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Lilburn P, Williamson JP, Phillips M, Tillekeratne N, Ing A, Glanville A, Saghaie T. Tracheobronchial stents: an expanding prospect. Intern Med J 2024; 54:204-213. [PMID: 38140778 DOI: 10.1111/imj.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Abstract
The first dedicated tracheobronchial silicone stent was designed by the French pulmonologist Jean-Paul Dumon. The most common indications for stenting are to minimise extrinsic airway compression from mass effect, maintain airway patency due to intrinsic obstruction or treat significant nonmalignant airway narrowing or fistulae. Silicone stents require rigid bronchoscopy for insertion; however, they are more readily repositioned and removed compared with metallic stents. Metallic stents demonstrate luminal narrowing when loads are applied to their ends, therefore stents should either be reinforced at the ends or exceed the area of stenosis by a minimum of 5 mm. Nitinol, a nickel-titanium metal alloy, is currently the preferred material used for airway stents. Airway stenting provides effective palliation for patients with severe symptomatic obstruction. Drug-eluting and three-dimensional printing of airway stents present promising solutions to the challenges of the physical and anatomical constraints of the tracheobronchial tree. Biodegradable stents could also be a solution for the treatment of nonmalignant airway obstruction.
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Affiliation(s)
- Paul Lilburn
- Department of Respiratory and Sleep Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan P Williamson
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Martin Phillips
- MQ Health, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Nikela Tillekeratne
- MQ Health, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Alvin Ing
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Allan Glanville
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tajalli Saghaie
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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2
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Pugh CP, Ali S, Agarwal A, Matlock DN, Sharma M. Dynamic computed tomography for evaluation of tracheobronchomalacia in premature infants with bronchopulmonary dysplasia. Pediatr Pulmonol 2023; 58:3255-3263. [PMID: 37646125 PMCID: PMC10993911 DOI: 10.1002/ppul.26652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/26/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Dynamic computed tomography (dCT) gives real-time physiological information and objective descriptions of airway narrowing in tracheobronchomalacia (TBM). There is a paucity of literature in the evaluation of TBM by dCT in premature infants with bronchopulmonary dysplasia (BPD). The aim of this study is to describe the findings of dCT and resultant changes in management in premature infants with TBM. METHODS A retrospective study of 70 infants was performed. Infants included were <32 weeks gestation without major anomalies. TBM was defined as ≥50% expiratory reduction in cross-sectional area with severity defined as mild (50%-75%), moderate (≥75%-90%), or severe (≥90%). RESULTS Dynamic CT diagnosed malacia in 53% of infants. Tracheomalacia was identified in 49% of infants with severity as 76% mild, 18% moderate, and 6% severe. Bronchomalacia was identified in 43% of infants with varying severity (53% mild, 40% moderate, 7% severe). Resultant management changes included PEEP titration (44%), initiation of bethanechol (23%), planned tracheostomy (20%), extubation trial (13%), and inhaled ipratropium bromide (7%). CONCLUSION Dynamic CT is a useful noninvasive diagnostic tool for airway evaluation of premature infants. Presence and severity of TBM can provide actionable information to guide more precise clinical decision making.
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Affiliation(s)
- C. Preston Pugh
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sumera Ali
- Department of Radiology, Emory University, Children’s Hospital of Atlanta, GA
| | - Amit Agarwal
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - David N. Matlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Megha Sharma
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
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Glenn LM, Troy LK, Corte TJ. Novel diagnostic techniques in interstitial lung disease. Front Med (Lausanne) 2023; 10:1174443. [PMID: 37188089 PMCID: PMC10175799 DOI: 10.3389/fmed.2023.1174443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Research into novel diagnostic techniques and targeted therapeutics in interstitial lung disease (ILD) is moving the field toward increased precision and improved patient outcomes. An array of molecular techniques, machine learning approaches and other innovative methods including electronic nose technology and endobronchial optical coherence tomography are promising tools with potential to increase diagnostic accuracy. This review provides a comprehensive overview of the current evidence regarding evolving diagnostic methods in ILD and to consider their future role in routine clinical care.
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Affiliation(s)
- Laura M. Glenn
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, NSW, Australia
- *Correspondence: Laura M. Glenn,
| | - Lauren K. Troy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, NSW, Australia
| | - Tamera J. Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, NSW, Australia
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Moslemi A, Kontogianni K, Brock J, Wood S, Herth F, Kirby M. Differentiating COPD and Asthma using Quantitative CT Imaging and Machine Learning. Eur Respir J 2022; 60:13993003.03078-2021. [PMID: 35210316 DOI: 10.1183/13993003.03078-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/04/2022] [Indexed: 11/05/2022]
Abstract
There are similarities and differences between chronic obstructive pulmonary disease (COPD) and asthma patients in terms of computed tomography (CT) disease-related features. Our objective was to determine the optimal subset of CT imaging features for differentiating COPD and asthma using machine learning.COPD and asthma patients were recruited from Heidelberg University Hospital. CT was acquired and 93 features were extracted (VIDA Diagnostics): percentage of low-attenuating-areas below -950HU (LAA950), LAA950 hole count, estimated airway-wall-thickness for a 10 mm internal perimeter airway (Pi10), total-airway-count (TAC), as well as inner/outer perimeter/areas and wall thickness for each of five segmental airways, and the average of those five airways. Hybrid feature selection was used to select the optimum number of features, and support vector machine was used to classify COPD and asthma.Ninety-five participants were included (n=48 COPD; n=47 asthma); there were no differences between COPD and asthma for age (p=0.25) or FEV1 (p=0.31). In a model including all CT features, the accuracy and F1-score was 80% and 81%, respectively. The top features were: LAA950, LAA950 hole count, average outer and inner airway perimeter, outer and inner airway area RB1, and TAC. In the model with only airway features, the accuracy and F1-score were 66% and 68%, respectively. The top features were: inner area RB1, wall thickness RB1, outer area LB1, TAC LB10, average outer/inner perimeter, Pi10, and TAC.In conclusions, COPD and asthma can be differentiated using machine learning with moderate-high accuracy by a subset of only 7 CT features.
