Visualization of the Small Airways:What It Is and Why It Matters

Schiebler, Mark L.; Párraga, Grace

doi:10.1148/radiol.2019192025

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Radiology

2019

DOI: 10.1148/radiol.2019192025

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Visualization of the Small Airways:What It Is and Why It Matters

Mark L. Schiebler

Grace Párraga

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Cited by 3 publications

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References 10 publications

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“…In patients with COPD, it showed a strong correlation compared with hyperpolarized xenon 129 (HPX) MRI and ventilation SPECT (V-SPECT) imaging data (14). The FAN flow model has the potential to be introduced into clinical practice to probe the role of disease at a microstructural level beyond the limits of conventional imaging analysis (15). In the prior report, CT, HPX MRI, and V-SPECT were performed at different times with inevitable differences in lung volumes and at different planes and section thicknesses, which required image coregistration for FAN model comparisons, inevitably introducing inaccuracies.…”

mentioning

confidence: 99%

Lobar Ventilation in Patients with COPD Assessed with the Full-Scale Airway Network Flow Model and Xenon-enhanced Dual-Energy CT

Kim¹,

Doganay²,

Hwang³

et al. 2021

Radiology

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C hronic obstructive pulmonary disease (COPD) is characterized by long-term airway inflammation and parenchymal destruction that interferes with normal airway flow, causing respiratory impairment. It is a major burden on the health care system, with a prevalence of 251 million cases reported globally in 2016, and it caused 3.17 million deaths in 2015 (1). Recent advances in medical imaging technology have improved the structural assessment of COPD. However, challenges remain in early diagnosis, severity stratification, and effective treatments.Thoracic CT provides excellent spatial resolution, enabling identification of anatomic and structural changes caused by COPD, but it provides limited functional information. Pulmonary function tests (PFTs) are well established and offer some functional information but only at a whole-lung and nonregional level. The more expensive and time-consuming functional imaging modalities, such as hyperpolarized gas MRI and single-photon emission CT (SPECT) can be used to identify regional functional abnormalities in patients with COPD (2-6), but they are less readily available for routine clinical practice.Xenon-enhanced dual-energy (DE) CT is a promising tool in the investigation of regional lung ventilation abnormalities in patients with COPD (7,8). It uses two (low and high) photon energy spectra to differentiate inhaled xenon from the natural lung contents of air, blood, and soft tissue (9). Thus, it provides high-spatial-resolution images compared with SPECT (10-12). Xenon-enhanced DE CT is less expensive and more readily available for clinical practice than hyperpolarized gas MRI.We previously reported on a CT image-based computational model, the full-scale airway network (FAN) flow

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confidence: 99%

Lobar Ventilation in Patients with COPD Assessed with the Full-Scale Airway Network Flow Model and Xenon-enhanced Dual-Energy CT

Kim¹,

Doganay²,

Hwang³

et al. 2021

Radiology

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“…In recent studies, FAN assisted by an artificial intelligence tool for detecting pneumonia identified ventilation defects in post-COVID-19 infection lungs, 15 possibly because the FAN model elucidates abnormal flow characteristics in small airways. 16 We investigated whether, using FAN model analysis, it was possible to identify dysfunctional ventilation distribution in the small airways of patients with Long-COVID and breathlessness, who have normal CT scans using HP Xe MRI as the gold standard.…”

mentioning

confidence: 99%

“…Alongside functional lung imaging, a computational modeling technique, the full-scale airway network (FAN) flow model, enables a detailed assessment of regional lung ventilation using conventional CT images. In recent studies, FAN assisted by an artificial intelligence tool for detecting pneumonia identified ventilation defects in post–COVID-19 infection lungs, 15 possibly because the FAN model elucidates abnormal flow characteristics in small airways 16 …”

mentioning

confidence: 99%

Functional Impairment in Small Airways Associated With the Breathlessness Symptoms in Long–Coronavirus Disease

Kim,

Hwang,

Grist

et al. 2023

Journal of Thoracic Imaging

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Purpose: This study aimed to determine the association between functional impairment in small airways and symptoms of dyspnea in patients with Long-coronavirus disease (COVID), using imaging and computational modeling analysis. Patients and Methods: Thirty-four patients with Long-COVID underwent thoracic computed tomography and hyperpolarized Xenon-129 magnetic resonance imaging (HP Xe MRI) scans. Twenty-two answered dyspnea-12 questionnaires. We used a computed tomography–based full-scale airway network (FAN) flow model to simulate pulmonary ventilation. The ventilation distribution projected on a coronal plane and the percentage lobar ventilation modeled in the FAN model were compared with the HP Xe MRI data. To assess the ventilation heterogeneity in small airways, we calculated the fractal dimensions of the impaired ventilation regions in the HP Xe MRI and FAN models. Results: The ventilation distribution projected on a coronal plane showed an excellent resemblance between HP Xe MRI scans and FAN models (structure similarity index: 0.87 ± 0.04). In both the image and the model, the existence of large clustered ventilation defects was not identifiable regardless of dyspnea severity. The percentage lobar ventilation of the HP Xe MRI and FAN model showed a strong correlation (ρ = 0.63, P < 0.001). The difference in the fractal dimension of impaired ventilation zones between the low and high dyspnea-12 score groups was significant (HP Xe MRI: 1.97 [1.89 to 2.04] and 2.08 [2.06 to 2.14], P = 0.005; FAN: 2.60 [2.59 to 2.64] and 2.64 [2.63 to 2.65], P = 0.056). Conclusions: This study has identified a potential association of small airway functional impairment with breathlessness in Long-COVID, using fractal analysis of HP Xe MRI scans and FAN models.

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Measuring Regional Pulmonary Function Using Noncontrast CT: More Reasons to Join the FAN Bandwagon

Párraga

Eddy

2021

Radiology

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Visualization of the Small Airways:What It Is and Why It Matters

Cited by 3 publications

References 10 publications

Lobar Ventilation in Patients with COPD Assessed with the Full-Scale Airway Network Flow Model and Xenon-enhanced Dual-Energy CT

Lobar Ventilation in Patients with COPD Assessed with the Full-Scale Airway Network Flow Model and Xenon-enhanced Dual-Energy CT

Functional Impairment in Small Airways Associated With the Breathlessness Symptoms in Long–Coronavirus Disease

Measuring Regional Pulmonary Function Using Noncontrast CT: More Reasons to Join the FAN Bandwagon

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