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Blank C, Granger LA, Gaschen L, Liu CC, Gaschen F. Fluoroscopically measured bronchial collapse in healthy dogs during cough exceeds 25%, and a cutoff of 60% bronchial collapse can be used to distinguish healthy from chronically coughing dogs. Vet Radiol Ultrasound 2024; 65:219-226. [PMID: 38363122 DOI: 10.1111/vru.13344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
Bronchomalacia, the weakening of bronchial cartilage, is a common cause of cough in dogs. The gold standard for diagnosis of bronchomalacia is bronchoscopy; however, fluoroscopy is often used as a preliminary diagnostic test due to its noninvasiveness. The normal amount of bronchial collapse in healthy dogs using fluoroscopy has not been previously established, with some authors citing <25%. The aims of this prospective and retrospective analytical observational study were to determine the normal amount of airway collapse in healthy animals, the amount of airway collapse in dogs with chronic cough and presumed bronchomalacia, and cut-off values of airway collapse during expiration and cough to distinguish between the two groups. Thoracic fluoroscopy was performed in right and left lateral recumbency during inspiration, expiration, and cough to evaluate the percentage collapse of the trachea and lobar bronchi in 45 healthy and 76 chronically coughing dogs. The bronchi of chronically coughing dogs exhibited a significantly greater amount of collapse during both expiration and cough compared with healthy dogs. Chronically coughing dogs exhibited up to 31.7 ± 26.6% collapse in expiration and 87.5 ± 23.7% collapse during cough, whereas healthy dogs exhibited 14.9 ± 6.1% collapse in expiration and 35.0 ± 13.7% collapse during cough. Based on ROC curves, the authors suggest using cut-off values of 30% during expiration and 60% during cough to distinguish between healthy dogs and those with presumed bronchomalacia. Findings suggest that though healthy dogs can exhibit a greater degree of airway collapse than previously thought, fluoroscopy can be used to distinguish between healthy and presumed bronchomalacic dogs.
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Affiliation(s)
- Carolyn Blank
- Department of Radiology, Louisiana State School of Veterinary Medicine, Baton Rouge, Louisiana, USA
| | - L Abbigail Granger
- Department of Radiology, Louisiana State School of Veterinary Medicine, Baton Rouge, Louisiana, USA
| | - Lorrie Gaschen
- Department of Radiology, Louisiana State School of Veterinary Medicine, Baton Rouge, Louisiana, USA
- VetCT, Orlando, Florida, USA
| | - Chin-Chi Liu
- Department of Veterinary Clinical Sciences, Louisiana State School of Veterinary Medicine, Baton Rouge, Louisiana, USA
| | - Frederic Gaschen
- Department of Internal Medicine, Louisiana State School of Veterinary Medicine, Baton Rouge, Louisiana, USA
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Lee SY, Bade BC, Sison CP, Karp J, Inra M, Paul S, Lee P, Lazzaro RS, Shah R, Cohen SL. Ultralow-Dose Dynamic Expiratory CT and Repeated Imaging Enhance Evaluation for Tracheomalacia. J Comput Assist Tomogr 2024:00004728-990000000-00306. [PMID: 38595148 DOI: 10.1097/rct.0000000000001613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This study aims to determine if a novel imaging protocol (ultralow-dose dynamic expiratory computed tomography [CT] with repeated imaging) identifies tracheomalacia (TM) more reliably than traditional dynamic tracheal CT. METHODS We performed a retrospective evaluation of 184 consecutive ultralow-dose dynamic CTs for TM during 2017. The protocol obtains images during 1 inspiration and 2 forced expirations. Tracheal narrowing during both expirations (airway narrowing [percentage] during first dynamic expiration CT [DE1], airway narrowing [percentage] during second dynamic expiration CT [DE2]) was reported as a percentage of inspiratory area. We identified maximum narrowing of each patient's sequence (maximum narrowing [percentage] on either dynamic expiration CT [DEmax] = greatest narrowing of DE1 or DE2) and compared DE1, DE2, and DEmax in individual studies and between patients. Outcomes included frequency of TM, tracheal narrowing, and severity. Reliability was assessed by comparing tracheal area narrowing and TM grade. RESULTS There was significantly more airway narrowing using 2 expiratory image acquisitions. Average DEmax tracheal area was 12% narrower than DE1 alone and 21% worse than DE2 alone (both P < 0.001). Using DEmax, TM was diagnosed 35% more often than DE1 alone and 31% more often than DE2 alone ( P < 0.001). DEmax identified more severe distribution of TM compared with DE1 or DE2 alone ( P < 0.001). Reliability between DE1 and DE2 was good for tracheal narrowing and moderate for TM grade. The mean effective radiation dose was 2.41 millisievert (mSv) for routine inspiration CT and 0.07 mSv for each dynamic expiration CT (total effective radiation, 2.55 mSv). CONCLUSIONS Dynamic expiration CT with 2 expiratory image acquisitions enhanced evaluation of TM, minimally increased radiation dose, and should be considered as a noninvasive screening option.
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Affiliation(s)
- Seung Yup Lee
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | | | | | - Jason Karp
- Pulmonary Division, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York
| | - Matthew Inra
- Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Subroto Paul
- Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Paul Lee
- Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | | | - Rakesh Shah
- From the Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
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Mitropoulos A, Song WJ, Almaghlouth F, Kemp S, Polkey M, Hull JH. Detection and diagnosis of large airway collapse: a systematic review. ERJ Open Res 2021; 7:00055-2021. [PMID: 34381840 PMCID: PMC8350125 DOI: 10.1183/23120541.00055-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/03/2021] [Indexed: 12/20/2022] Open
Abstract
Large airway collapse (LAC) is a frequently encountered clinical problem, caused by tracheobronchomalacia +/− excessive dynamic airway collapse, yet there are currently no universally accepted diagnostic criteria. We systematically reviewed studies reporting a diagnostic approach to LAC in healthy adults and patients, to compare diagnostic modalities and criteria used. Electronic databases were searched for relevant studies between 1989 and 2019. Studies that reported a diagnostic approach using computed tomography (CT), magnetic resonance imaging or flexible fibreoptic bronchoscopy were included. Random effects meta-analyses were performed to estimate the prevalence of LAC in healthy subjects and in patients with chronic obstructive airway diseases. We included 41 studies, describing 10 071 subjects (47% female) with a mean±sd age of 59±9 years. Most studies (n=35) reported CT findings, and only three studies reported bronchoscopic findings. The most reported diagnostic criterion was a ≥50% reduction in tracheal or main bronchi calibre at end-expiration on dynamic expiratory CT. Meta-analyses of relevant studies found that 17% (95% CI: 0–61%) of healthy subjects and 27% (95% CI: 11–46%) of patients with chronic airways disease were classified as having LAC, using this threshold. The most reported approach to diagnose LAC utilises CT diagnostics, and at a threshold used by most clinicians (i.e., ≥50%) may classify a considerable proportion of healthy individuals as being abnormal and having LAC in a quarter of patients with chronic airways disease. Future work should focus on establishing more precise diagnostic criteria for LAC, relating this to relevant physiological and disease sequelae. CT is mostly used to diagnose LAC, and at a threshold used by most clinicians (i.e. ≥50%) that would classify a large proportion of healthy individuals as being abnormal and LAC in a quarter of patients with chronic airway diseaseshttps://bit.ly/3izAuSk
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Affiliation(s)
| | - Woo-Jung Song
- Dept of Allergy and Clinical Immunology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Samuel Kemp
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Michael Polkey
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - James H Hull
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
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Aljathlany Y, Alamari K, Aljasser A, Alhelali A, Bukhari M, Almohizea M, Khan A, Alammar A. Comparison Between Mathematical and Software Calculation Methods for the Measurement of the Cross-sectional Area in Upper Airway Imaging. Cureus 2019; 11:e6106. [PMID: 31886046 PMCID: PMC6901374 DOI: 10.7759/cureus.6106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives This study aimed to compare the results of a software calculation method (SCM) and the mathematical calculation method (MCM) in measuring the cross-sectional area (CSA) at four different upper airway segments. Methods The data from the retrospective chart reviews of patients older than 18 years who had undergone computed tomography (CT) of the neck at our tertiary care center between September 2014 and September 2018 were reviewed. Data of patients who were intubated, tracheostomized, had nasogastric tubes, tumors, craniofacial anomalies, trauma, or any pathology that may affect the normal airway anatomy were excluded. We measured the anteroposterior (APD) and transverse diameter (TD) utilizing the CT software. CSA was calculated using both the mathematical formula (MCM) and software (SCM) at the glottis, proximal subglottis, distal subglottis, and tracheal levels. A paired sample t-test was used to determine the significant difference between SCM and MCM at each level. Results The data of 100 patients (59% female) were reviewed. There was a significant difference between the SCM and MCM at all four levels. The mean differences between the SCM and MCM were -33.63 mm2, -24.20 mm2, 6.04 mm2 (p < 0.001) at the glottis, proximal subglottis, and trachea, respectively. The mean difference at the distal subglottis was -4.08 mm2 (p = 0.01). Conclusion Our study found a significant difference between the SCM and MCM in measuring the CSA of the four airway segments. Theoretically, the SCM is more accurate and precise than MCM in measuring CSA; however, we could not prove the superiority of either method.