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Affiliation(s)
- Amir Moslemi
- Department of Physics, Ryerson University, Toronto, ON, Canada.,Co-first authors
| | - Konstantina Kontogianni
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), University of Heidelberg, Germany.,Co-first authors
| | - Judith Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), University of Heidelberg, Germany
| | | | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), University of Heidelberg, Germany .,Co-senior authors
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, ON, Canada.,Co-senior authors
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Chalwadi UK, Swamy N, Agarwal A, Gauss CH, Greenberg SB, Lyons KA. Determining normal values for lower trachea and bronchi size in children by computed tomography (CT). Pediatr Pulmonol 2021; 56:2940-2948. [PMID: 34133085 DOI: 10.1002/ppul.25536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/12/2021] [Accepted: 05/25/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Normative data for central airway dimensions are a prerequisite to objectively assess large airway pathologies. Studies with computed tomography (CT) measurements of normal trachea and bronchi size in children are scarce. OBJECTIVE The purpose of this study is to establish normal values of central airway dimensions in children by CT. METHODS The study included chest CT studies from children aged 0-18 years. Any condition that predisposed the patient to have an abnormal tracheal or bronchial size was excluded. Airway diameters and cross-sectional area (CSA) were measured using double oblique reconstructions at five levels: proximal trachea, mid-trachea, distal trachea, right main bronchus, and left main bronchus. RESULTS The inclusion criteria were met by 110 subjects (mean age, 10.8 years; SD, 5.2 years). Various regression models that considered the relationship between patient demographics and anteroposterior (AP) diameter, transverse diameter, and CSA at each of the five levels were assessed. R2 was utilized to select the best model. Multiple formulae (using patient age) were developed to calculate expected normal dimensions for five levels in the central airways on the natural log scale. Finally, z-scores were obtained for central airway dimensions at these five levels. CONCLUSION Normative data in pediatric central airways are crucial to identify large airway pathologies. We propose using the formulae devised in our study to calculate the predicted dimensions of central airways and their z-scores in pediatric patients. Normative data from our study will aid in objective quantification of central airways, increase clinician confidence, and provide appropriate patient care.
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Affiliation(s)
- Uday Kumar Chalwadi
- Division of Pediatric Pulmonary and Sleep Medicine, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Clinical Trials Innovation Unit, Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nayanatara Swamy
- Department of Radiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amit Agarwal
- Division of Pediatric Pulmonary and Sleep Medicine, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Clinton Heath Gauss
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Stewart Bruce Greenberg
- Department of Radiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Karen A Lyons
- Department of Radiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Ajmera P, Prasad N. Comparison of Tracheal Diameter Measurements on Radiograph Versus Computed Tomography at a Tertiary Care Hospital in Pune, Central India. Cureus 2021; 13:e13755. [PMID: 33842132 PMCID: PMC8024437 DOI: 10.7759/cureus.13755] [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: 11/09/2022] Open
Abstract
Background Variations in tracheal diameter with respect to factors like age and gender are one of the major factors affecting the size of the endotracheal tube (ETT) preferred in a patient. It is important to pre-determine this figure because a tube of a larger size predisposes the patient for tracheal mucosal ischemia, while one of a smaller size may not ensure adequate oxygen saturation in the patient. Purpose We undertook this study to assess the accuracy of radiograph versus computed tomography (CT) and comment on whether a CT should be carried out mandatorily in all patients where intubation is needed. Materials and methods The study was undertaken at Dr DY Patil Medical College, Hospital, and Research Center, a tertiary care institute in Pune, India. A total of 217 patients in whom both chest radiograph and chest CT were performed were enrolled in the study and measurements were performed at suitable landmarks which correspond to the position of endotracheal tubes. Results The males had a mean age of 44.2 years and females of 41.7 years. The mean X-ray transverse diameter was 15.4 ± 3.2 (SD) mm, mean CT axial transverse diameter was 15.3 ± 3.4 (SD) mm, mean CT sagittal diameter was 14.8 ± 3.7 (SD) mm, and the mean CT coronal diameter was 15.2 ± 3.5(SD)mm. Conclusions There was a significant difference in mean X-ray transverse diameter (Low kV), CT axial transverse diameter, CT sagittal diameter, and CT coronal diameter between males and females. Mean values were significantly higher in males as compared to females. There was a significant difference in tracheal diameters for different age groups, irrespective of the modality. Bland-Altman analysis revealed no significant difference between chest radiograph and CT for tracheal diameter measurement.
