karmanos Cancer Institute, Detroit, Michigan
| | - Christine Neslund-Dudas
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.,Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan
| | - Michael J Flynn
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.,Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Thomas Song
- Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - David Spizarny
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.,Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Michael J Simoff
- Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan.,Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, Michigan
| | - Ayman O Soubani
- Karmanos Cancer Institute, Detroit, Michigan.,Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, Michigan
| | - Shirish Gadgeel
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Ann G Schwartz
- Karmanos Cancer Institute, Detroit, Michigan. .,Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan
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21
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Nagatani Y, Hashimoto M, Nitta N, Oshio Y, Yamashiro T, Sato S, Tsukagoshi S, Moriya H, Kimoto T, Igarashi T, Ushio N, Sonoda A, Otani H, Hanaoka J, Murata K. Continuous quantitative measurement of the main bronchial dimensions and lung density in the lateral position by four-dimensional dynamic-ventilation CT in smokers and COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:3845-3856. [PMID: 30568436 PMCID: PMC6267741 DOI: 10.2147/copd.s178836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to measure changes in lung density and airway dimension in smokers in the lateral position using four-dimensional dynamic-ventilation computed tomography (CT) during free breathing and to evaluate their correlations with spirometric values. Materials and methods Preoperative pleural adhesion assessments included dynamic-ventilation CT of 42 smokers (including 22 patients with COPD) in the lateral position, with the unoperated lung beneath (dependent lung). The scanned lungs' mean lung density (MLD) and the bilateral main bronchi's luminal areas (Ai) were measured automatically (13-18 continuous image frames, 0.35 seconds/frame). Calculations included cross-correlation coefficients (CCCs) between the MLD and Ai time curves, and correlations between the quantitative measurements and spirometric values were evaluated by using Spearman's rank coefficient. Results The ΔMLD1.05 (from the peak inspiration frame to the third expiratory frame, 1.05 seconds later) in the nondependent lung negatively correlated with FEV1/FVC (r=-0.417, P<0.01), suggesting that large expiratory movement of the nondependent lung would compensate limited expiratory movement of the dependent lung due to COPD. The ΔAi1.05 negatively correlated with the FEV1/FVC predicted in both the lungs (r=-0.465 and -0.311, P<0.05), suggesting that early expiratory collapses of the main bronchi indicate severe airflow limitation. The CCC correlated with FEV1/FVC in the dependent lung (r=-0.474, P<0.01), suggesting that reduced synchrony between the proximal airway and lung occurs in patients with severe airflow limitation. Conclusion In COPD patients, in the lateral position, the following abnormal dynamic-ventilation CT findings are associated with airflow limitation: enhanced complementary ventilation in the nondependent lung, early expiratory airway collapses, and reduced synchrony between airway and lung movements in the dependent lung.
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Affiliation(s)
- Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Masayuki Hashimoto
- Department of Surgery, Division of General Thoracic Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Yasuhiko Oshio
- Department of Surgery, Division of General Thoracic Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan,
| | - Shigetaka Sato
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | | | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima, Fukushima 960-8611, Japan
| | - Tatsuya Kimoto
- Healthcare IT Development Center, Canon Medical Systems, Otawara, Tochigi 324-8550, Japan
| | - Tomoyuki Igarashi
- Department of Surgery, Division of General Thoracic Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Noritoshi Ushio
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Hideji Otani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Jun Hanaoka
- Department of Surgery, Division of General Thoracic Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
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22
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Doganay O, Matin T, Chen M, Kim M, McIntyre A, McGowan DR, Bradley KM, Povey T, Gleeson FV. Time-series hyperpolarized xenon-129 MRI of lobar lung ventilation of COPD in comparison to V/Q-SPECT/CT and CT. Eur Radiol 2018; 29:4058-4067. [PMID: 30552482 PMCID: PMC6610266 DOI: 10.1007/s00330-018-5888-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/08/2018] [Accepted: 11/13/2018] [Indexed: 12/23/2022]
Abstract
Purpose To derive lobar ventilation in patients with chronic obstructive pulmonary disease (COPD) using a rapid time-series hyperpolarized xenon-129 (HPX) magnetic resonance imaging (MRI) technique and compare this to ventilation/perfusion single-photon emission computed tomography (V/Q-SPECT), correlating the results with high-resolution computed tomography (CT) and pulmonary function tests (PFTs). Materials and methods Twelve COPD subjects (GOLD stages I–IV) participated in this study and underwent HPX-MRI, V/Q-SPECT/CT, high-resolution CT, and PFTs. HPX-MRI was performed using a novel time-series spiral k-space sampling approach. Relative percentage ventilations were calculated for individual lobe for comparison to the relative SPECT lobar ventilation and perfusion. The absolute HPX-MRI percentage ventilation in each lobe was compared to the absolute CT percentage emphysema score calculated using a signal threshold method. Pearson’s correlation and linear regression tests were performed to compare each imaging modality. Results Strong correlations were found between the relative lobar percentage ventilation with HPX-MRI and percentage ventilation SPECT (r = 0.644; p < 0.001) and percentage perfusion SPECT (r = 0.767; p < 0.001). The absolute CT percentage emphysema and HPX percentage ventilation correlation was also statistically significant (r = 0.695, p < 0.001). The whole lung HPX percentage ventilation correlated with the PFT measurements (FEV1 with r = − 0.886, p < 0.001*, and FEV1/FVC with r = − 0.861, p < 0.001*) better than the whole lung CT percentage emphysema score (FEV1 with r = − 0.635, p = 0.027; and FEV1/FVC with r = − 0.652, p = 0.021). Conclusion Lobar ventilation with HPX-MRI showed a strong correlation with lobar ventilation and perfusion measurements derived from SPECT/CT, and is better than the emphysema score obtained with high-resolution CT. Key Points • The ventilation hyperpolarized xenon-129 MRI correlates well with ventilation and perfusion with SPECT/CT with the advantage of higher temporal and spatial resolution. • The hyperpolarized xenon-129 MRI correlates with the PFT measurements better than the high-resolution CT with the advantage of avoiding the use of ionizing radiation. Electronic supplementary material The online version of this article (10.1007/s00330-018-5888-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ozkan Doganay
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, OX3 7DQ, Oxford, UK.
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK.
| | - Tahreema Matin
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Mitchell Chen
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Minsuok Kim
- Department of Engineering Science, University of Oxford, OX1 3PJ, Oxford, UK
| | - Anthony McIntyre
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Daniel R McGowan
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, OX3 7DQ, Oxford, UK
- Radiation Physics and Protection, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Kevin M Bradley
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Thomas Povey
- Department of Engineering Science, University of Oxford, OX1 3PJ, Oxford, UK
| | - Fergus V Gleeson
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, OX3 7DQ, Oxford, UK
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
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23
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Gawlitza J, Haubenreisser H, Henzler T, Akin I, Schönberg S, Borggrefe M, Trinkmann F. Finding the right spot: Where to measure airway parameters in patients with COPD. Eur J Radiol 2018; 104:87-93. [PMID: 29857872 DOI: 10.1016/j.ejrad.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The importance of spirometry for management of COPD was reduced in the 2017 revision of the GOLD report. CT derived airway measurements show strong correlations with lung function tests and symptoms. However, these correlations are specific to the airway localization, and currently there is no evidence for the ideal spot. Therefore, the aim of this prospective study was to systematically correlate CT derived airway measurements with extensive lung function testing. METHODS AND MATERIALS 65 patients with diagnosed COPD underwent body plethysmography, impulse oscillometry and dose optimized qCT examination (Somatom Force, Healthineers, Germany) in inspiration and expiration. Eight airway parameters (e.g. outer diameter, maximal wall thickness) were acquired for both scans in every lobe for the third to fifth generation bronchus and correlated with the lung function tests. RESULTS The most significant correlations between airway parameters were found for the third generation bronchus of the upper left lobe during expiration (25 out of 48 correlation pairs, mean r = -0.39) and for the third generation bronchus of the upper right lobe during inspiration (9 out of 48 correlation pairs, mean r = -0.25). No significant correlations were for example found for the upper right lobe in expiration. CONCLUSION Correlations between airway parameters and lung function tests vary widely between lobes, bronchus generations and breathing states. Our work suggests that the third generation bronchus of the upper left lobe in expiration could be the preferred localization for airway quantification in future studies.
