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

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

Abstract

Objectives

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

Methods

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.

Results

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 %).

Conclusions

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

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Abbreviations

ALD:

airway lumen diameter

AWT:

airway wall thickness

Pi10:

wall thickness at an interior perimeter of 10 mm

FEV1 :

forced expired volume in 1st second

FVC:

forced vital capacity

TLV:

total lung volume

pTLC:

predicted total lung capacity

COPD:

chronic obstructive pulmonary disease

%LAA-910:

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

%LAA-950:

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

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Acknowledgments

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.

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Authors and Affiliations

  1. Department of Computer Science, University of Copenhagen, Nørre Campus, Universitetsparken 5, 2100, Copenhagen Ø, Denmark

    Jens Petersen, Lars Lau Rakêt, Aasa Feragen, Mads Nielsen & Marleen de Bruijne

  2. Department of Respiratory Medicine, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Denmark

    Mathilde M. W. Wille & Asger Dirksen

  3. Max Planck Institute for Intelligent Systems and Max Planck Institute for Developmental Biology, Spemannstraße 41, 72076, Tübingen, Germany

    Aasa Feragen

  4. Department of Cardio-Thoracic Surgery RT, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    Jesper H. Pedersen

  5. Departments of Medical Informatics and Radiology, Erasmus MC Rotterdam, P.O. Box 2040, 3000, Rotterdam, The Netherlands

    Marleen de Bruijne

Authors
  1. Jens Petersen
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  2. Mathilde M. W. Wille
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  3. Lars Lau Rakêt
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Correspondence to Jens Petersen.

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Petersen, J., Wille, M.M.W., Rakêt, L.L. et al. Effect of inspiration on airway dimensions measured in maximal inspiration CT images of subjects without airflow limitation. Eur Radiol 24, 2319–2325 (2014). https://doi.org/10.1007/s00330-014-3261-3

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  • DOI: https://doi.org/10.1007/s00330-014-3261-3

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