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Affiliation(s)
- Pranav Ajmera
- Radiology, Dr DY Patil Medical College, Hospital and Research Center, Pune, IND
| | - Niharika Prasad
- Radiology, Dr DY Patil Medical College, Hospital and Research Center, Pune, IND
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Gulhane A, Chen DL. Imaging in Asthma. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Xu J, Sullivan C, Ong HX, Williamson JP, Traini D, Hersch N, Byrom M, Young PM. Using individualized three-dimensional printed airway models to guide airway stent implantation. Interact Cardiovasc Thorac Surg 2020; 31:900-903. [PMID: 33150423 DOI: 10.1093/icvts/ivaa206] [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: 05/03/2020] [Revised: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 11/12/2022] Open
Abstract
Airway stents are used to manage central airway obstructions by restoring airway patency. Current manufactured stents are limited in shape and size, which pose issues in stent fenestrations needed to be manually created to allow collateral ventilation to airway branches. The precise location to place these fenestrations can be difficult to predict based on 2-dimensional computed tomography images. Inspiratory computed tomography scans were obtained from 3 patients and analysed using 3D-Slicer™, Blender™ and AutoDesk® Meshmixer™ programmes to obtain working 3D-airway models, which were 3D printed. Stent customizations were made based on 3D-model dimensions, and fenestrations into the stent were cut. The modified stents were then inserted as per usual technique. Two patients reported improved airway performance; however, stents were later removed due to symptoms related to in-stent sputum retention. In a third patient, the stent was removed a few weeks later due to the persistence of fistula leakage. The use of a 3D-printed personalized airway model allowed for more precise stent customization, optimizing stent fit and allowing for cross-ventilation of branching airways. We determine that an airway model is a beneficial tool for stent optimization but does not prevent the development of some stent-related complications such as airway secretions.
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Affiliation(s)
- Jesse Xu
- Respiratory Technology Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Cameron Sullivan
- MQ Health, Respiratory and Sleep, Macquarie University, Sydney, NSW, Australia
| | - Hui Xin Ong
- Respiratory Technology Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jonathan P Williamson
- MQ Health, Respiratory and Sleep, Macquarie University, Sydney, NSW, Australia.,South West Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Daniela Traini
- Respiratory Technology Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicole Hersch
- MQ Health, Respiratory and Sleep, Macquarie University, Sydney, NSW, Australia
| | - Michael Byrom
- RPA Institute of Academic Surgery, Sydney, NSW, Australia
| | - Paul M Young
- Respiratory Technology Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Discipline of Pharmacology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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9
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Elders BBLJ, Hermelijn SM, Tiddens HAWM, Pullens B, Wielopolski PA, Ciet P. Magnetic resonance imaging of the larynx in the pediatric population: A systematic review. Pediatr Pulmonol 2019; 54:478-486. [PMID: 30680950 PMCID: PMC6590591 DOI: 10.1002/ppul.24250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/15/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) techniques to image the larynx have evolved rapidly into a promising and safe imaging modality, without need for sedation or ionizing radiation. MRI is therefore of great interest to image pediatric laryngeal diseases. Our aim was to review MRI developments relevant for the pediatric larynx and to discuss future imaging options. METHODS A systematic search was conducted to identify all morphological and diagnostic studies in which MRI was used to image the pediatric larynx, laryngeal disease, or vocal cords. RESULTS Fourteen articles were included: three studies on anatomical imaging of the larynx, two studies on Diffusion Weighted Imaging, four studies on vocal cord imaging and five studies on the effect of anaesthesiology on the pediatric larynx. MRI has been used for pediatric laryngeal imaging since 1991. MRI provides excellent soft tissue contrast and good visualization of vascular diseases such as haemangiomas. However, visualization of cartilaginous structures, with varying ossification during childhood, and tissue differentiation remain challenging. The latter has been partly overcome with diffusion weighted imaging (DWI), differentiating between benign and malignant masses with excellent sensitivity (94-94.4%) and specificity (91.2-100%). Vocal cord imaging evolved from static images focused on vocal tract growth to dynamic images able to detect abnormal vocal cord movement. CONCLUSION MRI is promising to evaluate the pediatric larynx, but studies using MRI as diagnostic imaging modality are scarce. New static and dynamic MR imaging techniques could be implemented in the pediatric population. Further research on imaging of pediatric laryngeal diseases should be conducted.
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Affiliation(s)
- Bernadette B L J Elders
- Department of Paediatric Pulmonology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sergei M Hermelijn
- Department of Paediatric Pulmonology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Paediatric Pulmonology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Bas Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Pjotr A Wielopolski
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Pierluigi Ciet
- Department of Paediatric Pulmonology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
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10
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Diagnostic flexible versus rigid bronchoscopy for the assessment of tracheomalacia in children. The Journal of Laryngology & Otology 2018; 132:1083-1087. [PMID: 30565533 DOI: 10.1017/s0022215118002050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This project compares the degree of tracheal collapse determined by rigid and flexible bronchoscopy in paediatric patients with tracheomalacia. METHODS A total of nine patients with tracheomalacia underwent both rigid and flexible video bronchoscopy. All patients were breathing spontaneously. Cross-sectional images of the airway were processed using the ImageJ program and analysed via colour histogram mode technique in order to delineate the luminal area. Paired t-tests (conducted using Stata software version 13.0) quantified differences between rigid and flexible bronchoscopes regarding the ratios of luminal pixels at maximum airway collapse to expansion. Correlation between both techniques in terms of airway collapse to expansion ratios was determined by calculating the Pearson correlation coefficient (R). RESULTS The difference in ratios of maximum collapse to expansion between rigid and flexible bronchoscopy was not statistically significant (p = 0.4656) and was positively correlated (R = 0.523). CONCLUSION The ratios suggest that rigid and flexible bronchoscopy are equally efficacious in assessing tracheomalacia severity, and may be used interchangeably in a clinical setting.