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Affiliation(s)
- Joshua Gawlitza
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Ibrahim Akin
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Mannheim, Germany.
| | - Stefan Schönberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Mannheim, Germany.
| | - Martin Borggrefe
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Mannheim, Germany.
| | - Frederik Trinkmann
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Nishine H, Hiramoto T, Inoue T, Furuya N, Kida H, Handa H, Nobuyama S, Mineshita M, Miyazawa T. Assessment of Bronchial Obstruction Using Lateral Pressure Measurement during Bronchoscopy. Respiration 2017; 95:106-113. [PMID: 29190612 DOI: 10.1159/000481572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 09/17/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with bronchial obstruction estimating the location of the maximal obstruction is crucial for guiding interventional bronchoscopy. However, flow-volume curves cannot discriminate between the right and left lungs. OBJECTIVES The aim of this study was to physiologically evaluate bronchial obstruction during interventional bronchoscopy. METHODS We prospectively measured lateral airway pressure (Plat) at either side of the obstruction using a double-lumen catheter (pressure-pressure [P-P] curve) simultaneously to assess the degree of bronchial obstruction in 22 patients. The shape of the P-P curve was assessed to confirm the site of maximal obstruction. RESULTS In the experimental study, Plat was uniform between both bronchi in the normal model. For the unilateral and bilateral obstruction models, a phase shift was only seen for the more obstructed side. In healthy subjects, the angle of the P-P curve was close to 45° and linear in shape. In patients with bronchial obstruction, the angle was much smaller but approached 45° after the bronchoscopic procedure. The degree of bronchial obstruction was significantly correlated with the angle of the P-P curve (r = -0.51, p < 0.01). Dyspnea significantly increased when the airway lumen was obstructed by more than 60% (p < 0.0001), and when the P-P curve appeared loop-shaped (p < 0.01). CONCLUSIONS The shape of the P-P curve could be used to detect the site of maximal obstruction for the optimal positioning of the stent and assess the need for additional procedures in real time in patients with bronchial obstruction.
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Comparison of Airway Measurements for Tracheobronchial Stenosis Between Stereoscopic Bronchoscope and MD-CT. J Bronchology Interv Pulmonol 2017; 24:296-302. [PMID: 28957890 DOI: 10.1097/lbr.0000000000000409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stereoscopic bronchoscopy is a new diagnostic tool to measure the diameter and cross-sectional area of the airway. The stereoscopic bronchoscope, which operates the same as a standard bronchoscope, utilizes 2 lenses to measure the airway using the principles of triangulation. Furthermore, the stereoscopic bronchoscope has the capability to measure the size of the airway during intervention in real-time, including variable stenosis. MATERIALS AND METHODS To prospectively compare preoperative stereoscopic and multidetector computed tomography (MD-CT) images to select the appropriate stent size for airway stenosis. Stereoscopic and MD-CT images were then measured to confirm the correct placement of the stent. RESULTS Airway stenting was performed on 21 consecutive patients of whom, 15 were diagnosed with malignant and 6 with benign diseases. In total, 165 measurements were taken (134 healthy; 31 affected). For the diameter, Bland-Altman plots were used to measure data from 165 matched stereoscopic and MD-CT measurement sites (bias, 0.40±2.86 mm SD; percentage error, 33%), 134 healthy sites (bias, 0.554±2.83 mm SD; percentage error, 34%), and 31 affected sites (bias, 1.20±2.67 mm SD; percentage error, 52%). For the cross-sectional area, matched stereoscopic and MD-CT measurements were analyzed for 65 sites (bias, -10.53±92.85 mm SD; percentage error, 89%), 49 healthy sites (bias, -9.88±39.00 mm SD; percentage error, 32%), and 16 affected sites (bias, -13.12±48.81 mm SD; percentage error, 92%). CONCLUSION Stereoscopic bronchoscopy was able to accurately measure the size of the airway during intervention, to assist in selecting the appropriate size of the stent.
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Montesantos S, Katz I, Pichelin M, Caillibotte G. The Creation and Statistical Evaluation of a Deterministic Model of the Human Bronchial Tree from HRCT Images. PLoS One 2016; 11:e0168026. [PMID: 27977730 PMCID: PMC5157997 DOI: 10.1371/journal.pone.0168026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/25/2016] [Indexed: 02/03/2023] Open
Abstract
A quantitative description of the morphology of lung structure is essential prior to any form of predictive modeling of ventilation or aerosol deposition implemented within the lung. The human lung is a very complex organ, with airway structures that span two orders of magnitude and having a multitude of interfaces between air, tissue and blood. As such, current medical imaging protocols cannot provide medical practitioners and researchers with in-vivo knowledge of deeper lung structures. In this work a detailed algorithm for the generation of an individualized 3D deterministic model of the conducting part of the human tracheo-bronchial tree is described. Distinct initial conditions were obtained from the high-resolution computed tomography (HRCT) images of seven healthy volunteers. The algorithm developed is fractal in nature and is implemented as a self-similar space sub-division procedure. The expansion process utilizes physiologically realistic relationships and thresholds to produce an anatomically consistent human airway tree. The model was validated through extensive statistical analysis of the results and comparison of the most common morphological features with previously published morphometric studies and other equivalent models. The resulting trees were shown to be in good agreement with published human lung geometric characteristics and can be used to study, among other things, structure-function relationships in simulation studies.