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Affiliation(s)
- Yousef Aljathlany
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Kholoud Alamari
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Abdullah Aljasser
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Abdullah Alhelali
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Manal Bukhari
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Mohammed Almohizea
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Adeena Khan
- Radiology, King Saud University Medical City, Riyadh, SAU
| | - Ahmed Alammar
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
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Paratracheal Paraseptal Emphysema and Expiratory Central Airway Collapse in Smokers. Ann Am Thorac Soc 2019; 15:479-484. [PMID: 29298081 DOI: 10.1513/annalsats.201709-713oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Expiratory central airway collapse is associated with respiratory morbidity independent of underlying lung disease. However, not all smokers develop expiratory central airway collapse, and the etiology of expiratory central airway collapse in adult smokers is unclear. Paraseptal emphysema in the paratracheal location, by untethering airway walls, may predispose smokers to developing expiratory central airway collapse. OBJECTIVES To evaluate whether paratracheal paraseptal emphysema is associated with expiratory central airway collapse. METHODS We analyzed paired inspiratory and expiratory computed tomography scans from participants enrolled in a multicenter study (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) of smokers aged 45 to 80 years. Expiratory central airway collapse was defined as greater than or equal to 50% reduction in cross-sectional area of the trachea during expiration. In a nested case-control design, participants with and without expiratory central airway collapse were included in a 1:2 fashion, and inspiratory scans were further analyzed using the Fleischner Society criteria for presence of centrilobular emphysema, paraseptal emphysema, airway wall thickening, and paratracheal paraseptal emphysema (maximal diameter ≥ 0.5 cm). RESULTS A total of 1,320 patients were included, 440 with and 880 without expiratory central airway collapse. Those with expiratory central airway collapse were older, had higher body mass index, and were less likely to be men or current smokers. Paratracheal paraseptal emphysema was more frequent in those with expiratory central airway collapse than control subjects (16.6 vs. 11.8%; P = 0.016), and after adjustment for age, race, sex, body mass index, smoking pack-years, and forced expiratory volume in 1 second, paratracheal paraseptal emphysema was independently associated with expiratory central airway collapse (adjusted odds ratio, 1.53; 95% confidence interval, 1.18-1.98; P = 0.001). Furthermore, increasing size of paratracheal paraseptal emphysema (maximal diameter of at least 1 cm and 1.5 cm) was associated with greater odds of expiratory central airway collapse (adjusted odds ratio, 1.63; 95% confidence interval, 1.18-2.25; P = 0.003 and 1.77; 95% confidence interval, 1.19-2.64; P = 0.005, respectively). CONCLUSIONS Paraseptal emphysema adjacent to the trachea is associated with expiratory central airway collapse. The identification of this risk factor on inspiratory scans should prompt further evaluation for expiratory central airway collapse. Clinical trial registered with ClinicalTrials.gov (NCT 00608764).
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Ultralow Dose Dynamic Expiratory Computed Tomography for Evaluation of Tracheomalacia. J Comput Assist Tomogr 2019; 43:307-311. [PMID: 30531547 DOI: 10.1097/rct.0000000000000806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the average effective radiation dose and feasibility of ultralow dose dynamic expiratory computed tomography (CT) for evaluation of tracheomalacia (ULD) and to evaluate factors that impact image quality. METHODS This is a retrospective study of 64 consecutive patients from September to October 2016 for the evaluation of tracheomalacia. All studies were performed with routine inspiration chest CT followed by ULD z(kilovoltage peak (kVp) 80, 100, or 120 and fixed milliamperage 10) or typical dose CT (TD) (kVp 100 or 120 with automated milliamperage) dynamic expiration CT. Image quality was considered diagnostic if the trachea area could be accurately measured for tracheomalacia assessment, and diagnostic studies were graded fair, good, or excellent. Scan length, image quality, and effective radiation dose were compared for ULD versus TD and ULD at 100 kVp versus ULD at 80 kVp. For ULD studies, patient factors were compared across image quality. RESULTS The ULD had a mean effective radiation dose of 0.08 mSv, with all studies of diagnostic image quality. The ULD showed 95% reduction in effective radiation dose (P < 0.001), 14% significant reduction in scan length (P = 0.029), and qualitatively decreased image quality compared w2 ith TD (P < 0.001). The ULD at 100 kVp had significantly better image quality compared with ULD at 80 kVp (P = 0.041) with higher effective radiation dose (0.09 vs 0.05 mSv) (P < 0.001). Body mass index significantly impacted image quality for all ULD studies but not for ULD at 80 or 100 kVp. CONCLUSION For evaluation of tracheomalacia, ULD showed low effective radiation dose less than 0.1 mSv and maintained diagnostic image quality.
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Bossé Y. The Strain on Airway Smooth Muscle During a Deep Inspiration to Total Lung Capacity. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2019; 2:0108021-1080221. [PMID: 32328568 PMCID: PMC7164505 DOI: 10.1115/1.4042309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/06/2018] [Indexed: 02/05/2023]
Abstract
The deep inspiration (DI) maneuver entices a great deal of interest because of its ability to temporarily ease the flow of air into the lungs. This salutary effect of a DI is proposed to be mediated, at least partially, by momentarily increasing the operating length of airway smooth muscle (ASM). Concerningly, this premise is largely derived from a growing body of in vitro studies investigating the effect of stretching ASM by different magnitudes on its contractility. The relevance of these in vitro findings remains uncertain, as the real range of strains ASM undergoes in vivo during a DI is somewhat elusive. In order to understand the regulation of ASM contractility by a DI and to infer on its putative contribution to the bronchodilator effect of a DI, it is imperative that in vitro studies incorporate levels of strains that are physiologically relevant. This review summarizes the methods that may be used in vivo in humans to estimate the strain experienced by ASM during a DI from functional residual capacity (FRC) to total lung capacity (TLC). The strengths and limitations of each method, as well as the potential confounders, are also discussed. A rough estimated range of ASM strains is provided for the purpose of guiding future in vitro studies that aim at quantifying the regulatory effect of DI on ASM contractility. However, it is emphasized that, owing to the many limitations and confounders, more studies will be needed to reach conclusive statements.
