Quantitative computed tomography analysis of the airways in patients with cystic fibrosis using automated software: correlation with spirometry in the evaluation of severity

Abstract

ObjectiveTo perform a quantitative analysis of the airways using automated software, in computed tomography images of patients with cystic fibrosis, correlating the results with spirometric findings.Materials and MethodsThirty-four patients with cystic fibrosis were studied-20 males and 14 females; mean age 18 ± 9 years-divided into two groups according to the spirometry findings: group I (n = 21), without severe airflow obstruction (forced expiratory volume in first second [FEV1] > 50% predicted), and group II (n = 13), with severe obstruction (FEV1 ≤ 50% predicted). The following tracheobronchial tree parameters were obtained automatically: bronchial diameter, area, thickness, and wall attenuation.ResultsOn average, 52 bronchi per patient were studied. The number of bronchi analyzed was higher in group II. The correlation with spirometry findings, especially between the relative wall thickness of third to eighth bronchial generation and predicted FEV1, was better in group I.ConclusionQuantitative analysis of the airways by computed tomography can be useful for assessing disease severity in cystic fibrosis patients. In patients with severe airflow obstruction, the number of bronchi studied by the method is higher, indicating more bronchiectasis. In patients without severe obstruction, the relative bronchial wall thickness showed a good correlation with the predicted FEV1.

The Role of Multidetector Computed Tomography and the Forced Oscillation Technique in Assessing Lung Damage in Adults With Cystic Fibrosis

“…This finding indicates that, despite the imbalance between the volume of non-aerated, poorly aerated, normally aerated, and hyperaerated regions, the total lung volume was close to values observed in healthy lungs, which is translated anatomopathologically by the presence of areas with increased density (mucoid impactions, consolidations, and collapses) in the lungs of adults with CF, along with areas of diminished density (air trapping, bubbles, and emphysema). 37,38 In addition, we observed that the adult CF subjects had larger non-aerated and poorly aerated regions with both inspiratory and expiratory lung-volume quantification using multidetector CT. These regions exhibited a higher density than the parenchyma with normal aeration, which suggests the presence of areas of consolidation, collapse, and fibrosis in CF.…”

Radiology of Bronchiectasis

“…Sampling of airway counts on interspaced CT imaging has been performed in patients with cystic fibrosis 35 . With volumetric imaging, more precise airway counts can be computed by calculating the number of airway segments between airway branching points using an airway segmentation 22,36 . Yet this method is heavily reliant on the particular CT acquisition protocol and reconstruction kernels used.…”

“…Several studies in cystic fibrosis (CF) and smokers with radiological bronchiectasis have shown that the airway lumen size is no different to that of that of control populations.. However when airways are measured using the outer airway wall, both airway size and wall thickness have been shown to be significantly different in disease populations compared to healthy subjects 6,34,36 .…”

Tomografia quantitativa de tórax: comparações entre asmáticos de difícil controle, asmáticos bem controlados e indivíduos sem doença respiratória e correlações com parâmetros espirométricos

“…Já no estudo realizado por Achenbach e colaboradores, o objetivo era avaliar quantitativamente as vias aéreas de pacientes com DPOC e, como conclusão, os autores destacaram que a espessura da parede brônquica dos indivíduos com DPOC era maior do que a dos indivíduos saudáveis e não tabagistas (ACHENBACH et al, 2008). Além desses estudos com pacientes com DPOC (HASEGAWA et al, 2006;COXSON, 2008;LEE et al, 2008;PATEL et al, 2008;GRYDELAND et al, 2011;KOSCIUCH et al, 2013;SCHROEDER et al, 2013), o método também foi utilizado para a avaliação quantitativa das vias aéreas em indivíduos com bronquiolite obliterante pós transplante de pulmão (DOELLINGER et al, 2016;GAZOURIAN et al, 2017), com fibrose cística (KOUMELLIS et al, 2005;WIELPÜTZ et al, 2013;DEBOER et al, 2014;SANTOS et al, 2016), com bronquiectasias (DIAZ et al, 2017), com fibrose pulmonar idiopática (COLOMBI et al, 2015;MILLER et al, 2018) e também com asma (NIIMI et al, 2000;LITTLE et al, 2002;GONO et al, 2003;AYSOLA et al, 2008;MONTAUDON et al, 2009;HOSHINO et al, 2010;LEDERLIN et al, 2012a;KOSCIUCH et al, 2013;BRILLET et al, 2013BRILLET et al, , 2015; HYUNG KIM; KYUNG LEE; YOO, 2013; ASKER; ASKER; OZBAY, 2014; WITT et al, 2014;GUPTA et al, 2014;BERAIR et al, 2017;D. et al, 2018;ZHANG et al, 2019).…”