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Affiliation(s)
| | - Ira Katz
- Medical R&D, Air Liquide Santé International, Paris Saclay, France
- Department of Mechanical Engineering, Lafayette College, Easton, PA, United States of America
| | - Marine Pichelin
- Medical R&D, Air Liquide Santé International, Paris Saclay, France
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27
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Kloth C, Thaiss WM, Ditt H, Hetzel J, Schülen E, Nikolaou K, Horger M. Segmental bronchi collapsibility: computed tomography-based quantification in patients with chronic obstructive pulmonary disease and correlation with emphysema phenotype, corresponding lung volume changes and clinical parameters. J Thorac Dis 2016; 8:3521-3529. [PMID: 28149545 DOI: 10.21037/jtd.2016.12.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Global pulmonary function tests lack region specific differentiation that might influence therapy in severe chronic obstructive pulmonary disease (COPD) patients. Therefore, the aim of this work was to assess the degree of expiratory 3rd generation bronchial lumen collapsibility in patients with severe COPD using chest-computed tomography (CT), to evaluate emphysema-phenotype, lobar volumes and correlate results with pulmonary function tests. METHODS Thin-slice chest-CTs acquired at end-inspiration & end-expiration in 42 COPD GOLD IV patients (19 females, median-age: 65.9 y) from November 2011 to July 2014 were re-evaluated. The cross-sectional area of all segmental bronchi was measured 5 mm below the bronchial origin in both examinations. Lung lobes were semi-automatically segmented, volumes calculated at end-inspiratory and end-expiratory phase and visually defined emphysema-phenotypes defined. Results of CT densitometry were compared with lung functional tests including forced expiratory volume at 1 s (FEV1), total lung capacity (TLC), vital capacity (VC), residual volume (RV), diffusion capacity parameters and the maximal expiratory flow rates (MEFs). RESULTS Mean expiratory bronchial collapse was 31%, stronger in lobes with homogenous (38.5%) vs. heterogeneous emphysema-phenotype (27.8%, P=0.014). The mean lobar expiratory volume reduction was comparable in both emphysema-phenotypes (volume reduction 18.6%±8.3% in homogenous vs. 17.6%±16.5% in heterogeneous phenotype). The degree of bronchial lumen collapsibility, did not correlate with expiratory volume reduction. MEF25 correlated weakly with 3rd generation airway collapsibility (r=0.339, P=0.03). All patients showed a concentric expiratory reduction of bronchial cross-sectional area. CONCLUSIONS Changes in collapsibility of 3rd generation bronchi in COPD grade IV patients is significantly lower than that in the trachea and the main bronchi. Collapsibility did not correlate with the reduction in lung volume but was significantly higher in lobes with homogeneous vs. heterogeneous emphysema phenotype. Changes in the 3rd generation bronchial calibres between inspiration and expiration are not predictive for the degree of small airway collapsibility and related airflow limitation.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, 72076 Tübingen, Germany
| | - Wolfgang Maximilian Thaiss
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, 72076 Tübingen, Germany
| | - Hendrik Ditt
- Siemens AG Healthcare, Imaging & Therapy Systems Computed Tomography & Radiation Oncology, HC IM CR R&D PA CA DC, 91301 Forchheim, Germany
| | - Jürgen Hetzel
- Department of Internal Medicine II, Eberhard-Karls-University, 72076 Tübingen, German
| | - Eva Schülen
- Department of Internal Medicine II, Eberhard-Karls-University, 72076 Tübingen, German
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, 72076 Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, 72076 Tübingen, Germany
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Yamashiro T, Moriya H, Tsubakimoto M, Matsuoka S, Murayama S. Continuous quantitative measurement of the proximal airway dimensions and lung density on four-dimensional dynamic-ventilation CT in smokers. Int J Chron Obstruct Pulmon Dis 2016; 11:755-64. [PMID: 27110108 PMCID: PMC4835141 DOI: 10.2147/copd.s100658] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Four-dimensional dynamic-ventilation computed tomography (CT) imaging demonstrates continuous movement of the airways and lungs, which cannot be depicted with conventional CT. We aimed to investigate continuous changes in lung density and airway dimensions and to assess the correlation with spirometric values in smokers. Materials and methods This retrospective study was approved by the Institutional Review Board, and informed consent was waived. Twenty-one smokers including six patients with COPD underwent four-dimensional dynamic-ventilation CT during free breathing (160 mm in length). The mean lung density (MLD) of the scanned lung and luminal areas (Ai) of fixed points in the trachea and the right proximal bronchi (main bronchus, upper bronchus, bronchus intermedius, and lower bronchus) were continuously measured. Concordance between the time curve of the MLD and that of the airway Ai values was expressed by cross-correlation coefficients. The associations between these quantitative measurements and the forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) values were assessed by Spearman’s rank correlation analysis. Results On the time curve for the MLD, the Δ-MLD1.05 values between the peak inspiratory frame to the later third frame (1.05 seconds later) were strongly correlated with the FEV1/FVC (ρ=0.76, P<0.0001). The cross-correlation coefficients between the airway Ai and MLD values were significantly correlated with the FEV1/FVC (ρ=−0.56 to −0.66, P<0.01), except for the right upper bronchus. This suggested that the synchrony between the airway and lung movement was lost in patients with severe airflow limitation. Conclusion Respiratory changes in the MLD and synchrony between the airway Ai and the MLD measured with dynamic-ventilation CT were correlated with patient’s spirometric values.
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Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima-shi, Fukushima, Japan
| | - Maho Tsubakimoto
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Shin Matsuoka
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
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Suwatanapongched T, Thongprasert C, Lertpongpiroon S, Muntham D, Kiatboonsri S. Expiratory air trapping during asthma exacerbation: Relationships with clinical indices and proximal airway morphology. Eur J Radiol 2015; 84:2671-8. [DOI: 10.1016/j.ejrad.2015.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/21/2015] [Accepted: 09/08/2015] [Indexed: 12/22/2022]
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Usuba A, Yamashiro T, Handa H, Matsuoka S, Yamano Y, Mineshita M, Miyazawa T. Quantitative Computed Tomography Measurement of Tracheal Cross-Sectional Areas in Relapsing Polychondritis: Correlations with Spirometric Values. Respiration 2015; 90:468-473. [PMID: 26509473 DOI: 10.1159/000441303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/18/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although tracheal stenosis occurs in relapsing polychondritis (RP), no studies exist that have clarified correlations between quantitative airway measurement and spirometry in RP patients. OBJECTIVES The aim of this study was to investigate correlations between the cross-sectional area (CSA) of the trachea and spirometric values in patients with RP. METHODS The institutional review board approved this retrospective study, and written informed consent was waived. Twenty-six patients with RP underwent spirometry and chest computed tomography (CT) at full inspiration and end-expiration. On inspiratory and expiratory chest CT images, CSA at the intrathoracic trachea was measured for all CT slices, and the mean and minimum tracheal CSA were obtained. Correlations between the tracheal CSA and spirometric values were assessed by Spearman's rank correlation analysis. Results: Tracheal CSA measurements for inspiratory and expiratory scans were significantly correlated with FEV 1 , FEV 25-75% , and peak flow values (ρ = 0.51-0.86, p <0.01). During each inspiratory or expiratory phase, the minimum tracheal CSA achieved a higher correlation coefficient with spirometric values than the mean CSA. CONCLUSION Tracheal dimensions for both inspiratory and expiratory CT are significant predictors of pulmonary function in patients with RP. The narrowest tracheal dimension likely determines the severity of airflow limitation in RP.
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Affiliation(s)
- Ayano Usuba
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Optimal threshold of subtraction method for quantification of air-trapping on coregistered CT in COPD patients. Eur Radiol 2015; 26:2184-92. [PMID: 26515547 DOI: 10.1007/s00330-015-4070-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/10/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the optimal threshold of subtraction method for quantification of air trapping on co-registered CT in COPD patients in correlation with pulmonary function parameters. METHODS From June 2005 to October 2010, 174 patients were included in our study. Inspiration and expiration CT were performed followed by non-rigid registration using in-house software. The subtraction value per voxel between inspiration and registered expiration CT was obtained, and volume fraction of air trapping (air trapping index, ATI), using variable thresholds was calculated. ATI, expiration/inspiration ratio of mean lung density (E/I MLD) and the percentage of lung voxels below -856 HU on expiration CT (Exp-856) were correlated with FEF25-75% and RV/TLC. RESULTS The highest correlation coefficient with FEF25-75% was -0.656, using the threshold of 80 HU. As for RV/TLC, the highest correlation coefficient was 0.664, using the threshold of 30 HU. When plotting the relationship between subtraction thresholds and FEF25-75% and RV/TLC, the threshold of 60 HU was most suitable (r = -0.649 and 0.651). Those correlation coefficients were comparable to the results with E/I MLD (r = -0.670 and 0.657) and Exp-856 (r = -0.604 and 0.565). CONCLUSIONS The optimal threshold for quantification of air trapping was 60 HU and showed comparable correlations with pulmonary function parameters. KEY POINTS • The optimal CT threshold of subtraction method for air trapping was 60 HU. • ATI with 60 HU threshold was comparable to E/I MLD and Exp -856 . • Emphysema may substantially contribute to air trapping with statistical significance (P < 0.001).