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Affiliation(s)
- Ynuk Bossé
- Université Laval, Faculty of Medicine, Department of Medicine, IUCPQ, M2694, Pavillon Mallet, Chemin Sainte-Foy, Québec, QC G1V 4G5, Canada e-mail:
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Douros K, Kremmydas G, Grammeniatis V, Papadopoulos M, Priftis KN, Alexopoulou E. Helical multi-detector CT scan as a tool for diagnosing tracheomalacia in children. Pediatr Pulmonol 2019; 54:47-52. [PMID: 30485735 DOI: 10.1002/ppul.24188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/01/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIMS Tracheomalacia (TM) is not an unusual diagnosis in pediatric respiratory clinics. The aim of this study was to assess the accuracy of paired static end-inspiratory/end-expiratory helical multi-detector CT scan (MDCT) in detecting TM. METHODS FB was performed in 28 children suspected of TM on the grounds of presence of recurrent episodes of vibrating cough and a need for more specific diagnostic information. Children diagnosed with flexible bronchoscopy (FB) as having TM were further investigated with MDCT. The cross-sectional area ratio of the trachea during end-expiration and end-inspiration, at the level of maximum end-expiration collapse (CSR), determined the basis for the MDCT diagnosis of TM. FB and MDCT were also performed in five children who suffered from mainly dry-but not honking, barking, or vibrating-cough for more than 3 months, and served as controls. RESULTS The diagnosis of TM was established bronchoscopically in 26 out of 28 children. CRS was significantly smaller in patients (0.59 ± 0.14) compared with controls (0.85 ± 0.11) (P = 0.001). The optimal CSR cut-off point for TM diagnosis, as it was estimated by the ROC curve, was ≤0.705 (95%CI: ≤0.635-≤0.850) with a sensitivity 84.6% (95%CI: 65.1-95.6), and specificity 100.0% (95%CI: 47.8-100.0). CONCLUSIONS MDCT can effectively diagnose TM in the majority of children and can be used as an alternative to FB. In children, the established criterion of CSR ≤0.5 should be replaced by CSR ≤0.7 that seems to be a more appropriate threshold.
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Affiliation(s)
- Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Pediatric Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Kremmydas
- Second Department of Radiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilis Grammeniatis
- Allergology and Pulmonology Unit, 3rd Pediatric Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Papadopoulos
- Allergology and Pulmonology Unit, 3rd Pediatric Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas N Priftis
- Allergology and Pulmonology Unit, 3rd Pediatric Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymia Alexopoulou
- Second Department of Radiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
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ACR Appropriateness Criteria ® Chronic Dyspnea-Noncardiovascular Origin. J Am Coll Radiol 2018; 15:S291-S301. [PMID: 30392598 DOI: 10.1016/j.jacr.2018.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Chronic dyspnea may result from a variety of disorders of cardiovascular, pulmonary, gastrointestinal, neuromuscular, systemic, and psychogenic etiology. This article discusses guidelines for the initial imaging of six variants for chronic dyspnea of noncardiovascular origin: (1) Chronic dyspnea of unclear etiology; (2) Chronic dyspnea with suspected chronic obstructive pulmonary disease; (3) Chronic dyspnea with suspected central airways disease; (4) Chronic dyspnea with suspected interstitial lung disease; (5) Chronic dyspnea with suspected disease of the pleura or chest wall; and (6) Chronic dyspnea with suspected diaphragm dysfunction. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Kim H, Kim YJ, Lee H, An T, Yu J, Yoon H, An G, Jung J, Chang J, Chang D. Computed tomographic and radiographic bronchial collapse may be a normal characteristic of forced expiration in dogs. Vet Radiol Ultrasound 2018; 59:551-563. [PMID: 29786925 DOI: 10.1111/vru.12625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/15/2018] [Accepted: 02/04/2018] [Indexed: 11/30/2022] Open
Abstract
Tracheobronchomalacia has been diagnosed using radiography or bronchoscopy to confirm bronchial changes in luminal diameter during the respiratory cycle. However, studies in healthy humans suggest that some degree of bronchial collapse may be observed during the normal respiratory cycle. In this analytical study, the luminal diameter of the bronchus to each of the six pulmonary lobes and the mean percentage of expiratory collapse from end inspiratory, end expiratory, and two forced expiratory phases (10 and 15 ml/kg) were determined via computed tomography (CT) and radiography in 22 healthy Beagle dogs. The bronchial collapsibility was significantly greater during the forced expiration than the end expiration (P < 0.001); the same results were observed in dorsal and sagittal CT images and radiographs (P < 0.001). Median collapsibility values associated with 15 ml/kg forced expiratory collapse determined via cross-sectional CT images were measured as 16.6-45.5% and differed according to the pulmonary lobe. Median collapsibilities on radiography with 15 ml/kg forced expiration were 57.8% and 62.1% in the right cranial lobe and right caudal lobe, respectively. In conclusion, bronchial diameter may change during the respiratory cycle, and some degree of reduction in bronchial diameter may be an incidental finding in healthy dogs. More rigorous criteria are needed with regards to bronchial collapsibility during normal respiration for the diagnosis of bronchomalacia in order to avoid false-positive diagnoses.
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Affiliation(s)
- Hyunryung Kim
- Section of Veterinary Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Young Joo Kim
- Western University of Health Science, College of Veterinary Medicine, Pomona, CA
| | - Hanbin Lee
- Section of Veterinary Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Taegeon An
- Section of Veterinary Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Jin Yu
- Section of Veterinary Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Hyounglok Yoon
- Section of Veterinary Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Gayeon An
- Section of Veterinary Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Jaihyun Jung
- Section of Veterinary Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Jinhwa Chang
- Section of Veterinary Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Dongwoo Chang
- Section of Veterinary Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
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Ullmann N, Secinaro A, Menchini L, Caggiano S, Verrillo E, Santangelo TP, Cutrera R, Tomà P. Dynamic expiratory CT: An effective non-invasive diagnostic exam for fragile children with suspected tracheo-bronchomalacia. Pediatr Pulmonol 2018; 53:73-80. [PMID: 29148213 DOI: 10.1002/ppul.23831] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/19/2017] [Accepted: 08/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tracheobronchomalacia, defined as variable collapse of the airways, has been recognized as an important cause of respiratory morbidity but still widely underdiagnosed. Bronchoscopy is still considered as the gold standard, but numerous limitations are known, especially for fragile sick children. Moreover, information on parenchymal lung disease cannot be described. There is a real need for a reliable, non-invasive test to help detection of airway and parenchymal malformations in children, specifically when bronchoscopy cannot be performed. METHODS AND RESULTS 34 paediatric patients underwent cine multidector CT for ongoing respiratory symptoms and were included. All CT images were of good quality and sedation was never needed. Airway disease such as trachea-broncomalacia with/without stenosis was described in 53% with the first being more frequent. Bronchomalacia alone was described in 10 patients and in 4 patients was associated with tracheomalacia. Moreover, CT allowed identification of parenchymal disease in 10 patients. Airways stenosis alone was detected in seven patients. The majority of patients (85%) underwent also bronchoscopy for clinical decision. The agreement between CT and bronchoscopy was explored. The two examinations did not agree only in two cases. CT dynamic showed an excellent sensitivity of 100% (81.47-100 %), a great specificity of 82% (48.22-97.72 %), NPV 100%, and PPV 90% (72-96.9 %). CONCLUSION Dynamic CT results an effective and highly sensitive diagnostic exam for children with tracheo-bronchomalacia. CT is especially indicated for those small and fragile patients that cannot undergo an invasive investigation. Moreover, CT allows a detailed evaluation both of the airways and the lungs which is useful for the clinical management.