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Xu J, Ong HX, Traini D, Byrom M, Williamson J, Young PM. The utility of 3D-printed airway stents to improve treatment strategies for central airway obstructions. Drug Dev Ind Pharm 2018; 45:1-10. [PMID: 30207189 DOI: 10.1080/03639045.2018.1522325] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Airway stents are commonly used in the management of patients suffering from central airway obstruction (CAO). CAO may occur directly from airway strictures, obstructing airway cancers, airway fistulas or tracheobronchomalacia, resulting from the weakening and dynamic collapse of the airway wall. Current airway stents are constructed from biocompatible medical-grade silicone or from a nickel-titanium (nitinol) alloy with fixed geometry. The stents are inserted via the mouth during a bronchoscopic procedure. Existing stents have many shortcomings including the development of obstructing granulation tissue in the weeks and months following placement, mucous build up within the stent, and cough. Furthermore, airway stents are expensive and, if improperly sized for a given airway, may be easily dislodged (stent migration). Currently, in Australia, it is estimated that approximately 12,000 patients will develop CAO annually, many of whom will require airway stenting intervention. Of all stenting procedures, the rate of failure is currently reported to be at 22%. With a growing incidence of lung cancer prevalence globally, the need for updating airway stent technology is now greater than ever and personalizing stents using 3D-printing technology may offer the best chance of addressing many of the current limitations in stent design. This review article will assess what represents the gold standard in stent manufacture with regards to treatment of tracheobronchial CAO, the challenges of current airway stents, and outlines the necessity and challenges of incorporating 3D-printing technology into personalizing airway stents today.
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Affiliation(s)
- Jesse Xu
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Hui X Ong
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Daniela Traini
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Michael Byrom
- d RPA Institute of Academic Surgery , Sydney , NSW , Australia
| | - Jonathan Williamson
- e MO Respiratory and Sleep, Macquarie University Hospital and Clinic , Macquarie University , Sydney , NSW , Australia.,f Respiratory, Sleep and Environmental and Occupational Health (RSEOH) , The Ingham Institute of Applied Medical Research , Sydney , NSW , Australia
| | - Paul M Young
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
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12
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Silva BRA, Rodrigues RS, Rufino R, Costa CH, Vilela VS, Levy RA, Guimarães ARM, Carvalho ARS, Lopes AJ. Computed tomography trachea volumetry in patients with scleroderma: Association with clinical and functional findings. PLoS One 2018; 13:e0200754. [PMID: 30067820 PMCID: PMC6070209 DOI: 10.1371/journal.pone.0200754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In scleroderma, excessive collagen production can alter tracheal geometry, and computed tomography (CT) volumetry of this structure may aid in detecting possible abnormalities. The objectives of this study were to quantify the morphological abnormalities in the tracheas of patients with scleroderma and to correlate these findings with data on clinical and pulmonary function. METHODS This was a cross-sectional study in which 28 adults with scleroderma and 27 controls matched by age, gender and body mass index underwent chest CT with posterior segmentation and skeletonization of the images. In addition, all participants underwent pulmonary function tests and clinical evaluation, including the modified Rodnan skin score (mRSS). RESULTS Most patients (71.4%) had interstitial lung disease on CT. Compared to controls, patients with scleroderma showed higher values in the parameters measured by CT trachea volumetry, including area, eccentricity, major diameter, minor diameter, and tortuosity. The tracheal area and equivalent diameter were negatively correlated with the ratio between forced expiratory flow and forced inspiratory flow at 50% of forced vital capacity (FEF50%/FIF50%) (r = -0.44, p = 0.03 and r = -0.46, p = 0.02, respectively). The tracheal tortuosity was negatively correlated with peak expiratory flow (r = -0.51, p = 0.008). The mRSS showed a positive correlation with eccentricity (r = 0.62, p < 0.001) and tracheal tortuosity (r = 0.51, p = 0.007), while the presence of anti-topoisomerase I antibody (ATA) showed a positive correlation with tracheal tortuosity (r = 0.45, p = 0.03). CONCLUSIONS In a sample composed predominantly of scleroderma patients with associated interstitial lung disease, there were abnormalities in tracheal geometry, including greater eccentricity, diameter and tortuosity. In these patients, abnormalities in the geometry of the trachea were associated with functional markers of obstruction. In addition, tracheal tortuosity was correlated with cutaneous involvement and the presence of ATA.
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Affiliation(s)
- Bruno Rangel Antunes Silva
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rogério Rufino
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Henrique Costa
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Veronica Silva Vilela
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roger Abramino Levy
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alan Ranieri Medeiros Guimarães
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alysson Roncally Silva Carvalho
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Pulmonary Engineering, Biomedical Engineering Programme, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Reference Values for Central Airway Dimensions on CT Images of Children and Adolescents. AJR Am J Roentgenol 2018; 210:423-430. [DOI: 10.2214/ajr.17.18597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
The term tracheobronchomalacia refers to excessively compliant and collapsible central airways leading to symptoms. Although seen as a coexisting condition with various other pulmonary condition, it may cause symptoms by itself. The condition is often misdiagnosed as asthma, bronchitis or just chronic cough due to a lack of specific pathognomonic history and clinical findings. The investigation revolves around different modes of imaging, lung function testing and usually confirmed by flexible bronchoscopy. The treatment widely varies based on the cause, with most cases treated conservatively with non-invasive ventilation. Some may require surgery or stent placement. In this article, we aim to discuss the pathophysiology behind this condition and recognize the common symptoms and causes of tracheobronchomalacia. The article will highlight the diagnostic steps as well as therapeutic interventions based on the specific cause.
