Computed Tomographic Imaging of the Airways in COPD and Asthma

Computed tomography (CT) is the modality of choice for imaging the airways. Volumetric data sets with isotropic spatial resolution based on multidetector thin-section CT with overlapping reconstruction should be used. Chronic obstructive pulmonary disease and asthma are the 2 most common disease entities that are defined by airflow obstruction. The morphologic correlates of airway changes are dilation of the lumen, thickening of the wall, visibility of small airways due to mucus or edema, air trapping, hypoxic vasoconstriction, and collapsibility. To assess air trapping, additional expiratory low-dose scans are recommended. In clinical routine, these findings are visually assessed and should be routinely reported. However, the interobserver variability is high, and there is a clear need for objective software-based measurements. The development of such tools is challenging, and they are just becoming available on a broader scale. Novel techniques based on dual-energy CT aim to measure iodine distribution maps to assess pulmonary perfusion as well as the distribution of inhaled xenon gas to assess the distribution and time course of pulmonary ventilation. However, these techniques are still being investigated in clinical studies. This review will provide an overview of CT for the diagnosis of chronic obstructive pulmonary disease and asthma, its role in phenotyping these diseases, and the measurement of disease severity and functional compromise.

[1]  N. Müller,et al.  Heterogeneity of narrowing in normal and asthmatic airways measured by HRCT , 2004, European Respiratory Journal.

[2]  Geoffrey D. Rubin,et al.  Fully Automated System for Three-Dimensional Bronchial Morphology Analysis Using Volumetric Multidetector Computed Tomography of the Chest , 2006, Journal of Digital Imaging.

[3]  Kunihiro Yagihashi,et al.  Quantitative assessment of air trapping in chronic obstructive pulmonary disease using inspiratory and expiratory volumetric MDCT. , 2008, AJR. American journal of roentgenology.

[4]  D. Lynch,et al.  Asthma: an imaging update. , 2009, Radiologic clinics of North America.

[5]  A. Bush.  How early do airway inflammation and remodeling occur? , 2008, Allergology international : official journal of the Japanese Society of Allergology.

[6]  L. Boulet,et al.  Obesity and asthma: a specific phenotype? , 2008, Chest.

[7]  Mathieu Lederlin,et al.  Bronchial measurements in patients with asthma: comparison of quantitative thin-section CT findings with those in healthy subjects and correlation with pathologic findings. , 2009, Radiology.

[8]  D. Feller-Kopman,et al.  2003 AUR Memorial Award. Dynamic expiratory volumetric CT imaging of the central airways: comparison of standard-dose and low-dose techniques. , 2003, Academic radiology.

[9]  J. Remy,et al.  Vascular disease in chronic obstructive pulmonary disease. , 2008, Proceedings of the American Thoracic Society.

[10]  Hans-Ulrich Kauczor,et al.  Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis: comparison of different quantitative evaluations and pulmonary function test. , 2005, Chest.

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

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

[13]  Eduard E de Lange,et al.  Demonstration of the heterogeneous distribution of asthma in the lungs using CT and hyperpolarized helium‐3 MRI , 2010, Journal of magnetic resonance imaging : JMRI.

[14]  N L Müller,et al.  Airway obstruction in asthmatic and healthy individuals: inspiratory and expiratory thin-section CT findings. , 1997, Radiology.

[15]  J. Seo,et al.  Xenon ventilation CT using a dual-source dual-energy technique: dynamic ventilation abnormality in a child with bronchial atresia , 2008, Pediatric Radiology.

[16]  J. Bousquet,et al.  Computed tomography of the lungs in asthma: influence of disease severity and etiology. , 1996, American journal of respiratory and critical care medicine.

[17]  K. Kurashima,et al.  Effect of early versus late intervention with inhaled corticosteroids on airway wall thickness in patients with asthma , 2008, Respirology.

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

[19]  Armin Ernst,et al.  Tracheomalacia and tracheobronchomalacia in children and adults: an in-depth review. , 2005, Chest.

[20]  D M Hansell,et al.  Small airways diseases: detection and insights with computed tomography. , 2001, The European respiratory journal.

[21]  C. W. Kim,et al.  High-resolution computed tomography in patients with bronchial asthma: correlation with clinical features, pulmonary functions and bronchial hyperresponsiveness. , 1997, Journal of investigational allergology & clinical immunology.

[22]  E. Hoffman,et al.  A multivariate analysis of risk factors for the air-trapping asthmatic phenotype as measured by quantitative CT analysis. , 2009, Chest.

[23]  H. Coxson,et al.  Quantitative computed tomography assessment of airway wall dimensions: current status and potential applications for phenotyping chronic obstructive pulmonary disease. , 2008, Proceedings of the American Thoracic Society.

