Assessment of Airways with Three-dimensional Quantitative Thin-Section CT: In Vitro and in Vivo Validation

Montaudon, Michel; Berger, Patrick; Dietrich, G; Braquelaire, Achille; Marthan, Roger; Tunon-de-Lara, José-Manuel; Laurent, François

doi:10.1148/radiol.2422060029

Cited by 71 publications

(81 citation statements)

References 27 publications

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“…In this study, the overall success rates for the extraction of segmental and subsegmental bronchi by this software were 92.9% (936/1 008) and 74.8% (754/ 1 008), respectively ( Table 2). One study has shown that 80.8% of third-generation bronchi and 72.5% of fourthgeneration bronchi were successfully identified in this way, in vivo [17]. Although it was not possible to perform an accurate comparison, owing to the differences among subjects and evaluation methods, it seemed that there was no large difference between these results.…”

Section: Three-dimensional Airway Lumen Volumetry In Pulmonary Emphysemamentioning

confidence: 99%

“…One of the reasons for this might be that the luminal area/volume of emphysema patients tends to decrease. In fact, Montaudon et al [17] showed that the number of bronchi reconstructed by their software package decreased dramatically beyond the fifth generation (third-generation bronchi 80.8%; fourth generation 72.5%; fifth generation 37.7%; sixth generation 10.7%). Considering these findings, it seems that luminal area/volume is influenced by the extraction of bronchi.…”

Section: Three-dimensional Airway Lumen Volumetry In Pulmonary Emphysemamentioning

confidence: 99%

See 1 more Smart Citation

Three-dimensional airway lumen volumetry: comparison with bronchial wall area and parenchymal densitometry in assessment of airway obstruction in pulmonary emphysema

Koyama

Ohno²,

Nishio³

et al. 2012

BJR

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Objectives: The purpose of this study was to compare three-dimensional airway lumen volumetry with bronchial wall area and parenchymal densitometry in the assessment of airway obstruction in pulmonary emphysema. Methods: 56 patients, who were smokers, underwent CT examination and pulmonary function tests (PFTs). For quantitative assessments, the following parameters were computationally calculated: (1) Worldwide, chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of mortality and the twelfth leading cause of disability, and by 2020 it is expected to be the third leading cause of death and the fifth leading cause of disability [1]. COPD is a slowly progressive disease characterised by airflow limitation, cough, sputum production and, at the later stages, dyspnoea. It is assessed using whole-lung pulmonary function tests (PFTs) and is characterised by increased airway obstruction and diffusional abnormalities detected in routine clinical practice. Recently, assessments of the extent and severity of pulmonary emphysema based on morphological findings in CT have become a popular method [2,3]. There are two main CT-based methods of assessing morphological change caused by COPD. One assesses destruction of lung parenchyma; the other assesses bronchial wall thickening and decreasing of the bronchial lumen.Destruction of lung parenchyma corresponds to the low attenuation areas (LAAs) detected through CT imagery. CT has been used to quantify emphysema by detecting LAAs and to assess disease severity quantitatively and qualitatively [4,5]. However, airflow limitation in COPD is a complicated phenomenon related only in part to emphysematous lung destruction; therefore, the extent of emphysema does not always correlate with the severity of airflow limitation [6,7]. On the other hand, regarding bronchial wall thickening and decreasing of the bronchial lumen, many investigators qualitatively and quantitatively evaluated the relationship between the CT findings and increased airflow limitation [8][9][10]. In CT-based quantitative analyses of these

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Section: Three-dimensional Airway Lumen Volumetry In Pulmonary Emphysemamentioning

confidence: 99%

Section: Three-dimensional Airway Lumen Volumetry In Pulmonary Emphysemamentioning

confidence: 99%

Three-dimensional airway lumen volumetry: comparison with bronchial wall area and parenchymal densitometry in assessment of airway obstruction in pulmonary emphysema

Koyama

Ohno²,

Nishio³

et al. 2012

BJR

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“…Subsequently, automated and semi-automated computer-based algorithms have been developed. The principles underlying these techniques include: threshold-based methods [18,28,29]; the full-width at half maximum (FWHM) distance [20,30]; score-guided erosion [18]; ''Laplacian of Gaussian'' filters to detect airway edges [9,31]; and algorithms based on idealised airway models [32,33]. These computer algorithms are based on tissue density measures rather than on arbitrary grayscale measures and have been discussed elsewhere in detail [17,34,35].…”

Section: Measuring Airway Dimensions From Ct Datamentioning

confidence: 99%

“…''Skeletonisation'' facilitates such reconstruction by segmenting the bronchial tree and connecting the resulting contiguous airway centrelines to form a branching tree-like structure ( fig. 3) [22,31,36,40]. Creation of an airway skeleton facilitates orderly exploration of the tracheobronchial tree and serves as a viewpoint trajectory for navigation during bronchoscopy [22].…”

Section: Measuring Airway Dimensions From Ct Datamentioning

confidence: 99%

Quantifying tracheobronchial tree dimensions: methods, limitations and emerging techniques