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Chen Y, Ding M, Guan WJ, Wang W, Luo WZ, Zhong CH, Jiang M, Jiang JH, Gu YY, Li SY, Zhong NS. Validation of human small airway measurements using endobronchial optical coherence tomography. Respir Med 2015; 109:1446-53. [PMID: 26427628 DOI: 10.1016/j.rmed.2015.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Small airway remodeling is the cardinal feature underlying chronic airway diseases. There is no modality which identifies small airway pathological changes, which is crucial for early diagnosis, efficacy and prognostic assessment. OBJECTIVE To evaluate the usefulness of endobronchial optical coherence tomography (EB-OCT) in assessing small airways morphology in vivo. METHODS Twelve patients with pulmonary nodules scheduled for lung resection underwent spirometry, multi-detector computed tomography (MDCT) and EB-OCT. We measured D(mean) (mean luminal diameter), Ai (inner luminal area), Aw (airway wall area) and Aw% [Aw/(Ai + Aw) × 100%] from the 3rd to 5th generation bronchi of RB9 segment by MDCT. D(mean), Ai, Aw and Aw% from the 3rd to 9th generation bronchi of RB9 segment were measured by EB-OCT and histology. Correlations of these parameters, measured by three different methods, were evaluated. We recruited 4 COPD patients to determine if EB-OCT could identify peripheral airway remodeling. RESULTS The 4 parameters, measured by CT and EB-OCT, correlated significantly [D(mean) (r = 0.991), Ai (r = 0.997), Aw (r = 0.997), Aw% (r = 0.991), all P < 0.01]. Significant correlation were found for these parameters, measured by histology and EB-OCT, from the 3rd to 5th generation bronchi [D(mean) (r = 0.989), Ai (r = 0.997), Aw (r = 0.999), Aw% (r = 0.988), all P < 0.01], and from the 6th to 9th generation bronchi [D(mean) (r = 0.979), Ai (r = 0.997), Aw (r = 0.994) and Aw% (r = 0.988), all P < 0.01]. Significant small airways morphological abnormalities were observed in COPD patients. CONCLUSIONS EB-OCT, a minimally invasive imaging modality with high-resolution, is useful and clinically practical for assessing proximal and distal airways of human compared with CT and histology.
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Affiliation(s)
- Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ming Ding
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei-jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Wang
- Department of Cardiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei-zhan Luo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chang-hao Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ju-hong Jiang
- Department of Pathology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ying-ying Gu
- Department of Pathology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shi-yue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Nan-shan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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Yamashiro T, Tsubakimoto M, Nagatani Y, Moriya H, Sakuma K, Tsukagoshi S, Inokawa H, Kimoto T, Teramoto R, Murayama S. Automated continuous quantitative measurement of proximal airways on dynamic ventilation CT: initial experience using an ex vivo porcine lung phantom. Int J Chron Obstruct Pulmon Dis 2015; 10:2045-54. [PMID: 26445535 PMCID: PMC4590570 DOI: 10.2147/copd.s87588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The purpose of this study was to evaluate the feasibility of continuous quantitative measurement of the proximal airways, using dynamic ventilation computed tomography (CT) and our research software. Methods A porcine lung that was removed during meat processing was ventilated inside a chest phantom by a negative pressure cylinder (eight times per minute). This chest phantom with imitated respiratory movement was scanned by a 320-row area-detector CT scanner for approximately 9 seconds as dynamic ventilatory scanning. Obtained volume data were reconstructed every 0.35 seconds (total 8.4 seconds with 24 frames) as three-dimensional images and stored in our research software. The software automatically traced a designated airway point in all frames and measured the cross-sectional luminal area and wall area percent (WA%). The cross-sectional luminal area and WA% of the trachea and right main bronchus (RMB) were measured for this study. Two radiologists evaluated the traceability of all measurable airway points of the trachea and RMB using a three-point scale. Results It was judged that the software satisfactorily traced airway points throughout the dynamic ventilation CT (mean score, 2.64 at the trachea and 2.84 at the RMB). From the maximum inspiratory frame to the maximum expiratory frame, the cross-sectional luminal area of the trachea decreased 17.7% and that of the RMB 29.0%, whereas the WA% of the trachea increased 6.6% and that of the RMB 11.1%. Conclusion It is feasible to measure airway dimensions automatically at designated points on dynamic ventilation CT using research software. This technique can be applied to various airway and obstructive diseases.
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Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Maho Tsubakimoto
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima, Japan
| | - Kotaro Sakuma
- Department of Radiology, Ohara General Hospital, Fukushima, Japan
| | | | - Hiroyasu Inokawa
- Center for Medical Research and Development, Toshiba Medical Systems Corporation, Otawara, Japan
| | - Tatsuya Kimoto
- Center for Medical Research and Development, Toshiba Medical Systems Corporation, Otawara, Japan
| | - Ryuichi Teramoto
- Corporate Manufacturing Engineering Center, Toshiba Corporation, Yokohama, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
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Comparison of a New Integral-Based Half-Band Method for CT Measurement of Peripheral Airways in COPD With a Conventional Full-Width Half-Maximum Method Using Both Phantom and Clinical CT Images. J Comput Assist Tomogr 2015; 39:428-36. [PMID: 25700223 DOI: 10.1097/rct.0000000000000218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare a new integral-based half-band method (IBHB) and a conventional full-width half-maximum (FWHM) method in measuring peripheral airway dimensions at airway phantoms and thin-section computed tomography of chronic obstructive pulmonary disease (COPD). METHODS The IBHB was validated and compared using airway phantoms and 50 patients with COPD. Airway parameters (wall area percentage [WA%], mean lumen radius, and mean wall thickness) were measured at fourth to sixth generations of the right apical bronchus. Matched results from 2 methods were compared and correlated with forced expiratory volume (FEV) in 1 second (FEV1), FEV1 / forced vital capacity (FVC), and global initiative for chronic obstructive lung disease (GOLD) stage. Linear regression analysis was performed using airway dimensions and emphysema index. RESULTS The IBHB generated more accurate measurements at phantom study. Measured airway parameters by both methods at thin-section computed tomography study were significantly different (all P < 0.05, paired t test). The IBHB method-measured WA% and wall thickness were significantly smaller. Mean WA% with IBHB also showed better correlation than that with FWHM (FEV1, r = -0.52 vs -0.28; FEV1 / FVC, r = -0.41 vs r = -0.20; GOLD, 0.52 vs 0.33, respectively). Linear regression analysis revealed fifth-generation WA% measured by IBHB was an independent variable, and addition to emphysema index increased predictability (FEV1, r = 0.63; FEV1 / FVC, r = 0.61; GOLD, r = 0.70). CONCLUSIONS The new IBHB measured peripheral airway dimensions differently than FWHM and showed better correlations with functional parameters in COPD.