[24]  J. Remy,et al.  Assessment of lobar perfusion in smokers according to the presence and severity of emphysema: preliminary experience with dual-energy CT angiography , 2009, European Radiology.

[25]  D. Hansell,et al.  Bronchial diverticula in smokers on thin-section CT , 2009, European Radiology.

[26]  E. V. van Beek,et al.  Imaging phenotypes of chronic obstructive pulmonary disease , 2010, Journal of magnetic resonance imaging : JMRI.

[27]  Grace Parraga,et al.  Imaging of lung function using hyperpolarized helium‐3 magnetic resonance imaging: Review of current and emerging translational methods and applications , 2010, Journal of magnetic resonance imaging : JMRI.

[28]  Eric A. Hoffman,et al.  Accurate measurement of intrathoracic airways , 1997, IEEE Transactions on Medical Imaging.

[29]  P. J. Barnes,et al.  Global strategy for asthma management and prevention: GINA executive summary , 2008, European Respiratory Journal.

[30]  J. Hogg.  State of the art. Bronchiolitis in chronic obstructive pulmonary disease. , 2006, Proceedings of the American Thoracic Society.

[31]  H. Kauczor,et al.  Imaging of airways: chronic obstructive pulmonary disease. , 2009, Radiologic clinics of North America.

[32]  Joon Beom Seo,et al.  Xenon ventilation CT with a dual-energy technique of dual-source CT: initial experience. , 2008, Radiology.

[33]  Raúl San José Estépar,et al.  Airway wall attenuation: a biomarker of airway disease in subjects with COPD. , 2009, Journal of applied physiology.

[34]  W. Webb,et al.  Thin-section CT of the secondary pulmonary lobule: anatomy and the image--the 2004 Fleischner lecture. , 2006, Radiology.

[35]  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.

[36]  D. Lynch,et al.  Quantitative computed tomography detects air trapping due to asthma. , 1994, Chest.

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

[38]  R. Gilkeson,et al.  ORIGINAL REPORT , 2022 .

[39]  Gianna Camiciottoli,et al.  Chronic obstructive pulmonary disease: thin-section CT measurement of airway wall thickness and lung attenuation. , 2005, Radiology.

[40]  P. Paré,et al.  The nature of small-airway obstruction in chronic obstructive pulmonary disease. , 2004, The New England journal of medicine.

[41]  H. Kauczor,et al.  Focal airtrapping at expiratory high-resolution CT: comparison with pulmonary function tests , 2000, European Radiology.

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

[43]  Oliver Weinheimer,et al.  MDCT assessment of airway wall thickness in COPD patients using a new method: correlations with pulmonary function tests , 2008, European Radiology.

[44]  A. Ernst,et al.  MDCT of the Central Airways: Comparison With Bronchoscopy in the Evaluation of Complications of Endotracheal and Tracheostomy Tubes , 2007, Journal of thoracic imaging.

[45]  Catherine Beigelman-Aubry,et al.  Multi-detector row CT and postprocessing techniques in the assessment of diffuse lung disease. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.

[46]  I. Pavord,et al.  Qualitative analysis of high-resolution CT scans in severe asthma. , 2009, Chest.

[47]  J. Bogaert,et al.  Expiratory CT in cigarette smokers: correlation between areas of decreased lung attenuation, pulmonary function tests and smoking history , 1998, European Radiology.

[48]  H. Kauczor,et al.  Paired inspiratory/expiratory spiral CT and continuous respiration cine CT in the diagnosis of tracheal instability , 2001, European Radiology.

[49]  E. Hoffman,et al.  High-resolution Computed Tomography Imaging of Airway Disease in Infants with Cystic , 2002 .

[50]  T. Palva,et al.  Chronic bronchitis. A bronchologic evaluation. , 1976, ORL; journal for oto-rhino-laryngology and its related specialties.

[51]  Françoise J. Prêteux,et al.  Pulmonary airways: 3-D reconstruction from multislice CT and clinical investigation , 2004, IEEE Transactions on Medical Imaging.

[52]  J. Seo,et al.  Quantitative Assessment of Emphysema, Air Trapping, and Airway Thickening on Computed Tomography , 2008, Lung.

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

[54]  I. Pavord.  Asthma Phenotypes , 2012, Seminars in Respiratory and Critical Care Medicine.

[55]  M. Hasegawa,et al.  Relationship between improved airflow limitation and changes in airway calibre induced by inhaled anticholinergic agents in COPD , 2008, Thorax.

[56]  Bernhard Geiger,et al.  Computer-aided diagnosis of the airways: beyond nodule detection. , 2008, Journal of thoracic imaging.