Williamson¹,

James²,

Phillips³

et al. 2009

European Respiratory Journal

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The ability to measure airway dimensions is important for clinicians, interventional bronchoscopists and researchers in order to accurately quantify structural abnormalities and track their changes over time or in response to treatment.Most quantitative airway measurements are based on X-ray computed tomography and, more recently, on multidetector computed tomography. Quantitative bronchoscopic techniques have also been developed, although these are less widely employed. Emerging techniques, including magnetic resonance imaging, endoscopic optical coherence tomography, endobronchial ultrasound and confocal endomicroscopy, provide new research tools with potential clinical applications.An understanding of issues related to the acquisition, processing and analysis of images, and how such issues impact on imaging the tracheobronchial tree, is essential in order to assess measurement accuracy and to make effective use of the newer methods. This article contributes to this understanding by providing a comprehensive review of current and emerging techniques for quantifying airway dimensions.KEYWORDS: Airway dimensions, confocal endomicroscopy, multidetector computed tomography, optical coherence tomography, videobronchoscopy A dvances over the past 20 yrs in medical imaging and bronchoscopy have heralded an era of unprecedented access to quantitative information on tracheobronchial structure and, increasingly, function. The expanding scope of technical advances challenges the ability of clinicians and researchers to keep abreast of recent developments and emerging techniques. Computed tomography (CT) and, to a lesser extent, bronchoscopy are the two imaging tools that have contributed most to our understanding of the airway in vivo and are used on a daily basis by clinicians in the management of airway diseases. Newer techniques, such as magnetic resonance imaging, optical coherence tomography, fibreoptic confocal endomicroscopy and endobronchial ultrasound, offer fresh insights into the way we view and quantify the airway.Over the coming years, the clinical applications of these newer techniques will be defined. As with endobronchial ultrasound, which has been adopted by interventional bronchoscopists in a little over a decade from its first reported use [1], it is likely that smoking-related lung diseases, such as bronchogenic cancer and chronic obstructive pulmonary disease (COPD), will drive the rapid development of new endoscopic imaging modalities and maintain the current pace of technical improvements of existing techniques, in particular CT. Initial applications of these techniques may focus on screening and surveillance of endobronchial malignancies and the use of real-time airway measurements during interventional procedures to deploy endobronchial stents. In these settings, accurate real-time quantitative imaging is advantageous.

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“…These include partial volume averaging, the applied reconstruction kernel, the software used to make the measurements, the radiation dose and lung volume [13,14]. Labelling and categorising bronchi by generation and location are important, and are a further source of variation [31].…”

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confidence: 99%

Computed tomography-derived pathological phenotypes in COPD

MacNee

2016

Eur Respir J

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@ERSpublicationsThere is a need to reach a consensus on the most appropriate method for quantifying emphysema and airways by CT http://ow.ly/YCKP300tQQiChronic obstructive pulmonary disease (COPD) is considered to be a complex, multicomponent, heterogeneous disease, the pathology, clinical and functional presentation of which vary greatly between individual patients despite similar degrees of airflow limitation [1]. COPD has therefore been considered to have distinct phenotypes that represent a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes such as symptoms, exacerbations, rate of disease progression or death [2]. Importantly, these phenotypes of COPD may require different targeted treatment strategies [3].From the early descriptions of COPD, the major pathological features of COPD (chronic bronchitis in the large airways, emphysema in the lung parenchyma and small-airway disease in airways less than 2-3 mm in diameter) have been considered as potential phenotypes of COPD. Since the first description, over 35 years ago, of the use of computed tomography (CT) lung density measurements to quantify the extent of emphysema [4], CT lung imaging has been used as a noninvasive method to evaluate changes in pulmonary structure [5] and thus to assess the pathological phenotype in COPD patients [6].Emphysema was the first pathological phenotype to be assessed by CT imaging where the lung density value (in Hounsfield units (HU)) characterising the fifth percentile (and later the 15th percentile (Perc15/PD15)) of the frequency histogram of lung density values was shown to correlate with morphometric measurements of airspace size [7]. Other reports have used the percentage of low-attenuation lung voxels below a threshold value, commonly of −950 HU (% low attenuation areas (%LAA) or relative area −950 (RA−950)), and shown it to have the strongest pathological correlation with both macroscopic and microscopic emphysema [8,9]. It is now fairly well established that both measures are reliable and reproducible measures to quantify emphysema in cross-sectional studies [10]. However, the use of a single threshold can over-or under-estimate the presence of emphysema [11]. Some would also argue that the Perc15/PD15 is a more sensitive and reproducible measure to assess a change in the extent of emphysema in longitudinal and interventional studies (as an aside, we need to agree on a standard nomenclature for these values) [12].There are important factors that influence the measurement of CT lung density and need standardisation in all studies, particularly in multicentre and longitudinal studies. These include the type and manufacturer of the CT scanner, the radiation dose, slice thickness, the image reconstruction algorithm, body size and the lung volume at which the scan was acquired [13,14]. The latter is of particular importance and methods are required to compensate for variations in lung volume, including spirometrically gating ...

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Assessment of Airways with Three-dimensional Quantitative Thin-Section CT: In Vitro and in Vivo Validation

Abstract: This method enables accurate and reproducible measurement of WA and LA on reformatted CT sections perpendicular to the main axis of bronchi visible on thin-section CT scans.

Cited by 71 publications

References 27 publications

Three-dimensional airway lumen volumetry: comparison with bronchial wall area and parenchymal densitometry in assessment of airway obstruction in pulmonary emphysema

Three-dimensional airway lumen volumetry: comparison with bronchial wall area and parenchymal densitometry in assessment of airway obstruction in pulmonary emphysema

Quantifying tracheobronchial tree dimensions: methods, limitations and emerging techniques

Computed tomography-derived pathological phenotypes in COPD

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