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Nordenmark LH, Taylor R, Jorup C. Feasibility of Computed Tomography in a Multicenter COPD Trial: A Study of the Effect of AZD9668 on Structural Airway Changes. Adv Ther 2015; 32:548-66. [PMID: 26043724 DOI: 10.1007/s12325-015-0215-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The aim of this study was to establish the feasibility of using computed tomography (CT) in a multicenter setting to assess structural airway changes. METHODS This was a 12-week, randomized, double-blind, placebo-controlled, Phase IIb trial using CT to investigate the effect of a novel, oral, reversible neutrophil elastase inhibitor, AZD9668 60 mg twice daily (BID), on structural airway changes in patients aged 50-80 years with chronic obstructive pulmonary disease (COPD) (ex-smokers). PRIMARY OUTCOME VARIABLE airway wall thickness at an extrapolated interior perimeter of 10 mm (AWT-Pi10). Secondary outcome variables: fifth-generation wall area %; air trapping index; pre- and post-bronchodilator forced expiratory volume in 1 s (FEV1); morning and evening peak expiratory flow and FEV1; body plethysmography; EXAcerbations of Chronic pulmonary disease Tool (EXACT); Breathlessness, Cough, and Sputum Scale (BCSS); St George's Respiratory Questionnaire for COPD; and proportion of reliever-medication-free trial days. Safety variables were also assessed. RESULTS There was no difference between placebo (n = 19) and AZD9668 (n = 17) for AWT-Pi10 at treatment end. This was consistent with results for most secondary variables. However, patients randomized to AZD9668 experienced an improvement versus placebo for morning and evening FEV1, and EXACT and BCSS cough and sputum scores. AZD9668 60 mg BID was well tolerated and no new safety concerns were identified. CONCLUSIONS This study confirmed the feasibility of using CT to assess structural airway changes in COPD. However, there was no evidence of improvements in CT structural measures following 12 weeks' treatment with AZD9668 60 mg BID. FUNDING AstraZeneca.
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Camiciottoli G, Diciotti S, Bigazzi F, Lombardo S, Bartolucci M, Paoletti M, Mascalchi M, Pistolesi M. Is intrathoracic tracheal collapsibility correlated to clinical phenotypes and sex in patients with COPD? Int J Chron Obstruct Pulmon Dis 2015; 10:843-52. [PMID: 25960647 PMCID: PMC4423505 DOI: 10.2147/copd.s80558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A substantial proportion of patients with chronic obstructive pulmonary disease (COPD) develops various degree of intrathoracic tracheal collapsibility. We studied whether the magnitude of intrathoracic tracheal collapsibility could be different across clinical phenotypes and sex in COPD. Intrathoracic tracheal collapsibility measured at paired inspiratory-expiratory low dose computed tomography (CT) and its correlation with clinical, functional, and CT-densitometric data were investigated in 69 patients with COPD according to their predominant conductive airway or emphysema phenotypes and according to sex. Intrathoracic tracheal collapsibility was higher in patients with predominant conductive airway disease (n=28) and in females (n=27). Women with a predominant conductive airway phenotype (n=10) showed a significantly greater degree of collapsibility than women with predominant emphysema (28.9%±4% versus 11.6%±2%; P<0.001). Intrathoracic tracheal collapsibility was directly correlated with inspiratory-expiratory volume variation at CT and with forced expiratory volume (1 second), and inversely correlated with reduced CT lung density and functional residual capacity. Intrathoracic tracheal collapsibility was not correlated with cough and wheezing; however, intrathoracic tracheal collapsibility and clinical phenotypes of COPD are closely correlated. In patients with a predominant emphysematous phenotype, a reduced collapsibility may reflect the mechanical properties of the stiff hyperinflated emphysematous lung. The high collapsibility in patients with predominant airway disease, mild airway obstruction, and in women with this phenotype may reflect chronic airway inflammation. The lack of relationship with such symptoms as wheezing, cough, and dyspnea could indicate that intrathoracic tracheal collapsibility itself should be considered neither an abnormal feature of COPD nor a relevant clinical finding.
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Affiliation(s)
- Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi," University of Bologna, Cesena, Italy
| | - Francesca Bigazzi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Simone Lombardo
- Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Maurizio Bartolucci
- Department of Diagnostic Imaging, Careggi University Hospital, Florence, Italy
| | - Matteo Paoletti
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Mario Mascalchi
- Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Massimo Pistolesi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Yanagawa N, Kawata N, Matsuura Y, Sugiura T, Suzuki T, Kasai H, Irie R, Iesato K, Tada Y, Tanabe N, Suzuki Y, Tatsumi K. Effect of threshold on the correlation between airflow obstruction and low attenuation volume in smokers assessed by inspiratory and expiratory MDCT. Acta Radiol 2015; 56:438-46. [PMID: 24633696 DOI: 10.1177/0284185114528489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The estimation of emphysematous changes is very sensitive to computed tomography (CT) threshold level. In clinical practice, the predetermined threshold is usually set at -950 Hounsfield units (HU) for the detection of low attenuation volume (LAV). However, threshold levels that are tightly connected to pulmonary function abnormalities have not been determined. PURPOSE To determine the threshold level for calculating an LAV that closely reflects airflow limitation in patients with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS Seventy-six consecutive non-COPD smokers and COPD patients underwent paired inspiratory and expiratory multidetector CT (MDCT). LAV% was segmented every 10 HU between -1000 and -750 HU to examine the correlation between LAV% and indexes of obstructive impairment. RESULTS LAV% gradually increased as the threshold level increased on both inspiratory and expiratory images. LAV% on inspiratory images was higher than that on expiratory images at all threshold levels between -1000 and -750 HU. The threshold level that correlated with obstructive impairment differed between the two images: -930 HU on inspiratory and -870 or -880 HU on expiratory images. CONCLUSION LAV% dramatically changed according to the threshold level on both inspiratory and expiratory images, indicating that LAV% is dependent on the attenuation threshold level in patients with COPD. The threshold linking LAV% to airflow limitation was higher on expiratory than on inspiratory images.
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Affiliation(s)
- Noriyuki Yanagawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yukiko Matsuura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshio Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryosuke Irie
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ken Iesato
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoichi Suzuki
- Department of public Health, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Regional bronchodilator response assessed by computed tomography in chronic obstructive pulmonary disease. Eur J Radiol 2015; 84:1196-201. [PMID: 25805332 DOI: 10.1016/j.ejrad.2015.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/18/2015] [Accepted: 02/20/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The reliability of CT assessment of regional bronchodilation is not universally accepted. In this study, using our proprietary 3D-CT software, we first examined airway inner luminal area (Ai) before and after inhalation of SFC in a group of COPD patients and then evaluated the same parameters for two sets of CT data obtained from clinically stable subjects with no intervention. METHODS We conducted CT at deep inspiration and pulmonary function tests before and one week after inhalation of SFC in 23 COPD patients. As a non-intervention group, we used two sets of CT data obtained with one-year interval in another group of subjects who demonstrated stable pulmonary function (n=8). We measured Ai at the mid-portions of 3rd to 6th generation in 8 bronchi of the right lung, a total of 32 identical sites before and after intervention. RESULTS The average bronchodilation at all sites (ΔAi%: 28.2 ± 4.1 (SE)%) (r=0.65, p<0.001) and that of each generation significantly correlated with % improvement of FEV1 (ΔFEV1%), which increased from 1.40 ± 0.10 L to 1.58 ± 0.10 L. When subjects were classified into two groups in terms of mean ΔFEV1%, even the poor responders (ΔFEV1% <14% above baseline, n=13) displayed significantly larger ΔAi% compared with the non-intervention group (19.1 ± 4.6% versus 2.1 ± 3.9%). Inter-observer variability for overall ΔAi% was within acceptable levels. CONCLUSIONS CT can reliably detect the regional bronchodilation in 3rd to 6th generation airways when ΔFEV1 is as small as 180 ml on average. This study was registered in the UMIN Clinical Trials Registry (UMIN-CTR) system (http://www.umin.ac.jp/. No. UMIN 000002668).
