European Radiology

, Volume 24, Issue 9, pp 2319–2325 | Cite as

Effect of inspiration on airway dimensions measured in maximal inspiration CT images of subjects without airflow limitation

  • Jens PetersenEmail author
  • Mathilde M. W. Wille
  • Lars Lau Rakêt
  • Aasa Feragen
  • Jesper H. Pedersen
  • Mads Nielsen
  • Asger Dirksen
  • Marleen de Bruijne
Computed Tomography



To study the effect of inspiration on airway dimensions measured in voluntary inspiration breath-hold examinations.


961 subjects with normal spirometry were selected from the Danish Lung Cancer Screening Trial. Subjects were examined annually for five years with low-dose CT. Automated software was utilized to segment lungs and airways, identify segmental bronchi, and match airway branches in all images of the same subject. Inspiration level was defined as segmented total lung volume (TLV) divided by predicted total lung capacity (pTLC). Mixed-effects models were used to predict relative change in lumen diameter (ALD) and wall thickness (AWT) in airways of generation 0 (trachea) to 7 and segmental bronchi (R1-R10 and L1-L10) from relative changes in inspiration level.


Relative changes in ALD were related to relative changes in TLV/pTLC, and this distensibility increased with generation (p < 0.001). Relative changes in AWT were inversely related to relative changes in TLV/pTLC in generation 3--7 (p < 0.001). Segmental bronchi were widely dispersed in terms of ALD (5.7 ± 0.7 mm), AWT (0.86 ± 0.07 mm), and distensibility (23.5 ± 7.7 %).


Subjects who inspire more deeply prior to imaging have larger ALD and smaller AWT. This effect is more pronounced in higher-generation airways. Therefore, adjustment of inspiration level is necessary to accurately assess airway dimensions.

Key Points

Airway lumen diameter increases and wall thickness decreases with inspiration

The effect of inspiration is greater in higher-generation (more peripheral) airways

Airways of generation 5 and beyond are as distensible as lung parenchyma

Airway dimensions measured from CT should be adjusted for inspiration level


Computed tomography Lung Airway Inspiration Obstructive disease 



airway lumen diameter


airway wall thickness


wall thickness at an interior perimeter of 10 mm


forced expired volume in 1st second


forced vital capacity


total lung volume


predicted total lung capacity


chronic obstructive pulmonary disease


percentage of voxels in the lung with Hounsfield units below -910


percentage of voxels in the lung with Hounsfield units below -950



The scientific guarantor of this publication is Marleen de Bruijne. The authors of this manuscript declare relationships with the following companies: AstraZeneca, Sweden. This study has received funding by AstraZeneca, Sweden and the Netherlands Organisation for Scientific Research (NWO). One of the authors, Lars Lau Rakêt, has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Approval from the institutional animal care committee was not required, as the study did not involve animal subjects. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

Supplementary material

330_2014_3261_MOESM1_ESM.doc (180 kb)
ESM 1 (DOC 180 kb)


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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Jens Petersen
    • 1
    Email author
  • Mathilde M. W. Wille
    • 2
  • Lars Lau Rakêt
    • 1
  • Aasa Feragen
    • 1
    • 3
  • Jesper H. Pedersen
    • 4
  • Mads Nielsen
    • 1
  • Asger Dirksen
    • 2
  • Marleen de Bruijne
    • 1
    • 5
  1. 1.Department of Computer ScienceUniversity of CopenhagenCopenhagen ØDenmark
  2. 2.Department of Respiratory Medicine, Gentofte HospitalUniversity of CopenhagenHellerupDenmark
  3. 3.Max Planck Institute for Intelligent Systems and Max Planck Institute for Developmental BiologyTübingenGermany
  4. 4.Department of Cardio-Thoracic Surgery RTRigshospitalet, University Hospital of CopenhagenCopenhagen ØDenmark
  5. 5.Departments of Medical Informatics and RadiologyErasmus MC RotterdamRotterdamThe Netherlands

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