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Affiliation(s)
- Nicola Ullmann
- Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Laura Menchini
- Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Serena Caggiano
- Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy
| | - Elisabetta Verrillo
- Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Renato Cutrera
- Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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Nygaard M, Bendstrup E, Dahl R, Hilberg O, Rasmussen F. Tracheal collapse diagnosed by multidetector computed tomography: evaluation of different image analysis methods. Eur Clin Respir J 2017; 4:1407624. [PMID: 29707170 PMCID: PMC5915113 DOI: 10.1080/20018525.2017.1407624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 10/22/2017] [Indexed: 12/19/2022] Open
Abstract
Background: The gold standard for diagnosing excessive tracheal collapse is still evaluation during bronchoscopy. Today, multidetector computed tomography (MDCT) is used to confirm a suspicion of abnormal tracheal collapse. There is no gold standard for computed tomography (CT) image analysis of tracheal collapse. Purpose: To evaluate four different methods for the diagnosis of tracheal collapse using the images obtained through MDCT to help clinicians evaluate the images in daily practice. Objectives: 374 consecutive high-resolution CT scans with full inspiratory and end-expiratory CT scans were retrospectively analyzed. Methods: The images were analyzed in four different ways. The degree of collapse was based on cross-sectional areas of individual locations or volumes of entire regions: (1) 1 cm above the carina, (2) the level of maximal collapse of the trachea, (3) the entire region from the carina to the thoracic inlet, and (4) the trachea and bronchial region as defined by the software. Results: We compared three existing and one new method for image analysis of tracheal collapse by MDCT. The prevalence of tracheal collapse varied from 10.7% to 19.5% in this cohort of patients suffering from mixed lung diseases when using an expiratory collapse of ≥50% as a threshold. The four methods were comparable with highly significant Pearsons correlation coefficients (0.764–0.856). However, the four methods identified different patients with collapse of ≥50%. There was no correlation between symptoms and the degree of collapse. Conclusion: The different methods identify tracheal collapse in different patients. Hence, the diagnosis of excessive tracheal collapse can not rely solely on MDCT images. Generally, there is a poor correlation between symptoms and the degree of collapse in the different methods. However, when using the maximal collapse, there is some correlation with symptoms. When in doubt regarding the diagnosis, further investigations, such as bronchoscopy, should be carried out.
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Affiliation(s)
- Mette Nygaard
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Ronald Dahl
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark
| | - Ole Hilberg
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
The term tracheobronchomalacia refers to excessively compliant and collapsible central airways leading to symptoms. Although seen as a coexisting condition with various other pulmonary condition, it may cause symptoms by itself. The condition is often misdiagnosed as asthma, bronchitis or just chronic cough due to a lack of specific pathognomonic history and clinical findings. The investigation revolves around different modes of imaging, lung function testing and usually confirmed by flexible bronchoscopy. The treatment widely varies based on the cause, with most cases treated conservatively with non-invasive ventilation. Some may require surgery or stent placement. In this article, we aim to discuss the pathophysiology behind this condition and recognize the common symptoms and causes of tracheobronchomalacia. The article will highlight the diagnostic steps as well as therapeutic interventions based on the specific cause.
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Affiliation(s)
- Abhishek Biswas
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, United States.
| | - Michael A Jantz
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, United States
| | - P S Sriram
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, United States
| | - Hiren J Mehta
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, United States
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Kamada T, Ito I, Kanemitsu Y, Sato S, Matsumoto H, Niimi A, Mishima M. Three-dimensional imaging forced oscillation technique to assess position-dependent airway obstruction in relapsing polychondritis: A case report. Respir Investig 2017; 55:69-73. [PMID: 28012498 DOI: 10.1016/j.resinv.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 09/08/2016] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
Relapsing polychondritis (RP) is characterized by recurrent systemic inflammation of the cartilages and is accompanied by central airway collapse. We report a case wherein three-dimensional imaging of respiratory system resistance (Rrs) and respiratory system reactance (Xrs) by using MostGraph (CHEST M.I., Tokyo, Japan), a forced oscillation system, revealed that Rrs and Xrs in the inspiratory and expiratory phases correlated with proximal airway collapse. The degree of difference in Rrs and Xrs between the supine and sitting positions reflected airway collapse more closely than did the pulmonary function test. MostGraph could be a useful tool for assessing airway collapse in RP.
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Affiliation(s)
- Takahiro Kamada
- Department of Respiratory Medicine, Kyoto University Hospital, Japan; Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Japan.
| | - Isao Ito
- Department of Respiratory Medicine, Kyoto University Hospital, Japan.
| | | | - Susumu Sato
- Department of Respiratory Medicine, Kyoto University Hospital, Japan.
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Kyoto University Hospital, Japan.
| | - Akio Niimi
- Department of Respiratory Medicine, Kyoto University Hospital, Japan; Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan.
| | - Michiaki Mishima
- Department of Respiratory Medicine, Kyoto University Hospital, Japan.
