Airway Dimensions at Inspiratory and Expiratory Multisection CT in Chronic Obstructive Pulmonary Disease: Correlation with Airflow Limitation

Matsuoka, Shin; Kurihara, Yasuyuki; Yagihashi, Kunihiro; Hoshino, Makoto; Nakajima, Yasuo

doi:10.1148/radiol.2491071650

Cited by 106 publications

(125 citation statements)

References 28 publications

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“…At this point, our results suggest that airflow limitation could be located behind the third generation bronchi as reported already by Matsuoka et al (14). However, these authors did not examined all segmental and subsegmental bronchi which limits in our opinion the validity of such statements as the bronchial system is expected to underlie some regional variations in terms of luminal collapsibility dictated by the local anatomy and physiologic influence of thoracic cage mobility.…”

supporting

confidence: 82%

“…Other reports suggested that airflow limitation in COPD was closely related to the airway dimensions from the 3 rd to the 6 th generation bronchi (13). Again previous reports have asserted that airway dimensions of the large-and intermediate-sized airways reflect airway dimensions in the smaller airways, which are the most important site of airway obstruction in COPD (7,14). The compliance of the extra-and intrapulmonary airways depends finally both on the mechanical structure (bronchial wall characteristics) as well as on the quality of lung parenchyma surrounding the bronchial tree (23).…”

Section: Discussionmentioning

confidence: 97%

“…Whereas changes in the luminal area of the large airways are known to vary considerably even in healthy people between forced inspiration and forced expiration, corresponding changes of bronchial crosssectional area below e.g., in segmental (the 3 rd generation) bronchi have not yet been intensively studied. Nevertheless, some reports have suggested that airflow limitation in COPD is closely related to the airway dimensions from the 3 rd to the 6 th generation bronchi (13,14). Generally, technical limitations have been the reason for delayed investigation of smaller airways.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2016

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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 3 rd 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 crosssectional 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 (FEV 1 ), 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. MEF 25 correlated weakly with 3 rd 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 3 rd 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 3 rd 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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supporting

confidence: 82%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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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

et al. 2016

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“…Morphometric bronchoscopy is also useful for identifying and quantifying fixed and variable CAO 20,29 ; however, image analysis is not performed immediately, but post-procedure, with image processing software. Immediate quantification of the degree of CAO might be achieved in the future, with stereoscopic bronchoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…The cross-sectional area at the narrowest bronchial segment was measured with CT analysis software (Ziostation, Ziosoft, Tokyo, Japan). 20 …”

Section: Computed Tomographymentioning

confidence: 99%

Assessment of Central Airway Obstruction Using Impulse Oscillometry Before and After Interventional Bronchoscopy

Handa¹,

Huang

Murgu

et al. 2013

Respir Care

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BACKGROUND: Spirometry is used to physiologically assess patients with central airway obstruction (CAO) before and after interventional bronchoscopy, but is not always feasible in these patients, does not localize the anatomic site of obstruction, and may not correlate with the patient's functional impairment. Impulse oscillometry may overcome these limitations. We assessed the correlations between impulse oscillometry measurements, symptoms, and type of airway narrowing, before and after interventional bronchoscopy, and whether impulse oscillometry parameters can discriminate between fixed and dynamic CAO. METHODS: Twenty consecutive patients with CAO underwent spirometry, impulse oscillometry, computed tomography, dyspnea assessment, and bronchoscopy, before and after interventional bronchoscopy. The collapsibility index (the percent difference in airway lumen diameter during expiration versus during inspiration) was calculated using morphometric bronchoscopic images during quiet breathing. Variable CAO was defined as a collapsibility index of > 50%. Fixed CAO was defined as a collapsibility index of < 50%. The degree of obstruction was analyzed with computed tomography measurements. RESULTS: After interventional bronchoscopy, all impulse oscillometry measurements significantly improved, especially resistance at 5 Hz, which decreased from 0.67 ؎ 0.29kPa/L/s to 0.38 ؎ 0.17kPa/L/s (P < .001), and reactance at 20 Hz, which increased from -0.09 ؎ 0.11 to 0.03 ؎ 0.08 (P < .001). Changes in dyspnea score correlated with resistance at 5 Hz, the difference between the resistance at 5 Hz and the resistance at 20 Hz, and the reactance at 5 Hz, but not with spirometry measurements. The type of obstruction also correlated with dyspnea score, and showed distinct impulse oscillometry measurements. CONCLUSIONS: Impulse oscillometry measurements correlate with symptom improvements after interventional bronchoscopy. Impulse oscillometry might be useful to discriminate variable from fixed central airway obstruction. (University Hospital Medical Information Network, http://www.umin.ac.jp/english, ID000005322).

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Difference in the airway luminal area between the standing and supine positions using upright and conventional computed tomography

Matsumoto

Yamada

et al. 2021

Clinical Anatomy

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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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Airway Dimensions at Inspiratory and Expiratory Multisection CT in Chronic Obstructive Pulmonary Disease: Correlation with Airflow Limitation

Abstract: Airway lumen measured at expiratory CT was more closely related to expiratory airflow measurements than was lumen measured at inspiratory CT. In addition, the changes of airway luminal area between inspiration and expiration were strongly related to airflow limitation.

Cited by 106 publications

References 28 publications

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

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

Assessment of Central Airway Obstruction Using Impulse Oscillometry Before and After Interventional Bronchoscopy

Difference in the airway luminal area between the standing and supine positions using upright and conventional computed tomography

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