J Korean Soc Radiol.  2016 May;74(5):299-307. 10.3348/jksr.2016.74.5.299.

CT Quantification of Central Airway in Tracheobronchomalacia

• Im WH
• Jin GY
• Han YM
• Kim EY

• KMID: 2164825
• DOI: http://doi.org/10.3348/jksr.2016.74.5.299

Abstract

PURPOSE
To know which factors help to diagnose tracheobronchomalacia (TBM) using CT quantification of central airway.
MATERIALS AND METHODS
From April 2013 to July 2014, 19 patients (68.0 ± 15.0 years; 6 male, 13 female) were diagnosed as TBM on CT. As case-matching, 38 normal subjects (65.5 ± 21.5 years; 6 male, 13 female) were selected. All 57 subjects underwent CT with end-inspiration and end-expiration. Airway parameters of trachea and both main bronchus were assessed using software (VIDA diagnostic). Airway parameters of TBM patients and normal subjects were compared using the Student t-test.
RESULTS
In expiration, both wall perimeter and wall thickness in TBM patients were significantly smaller than normal subjects (wall perimeter: trachea, 43.97 mm vs. 49.04 mm, p = 0.020; right main bronchus, 33.52 mm vs. 42.69 mm, p < 0.001; left main bronchus, 26.76 mm vs. 31.88 mm, p = 0.012; wall thickness: trachea, 1.89 mm vs. 2.22 mm, p = 0.017; right main bronchus, 1.64 mm vs. 1.83 mm, p = 0.021; left main bronchus, 1.61 mm vs. 1.75 mm, p = 0.016).
CONCLUSION
Wall thinning and decreased perimeter of central airway of expiration by CT quantification would be a new diagnostic indicators in TBM.

MeSH Terms

Airway Remodeling
Bronchi
Evaluation Studies as Topic
Humans
Male
Trachea
Tracheobronchomalacia*

Figure

• 

  Fig. 1 CT (axial plane) and three-dimensional reconstructed VIDA images (axial and coronal view) of normal and tracheobronchomalacia group. Inspiration (A) and expiration (B) of normal subjects: there is no significant change of tracheal luminal area on inspiration and expiration. Inspiration (C) and expiration (D) of tracheobronchomalacia patients: the luminal area of the trachea on reduces on exhalation, as compared with inhalation.

• 

  Fig. 2 Quantified four airway parameters of normal 37-year-old woman at inspiration. A. Minimal luminal area: 145.91 mm2. B. Luminal perimeter: 43.36 mm. C. Wall thickness between outer and inner margin (arrow): 2.69 mm. D. Wall to total area ratio: 0.49.

• 

  Fig. 3 A 61-year-old woman complained of dyspnea of 2 months duration. She was diagnosed as tracheobronchomalacia by HRCT and bronchoscopy. CT and bronchoscopy images in (A) inspiration and (B) expiration. Luminal area of trachea at expiration is significantly decreased, compared with inspiration. 3D reconstructed VIDA images from HRCT images in (C) inspiration and (D) expiration. All luminal areas, wall thickness and luminal perimeter were calculated automatically by 3D reconstruction. Calculated parameters for inspiration vs. expiration are as follows - minimal luminal area: 108.90 mm2 vs. 21.23 mm2; luminal perimeter: 43.72 mm vs. 23.52 mm; wall thickness: 1.65 mm vs. 1.49 mm; wall to total area ratio: 0.37 vs. 0.54. HRCT = high-resolution computed tomography, 3D = three-dimensional

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