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Bhatt SP, Terry NL, Nath H, Zach JA, Tschirren J, Bolding MS, Stinson DS, Wilson CG, Curran-Everett D, Lynch DA, Putcha N, Soler X, Wise RA, Washko GR, Hoffman EA, Foreman MG, Dransfield MT. Association Between Expiratory Central Airway Collapse and Respiratory Outcomes Among Smokers. JAMA 2016; 315:498-505. [PMID: 26836732 PMCID: PMC5173387 DOI: 10.1001/jama.2015.19431] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Central airway collapse greater than 50% of luminal area during exhalation (expiratory central airway collapse [ECAC]) is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, its prevalence and clinical significance are unknown. OBJECTIVE To determine whether ECAC is associated with respiratory morbidity in smokers independent of underlying lung disease. DESIGN, SETTING, AND PARTICIPANTS Analysis of paired inspiratory-expiratory computed tomography images from a large multicenter study (COPDGene) of current and former smokers from 21 clinical centers across the United States. Participants were enrolled from January 2008 to June 2011 and followed up longitudinally until October 2014. Images were initially screened using a quantitative method to detect at least a 30% reduction in minor axis tracheal diameter from inspiration to end-expiration. From this sample of screen-positive scans, cross-sectional area of the trachea was measured manually at 3 predetermined levels (aortic arch, carina, and bronchus intermedius) to confirm ECAC (>50% reduction in cross-sectional area). EXPOSURES Expiratory central airway collapse. MAIN OUTCOMES AND MEASURES The primary outcome was baseline respiratory quality of life (St George's Respiratory Questionnaire [SGRQ] scale 0 to 100; 100 represents worst health status; minimum clinically important difference [MCID], 4 units). Secondary outcomes were baseline measures of dyspnea (modified Medical Research Council [mMRC] scale 0 to 4; 4 represents worse dyspnea; MCID, 0.7 units), baseline 6-minute walk distance (MCID, 30 m), and exacerbation frequency (events per 100 person-years) on longitudinal follow-up. RESULTS The study included 8820 participants with and without COPD (mean age, 59.7 [SD, 6.9] years; 4667 [56.7%] men; 4559 [51.7%] active smokers). The prevalence of ECAC was 5% (443 cases). Patients with ECAC compared with those without ECAC had worse SGRQ scores (30.9 vs 26.5 units; P < .001; absolute difference, 4.4 [95% CI, 2.2-6.6]) and mMRC scale scores (median, 2 [interquartile range [IQR], 0-3]) vs 1 [IQR, 0-3]; P < .001]), but no significant difference in 6-minute walk distance (399 vs 417 m; absolute difference, 18 m [95% CI, 6-30]; P = .30), after adjustment for age, sex, race, body mass index, forced expiratory volume in the first second, pack-years of smoking, and emphysema. On follow-up (median, 4.3 [IQR, 3.2-4.9] years), participants with ECAC had increased frequency of total exacerbations (58 vs 35 events per 100 person-years; incidence rate ratio [IRR], 1.49 [95% CI, 1.29-1.72]; P < .001) and severe exacerbations requiring hospitalization (17 vs 10 events per 100 person-years; IRR, 1.83 [95% CI, 1.51-2.21]; P < .001). CONCLUSIONS AND RELEVANCE In a cross-sectional analysis of current and former smokers, the presence of ECAC was associated with worse respiratory quality of life. Further studies are needed to assess long-term associations with clinical outcomes.
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Affiliation(s)
- Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
- UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL 35294
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Nina L.J. Terry
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL 35294
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Hrudaya Nath
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL 35294
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Jordan A. Zach
- Quantitiative Imaging Laboratory, National Jewish Health, Denver, CO 80206
| | | | - Mark S. Bolding
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL 35294
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294
| | | | - Carla G. Wilson
- Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206
| | - Douglas Curran-Everett
- Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206
| | - David A. Lynch
- Quantitiative Imaging Laboratory, National Jewish Health, Denver, CO 80206
- Department of Radiology, National Jewish Health, Denver, CO 80206
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Xavi Soler
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA 92093
| | - Robert A. Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - George R. Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA 02115
| | - Eric A. Hoffman
- Department of Radiology and Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, IA 52242
| | - Marilyn G. Foreman
- Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, 30303
| | - Mark T. Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
- UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL 35294
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL 35294
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Ciet P, Boiselle PM, Michaud G, O'Donnell C, Litmanovich DE. Optimal imaging protocol for measuring dynamic expiratory collapse of the central airways. Clin Radiol 2015; 71:e49-55. [PMID: 26611199 DOI: 10.1016/j.crad.2015.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/28/2015] [Accepted: 10/14/2015] [Indexed: 02/03/2023]
Abstract
AIM To compare measurements of expiratory collapse obtained using multidetector computed tomography (MDCT) of the central airways on routine axial and multiplanar reformatted (MPR) images. MATERIALS AND METHODS Fifty volunteers with normal pulmonary function and no smoking history were imaged using a 64 MDCT system (40 mAs, 120 kVp, 0.625 mm collimation) with spirometric monitoring at end-inspiration and during forced expiration. Measurements of the trachea, right main (RMB) and left main bronchus (LMB) were obtained on axial and MPR images. Inspiratory and dynamic-expiratory cross-sectional area (CSA) measurements were used to calculate the mean percentage expiratory collapse (%Collapse). A paired t-test was used to assess within-subject differences and a Bland-Altman plot was used to assess agreement between the methods. RESULTS Among 24 men and 26 women (mean age±standard deviation 50±15 years), CSA values were significantly greater on axial than MPR images (all p<0.001); however, the mean difference in %Collapse values for axial versus MPR were small: trachea ≈1% (55 ±19 versus 56±18, p=0.338); LMB identical (60±20 versus 60±17 p=0.856); and, RMB 4% (62 ±19 versus 66±19 p<0.001). On average, creation of MPR required 12 minutes of additional time per case (range=10-15 min). CONCLUSION Differences in mean %Collapse for axial versus MPR images were small and unlikely to influence clinical management. This finding suggests that MPR may not be indicated for routine assessment of central airway collapse.
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Affiliation(s)
- P Ciet
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA; Department of Pediatric Pulmonology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Radiology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P M Boiselle
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - G Michaud
- Yale School of Medicine, LCI 100C, 20 York Street, New Haven, CT 06510, USA
| | - C O'Donnell
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - D E Litmanovich
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
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Yamashiro T, Tsubakimoto M, Nagatani Y, Moriya H, Sakuma K, Tsukagoshi S, Inokawa H, Kimoto T, Teramoto R, Murayama S. Automated continuous quantitative measurement of proximal airways on dynamic ventilation CT: initial experience using an ex vivo porcine lung phantom. Int J Chron Obstruct Pulmon Dis 2015; 10:2045-54. [PMID: 26445535 PMCID: PMC4590570 DOI: 10.2147/copd.s87588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The purpose of this study was to evaluate the feasibility of continuous quantitative measurement of the proximal airways, using dynamic ventilation computed tomography (CT) and our research software. Methods A porcine lung that was removed during meat processing was ventilated inside a chest phantom by a negative pressure cylinder (eight times per minute). This chest phantom with imitated respiratory movement was scanned by a 320-row area-detector CT scanner for approximately 9 seconds as dynamic ventilatory scanning. Obtained volume data were reconstructed every 0.35 seconds (total 8.4 seconds with 24 frames) as three-dimensional images and stored in our research software. The software automatically traced a designated airway point in all frames and measured the cross-sectional luminal area and wall area percent (WA%). The cross-sectional luminal area and WA% of the trachea and right main bronchus (RMB) were measured for this study. Two radiologists evaluated the traceability of all measurable airway points of the trachea and RMB using a three-point scale. Results It was judged that the software satisfactorily traced airway points throughout the dynamic ventilation CT (mean score, 2.64 at the trachea and 2.84 at the RMB). From the maximum inspiratory frame to the maximum expiratory frame, the cross-sectional luminal area of the trachea decreased 17.7% and that of the RMB 29.0%, whereas the WA% of the trachea increased 6.6% and that of the RMB 11.1%. Conclusion It is feasible to measure airway dimensions automatically at designated points on dynamic ventilation CT using research software. This technique can be applied to various airway and obstructive diseases.
