Size and Morphology of the Trachea Before and After Lung Volume Reduction Surgery

Leader, Joseph K.; Rogers, Robert M.; Fuhrman, Carl R.; Sciurba, Frank C.; Thompson, Paul; Weissfeld, Joel L.; Golla, Sara; Gur, David

doi:10.2214/ajr.183.2.1830315

Cited by 11 publications

(9 citation statements)

References 14 publications

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“…The observed strong negative correlations for the normalized trachea length suggest the effect of the trachea on air transport and thereby, indirectly, gas exchange. Our limited observation in this regard is in agreement with Leader et al (15) and extends in part the more extensive investigation to a larger and more diverse data set. Airway resistance (eg, lung resistance at 5 Hz and lung resistance at 20 Hz) decreases and airway reactance (ie, lung reactance at 5 Hz) increases with larger airway architecture because resistance depends on the number of parallel pathways present.…”

Section: Discussionsupporting

confidence: 93%

“…McDonough et al (13) and Diaz et al (14) studied the relationship between manually ascertained airway branch counts and the severity of emphysema and found that total airway count was lower in subjects with emphysema, suggesting that the number of airway branches may be associated with lung function. Leader et al (15) reported that tracheal features changed significantly from before to after lung volume reduction surgery and concluded that combining PFT and tracheal imaging features could potentially provide a more accurate assessment of disease status and progression. Handa et al (16) verified this observation, reporting a positive correlation between tracheal area corrected for body surface area and percentage peak expiratory flow and a negative correlation between wall area percentage and percentage peak expiratory flow.…”

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confidence: 99%

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Three-dimensional Airway Tree Architecture and Pulmonary Function

Leader

Meng³

et al. 2012

Academic Radiology

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Rationale and Objectives The airway tree is a primary conductive structure, and airways’ morphologic characteristics, or variations thereof, may have an impact on airflow, thereby affecting pulmonary function. The objective of this study was to investigate the correlation between airway tree architecture, as depicted on computed tomography, and pulmonary function. Materials and Methods A total of 548 chest computed tomographic examinations acquired on different patients at full inspiration were included in this study. The patients were enrolled in a study of chronic obstructive pulmonary disease (Specialized Center for Clinically Oriented Research) and underwent pulmonary function testing in addition to computed tomographic examinations. A fully automated airway tree segmentation algorithm was used to extract the three-dimensional airway tree from each examination. Using a skeletonization algorithm, airway tree volume–normalized architectural measures, including total airway length, branch count, and trachea length, were computed. Correlations between airway tree measurements with pulmonary function testing parameters and chronic obstructive pulmonary disease severity in terms of the Global Initiative for Obstructive Lung Disease classification were computed using Spearman’s rank correlations. Results Non-normalized total airway volume and trachea length were associated (P < .01) with lung capacity measures (ie, functional residual capacity, total lung capacity, inspiratory capacity, vital capacity, residual volume, and forced expiratory vital capacity). Spearman’s correlation coefficients ranged from 0.27 to 0.55 (P < .01). With the exception of trachea length, all normalized architecture-based measures (ie, total airway volume, total airway length, and total branch count) had statistically significant associations with the lung function measures (forced expiratory volume in 1 second and the ratio of forced expiratory volume in 1 second to forced expiratory vital capacity), and adjusted volume was associated with all three respiratory impedance measures (lung reactance at 5 Hz, lung resistance at 5 Hz, and lung resistance at 20 Hz), and adjusted branch count was associated with all respiratory impedance measures but lung resistance at 20 Hz. When normalized for lung volume, all airway architectural measures were statistically significantly associated with chronic obstructive pulmonary disease severity, with Spearman’s correlation coefficients ranging from −0.338 to −0.546 (P < .01). Conclusions Despite the large variability in anatomic characteristics of the airway tree across subjects, architecture-based measures demonstrated statistically significant associations (P < .01) with nearly all pulmonary function testing measures, as well as with disease severity.

