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. 2013 Jan 28;14(1):11.
doi: 10.1186/1465-9921-14-11.

Low-dose CT measurements of airway dimensions and emphysema associated with airflow limitation in heavy smokers: a cross sectional study

Akkelies E Dijkstra  1 , Dirkje S Postma, Nick ten Hacken, Judith M Vonk, Matthijs Oudkerk, Peter M A van Ooijen, Pieter Zanen, Firdaus A Mohamed Hoesein, Bram van Ginneken, Michael Schmidt, Harry J M Groen
Affiliations

Low-dose CT measurements of airway dimensions and emphysema associated with airflow limitation in heavy smokers: a cross sectional study

Akkelies E Dijkstra et al. Respir Res. .

Abstract

Background: Increased airway wall thickness (AWT) and parenchymal lung destruction both contribute to airflow limitation. Advances in computed tomography (CT) post-processing imaging allow to quantify these features. The aim of this Dutch population study is to assess the relationships between AWT, lung function, emphysema and respiratory symptoms.

Methods: AWT and emphysema were assessed by low-dose CT in 500 male heavy smokers, randomly selected from a lung cancer screening population. AWT was measured in each lung lobe in cross-sectionally reformatted images with an automated imaging program at locations with an internal diameter of 3.5 mm, and validated in smaller cohorts of patients. The 15th percentile method (Perc15) was used to assess the severity of emphysema. Information about respiratory symptoms and smoking behavior was collected by questionnaires and lung function by spirometry.

Results: Median AWT in airways with an internal diameter of 3.5 mm (AWT3.5) was 0.57 (0.44 - 0.74) mm. Median AWT in subjects without symptoms was 0.52 (0.41-0.66) and in those with dyspnea and/or wheezing 0.65 (0.52-0.81) mm (p<0.001). In the multivariate analysis only AWT3.5 and emphysema independently explained 31.1%and 9.5%of the variance in FEV1%predicted, respectively, after adjustment for smoking behavior.

Conclusions: Post processing standardization of airway wall measurements provides a reliable and useful method to assess airway wall thickness. Increased airway wall thickness contributes more to airflow limitation than emphysema in a smoking male population even after adjustment for smoking behavior.

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Figures

Figure 1
Figure 1
Determination of the optimal airway size. Mean cumulative assessed perimeter fractions in the total lung, for different groups of patients at different internal airway lumen diameters. APF was measured on low-dose CT of 20 selected NELSON subjects divided into 3 groups: subjects without emphysema and with normal lung function (n = 8, perc15 > −910 and FEV1/FVC > 85 %), with moderate emphysema and normal lung function (n = 4, -940 < perc15 < −960 and FEV1/FVC > 70 %) and without emphysema and having severe airflow limitation (n = 8, perc15 > −920 and FEV1/FVC < 50 %), in airways with a lumen diameter of 2.5, 3.0, 3.5, 4.0, 4.5 and 5.0 mm (± 0.25 mm).
Figure 2
Figure 2
Comparison of airway wall thickness on high- and low-dose CT. AWT3.5 was measured on high and low-dose CT of 8 NELSON subjects. Bland & Altman plot shows agreement between mean AWT3.5 determined by high- and low-dose CT. Dashed lines depict the 95% confidence interval.
Figure 3
Figure 3
Distribution of 3.5 mm sized airways over airway generations. The distribution of 3.5 mm internal lumen sized airways over the 2nd till 7th airway generations in the apical upper lobe bronchus (B1) and over the 6th till 12th generation in the lower lobe bronchus (B10) in the right lung, for subjects with and without airway obstruction, for subjects with and without Chronic Mucus Hypersecretion (CMH) and for current and former smokers. The number of cases (e.g. no CMH and CMH) in each group was limited but the distribution was similar.
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