[57]  Jonathan G Goldin,et al.  Quantitative CT of the lung. , 2002, Radiologic clinics of North America.

[58]  Hans-Ulrich Kauczor,et al.  About Objective 3-D Analysis of Airway Geometry in Computerized Tomography , 2008, IEEE Transactions on Medical Imaging.

[59]  N L Müller,et al.  Computed tomographic imaging of the airways: relationship to structure and function , 2005, European Respiratory Journal.

[60]  M. Okamoto,et al.  Influence of age and disease severity on high resolution CT lung densitometry in asthma , 2001, Thorax.

[61]  P. Grenier,et al.  Variability of bronchial measurements obtained by sequential CT using two computer-based methods , 2009, European Radiology.

[62]  Sang Joon Park,et al.  Chronic obstructive pulmonary disease: quantitative and visual ventilation pattern analysis at xenon ventilation CT performed by using a dual-energy technique. , 2010, Radiology.

[63]  C. Thieke,et al.  [Computed tomography of the lungs. A step into the fourth dimension]. , 2009, Der Radiologe.

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

[65]  Raúl San José Estépar,et al.  Quantitative assessment of bronchial wall attenuation with thin-section CT: An indicator of airflow limitation in chronic obstructive pulmonary disease. , 2010, AJR. American journal of roentgenology.

[66]  P. Boiselle,et al.  Cine CT during coughing for assessment of tracheomalacia: preliminary experience with 64-MDCT. , 2006, AJR. American journal of roentgenology.

[67]  M. Mishima,et al.  Bronchial dilatation in asthma: relation to clinical and sputum indices. , 2004, Chest.

[68]  M. Okamoto,et al.  Decreased computed tomographic lung density during exacerbation of asthma , 2003, European Respiratory Journal.

[69]  P. Grenier,et al.  Investigation of airways using MDCT for visual and quantitative assessment in COPD patients , 2008, International journal of chronic obstructive pulmonary disease.

[70]  Sharyn MacDonald,et al.  Functional impairment in emphysema: contribution of airway abnormalities and distribution of parenchymal disease. , 2005, AJR. American journal of roentgenology.

[71]  Milan Sonka,et al.  Segmentation and quantitative analysis of intrathoracic airway trees from computed tomography images. , 2005, Proceedings of the American Thoracic Society.

[72]  Kunihiro Yagihashi,et al.  Correlation between airflow limitation and airway dimensions assessed by multidetector CT in asthma. , 2010, Respiratory medicine.

[73]  R. Günther,et al.  Multislice computed tomography perfusion imaging for visualization of acute pulmonary embolism: animal experience , 2005, European Radiology.

[74]  S. Murgu,et al.  Tracheobronchomalacia and excessive dynamic airway collapse , 2006, Respirology.

[75]  Catherine Beigelman-Aubry,et al.  New frontiers in CT imaging of airway disease , 2002, European Radiology.

[76]  M. Metintaş,et al.  High-Resolution Computed Tomography Findings Are Correlated with Disease Severity in Asthma , 2002, Respiration.

[77]  S. Lam,et al.  New and current clinical imaging techniques to study chronic obstructive pulmonary disease. , 2009, American journal of respiratory and critical care medicine.

[78]  L Battolla,et al.  Relationship between extent of pulmonary emphysema by high-resolution computed tomography and lung elastic recoil in patients with chronic obstructive pulmonary disease. , 2001, American journal of respiratory and critical care medicine.

[79]  J. Seo,et al.  Xenon Ventilation Imaging Using Dual-Energy Computed Tomography in Asthmatics: Initial Experience , 2010, Investigative radiology.

[80]  Yasutaka Nakano,et al.  The prediction of small airway dimensions using computed tomography. , 2005, American journal of respiratory and critical care medicine.

[81]  Armin Ernst,et al.  Central airway mechanics and flow limitation in acquired tracheobronchomalacia. , 2007, Chest.

[82]  H. Bruder,et al.  Pushing the envelope: new computed tomography techniques for cardiothoracic imaging. , 2010, Journal of thoracic imaging.

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

[84]  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.

[85]  J. Dinkel,et al.  Computertomographie der Lunge , 2009, Der Radiologe.

[86]  R. Pauwels,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. , 2001, American journal of respiratory and critical care medicine.

[87]  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.

[88]  Catherine Beigelman-Aubry,et al.  Multidetector-row CT of the airways. , 2003, Seminars in roentgenology.

[89]  Hiroto Hatabu,et al.  Tracheobronchomalacia: comparison between end-expiratory and dynamic expiratory CT for evaluation of central airway collapse. , 2005, Radiology.