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Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Maho Tsubakimoto
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima, Japan
| | - Kotaro Sakuma
- Department of Radiology, Ohara General Hospital, Fukushima, Japan
| | | | - Hiroyasu Inokawa
- Center for Medical Research and Development, Toshiba Medical Systems Corporation, Otawara, Japan
| | - Tatsuya Kimoto
- Center for Medical Research and Development, Toshiba Medical Systems Corporation, Otawara, Japan
| | - Ryuichi Teramoto
- Corporate Manufacturing Engineering Center, Toshiba Corporation, Yokohama, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
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Represas-Represas C, Leiro-Fernández V, Mallo-Alonso R, Botana-Rial MI, Tilve-Gómez A, Fernández-Villar A. Excessive dynamic airway collapse in a small cohort of chronic obstructive pulmonary disease patients. Ann Thorac Med 2015; 10:118-22. [PMID: 25829963 PMCID: PMC4375740 DOI: 10.4103/1817-1737.150733] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/15/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The prevalence of EDAC (Excessive Dynamic Airway Collapse) has not been studied specifically in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE The aim of this study was to investigate the prevalence of EDAC in COPD and to determine whether there are clinical factors or functional variables that could influence the degree of expiratory collapse of central airways. METHODS Prospective observational study of a group of patients with COPD. The degree of tracheobronchial collapse was evaluated by low-dose dynamic airway computed tomography (CT). We recorded clinical and pulmonary function tests data, quality of life and BODE index. RESULTS This study included 53 patients with COPD, 46 (87%) males, mean age 65 (SD, 9) years. CONCLUSIONS The prevalence of EDAC observed in a sample of patients with different levels of COPD severity is low. The degree of dynamic central airway collapse was not related to the patient's epidemiological or clinical features, and did not affect lung function, symptoms, capacity for effort, or quality of life.
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Affiliation(s)
- C Represas-Represas
- Department of Pneumology, Research Group of Respiratory and Infectious Diseases, University Hospital Complex of Vigo, Xerencia de Xestion Integrada de Vigo, Spain
| | - V Leiro-Fernández
- Department of Pneumology, Research Group of Respiratory and Infectious Diseases, University Hospital Complex of Vigo, Xerencia de Xestion Integrada de Vigo, Spain
| | - R Mallo-Alonso
- Department of Radiology, University Hospital Complex of Vigo, Xerencia de Xestion Integrada de Vigo, Spain
| | - MI Botana-Rial
- Department of Pneumology, Research Group of Respiratory and Infectious Diseases, University Hospital Complex of Vigo, Xerencia de Xestion Integrada de Vigo, Spain
| | - A Tilve-Gómez
- Department of Radiology, University Hospital Complex of Vigo, Xerencia de Xestion Integrada de Vigo, Spain
| | - A Fernández-Villar
- Department of Pneumology, Research Group of Respiratory and Infectious Diseases, University Hospital Complex of Vigo, Xerencia de Xestion Integrada de Vigo, Spain
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O'Donnell CR, Bankier AA, O'Donnell DH, Loring SH, Boiselle PM. Static end-expiratory and dynamic forced expiratory tracheal collapse in COPD. Clin Radiol 2013; 69:357-62. [PMID: 24361144 DOI: 10.1016/j.crad.2013.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/23/2013] [Accepted: 11/05/2013] [Indexed: 11/15/2022]
Abstract
AIM To determine the range of tracheal collapse at end-expiration among chronic obstructive pulmonary disease (COPD) patients and to compare the extent of tracheal collapse between static end-expiratory and dynamic forced-expiratory multidetector-row computed tomography (MDCT). MATERIALS AND METHODS After institutional review board approval and obtaining informed consent, 67 patients meeting the National Heart, Lung, and Blood Institute (NHLBI)/World Health Organization (WHO) Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for COPD were sequentially imaged using a 64-detector-row CT machine at end-inspiration, during forced expiration, and at end-expiration. Standardized respiratory coaching and spirometric monitoring were employed. Mean percentage tracheal collapse at end-expiration and forced expiration were compared using correlation analysis, and the power of end-expiratory cross-sectional area to predict excessive forced-expiratory tracheal collapse was computed following construction of receiver operating characteristic (ROC) curves. RESULTS Mean percentage expiratory collapse among COPD patients was 17 ± 18% at end-expiration compared to 62 ± 16% during forced expiration. Over the observed range of end-expiratory tracheal collapse (approximately 10-50%), the positive predictive value of end-expiratory collapse to predict excessive (≥80%) forced expiratory tracheal collapse was <0.3. CONCLUSION COPD patients demonstrate a wide range of end-expiratory tracheal collapse. The magnitude of static end-expiratory tracheal collapse does not predict excessive dynamic expiratory tracheal collapse.
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Affiliation(s)
- C R O'Donnell
- Department of Pulmonary, Critical Care and Sleep Medicine, Harvard Medical School, Boston, MA, USA.
| | - A A Bankier
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - D H O'Donnell
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - S H Loring
- Department of Anesthesia, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - P M Boiselle
- Department of Radiology, Harvard Medical School, Boston, MA, USA
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Abstract
Tracheobronchomalacia (TBM) refers to a weakening of the anterior tracheal rings leading to splaying and collapse of the central airways. In this report, we review the treatment of TBM, including preoperative workup, intraoperative anesthesia management, and surgical technique for posterior splinting tracheobronchoplasty. Imperative in the preoperative preparation is a stent trial in which an airway stent is placed to temporarily relieve the TBM and reassess for improvement in symptoms. Definitive therapy is then carried out with posterior splinting tracheoplasty or tracheobronchoplasty. Surgical results are generally excellent with the majority of patients having significant improvements in breathing.
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Affiliation(s)
- Sagar S. Damle
- University of Colorado School of Medicine, Aurora, CO, USA
| | - John D. Mitchell
- University of Colorado School of Medicine, Aurora, CO, USA
- National Jewish Health, Denver, CO, USA
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Guillerman RP. Newer CT applications and their alternatives: what is appropriate in children? Pediatr Radiol 2011; 41 Suppl 2:534-48. [PMID: 21847736 DOI: 10.1007/s00247-011-2163-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 05/18/2011] [Accepted: 05/25/2011] [Indexed: 12/20/2022]
Abstract
Innovations in image acquisition and reconstruction technologies have greatly expanded the range of CT applications available in the routine clinical setting. CT images of sub-millimeter resolution can now be acquired of entire body regions in a few seconds or even sub-second time, allowing depiction of fine anatomical detail uncompromised by motion artifact. With sophisticated visualization software, image data can be processed into multiplanar, volume-rendered, cine and other formats to better display anatomical abnormalities and facilitate newer applications such as CT angiography, enterography, urography, tracheobronchography and cardiac CT. Newer applications including dual-energy material decomposition CT are furthering the transition of CT from a purely morphological to a combined anatomical, functional and metabolic imaging technique. These newer applications have largely been pioneered in adult populations, and heightened concern of the risk of carcinogenesis from ionizing radiation tempers dissemination of their use in children. Similar information can often be gleaned from alternative imaging modalities without ionizing radiation exposure, such as MRI and US, and what is most appropriate in children will depend on relative diagnostic efficacy, cost, availability and local expertise.
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Affiliation(s)
- R Paul Guillerman
- Department of Pediatric Radiology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030, USA.
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Gangadharan SP. Tracheobronchomalacia in adults. Semin Thorac Cardiovasc Surg 2011; 22:165-73. [PMID: 21092895 DOI: 10.1053/j.semtcvs.2010.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2010] [Indexed: 11/11/2022]
Abstract
Severe, diffuse tracheobronchomalacia (TBM) is an underrecognized cause of dyspnea, recurrent respiratory infections, cough, secretion retention, and even respiratory insufficiency. Patients often have comorbidities, such as asthma or chronic obstructive pulmonary disease, and inappropriate treatment for these conditions may precede eventual recognition of TBM by months or years. Most of these patients have an acquired form of TBM in which the etiology in unknown. Diagnosis of TBM is made by airway computed tomography scan and flexible bronchoscopy with forced expiration. The prevailing definition of TBM as a 50% reduction in cross-sectional area is nonspecific, with a high proportion of healthy volunteers meeting this threshold. The clinically significant threshold is complete or near-complete collapse of the airway. Airway stenting may treat TBM, although complications resulting from indwelling prostheses often limit the durability of stents. Surgical stabilization of the airway by posterior splinting (tracheobronchoplasty) effectively and permanently corrects malacic airways. Proper surgical selection is facilitated by a short-term stent trial.