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Affiliation(s)
- Abhishek Biswas
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, United States.
| | - Michael A Jantz
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, United States
| | - P S Sriram
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, United States
| | - Hiren J Mehta
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, United States
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Scaglione M, Linsenmaier U, Schueller G, Berger F, Wirth S. Airway Disease. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7119984 DOI: 10.1007/174_2016_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mariano Scaglione
- Dept of Radiology, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | | | | | - Ferco Berger
- VU University Medical Center, Amsterdam, The Netherlands
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16
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Analysis of pediatric airway morphology using statistical shape modeling. Med Biol Eng Comput 2015; 54:899-911. [DOI: 10.1007/s11517-015-1445-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 12/16/2015] [Indexed: 11/25/2022]
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17
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Abstract
RATIONALE All bronchoscopists will encounter, at some point, central airway obstruction (CAO) and will face the problem of documenting its severity. Axial imaging is suggested as the gold standard for assessing CAO, but anecdotal evidence indicates that many bronchoscopists use visual estimation. The prevalence and reliability of this method have not been extensively studied. OBJECTIVES This study aimed to determine bronchoscopists' opinions about assessing CAO and to assess the variability of visual estimation. METHODS All 438 members of the American Association of Bronchology and Interventional Pulmonology were invited to participate in an online questionnaire. In addition to reporting opinions and practice in measuring CAO, participants estimated degree of obstruction for 10 bronchoscopic photos of abnormal central airway lesions using a sliding scale from 0 to 100%. MEASUREMENTS AND MAIN RESULTS Responses were obtained from 118 individuals with varied interventional bronchoscopy experience. Most participants reported using visual estimation of CAO (91%) and largely by numeric estimates (87%). A total of 55 participants volunteered additional methods they employed, and their comments reflected discontent with the dependability of those. When shown the same 10 bronchoscopic photos, estimates varied considerably, with very large ranges of responses for all images. Most (86%) agreed that measurement of airway narrowing should be standardized. CONCLUSIONS Although limited by sample size and static photos of abnormal airways, this study supports the tenet that most bronchoscopists use a subjective and variable method of estimating CAO, which is anecdotally pervasive in the absence of a clinically practical alternative.
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Evaluation of Tracheobronchomalacia by Dynamic Flexible Bronchoscopy. A Pilot Study. Ann Am Thorac Soc 2014; 11:951-5. [DOI: 10.1513/annalsats.201312-435bc] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lutey BA, Conradi SH, Atkinson JJ, Zheng J, Schechtman KB, Senior RM, Gierada DS. Accurate measurement of small airways on low-dose thoracic CT scans in smokers. Chest 2013; 143:1321-1329. [PMID: 23172175 DOI: 10.1378/chest.12-0034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Partial volume averaging and tilt relative to the scan plane on transverse images limit the accuracy of airway wall thickness measurements on CT scan, confounding assessment of the relationship between airway remodeling and clinical status in COPD. The purpose of this study was to assess the effect of partial volume averaging and tilt corrections on airway wall thickness measurement accuracy and on relationships between airway wall thickening and clinical status in COPD. METHODS Airway wall thickness measurements in 80 heavy smokers were obtained on transverse images from low-dose CT scan using the open-source program Airway Inspector. Measurements were corrected for partial volume averaging and tilt effects using an attenuation- and geometry-based algorithm and compared with functional status. RESULTS The algorithm reduced wall thickness measurements of smaller airways to a greater degree than larger airways, increasing the overall range. When restricted to analyses of airways with an inner diameter < 3.0 mm, for a theoretical airway of 2.0 mm inner diameter, the wall thickness decreased from 1.07 ± 0.07 to 0.29 ± 0.10 mm, and the square root of the wall area decreased from 3.34 ± 0.15 to 1.58 ± 0.29 mm, comparable to histologic measurement studies. Corrected measurements had higher correlation with FEV₁, differed more between BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index scores, and explained a greater proportion of FEV1 variability in multivariate models. CONCLUSIONS Correcting for partial volume averaging improves accuracy of airway wall thickness estimation, allowing direct measurement of the small airways to better define their role in COPD.
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Affiliation(s)
- Barbara A Lutey
- Division of Medical Education, Washington University School of Medicine, St Louis, MO.
| | - Susan H Conradi
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Jeffrey J Atkinson
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO
| | - Jie Zheng
- Division of Biostatistics, Washington University School of Medicine, St Louis, MO
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine, St Louis, MO
| | - Robert M Senior
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO
| | - David S Gierada
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
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Muhlebach MS, Shaffer CB, Georges L, Abode K, Muenzer J. Bronchoscopy and airway management in patients with mucopolysaccharidoses (MPS). Pediatr Pulmonol 2013; 48:601-7. [PMID: 22949390 DOI: 10.1002/ppul.22629] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/08/2012] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders characterized by tissue deposition of glycosaminoglycans (GAG). Their musculoskeletal abnormalities and the GAG storage in the airway result in increased risk for patients undergoing anesthesia. This study evaluates a multi-disciplinary airway management approach and reports upper and lower airway findings of flexible bronchoscopy performed during these procedures. METHODS This is a retrospective study over 10 years evaluating approaches to and outcomes of airway management and bronchoscopic findings in this patient group. RESULTS Thirty-one patients underwent a total of 105 anesthetic events of which 74 involved multiple surgical services. The majority of patients were either MPS I (n = 9) or MPS II (n = 19). The median age was 8.6 years (range 1.1-24 years). Airway management by anesthesiologists alone occurred in 31 cases including natural airway (n = 7), perilaryngeal airway (n = 7), oral or nasal intubation (n = 7) or tracheostomy (n = 6) and emergent fiberoptic intubation in four cases. In 74 of the procedures, flexible bronchoscopy was performed which included fiberoptic intubation in 22 cases. Post-operative complications occurred in eight cases mostly when prolonged airway instrumentation had occurred. The most frequent findings on bronchoscopy were GAG deposits/adenoid hypertrophy in 72%, laryngomalacia in 31% and lower airway deposits and/or tracheobronchomalacia in 46% of procedures. Deposits of GAG were seen in patients as young as 4 years of age. CONCLUSION Our experience demonstrates that a multidisciplinary approach and combined surgeries in MPS provides for safe airway management and allows diagnostic assessments for further patient care without added risks. Significant, multi-factorial airway compromise may occur already in early childhood including upper and lower airway GAG deposits.