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Paired inspiratory/expiratory volumetric CT and deformable image registration for quantitative and qualitative evaluation of airflow limitation in smokers with or without copd. Acad Radiol 2015; 22:330-6. [PMID: 25488694 DOI: 10.1016/j.acra.2014.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/10/2014] [Accepted: 09/23/2014] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate paired inspiratory/expiratory computed tomography (CT; iCT/eCT) and deformable image registration for quantitative and qualitative assessment of airflow limitation in smokers. MATERIALS AND METHODS Paired iCT/eCT images acquired from 35 smokers (30 men and 5 women) were coregistered and subtraction images (air trapping CT images [aCT]) generated. To evaluate emphysema quantitatively, the percentage of low-attenuation volume (LAV%) on iCT was calculated at -950 HU, as were mean and kurtosis on aCT for quantitative assessment of air trapping. Parametric response maps of emphysema (PRMe) and of functional small airways disease (PRMs) were also obtained. For qualitative evaluation of emphysema, low-attenuation areas on iCT were scored by consensus of two radiologists using Goddard classification. To assess air trapping qualitatively, the degree of air trapping on aCT was scored. For each quantitative and qualitative index, the Spearman rank correlation coefficient for forced expiratory flow in 1 second was calculated, and differences in correlation coefficients were statistically tested. RESULTS The correlation coefficients for the indices were as follows: mean on aCT, 0.800; kurtosis on aCT, -0.726; LAV%, -0.472; PRMe, -0.570; PRMs, -0.565; addition of PRMe and PRMs, -0.653; emphysema score, -0.502; air trapping score, -0.793. The indices showing significant differences were as follows: mean on aCT and addition of PRMe and PRMs (P = 1.43 × 10(-8)); air trapping score and emphysema score (P = .0169). CONCLUSIONS Air trapping images yielded more accurate quantitative and qualitative evaluation of airflow limitation than did LAV%, PRMe, PRMs, and Goddard classification.
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Chronic respiratory symptoms associated with airway wall thickening measured by thin-slice low-dose CT. AJR Am J Roentgenol 2014; 203:W383-90. [PMID: 25247967 DOI: 10.2214/ajr.13.11536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In lung cancer screening, the prevalence of chronic respiratory symptoms is high among heavy smokers. The purpose of this study was to compare CT-derived airway wall measurements between male smokers with and those without chronic respiratory symptoms. MATERIALS AND METHODS Fifty male heavy smokers with chronic respiratory symptoms (cough, excessive mucus secretion, dyspnea, and wheezing) and 50 without any respiratory symptom were randomly selected from the Dutch-Belgian Randomized Lung Cancer Screening Trial. Thin-slice low-dose CT images were evaluated with dedicated software for airway measurements. Wall area percentage and airway wall thickness were measured from trachea to bronchi in five different pulmonary lobes of airways with a luminal diameter of 5 mm or greater. Association between airway wall measurements and respiratory symptoms was analyzed by multiple linear regression adjusted for age, body mass index, smoking status, emphysema, and pulmonary function. RESULTS After adjustment for relevant factors, a significant positive association between airway wall measurements and respiratory symptoms was found in airways with a luminal diameter between 5 to 10 mm (p < 0.01), but not in airways measuring 10 mm or greater (p > 0.05). At the airway level between 5 to 10 mm, the mean wall area percentages were 51.5% ± 7.9%. Airway wall thicknesses were 1.54 ± 0.39 mm and 1.37 ± 0.35 mm (p < 0.001). CONCLUSION Male heavy smokers with chronic respiratory symptoms in lung cancer screening, who are at high-risk of chronic bronchitis, have bronchial wall thickening in airways with a luminal diameter of 5-10 mm but not in larger airways.
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Nishio M, Matsumoto S, Koyama H, Ohno Y, Sugimura K. Airflow limitation in chronic obstructive pulmonary disease: ratio and difference of percentage of low-attenuation lung regions in paired inspiratory/expiratory computed tomography. Acad Radiol 2014; 21:1262-7. [PMID: 25086954 DOI: 10.1016/j.acra.2014.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/17/2014] [Accepted: 05/19/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to analyze the relationship between airflow limitation and two types of computed tomography (CT) measurements: expiratory/inspiratory (E/I) ratio and E/I difference of percentage of low-attenuation lung regions (LAA%). MATERIALS AND METHODS Thirty patients who underwent inspiratory and expiratory CT scans were included in this study. The CT data were used to calculate the LAA% E/I ratio and E/I difference. Other types of CT measurements were also obtained, including the E/I ratio and E/I difference of lung volume, mean lung density, standard deviation, skewness, and kurtosis. LAA% was calculated at 20 thresholds (-990 to -800 HU). Pearson's correlation between the measurements and forced expiratory flow in 1 second was used to determine the efficacy of LAA% E/I ratio and E/I difference. P values of <5.88 × 10⁻⁵ were considered statistically significant with Bonferroni correction. RESULTS The LAA% E/I ratio and E/I difference significantly correlated with forced expiratory flow in 1 second. The best correlation coefficient for the LAA% E/I ratio was -0.699 (P = 1.75 × 10⁻⁵) and for the LAA% E/I difference was -0.723 (P = 6.53 × 10⁻⁶). The best correlation coefficient for the LAA% E/I difference was stronger than that for the other types of CT measurements. CONCLUSIONS The LAA% E/I ratio and E/I difference significantly correlated with airflow limitation in chronic obstructive pulmonary disease.
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Affiliation(s)
- Mizuho Nishio
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Sumiaki Matsumoto
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hisanobu Koyama
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshiharu Ohno
- Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazuro Sugimura
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Hoshino M, Ohtawa J, Akitsu K. Comparison of airway dimensions with once daily tiotropium plus indacaterol versus twice daily Advair(®) in chronic obstructive pulmonary disease. Pulm Pharmacol Ther 2014; 30:128-33. [PMID: 25183687 DOI: 10.1016/j.pupt.2014.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/07/2014] [Accepted: 08/13/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Current guidelines recommend combining long-acting bronchodilators with different modes of action in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). We evaluated the effects of airway dimensions and pulmonary function with tiotropium plus indacaterol versus Advair(®). METHODS Subjects (n = 46) were randomized to receive tiotropium (18 μg once daily) plus indacaterol (150 μg once daily) or Advair(®) (50/250 μg twice daily) for 16 weeks. Airway geometry was determined by quantitative computed tomography (luminal area, Ai; total area of the airway, Ao; wall area, WA; and percentage wall area, WA/Ao and wall thickness, T). Spirometry (forced expiratory volume in 1 s, FEV1; forced vital capacity, FVC and inspiratory capacity, IC) and St. George's Respiratory Questionnaire (SGRQ) were evaluated. RESULTS Tiotropium plus indacaterol significantly increased CT-indices including Ai corrected for body surface area (Ai/BSA), and decreased WA/BSA, WA/Ao and T/√BSA compared with Advair(®) (p < 0.05, respectively). In physiological parameters, mean difference in IC was significantly higher under treatment with tiotropium plus indacaterol than Advair(®) (p < 0.05). The changes in Ai/BSA, WA/BSA, WA/Ao and T/√BSA were significantly correlated with changes in IC (r = 0.535, p = 0.011; r = -0.688, p < 0.001; r = -0.555, p = 0.002 and r = -0.542, p = 0.007; respectively). There were more significant improvements in SGRQ scores after treatment with tiotropium plus indacaterol than Advair(®). CONCLUSIONS These findings suggest that dual bronchodilation with tiotropium plus indacaterol is superior in airway geometry and lung function compared with Advair(®) in COPD.
