Bronchial measurements in patients with asthma: comparison of quantitative thin-section CT findings with those in healthy subjects and correlation with pathologic findings.

PURPOSE To analyze and compare computed tomographic (CT) bronchial measurements in patients with asthma and healthy subjects and to correlate bronchial morphometric parameters with functional data and immunohistologic markers of airway remodeling and inflammation. MATERIALS AND METHODS This retrospective study was approved by the institutional review board; patient informed consent was not required. CT and pulmonary function tests were performed in 27 patients separated into two groups: 15 patients with asthma (three men; mean age, 43.1 years +/- 5.3 [standard error of mean]) and 12 healthy subjects (10 men; mean age, 45.0 years +/- 5.4). Endobronchial biopsies were performed in 11 subjects. Bronchial cross-sectional wall area (WA) and lumen area (LA) were measured by using validated software, and wall thickness (WT), total area (TA), WA/LA ratio, and WA/TA ratio were computed. Slope and maximal local slope of each parameter along bronchial generations were calculated. RESULTS Patients with asthma demonstrated significantly lower LA, TA, and WA and higher WA/LA and WA/TA ratios than healthy subjects downward from the fourth bronchial generation. Correlations existed between slope and maximal local slope of WA/LA and/or WA/TA ratios and functional data reflecting bronchial obstruction (r = 0.46-0.58, P = .001-.025), subepithelial membrane thickness (r = 0.67-0.69, P = .019-.023), smooth muscle layer area (r = 0.75, P = .007), subepithelial layer area (r = 0.81, P = .002), and infiltration of the bronchial wall by inflammatory cells (r = 0.67-0.86, P = .049-.003). CONCLUSION Axial reconstructions with orthogonal measurements along the airways enabled by three-dimensional segmentation methods are able to demonstrate significant changes in bronchial morphometry, predicting airflow limitation in asthma, and may have a role in the noninvasive measurement of airway remodeling.

[1]  E. Weibel,et al.  An optimal bronchial tree may be dangerous , 2004, Nature.

[2]  Roger Marthan,et al.  Assessment of airways with three-dimensional quantitative thin-section CT: in vitro and in vivo validation. , 2007, Radiology.

[3]  F. Preteux,et al.  Quantification of bronchial dimensions at MDCT using dedicated software , 2007, European Radiology.

[4]  P. Paré,et al.  Quantitative assessment of airway remodeling using high-resolution CT. , 2002, Chest.

[5]  Jie Zheng,et al.  Airway remodeling measured by multidetector CT is increased in severe asthma and correlates with pathology. , 2008, Chest.

[6]  M. Mishima,et al.  Relationship of airway wall thickness to airway sensitivity and airway reactivity in asthma. , 2003, American journal of respiratory and critical care medicine.

[7]  Roger Marthan,et al.  Bronchial measurement with three-dimensional quantitative thin-section CT in patients with cystic fibrosis. , 2007, Radiology.

[8]  S. Kawakami,et al.  Evaluation of airway wall thickness and air trapping by HRCT in asymptomatic asthma , 2003, European Respiratory Journal.

[9]  F. Laurent,et al.  Bronchial morphometry in smokers: comparison with healthy subjects by using 3D CT , 2009, European Radiology.

[10]  G. Viegi,et al.  Standardisation of the measurement of lung volumes , 2005, European Respiratory Journal.

[11]  T. Koelmeyer,et al.  The effect of age and duration of disease on airway structure in fatal asthma. , 2000, American journal of respiratory and critical care medicine.

[12]  I. Tillie‐Leblond,et al.  High-resolution computed tomography scan and airway remodeling in children with severe asthma. , 2005, The Journal of allergy and clinical immunology.

[13]  J. Hankinson,et al.  Standardisation of spirometry , 2005, European Respiratory Journal.

[14]  J. Vernejoux,et al.  Inflammation of bronchial smooth muscle in allergic asthma , 2006, Thorax.

[15]  K. J. Macleod,et al.  High resolution computed tomographic assessment of airway wall thickness in chronic asthma: reproducibility and relationship with lung function and severity , 2002, Thorax.

[16]  M. Adachi,et al.  Correlation between the bronchial subepithelial layer and whole airway wall thickness in patients with asthma , 2002, Thorax.

[17]  J. Wilson,et al.  Increased vascularity of the bronchial mucosa in mild asthma. , 1997, American journal of respiratory and critical care medicine.

[18]  G G King,et al.  Evaluation of airways in obstructive pulmonary disease using high-resolution computed tomography. , 1999, American journal of respiratory and critical care medicine.

[19]  M. Hasegawa,et al.  Airflow limitation and airway dimensions in chronic obstructive pulmonary disease. , 2006, American journal of respiratory and critical care medicine.

[20]  F. Laurent,et al.  Assessment of bronchial wall thickness and lumen diameter in human adults using multi‐detector computed tomography: comparison with theoretical models , 2007, Journal of anatomy.

[21]  A. James,et al.  The structure of large and small airways in nonfatal and fatal asthma. , 1993, The American review of respiratory disease.

[22]  P. Grenier,et al.  Mild intermittent asthma: CT assessment of bronchial cross-sectional area and lung attenuation at controlled lung volume. , 2002, Radiology.

[23]  E. Weibel,et al.  Architecture of the Human Lung , 1962, Science.

[24]  Yasutaka Nakano,et al.  Effect of short-term treatment with inhaled corticosteroid on airway wall thickening in asthma. , 2004, The American journal of medicine.

[25]  S. Fukuhara,et al.  Relationship of airway wall thickening to an imbalance between matrix metalloproteinase-9 and its inhibitor in asthma , 2005, Thorax.

[26]  M. Aubier,et al.  Airway structural alterations selectively associated with severe asthma. , 2003, American journal of respiratory and critical care medicine.

[27]  F. Laurent,et al.  Assessment of bronchial inflammation using an automated cell recognition system based on colour analysis. , 1999, The European respiratory journal.

[28]  F. Laurent,et al.  Airway wall thickness in cigarette smokers: quantitative thin-section CT assessment. , 2005, Radiology.

[29]  Milan Sonka,et al.  Intrathoracic airway trees: segmentation and airway morphology analysis from low-dose CT scans , 2005, IEEE Transactions on Medical Imaging.

[30]  A. B. Kay,et al.  Pathology of mild, severe, and fatal asthma. , 1996, American journal of respiratory and critical care medicine.

[31]  Shin Matsuoka,et al.  Serial change in airway lumen and wall thickness at thin-section CT in asymptomatic subjects. , 2005, Radiology.

[32]  C. Lemière,et al.  Differences in airway remodeling between subjects with severe and moderate asthma. , 2005, The Journal of allergy and clinical immunology.

[33]  Dirk Bartz,et al.  Hybrid segmentation and virtual bronchoscopy based on CT images. , 2004, Academic radiology.

[34]  H Itoh,et al.  Airway wall thickness in asthma assessed by computed tomography. Relation to clinical indices. , 2000, American journal of respiratory and critical care medicine.

[35]  P. Paré,et al.  Computed tomographic measurements of airway dimensions and emphysema in smokers. Correlation with lung function. , 2000, American journal of respiratory and critical care medicine.