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Affiliation(s)
- Marianne S Muhlebach
- Division of Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina 27599-7217, USA.
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21
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Mumcuoğlu EU, Long FR, Castile RG, Gurcan MN. Image analysis for cystic fibrosis: computer-assisted airway wall and vessel measurements from low-dose, limited scan lung CT images. J Digit Imaging 2013; 26:82-96. [PMID: 22549245 PMCID: PMC3553364 DOI: 10.1007/s10278-012-9476-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Cystic fibrosis (CF) is a life-limiting genetic disease that affects approximately 30,000 Americans. When compared to those of normal children, airways of infants and young children with CF have thicker walls and are more dilated in high-resolution computed tomographic (CT) imaging. In this study, we develop computer-assisted methods for assessment of airway and vessel dimensions from axial, limited scan CT lung images acquired at low pediatric radiation doses. Two methods (threshold- and model-based) were developed to automatically measure airway and vessel sizes for pairs identified by a user. These methods were evaluated on chest CT images from 16 pediatric patients (eight infants and eight children) with different stages of mild CF related lung disease. Results of threshold-based, corrected with regression analysis, and model-based approaches correlated well with both electronic caliper measurements made by experienced observers and spirometric measurements of lung function. While the model-based approach results correlated slightly better with the human measurements than those of the threshold method, a hybrid method, combining these two methods, resulted in the best results.
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Affiliation(s)
- Erkan U Mumcuoğlu
- Health Informatics Department, Informatics Institute, Middle East Technical University, Ankara, Turkey.
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Rodrigues AJ, Takimura CK, Lemos Neto PA, Figueiredo VR. Optical coherence tomography in conjunction with bronchoscopy. J Bras Pneumol 2012; 38:174-80. [PMID: 22576424 DOI: 10.1590/s1806-37132012000200005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 01/30/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of and the potential for using optical coherence tomography in conjunction with conventional bronchoscopy in the evaluation of the airways. METHODS This was a pilot study based on an ex vivo experimental model involving three animals: one adult New Zealand rabbit and two Landrace pigs. An optical coherence tomography imaging catheter was inserted through the working channel of a flexible bronchoscope in order to reach the distal trachea of the animals. Images of the walls of the trachea were systematically taken along its entire length, from the distal to the proximal portion. RESULTS The imaging catheter was easily adapted to the working channel of the bronchoscope. High-resolution images of cross sections of the trachea were taken in real time, precisely delineating microstructures, such as the epithelium, submucosa, and cartilage, as well as the adventitia of the anterior and lateral tracheal walls. The corresponding layers of the epithelium, mucosa, and cartilage were clearly differentiated. The mucosa, submucosa, and trachealis muscle were clearly identified in the posterior wall. CONCLUSIONS It is feasible to use an optical coherence tomography imaging catheter in combination with a flexible bronchoscope. Optical coherence tomography produces high-resolution images that reveal the microanatomy of the trachea, including structures that are typically seen only on images produced by conventional histology.
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Affiliation(s)
- Ascedio José Rodrigues
- Instituto do Coração Serviço de Endoscopia Respiratória, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Paré PD, Nagano T, Coxson HO. Airway imaging in disease: gimmick or useful tool? J Appl Physiol (1985) 2012; 113:636-46. [PMID: 22604891 PMCID: PMC3424064 DOI: 10.1152/japplphysiol.00372.2012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/15/2012] [Indexed: 01/06/2023] Open
Abstract
Airway remodeling is an important pathophysiological mechanism in a variety of chronic airway diseases. Historically investigators have had to use invasive techniques such as histological examination of excised tissue to study airway wall structure. The last several years has seen a proliferation of relatively noninvasive techniques to assess the airway branching pattern, wall thickness, and more recently, airway wall tissue components. These methods include computed tomography, magnetic resonance imaging, and optical coherence tomography. These new imaging technologies have become popular because to understand the physiology of lung disease it is important we understand the underlying anatomy. However, these new approaches are not standardized or available in all centers so a review of their validity and clinical utility is appropriate. This review documents how investigators are working hard to correct for inconsistencies between techniques so that they become more accepted and utilized in clinical settings. These new imaging techniques are very likely to play a frontline role in the study of lung disease and will, hopefully, allow clinicians and investigators to better understand disease pathogenesis and to design and assess new therapeutic interventions.
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Affiliation(s)
- Peter D Paré
- University of British Columbia James Hogg Research Centre and Institute for Heart + Lung Health, Vancouver, British Columbia, Canada
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25
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Suter MJ, Lam S, Brenner M. Optical techniques in pulmonary medicine. SPIE photonics West. Expert Rev Respir Med 2012; 6:143-5. [PMID: 22455486 DOI: 10.1586/ers.12.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is ongoing interest in the emerging field of pulmonary photonic-based diagnostics. Potential clinical need areas that are being actively investigated at this time include airway and peripheral lung cancer diagnostics, pulmonary parenchymal and interstitial disorders, alveolar structure function, inhalation injury, ciliary function analysis, asthma and obstructive lung diseases.