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Affiliation(s)
- Makoto Hoshino
- Department of Respiratory Medicine, Atami Hospital, International University of Health and Welfare, Atami, Japan.
| | - Junichi Ohtawa
- Department of Radiology, Atami Hospital, International University of Health and Welfare, Atami, Japan
| | - Kenta Akitsu
- Department of Radiology, Atami Hospital, International University of Health and Welfare, Atami, Japan
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Mineshita M, Kida H, Nishine H, Handa H, Inoue T, Miyazawa T. Left and right lung asynchrony as a physiological indicator for unilateral bronchial obstruction in interventional bronchoscopy. PLoS One 2014; 9:e105327. [PMID: 25133760 PMCID: PMC4136828 DOI: 10.1371/journal.pone.0105327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/17/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In patients with bronchial obstruction, pulmonary function tests may not change significantly after intervention. The airflow asynchrony in both lungs due to unilateral bronchial obstruction may be applicable as a physiological indicator. The airflow asynchrony is reflected by the difference in the left and right lung sound development at tidal breathing. OBJECTIVES To investigate the usefulness of left and right lung asynchrony due to unilateral bronchial obstruction as a physiological indicator for interventional bronchoscopy. METHODS Fifty cases with central airway obstruction were classified into three groups: tracheal, bronchial and extensive obstruction. The gap index was defined as the absolute value of the average of gaps between the left and right lung sound intensity peaks for a 12-second duration. RESULTS Before interventional bronchoscopy, the gap index was significantly higher in the bronchial (p<0.05) and extensive obstruction groups (p<0.05) than in the tracheal group. The gap index in cases with unilateral bronchial obstruction of at least 80% (0.18±0.04 seconds) was significantly higher than in cases with less than 80% obstruction (0.02±0.01 seconds, p<0.05). After intervention for bronchial obstruction, the dyspnea scale (p<0.001) and gap index significantly improved (p<0.05), although no significant improvements were found in spirometric assessments. The responder rates for dyspnea were 79.3% for gap indexes over 0.06 seconds and 55.6% for gap indexes of 0.06 seconds or under. CONCLUSIONS Assessment of left and right lung asynchrony in central airway obstruction with bronchial involvement may provide useful physiological information for interventional bronchoscopy.
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Affiliation(s)
- Masamichi Mineshita
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- * E-mail:
| | - Hirotaka Kida
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroki Nishine
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroshi Handa
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takeo Inoue
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Teruomi Miyazawa
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Ratios of peripheral-to-central airway lumen area and percentage wall area as predictors of severity of chronic obstructive pulmonary disease. AJR Am J Roentgenol 2014; 203:78-84. [PMID: 24951198 DOI: 10.2214/ajr.13.11748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the ability of the ratios of peripheral-to-central airway lumen area (hereafter referred to as LA) and percentage wall area (hereafter referred to as %WA) to predict the severity of chronic obstructive pulmonary disease (COPD) according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. SUBJECTS AND METHODS We examined 32 patients (27 men and five women; mean age ± SD, 70.0 ± 6.8 years; seven GOLD stage 0 [at risk for COPD], 19 GOLD stage 1-2 [mild to moderate airflow limitation], and six GOLD stage 3-4 [severe to very severe airflow limitation]) using inspiratory CT. Mean LA and %WA were measured for the first (main bronchi), third, and fifth generations of five bronchi in each lobe and the ratios of peripheral to central airways were calculated (third to first, fifth to first, and fifth to third) and statistically compared. RESULTS The fifth-generation LA, LA fifth to first, and LA fifth to third significantly decreased and fifth %WA, %WA fifth to first, and %WA fifth to third also increased with progression of GOLD stage (p < 0.05), but central measurements, including first and third generations, did not. There were significant differences between GOLD 0 and GOLD 1-2 for %WA fifth to third and LA fifth to third and between GOLD 0 and GOLD 3-4 for all six parameters (p < 0.05); %WA fifth to third had the best cutoff value of 1.02 (sensitivity, 92%; specificity, 86%) for diagnosis of COPD (GOLD 1-4). The %WA fifth to first of 1.51 (sensitivity, 83%; specificity, 89%) was best for diagnosis of GOLD 3-4. CONCLUSION Ratios of peripheral-to-central airway LA and %WA show improved correlation with COPD severity.
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Smith BM, Hoffman EA, Rabinowitz D, Bleecker E, Christenson S, Couper D, Donohue KM, Han MK, Hansel NN, Kanner RE, Kleerup E, Rennard S, Barr RG. Comparison of spatially matched airways reveals thinner airway walls in COPD. The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study and the Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS). Thorax 2014; 69:987-96. [PMID: 24928812 DOI: 10.1136/thoraxjnl-2014-205160] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND COPD is characterised by reduced airway lumen dimensions and fewer peripheral airways. Most studies of airway properties sample airways based upon lumen dimension or at random, which may bias comparisons given reduced airway lumen dimensions and number in COPD. We sought to compare central airway wall dimensions on CT in COPD and controls using spatially matched airways, thereby avoiding selection bias of airways in the lung. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study and Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS) recruited smokers with COPD and controls aged 50-79 years and 40-80 years, respectively. COPD was defined by current guidelines. Using CT image data, airway dimensions were measured for all central airway segments (generations 0-6) following 5 standardised paths into the lungs. Case-control airway comparisons were spatially matched by generation and adjusted for demographics, body size, smoking, CT dose, per cent emphysema, airway length and lung volume. RESULTS Among 311 MESA COPD participants, airway wall areas at generations 3-6 were smaller in COPD compared with controls (all p<0.001). Among 1248 SPIROMICS participants, airway wall areas at generations 1-6 were smaller (all p<0.001), and this reduction was monotonic with increasing COPD severity (p<0.001). In both studies, sampling airways by lumen diameter or randomly resulted in a comparison of more proximal airways in COPD to more peripheral airways in controls (p<0.001) resulting in the appearance of thicker walls in COPD (p<0.02). CONCLUSIONS Airway walls are thinner in COPD when comparing spatially matched central airways. Other approaches to airway sampling result in comparisons of more proximal to more distal airways and potentially biased assessment of airway properties in COPD.
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Affiliation(s)
- Benjamin M Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA Department of Medicine, McGill University, Montreal, Canada
| | - Eric A Hoffman
- Departments of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Dan Rabinowitz
- Department of Statistics, Columbia University, New York, New York, USA
| | - Eugene Bleecker
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Stephanie Christenson
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - David Couper
- Deparment of Biostatistics, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathleen M Donohue
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Meilan K Han
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard E Kanner
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Eric Kleerup
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Stephen Rennard
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Effect of inspiration on airway dimensions measured in maximal inspiration CT images of subjects without airflow limitation. Eur Radiol 2014; 24:2319-25. [PMID: 24903230 DOI: 10.1007/s00330-014-3261-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/14/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To study the effect of inspiration on airway dimensions measured in voluntary inspiration breath-hold examinations. METHODS 961 subjects with normal spirometry were selected from the Danish Lung Cancer Screening Trial. Subjects were examined annually for five years with low-dose CT. Automated software was utilized to segment lungs and airways, identify segmental bronchi, and match airway branches in all images of the same subject. Inspiration level was defined as segmented total lung volume (TLV) divided by predicted total lung capacity (pTLC). Mixed-effects models were used to predict relative change in lumen diameter (ALD) and wall thickness (AWT) in airways of generation 0 (trachea) to 7 and segmental bronchi (R1-R10 and L1-L10) from relative changes in inspiration level. RESULTS Relative changes in ALD were related to relative changes in TLV/pTLC, and this distensibility increased with generation (p < 0.001). Relative changes in AWT were inversely related to relative changes in TLV/pTLC in generation 3--7 (p < 0.001). Segmental bronchi were widely dispersed in terms of ALD (5.7 ± 0.7 mm), AWT (0.86 ± 0.07 mm), and distensibility (23.5 ± 7.7%). CONCLUSIONS Subjects who inspire more deeply prior to imaging have larger ALD and smaller AWT. This effect is more pronounced in higher-generation airways. Therefore, adjustment of inspiration level is necessary to accurately assess airway dimensions. KEY POINTS Airway lumen diameter increases and wall thickness decreases with inspiration. The effect of inspiration is greater in higher-generation (more peripheral) airways. Airways of generation 5 and beyond are as distensible as lung parenchyma. Airway dimensions measured from CT should be adjusted for inspiration level.
