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Menstrual cycle impacts lung structure measures derived from quantitative computed tomography

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

Quantitative computed tomography (qCT) is being increasingly incorporated in research studies and clinical trials aimed at understanding lung disease risk, progression, exacerbations, and intervention response. Menstrual cycle–based changes in lung function are recognized; however, the impact on qCT measures is currently unknown. We hypothesize that the menstrual cycle impacts qCT-derived measures of lung structure in healthy women and that the degree of measurement change may be mitigated in subjects on cyclic hormonal birth control.

Methods

Thirty-one non-smoking, healthy women with regular menstrual cycles (16 of which were on cyclic hormonal birth control) underwent pulmonary function testing and qCT imaging at both menses and early luteal phase time points. Data were evaluated to identify lung measurements which changed significantly across the two key time points and to compare degree of change across metrics for the sub-cohort with versus without birth control.

Results

The segmental airway measurements were larger and mean lung density was higher at menses compared to the early luteal phase. The sub-cohort with cyclic hormonal birth control did not have less evidence of measurement difference over the menstrual cycle compared to the sub-cohort without hormonal birth control.

Conclusions

This study provides evidence that qCT-derived measures from the lung are impacted by the female menstrual cycle. This indicates studies seeking to use qCT as a more sensitive measure of cross-sectional differences or longitudinal changes in these derived lung measurements should consider acquiring data at a consistent time in the menstrual cycle for pre-menopausal women and warrants further exploration.

Key Points

• Lung measurements from chest computed tomography are used in multicenter studies exploring lung disease progression and treatment response.

• The menstrual cycle impacts lung structure measurements.

• Cyclic variability should be considered when evaluating longitudinal change with CT in menstruating women.

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Abbreviations

COPD:

Chronic obstructive pulmonary disease

DLCO :

Diffusing capacity for carbon monoxide

E/I ratio:

Expiratory/inspiratory ratio

ELP:

Early luteal phase

FEV1 :

Forced expiratory volume in 1 second

FVC:

Forced vital capacity

LAA:

Low attenuation area

M:

Menses

MLD :

Mean lung density

PFT:

Pulmonary function testing

PMA:

Perimenstrual asthma

qCT:

Quantitative computed tomography

RV:

Residual volume

TLC:

Total lung capacity

VA:

Alveolar volume

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Acknowledgements

We thank Debra O’Connell-Moore and Sue Ellen Salisbury for assistance with regulatory approvals and subject recruitment, Jarron Atha for technical assistance with CT acquisition, Joshua Schirm for facilitating VIDA processing, and Nicholas Wanner for assistance with CD34+CD133+ flow cytometry.

Funding

This work was supported by the National Institutes of Health (NIH) R01HL112986 and P01HL103453. Imaging was performed using a CT system purchased through a shared instrumentation award (NIH S10OD018526).

Author information

Authors and Affiliations

  1. Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA

    Jessica C. Sieren, Kimberly E. Schroeder, Junfeng Guo & Eric A. Hoffman

  2. Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA

    Jessica C. Sieren, Junfeng Guo & Eric A. Hoffman

  3. Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    Kewal Asosingh & Serpil Erzurum

  4. Flow Cytometry Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    Kewal Asosingh

Authors
  1. Jessica C. Sieren
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  2. Kimberly E. Schroeder
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  3. Junfeng Guo
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  4. Kewal Asosingh
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  5. Serpil Erzurum
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  6. Eric A. Hoffman
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Corresponding author

Correspondence to Jessica C. Sieren.

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Guarantor

The scientific guarantor of this publication is Jessica Sieren.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: EAH is a founder and shareholder of VIDA Diagnostics Inc., a company commercializing lung image analysis software developed, in part, at the University of Iowa. JG is a shareholder of VIDA Diagnostics Inc. and JCS has a family member that is a shareholder and receives compensation from VIDA Diagnostics. Siemens Healthcare has provided in-kind support for hardware and software residing at the University of Iowa and used in this project.

Statistics and biometry

The first and second authors, as biomedical engineers, have experience with biostatistics methods. No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Observational

• Performed at one institution

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Sieren, J.C., Schroeder, K.E., Guo, J. et al. Menstrual cycle impacts lung structure measures derived from quantitative computed tomography. Eur Radiol 32, 2883–2890 (2022). https://doi.org/10.1007/s00330-021-08404-9

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  • DOI: https://doi.org/10.1007/s00330-021-08404-9

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