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Affiliation(s)
- Sidhu P Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Yamashiro T, San José Estépar R, Matsuoka S, Bartholmai BJ, Ross JC, Diaz A, Murayama S, Silverman EK, Hatabu H, Washko GR. Intrathoracic tracheal volume and collapsibility on inspiratory and end-expiratory ct scans correlations with lung volume and pulmonary function in 85 smokers. Acad Radiol 2011; 18:299-305. [PMID: 21215660 DOI: 10.1016/j.acra.2010.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/02/2010] [Accepted: 11/03/2010] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the correlations of tracheal volume and collapsibility on inspiratory and end-expiratory computed tomography (CT) with lung volume and with lung function in smokers. MATERIALS AND METHODS The institutional review board approved this study at each institution. 85 smokers (mean age 68, range 45-87 years; 40 females and 45 males) underwent pulmonary function tests and chest CT at full inspiration and end-expiration. On both scans, intrathoracic tracheal volume and lung volume were measured. Collapsibility of the trachea and the lung was expressed as expiratory/inspiratory (E/I) ratios of these volumes. Correlations of the tracheal measurements with the lung measurements and with lung function were evaluated by the linear regression analysis. RESULTS Tracheal volume showed moderate or strong, positive correlations with lung volume on both inspiratory (r = 0.661, P < .0001) and end-expiratory (r = 0.749, P < .0001) scans. The E/I ratio of tracheal volume showed a strong, positive correlation with the E/I ratio of lung volume (r = 0.711, P < .0001). A weak, negative correlation was found between the E/I ratio of tracheal volume and the ratio of forced expiratory volume in the first second to forced vital capacity (r = -0.436, P < .0001). Also, a weak, positive correlation was observed between the E/I ratio of tracheal volume and the ratio of residual volume to total lung capacity (r = 0.253, P = .02). CONCLUSIONS Tracheal volume and collapsibility, measured by inspiratory and end-expiratory CT scans, is related to lung volume and collapsibility. The highly collapsed trachea on end-expiratory CT does not indicate more severe airflow limitation or air-trapping in smokers.
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Tracheal morphology and collapse in COPD: correlation with CT indices and pulmonary function test. Eur J Radiol 2011; 80:e531-5. [PMID: 21315531 DOI: 10.1016/j.ejrad.2010.12.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/28/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess the tracheal morphologic changes using CT in COPD (chronic obstructive lung disease) patients and to assess correlation between them and PFT (pulmonary function test) and CT parameters. MATERIALS AND METHODS Ninety-two healthy individuals and 115 patients with COPD who underwent volumetric inspiration/expiration CT scanning were included. The Lsag, Lcor, and the tLA were measured. The TI was defined as the ratio of Lcor/Lsag. The tracheal morphologic changes (tLA, TI, and collapsibility) were compared in healthy individuals and COPD. In COPD patients, correlation of the tracheal morphologic change with PFT and CT parameters was assessed. RESULTS The TIs in the COPD patients were significantly lower than those in the control group (0.80±0.15 vs. 0.88±0.11, Mean±SD) (p<0.01). In COPD patients, TI correlated with FEV1 (r=0.29, p=<0.01), FEV1/FVC (r=0.26, p<0.01), and the GOLD stage (r=-0.26, p<0.01). TI showed significant correlation with EI on both inspiration and expiration CT (r=-0.19, p=0.04 and r=-0.23, p=0.02), MLD on expiration CT (r=0.27, p<0.01), CT-ATI (r=0.34, p<0.01), and with LV on expiration CT (r=-0.25, p<0.01). CONCLUSION Among the tracheal morphologic changes, the most significant change in COPD patients compared with that in the control group, was the TI. In COPD patients, the tracheal morphologic change showed clinically significant correlation with severity of emphysema and CT indices.
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Ferretti GR, Jankowski A. Tomodensitométrie volumique : reconstructions 2D et 3D. Rev Mal Respir 2010; 27:1267-74. [DOI: 10.1016/j.rmr.2010.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 06/08/2010] [Indexed: 10/18/2022]
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Boiselle PM, O'Donnell CR, Loring SH, Bankier AA. Reproducibility of forced expiratory tracheal collapse: assessment with MDCT in healthy volunteers. Acad Radiol 2010; 17:1186-9. [PMID: 20591697 DOI: 10.1016/j.acra.2010.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 04/21/2010] [Accepted: 04/22/2010] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the reproducibility of multidetector-row computed tomography (MDCT)-measured forced expiratory tracheal collapse in healthy volunteers. METHODS AND MATERIALS Fourteen healthy, nonsmoking volunteers (6 males, 8 females, mean age 48.7 +/- 13.8 years) underwent repeat imaging 1 year after baseline imaging of tracheal dynamics employing the same scanner and technique (64-MDCT, 40 mAs, 120 kVp, and 0.625 mm detector collimation) with spirometric monitoring of total lung capacity and forced exhalation. Cross-sectional area (CSA) of the trachea was measured 1 cm above the aortic arch at end-inspiration and dynamic expiration, and percentage (%) expiratory reduction in tracheal lumen was calculated. Measurements were compared between baseline (Yr1) and repeat imaging (Yr2) using correlation coefficients and Bland-Altman plots. RESULTS Mean end-inspiratory CSA was 255.3 +/- 56 mm(2) at Yr1 and 255.1 +/- 52 mm(2) at Yr2; mean dynamic expiratory CSA was 125.6 +/- 60 mm(2) at Yr1 and 132.1 +/- 58 mm(2) at Yr2; and mean % expiratory reduction was 51.7 +/- 18% at Yr1 and 48.7 +/- 19% at Yr2. Mean differences between Yr1 and Yr2 values were 0.2 mm(2) for end-inspiratory CSA, 6.5 mm(2) for dynamic expiratory CSA, and 3.0% for percentage expiratory reduction. There was excellent correlation between the Yr1 and Yr2 measures of end-inspiratory CSA (r(2) = 0.97, P < .001), dynamic expiratory CSA (r(2) = 0.89, P < .001), and % expiratory reduction (r(2) = 0.86, P < .001). CONCLUSION MDCT measurements of forced expiratory tracheal collapse in healthy volunteers are highly reproducible over time.