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Affiliation(s)
- Melissa J Suter
- Harvard Medical School, Pulmonary and Critical Care Unit, Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Warren 408, Boston, MA 02114, USA
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Pu J, Gu S, Liu S, Zhu S, Wilson D, Siegfried JM, Gur D. CT based computerized identification and analysis of human airways: a review. Med Phys 2012; 39:2603-16. [PMID: 22559631 DOI: 10.1118/1.4703901] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
As one of the most prevalent chronic disorders, airway disease is a major cause of morbidity and mortality worldwide. In order to understand its underlying mechanisms and to enable assessment of therapeutic efficacy of a variety of possible interventions, noninvasive investigation of the airways in a large number of subjects is of great research interest. Due to its high resolution in temporal and spatial domains, computed tomography (CT) has been widely used in clinical practices for studying the normal and abnormal manifestations of lung diseases, albeit there is a need to clearly demonstrate the benefits in light of the cost and radiation dose associated with CT examinations performed for the purpose of airway analysis. Whereas a single CT examination consists of a large number of images, manually identifying airway morphological characteristics and computing features to enable thorough investigations of airway and other lung diseases is very time-consuming and susceptible to errors. Hence, automated and semiautomated computerized analysis of human airways is becoming an important research area in medical imaging. A number of computerized techniques have been developed to date for the analysis of lung airways. In this review, we present a summary of the primary methods developed for computerized analysis of human airways, including airway segmentation, airway labeling, and airway morphometry, as well as a number of computer-aided clinical applications, such as virtual bronchoscopy. Both successes and underlying limitations of these approaches are discussed, while highlighting areas that may require additional work.
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Affiliation(s)
- Jiantao Pu
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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27
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Morphologic and functional scoring of cystic fibrosis lung disease using MRI. Eur J Radiol 2012; 81:1321-9. [DOI: 10.1016/j.ejrad.2011.02.045] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 02/24/2011] [Indexed: 11/23/2022]
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Mets OM, de Jong PA, van Ginneken B, Gietema HA, Lammers JWJ. Quantitative computed tomography in COPD: possibilities and limitations. Lung 2011; 190:133-45. [PMID: 22179694 PMCID: PMC3310986 DOI: 10.1007/s00408-011-9353-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 11/28/2011] [Indexed: 01/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease that is characterized by chronic airflow limitation. Unraveling of this heterogeneity is challenging but important, because it might enable more accurate diagnosis and treatment. Because spirometry cannot distinguish between the different contributing pathways of airflow limitation, and visual scoring is time-consuming and prone to observer variability, other techniques are sought to start this phenotyping process. Quantitative computed tomography (CT) is a promising technique, because current CT technology is able to quantify emphysema, air trapping, and large airway wall dimensions. This review focuses on CT quantification techniques of COPD disease components and their current status and role in phenotyping COPD.
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Affiliation(s)
- O M Mets
- Department of Radiology, University Medical Center Utrecht, Huispostnummer E01.132, Postbus 85500, 3508 GA Utrecht, The Netherlands.
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Hou R, Le T, Murgu SD, Chen Z, Brenner M. Recent advances in optical coherence tomography for the diagnoses of lung disorders. Expert Rev Respir Med 2011; 5:711-24. [PMID: 21955240 PMCID: PMC3393648 DOI: 10.1586/ers.11.59] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There have been many advances in the field of diagnostic and therapeutic pulmonary medicine in the past several years, with major progress in the field of imaging. Optical coherence tomography (OCT) is a high-resolution (micron level) imaging modality currently being advanced with the potential to image airway wall structures in real time and at higher resolution than previously possible. OCT has the potential to increase the sensitivity and specificity of biopsies, create 3D images of the airway to guide diagnostics, and may have a future role in diverse areas such as the evaluation and treatment of patients with obstructive sleep apnea, tracheal stenosis, airway remodeling and inhalation injury. OCT has recently been investigated to monitor airway compliance in chronic obstructive pulmonary disease and asthma patients as well as differentiate causes of pulmonary hypertension. In future clinical and research applications, OCT will likely be combined with other endoscopic based modalities such as ultrasound, spectroscopy, confocal, and/or photoacoustic tomography to determine functional and biomolecular properties. This article discusses the current uses of OCT, its potential applications, as it relates to specific pulmonary diseases, and the future directions for OCT.
