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A non-invasive diagnostic tool to assess remodeling of the lung airways caused by disease is currently missing in the clinic. Measuring key features such as airway smooth muscle (ASM) thickness would increase the ability to improve diagnosis and enable treatment evaluation. In this research, polarization-sensitive optical coherence tomography (PS-OCT) has been used to image a total of 24 airways from two healthy lungs and four end-stage diseased lungs ex vivo, including fibrotic sarcoidosis, chronic obstructive pulmonary disease (COPD), fibrotic hypersensitivity pneumonitis, and cystic fibrosis. In the diseased lungs, except COPD, the amount of measured airway smooth muscle was increased. In COPD, airway smooth muscle could not be distinguished from surrounding collagen. COPD lungs showed increased alveolar size. 3D pullbacks in the same lumen provided reproducible assessment of airway smooth muscle (ASM). Image features such as thickened ASM and size/presence of alveoli were recognized in histology. The results of this study are preliminary and must be confirmed with further ex vivo and in vivo studies. PS-OCT is applicable for in vivo assessment of peribronchial and peribronchiolar lung structures and may become a valuable tool for diagnosis in pulmonology.

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We demonstrate the use of a motorized distal scanning endoscope to acquire in vivo data in lungs of severe-asthma patients before and after an asthma treatment procedure called bronchial thermoplasty. Conventional optical coherence tomography (OCT) intensity images and polarisation sensitive OCT images were extracted from the acquired data. PS-OCT endoscopy allowing the visualization and segmentation of airway smooth muscle layer - which plays a key role in bronchoconstriction during asthma attacks - showed its potential as means to evaluate the effectiveness of bronchial thermoplasty.