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Affiliation(s)
- Phillip M Boiselle
- Center for Airway Imaging and the Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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Lee EY, Strauss KJ, Tracy DA, Bastos MD, Zurakowski D, Boiselle PM. Comparison of standard-dose and reduced-dose expiratory MDCT techniques for assessment of tracheomalacia in children. Acad Radiol 2010; 17:504-10. [PMID: 20207318 DOI: 10.1016/j.acra.2009.11.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 10/21/2009] [Accepted: 11/26/2009] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to assess the effects of radiation dose reduction on the assessment of the tracheal lumen on expiratory multidetector computed tomographic (MDCT) images of pediatric patients referred for evaluation for tracheomalacia (TM). MATERIALS AND METHODS The hospital information system was used to retrospectively identify 20 standard-dose and 20 reduced-dose paired inspiratory and expiratory MDCT studies performed for the evaluation of suspected TM in pediatric patients (aged <or= 18 years). The reduced-dose technique used a 50% reduction of the tube current for the expiratory portion of the study compared to the standard-dose technique. Two experienced pediatric radiologists, who were blinded to the tube current of the study, reported their levels of confidence for measuring the tracheal lumen using a four-point scale ranging from zero (no confidence) to three (highest level of confidence). The difference in confidence level between the two groups of studies was analyzed using the Mann-Whitney U test. The percentage of radiation dose reduction using the reduced-dose technique in comparison to the standard-dose technique was estimated using anthropomorphic thorax phantoms. The presence or absence of TM (>or=50% expiratory reduction in tracheal cross-sectional luminal area) on MDCT imaging was compared to bronchoscopic results for the subset of 32 patients who underwent both procedures. RESULTS A high level of confidence was reported for measuring the tracheal lumen on MDCT imaging for both standard-dose (median, 3.0) and reduced-dose (median, 3.0) expiratory sequences (P = .80). The total radiation dose of the paired inspiratory-expiratory computed tomographic (CT) exam was decreased by 23% with the reduced-dose technique. TM was diagnosed by CT imaging in seven patients who underwent standard-dose and six patients who underwent reduced-dose paired inspiratory and expiratory MDCT studies. CT results for the presence or absence of TM were concordant with the results of bronchoscopy in all 32 patients who underwent both procedures. CONCLUSION The radiation dose of paired inspiratory-expiratory CT imaging can be reduced by 23% while maintaining similar diagnostic confidence for assessment of the tracheal lumen compared to a standard-dose technique in pediatric patients. Thus, a reduced-dose technique is recommended for evaluating TM in children.
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Affiliation(s)
- Edward Y Lee
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
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Excesivo colapso dinámico de la vía aérea: una nueva entidad. Rev Clin Esp 2010; 210:53-5. [DOI: 10.1016/j.rce.2009.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 03/13/2009] [Indexed: 11/19/2022]
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Inoue M, Hasegawa I, Nakano K, Yamaguchi K, Kuribayashi S. Incidence of tracheobronchomalacia associated with pulmonary emphysema: detection with paired inspiratory-expiratory multidetector computed tomography using a low-dose technique. Jpn J Radiol 2009; 27:303-8. [PMID: 19856225 DOI: 10.1007/s11604-009-0342-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 06/14/2009] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the frequency of tracheobronchomalacia (TBM) associated with pulmonary emphysema with paired inspiratory-expiratory multidetector computed tomography (MDCT) using a low-dose technique. MATERIALS AND METHODS This study included 56 consecutive patients (55 men, 1 woman; mean age 68.9 years) with pulmonary emphysema who had undergone paired inspiratory-expiratory CT scanning with a low-dose technique (40 mA). All images were retrospectively examined by two thoracic radiologists in a blinded fashion. The diagnosis of TBM was based on the standard criterion of >50% reduction in the cross-sectional area of the tracheobronchial lumen at the end-expiratory phase. A mild TBM criterion of >30% reduction was also reviewed. All patients underwent pulmonary function tests. The relation between the forced expiratory volume in 1 s (FEV(1.0%)) and TBM was statistically analyzed. RESULTS Four (7.1%) and eight (14.3%) patients were diagnosed as TBM based on the standard and mild criteria, respectively. In four patients, the percentages of luminal narrowing were 63.4% and 51.2%, respectively for tracheomalacia and 59.2% and 62.0%, respectively, for bronchomalacia. The FEV(1.0%) values between patients with and without TBM showed no statistical difference. CONCLUSION The incidence of TBM associated with pulmonary emphysema was 7.1% with the standard criterion. It is possible that TBM has been underdiagnosed in a number of patients with pulmonary emphysema.
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Affiliation(s)
- Masanori Inoue
- Department of Diagnostic Radiology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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McDermott S, Barry SC, Judge EE, Collins S, de Jong PA, Tiddens HAWM, McKone EF, Gallagher CG, Dodd JD. Tracheomalacia in Adults with Cystic Fibrosis: Determination of Prevalence and Severity with Dynamic Cine CT. Radiology 2009; 252:577-86. [DOI: 10.1148/radiol.2522081956] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Airway malacia in chronic obstructive pulmonary disease: prevalence, morphology and relationship with emphysema, bronchiectasis and bronchial wall thickening. Eur Radiol 2009; 19:1669-78. [PMID: 19205703 DOI: 10.1007/s00330-009-1306-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 11/26/2008] [Accepted: 12/02/2008] [Indexed: 10/21/2022]
Abstract
The aim of this study was to determine the prevalence of airway malacia and its relationship with ancillary morphologic features in patients with chronic obstructive pulmonary disease (COPD). A retrospective review was performed of a consecutive series of patients with COPD who were imaged with inspiratory and dynamic expiratory multidetector computed tomography (MDCT). Airway malacia was defined as > or =50% expiratory reduction of the airway lumen. Both distribution and morphology of airway malacia were assessed. The extent of emphysema, extent of bronchiectasis and severity of bronchial wall thickness were quantified. The final study cohort was comprised of 71 patients. Airway malacia was seen in 38 of 71 patients (53%), and such proportion was roughly maintained in each stage of COPD severity. Almost all tracheomalacia cases (23/25, 92%) were characterised by an expiratory anterior bowing of the posterior membranous wall. Both emphysema and bronchiectasis extent did not differ between patients with and without airway malacia (p > 0.05). Bronchial wall thickness severity was significantly higher in patients with airway malacia and correlated with the degree of maximal bronchial collapse (p < 0.05). In conclusion, we demonstrated a strong association between airway malacia and COPD, disclosing a significant relationship with bronchial wall thickening.
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Prevalence of tracheal collapse in an emphysema cohort as measured with end-expiration CT. Acad Radiol 2009; 16:46-53. [PMID: 19064211 DOI: 10.1016/j.acra.2008.05.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 05/22/2008] [Accepted: 05/22/2008] [Indexed: 10/21/2022]
Abstract
RATIONALE AND OBJECTIVES To retrospectively investigate the prevalence of tracheal collapse in an emphysema cohort. The occurrence of a large degree of tracheal collapse may have important implications for the clinical management of respiratory symptoms and air trapping in patients with emphysema. MATERIALS AND METHODS Paired full-inspiratory and end-expiratory thin-section volumetric computed tomographic scans were available for 1071 long-term smokers with clinically and physiologically confirmed emphysema. The percentage reduction in the cross-sectional tracheal luminal area from full-inspiration to end-expiration was automatically computed at 2.5-mm intervals along the centerline of the trachea using customized software. RESULTS Maximal tracheal collapse did not follow a normal distribution in the emphysema cohort (P < .0001, skewness/kurtosis tests for normality); the median collapse was 18% (intraquartile range, 11%-30%). Statistically significant differences were found in the distribution of maximal collapse by gender (P < .005, Wilcoxon rank sum test). Overall, 10.5% of men and 17.1% of women showed evidence of tracheomalacia on the basis of the criterion of a reduction of 50% or greater in cross-sectional tracheal luminal area at end-expiration. CONCLUSION This study offers insights into the prevalence of tracheal collapse in a cohort of patients with emphysema; future work is needed to determine the possible relationship between tracheal collapse and air trapping in subjects with emphysema.
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