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Section: Discussionsupporting

confidence: 93%

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confidence: 99%

Three-dimensional Airway Tree Architecture and Pulmonary Function

Leader

Meng³

et al. 2012

Academic Radiology

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“…Griscom and Wohl found that the similarity in tracheal lengths between male and female subjects persists into the teenage years 33 . The difference in tracheal length between genders appears to be at least somewhat attributable to post-pubescent changes 17,22,23,[32][33][34] . Based on the studies available, it is unclear if race, as an independent variable, affects tracheal length.…”

Section: Static Patient Factors: Race and Gender (Table 1)mentioning

confidence: 99%

“…It is intuitively obvious that over wide ranges of height in patients, tracheal length correlates with patient height. This is abundantly clear in the paediatric population where wide ranges in patient height exist 17,21,[30][31][32][33][34] . In the adult population, the ranges in height are not as dramatic and the correlation between patient stature and tracheal length reported in studies is not as strong, but does exist 22,23,[25][26][27]37 .…”

Section: Static Patient Factor: Heightmentioning

confidence: 99%

The Tracheal Accordion and the Position of the Endotracheal Tube

Herway

Benumof

2017

Anaesth Intensive Care

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The purpose of this review is to, first, determine the static factors that affect the length of the human trachea across different populations and, second, to investigate whether or not there are dynamic factors that cause the length of the human trachea to vary within the same individual. We also investigated whether these changes in tracheal length within the same individual are significant enough to increase the risk of endobronchial intubation or accidental extubation. A PubMed/MEDLINE and a Web of Science database English-language literature search was conducted in May 2016 with relevant keywords and MeSH terms when available. We found that gender, extremes of age, patient height, postsurgical changes and co-existing disease are static patient factors that affect the length of the human trachea. Dynamic clinical changes that occur under anaesthesia, including Trendelenburg position, head and neck flexion and extension, paralysis of the diaphragm and pneumoperitoneum, cause the trachea to act as an accordion, decreasing and increasing its length. The length of the human trachea in both awake and anaesthetised and paralysed patients is a critical consideration in preventing both endobronchial intubation and tracheal extubation. It is clear from the literature that tracheal length varies widely across populations and, additionally, with the dynamic clinical changes that occur under anaesthesia, the trachea acts as an accordion decreasing and increasing its length within the same individual. Knowledge of the magnitude of the change in tracheal dimensions in response to these factors is an important clinical consideration.

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“…Next, we started estimating trachea volume from the first axial slice that we found the trachea region with the Hough transform. Expected maximum capacity of trachea (i.e., < 30 cm 3 ) [52] and the rate of change of the volume were used to determine the stopping criteria for trachea inclusion/exclusion in the final segmentation. Note that main bronchi were not removed due to the capacity constraint feature of the trachea removal tool.…”

Section: Methodsmentioning

confidence: 99%

A Generic Approach to Pathological Lung Segmentation

Mansoor

Bağcı

et al. 2014

IEEE Trans. Med. Imaging

144

126

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Accurate segmentation of pathological lungs from computed tomography (CT) scans remains unsolved because available methods fail to provide a reliable generic solution for a wide spectrum of lung abnormalities. In this study, we propose a novel pathological lung segmentation method that takes into account neighbor prior constraints and a novel pathology recognition system. Our proposed framework has two stages; during stage one, we adapted the fuzzy connectedness (FC) image segmentation algorithm to perform initial lung parenchyma extraction. In parallel, we estimate the lung volume using rib-cage information without explicitly delineating lungs. This rudimentary, but intelligent lung volume estimation system allows comparison of volume differences between rib cage and FC based lung volume measurements. Significant volume difference indicates the presence of pathology, which invokes the second stage of the proposed framework for the refinement of segmented lung. In stage two, texture-based features are utilized to detect abnormal imaging patterns (consolidations, ground glass, interstitial thickening, tree-inbud, honeycombing, nodules, and micro-nodules) that might have been missed during the first stage of the algorithm. This refinement stage is further completed by a novel neighboring anatomy-guided segmentation approach to include abnormalities with weak textures, and pleura regions. We evaluated the accuracy and efficiency of the proposed method on more than 400 CT scans with the presence of a wide spectrum of abnormalities. To our best of knowledge, this is the first study to evaluate all abnormal imaging patterns in a single segmentation framework. The quantitative results show that our pathological lung segmentation method improves on current standards because of its high sensitivity and specificity and may have considerable potential to enhance the performance of routine clinical tasks.

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Size and Morphology of the Trachea Before and After Lung Volume Reduction Surgery

Abstract: Our data suggest that tracheal dimensions reflect the severity of emphysema as reflected by increased lung volumes. Tracheal features were poor predictors of changes in postsurgical pulmonary function parameters evaluated in this preliminary study.

Cited by 11 publications

References 14 publications

Three-dimensional Airway Tree Architecture and Pulmonary Function

Three-dimensional Airway Tree Architecture and Pulmonary Function

The Tracheal Accordion and the Position of the Endotracheal Tube

A Generic Approach to Pathological Lung Segmentation

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