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Affiliation(s)
- Randy Hou
- Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, Irvine, CA, USA
| | - Tho Le
- Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, Irvine, CA, USA
| | - Septimiu D Murgu
- Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, Irvine, CA, USA
| | - Zhongping Chen
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - Matt Brenner
- Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, Irvine, CA, USA
- Beckman Laser Institute, University of California, Irvine, CA, USA
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Salito C, Barazzetti L, Woods JC, Aliverti A. 3D Airway Tree Reconstruction in Healthy Subjects and Emphysema. Lung 2011; 189:287-93. [DOI: 10.1007/s00408-011-9305-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
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Paré PD. Central airway compliance in asthma: up or down? Good or bad? Am J Respir Crit Care Med 2011; 183:563-4. [PMID: 21471052 DOI: 10.1164/rccm.201009-1533ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Byron PR, Hindle M, Lange CF, Longest PW, McRobbie D, Oldham MJ, Olsson B, Thiel CG, Wachtel H, Finlay WH. In Vivo–In VitroCorrelations: Predicting Pulmonary Drug Deposition from Pharmaceutical Aerosols. J Aerosol Med Pulm Drug Deliv 2010; 23 Suppl 2:S59-69. [DOI: 10.1089/jamp.2010.0846] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Peter R. Byron
- School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
| | - Michael Hindle
- School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
| | | | - P. Worth Longest
- School of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Donald McRobbie
- Radiological Sciences Unit, Imperial College Healthcare NHS Trust, United Kingdom
| | - Michael J. Oldham
- School of Engineering, Virginia Commonwealth University, Richmond, Virginia
- Altria Client Services, Richmond, Virginia
| | | | | | - Herbert Wachtel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
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Feasibility of Applying Real-time Optical Imaging During Bronchoscopic Interventions for Central Airway Obstruction. J Bronchology Interv Pulmonol 2010; 17:307-16. [DOI: 10.1097/lbr.0b013e3181f9eaae] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
PURPOSE OF REVIEW Malignant central airway obstruction heavily impacts patients' quality of life and its management continues to be a challenge. The current article will review the use of airway stents in this population. RECENT FINDINGS Airway stenting is highly effective in palliating symptoms of airway obstruction. There are several types of stents available with different advantages and disadvantages depending mainly on the material they are made from. Clinical outcomes seem to be comparable between silicone and self-expanding metal stents. Self-expanding metal stents have proven to be efficient in recanalizing 'complex' central airway obstructions. Preliminary data show that a new self-expanding 'hybrid' stent appears to be effective and safe for malignant airway obstruction. Airway stent complications vary according to the type of stent and the type of obstruction. Multidetector computed tomography seems to be a valuable adjunct to bronchoscopy in detecting and characterizing stent complications. A clear definition of airway stent-related infection is urgently needed to provide adequate diagnosis and management of this complication. Metal stent fracture is less common in patients with malignant airway obstruction as compared with benign disease, and this could be partially explained by the decreased survival and shorter exposure to stent in the former population. SUMMARY Airway stents are of great help in palliating symptoms of malignant central airway obstruction. Unfortunately, there have been no recent striking advances in stent technology and the ideal stent has yet to be designed.
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DeCoro M, Wilder-Smith P. Potential of optical coherence tomography for early diagnosis of oral malignancies. Expert Rev Anticancer Ther 2010; 10:321-9. [PMID: 20214513 DOI: 10.1586/era.09.191] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With nearly 1,500,000 new patients diagnosed every year in the USA, cancer poses a considerable challenge to healthcare today. Oral cancer is responsible for a sizeable portion of deaths due to cancer, primarily because it is diagnosed at a late stage when the prognosis is poor. Current methods for diagnosing oral cancer need to be augmented by better early detection, monitoring and screening modalities. A new approach is needed that provides real-time, accurate, noninvasive diagnosis. The results of early clinical trials using in vivo optical coherence tomography for the diagnosis of oral dysplasia and malignancy are encouraging.
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Affiliation(s)
- Michael DeCoro
- Beckman Laser Institute, 1002 Health Sciences Road East, University of California, Irvine, CA 92612, USA.
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Bokov P, Mauroy B, Revel MP, Brun PA, Peiffer C, Daniel C, Nay MM, Mahut B, Delclaux C. Lumen areas and homothety factor influence airway resistance in COPD. Respir Physiol Neurobiol 2010; 173:1-10. [PMID: 20478416 DOI: 10.1016/j.resp.2010.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 04/16/2010] [Accepted: 05/10/2010] [Indexed: 11/30/2022]
Abstract
The remodelling process of COPD may affect both airway calibre and the homothety factor, which is a constant parameter describing the reduction of airway lumen (h(d): diameter of child/parent bronchus) that might be critical because its reduction would induce a frank increase in airway resistance. Airway dimensions were obtained from CT scan images of smokers with (n=22) and without COPD (n=9), and airway resistance from plethysmography. Inspiratory airway resistance correlated to lumen area of the sixth bronchial generation of right lung, while peak expiratory flow correlated to the area of the third right generation (p=0.0009, R=0.57). A significant relationship was observed between h(d) and resistance (p=0.036; R(2)=0.14). A modelling approach of central airways (5 generations) further described the latter relationship. In conclusion, a constant homothety factor can be described by CT scan analysis, which partially explains inspiratory resistance, as predicted by theoretical arguments. Airway resistance is related to lumen areas of less proximal airways than commonly admitted.
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Affiliation(s)
- Plamen Bokov
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie - Clinique de la Dyspnée, France
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Williamson JP, Phillips MJ, Hillman DR, Eastwood PR. Managing obstruction of the central airways. Intern Med J 2009; 40:399-410. [PMID: 19849741 DOI: 10.1111/j.1445-5994.2009.02113.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is the most common cause of cancer death in Australia, Europe and the USA. Up to 20-30% of these cancers eventually affect the central airways and result in reduced quality of life, dyspnoea, haemoptysis, post-obstructive pneumonia and ultimately death. Non-malignant processes may also lead to central airway obstruction and can have similar symptoms. With the development of newer technologies, the last 20 years have seen the emergence of the field of interventional pulmonology to deal specifically with the diagnosis and management of thoracic malignancy, including obstruction of the central airways. This review discusses the pathology, pre-procedure work-up and management options for obstructing central airway lesions. Several treatment modalities exist for dealing with endobronchial pathology with local availability and expertise guiding choice of treatment. While the literature lacks large, multicentre, randomized studies defining the optimal management strategy for a given problem, there is growing evidence from numerous case studies of improved physiology, of quality of life and possibly of survival with modern interventional techniques.
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Affiliation(s)
- J P Williamson
- Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Western Australia 6009, Australia.
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