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Iterative reconstruction technique vs filter back projection: utility for quantitative bronchial assessment on low-dose thin-section MDCT in patients with/without chronic obstructive pulmonary disease. Eur Radiol 2014; 24:1860-7. [PMID: 24838736 DOI: 10.1007/s00330-014-3207-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/08/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the utility of the iterative reconstruction (IR) technique for quantitative bronchial assessment during low-dose computed tomography (CT) as a substitute for standard-dose CT in patients with/without chronic obstructive pulmonary disease. METHODS Fifty patients (mean age, 69.2; mean % predicted FEV1, 79.4) underwent standard-dose CT (150mAs) and low-dose CT (25mAs). Except for tube current, the imaging parameters were identical for both protocols. Standard-dose CT was reconstructed using filtered back-projection (FBP), and low-dose CT was reconstructed using IR and FBP. For quantitative bronchial assessment, the wall area percentage (WA%) of the sub-segmental bronchi and the airway luminal volume percentage (LV%) from the main bronchus to the peripheral bronchi were acquired in each dataset. The correlation and agreement of WA% and LV% between standard-dose CT and both low-dose CTs were statistically evaluated. RESULTS WA% and LV% between standard-dose CT and both low-dose CTs were significant correlated (r > 0.77, p < 0.00001); however, only the LV% agreement between SD-CT and low-dose CT reconstructed with IR was moderate (concordance correlation coefficient = 0.93); the other agreement was poor (concordance correlation coefficient <0.90). CONCLUSIONS Quantitative bronchial assessment via low-dose CT has potential as a substitute for standard-dose CT by using IR and airway luminal volumetry techniques. KEY POINTS • Quantitative bronchial assessment of COPD using low-dose CT is possible. • Airway luminal volumetry with iterative reconstruction is insusceptible to dose reduction. • Filtered back-projection is susceptible to the effect of dose reduction. • Wall area percentage assessment is easily influenced by dose reduction.
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Yahaba M, Kawata N, Iesato K, Matsuura Y, Sugiura T, Kasai H, Sakurai Y, Terada J, Sakao S, Tada Y, Tanabe N, Tatsumi K. The effects of emphysema on airway disease: correlations between multi-detector CT and pulmonary function tests in smokers. Eur J Radiol 2014; 83:1022-1028. [PMID: 24703520 DOI: 10.1016/j.ejrad.2014.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/18/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation caused by emphysema and small airway narrowing. Quantitative evaluation of airway dimensions by multi-detector computed tomography (MDCT) has revealed a correlation between airway dimension and airflow limitation. However, the effect of emphysema on this correlation is unclear. OBJECTIVE The goal of this study was to determine whether emphysematous changes alter the relationships between airflow limitation and airway dimensions as measured by inspiratory and expiratory MDCT. METHODS Ninety-one subjects underwent inspiratory and expiratory MDCT. Images were evaluated for mean airway luminal area (Ai), wall area percentage (WA%) from the third to the fifth generation of three bronchi (B1, B5, B8) in the right lung, and low attenuation volume percent (LAV%). Correlations between each airway index and airflow limitation were determined for each patient and compared between patients with and without evidence of emphysema. RESULTS In patients without emphysema, Ai and WA% from both the inspiratory and expiratory scans were significantly correlated with FEV1. No correlation was detected in patients with emphysema. In addition, emphysematous COPD patients with GOLD stage 1 or 2 disease had significantly lower changes in B8 Ai than non-emphysematous patients. CONCLUSIONS A significant correlation exists between airway parameters and FEV1 in patients without emphysema. Emphysema may influence airway dimensions even in patients with mild to moderate COPD.
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Affiliation(s)
- Misuzu Yahaba
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Ken Iesato
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Yukiko Matsuura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Yoriko Sakurai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Jiro Terada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
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Effect of lung volume on airway luminal area assessed by computed tomography in chronic obstructive pulmonary disease. PLoS One 2014; 9:e90040. [PMID: 24587205 PMCID: PMC3938549 DOI: 10.1371/journal.pone.0090040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 01/31/2014] [Indexed: 11/19/2022] Open
Abstract
Background Although airway luminal area (Ai) is affected by lung volume (LV), how is not precisely understood. We hypothesized that the effect of LV on Ai would differ by airway generation, lung lobe, and chronic obstructive pulmonary disease (COPD) severity. Methods Sixty-seven subjects (15 at risk, 18, 20, and 14 for COPD stages 1, 2, and 3) underwent pulmonary function tests and computed tomography scans at full inspiration and expiration (at functional residual capacity). LV and eight selected identical airways were measured in the right lung. Ai was measured at the mid-portion of the 3rd, the segmental bronchus, to 6th generation of the airways, leading to 32 measurements per subject. Results The ratio of expiratory to inspiratory LV (LV E/I ratio) and Ai (Ai E/I ratio) was defined for evaluation of changes. The LV E/I ratio increased as COPD severity progressed. As the LV E/I ratio was smaller, the Ai E/I ratio was smaller at any generation among the subjects. Overall, the Ai E/I ratios were significantly smaller at the 5th (61.5%) and 6th generations (63.4%) and than at the 3rd generation (73.6%, p<0.001 for each), and also significantly lower in the lower lobe than in the upper or middle lobe (p<0.001 for each). And, the Ai E/I ratio decreased as COPD severity progressed only when the ratio was corrected by the LV E/I ratio (at risk v.s.stage3 p<0.001, stage1 v.s.stage3 p<0.05). Conclusions From full inspiration to expiration, the airway luminal area shrinks more at the distal airways compared with the proximal airways and in the lower lobe compared with the other lobes. Generally, the airways shrink more as COPD severity progresses, but this phenomenon becomes apparent only when lung volume change from inspiration to expiration is taken into account.
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Hoshino M, Ohtawa J. Computed tomography assessment of airway dimensions with combined tiotropium and indacaterol therapy in COPD patients. Respirology 2014; 19:403-10. [PMID: 24708031 DOI: 10.1111/resp.12256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 10/24/2013] [Accepted: 11/23/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Combining a long-acting muscarinic antagonist with a long-acting β₂-agonist has been shown to be pharmacologically useful in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to evaluate the effectiveness of the dual bronchodilator therapy on airway dimensions in COPD. METHODS Patients (n = 54) were randomly assigned to receive tiotropium (18 μg once daily), indacaterol (150 μg once daily) or tiotropium plus indacaterol for 16 weeks. Quantitative computed tomography (CT), pulmonary function and health status (St. George's Respiratory Questionnaire) were measured. RESULTS Compared with tiotropium or indacaterol alone, combination therapy resulted in a significant decrease in percentage wall area (WA%) and wall thickness, corrected for body surface area, and an increase in luminal area (Ai/BSA). Concurrent treatment was superior to monotherapy in physiological indices, including forced vital capacity, forced expiratory volume in 1 s (FEV₁) and inspiratory capacity. The changes in WA% and Ai/BSA were significantly correlated with changes in FEV₁ (r = -0.44, P < 0.01 and r = 0.37, P < 0.01). There were more significant improvements in SGRQ scores after treatment with combined therapy than with either treatment alone. CONCLUSIONS Concurrent therapy with tiotropium and indacaterol is effective for COPD patients to promote reduction in airway wall thickness, bronchodilation, and improvements in lung function compared with a single inhaler.
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Affiliation(s)
- Makoto Hoshino
- Department of Respiratory Medicine, Atami Hospital, International University of Health and Welfare, Atami, Japan
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