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. 2016 Nov-Dec;49(6):351-357.
doi: 10.1590/0100-3984.2015.0145.

Quantitative computed tomography analysis of the airways in patients with cystic fibrosis using automated software: correlation with spirometry in the evaluation of severity

Marcel Koenigkam Santos  1 , Danilo Lemos Cruvinel  2 , Marcelo Bezerra de Menezes  3 , Sara Reis Teixeira  4 , Elcio de Oliveira Vianna  5 , Jorge Elias Júnior  6 , José Antonio Baddini Martinez  5
Affiliations

Quantitative computed tomography analysis of the airways in patients with cystic fibrosis using automated software: correlation with spirometry in the evaluation of severity

Marcel Koenigkam Santos et al. Radiol Bras. 2016 Nov-Dec.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Radiol Bras. 2016 Nov-Dec;49(6):VIIIA. doi: 10.1590/0100-3984.2015.0145er. Radiol Bras. 2016. PMID: 31265513 Free PMC article.

Abstract
in English, Portuguese

Objective: To perform a quantitative analysis of the airways using automated software, in computed tomography images of patients with cystic fibrosis, correlating the results with spirometric findings.

Materials and methods: Thirty-four patients with cystic fibrosis were studied-20 males and 14 females; mean age 18 ± 9 years-divided into two groups according to the spirometry findings: group I (n = 21), without severe airflow obstruction (forced expiratory volume in first second [FEV1] > 50% predicted), and group II (n = 13), with severe obstruction (FEV1 ≤ 50% predicted). The following tracheobronchial tree parameters were obtained automatically: bronchial diameter, area, thickness, and wall attenuation.

Results: On average, 52 bronchi per patient were studied. The number of bronchi analyzed was higher in group II. The correlation with spirometry findings, especially between the relative wall thickness of third to eighth bronchial generation and predicted FEV1, was better in group I.

Conclusion: Quantitative analysis of the airways by computed tomography can be useful for assessing disease severity in cystic fibrosis patients. In patients with severe airflow obstruction, the number of bronchi studied by the method is higher, indicating more bronchiectasis. In patients without severe obstruction, the relative bronchial wall thickness showed a good correlation with the predicted FEV1.

Objetivo: Realizar a análise quantitativa das vias aéreas utilizando programa automático, em imagens de tomografia computadorizada de pacientes com fibrose cística, correlacionando com a espirometria.

Materiais e métodos: Foram estudados 34 pacientes com fibrose cística - 20 masculinos e 14 femininos; idade de 18 ± 9 anos -, divididos em dois grupos segundo a espirometria: grupo I (n = 21) - sem obstrução grave ao fluxo aéreo (volume expiratório forçado no primeiro segundo [VEF1] > 50% previsto); grupo II (n = 13) - com obstrução grave (VEF1 ≤ 50% previsto). Foram automaticamente obtidos: diâmetro, área, espessura e atenuação da parede da árvore traqueobrônquica.

Resultados: Na média, foram estudados 52 brônquios por paciente. O número de brônquios analisados foi maior no grupo II. A correlação com a espirometria foi melhor no grupo I, principalmente entre a espessura relativa da parede da terceira a oitava geração brônquica e o VEF1 previsto.

Conclusão: A análise quantitativa das vias aéreas em imagens de tomografia computadorizada pode ser útil na avaliação da gravidade da doença na fibrose cística. Nos pacientes com obstrução grave ao fluxo aéreo, o número de brônquios estudados pelo método é maior, indicando mais bronquiectasias. Nos pacientes sem obstrução grave, a espessura relativa da parede dos brônquios tem boa correlação com o VEF1 previsto.

Keywords: Airway remodeling/physiology; Cystic fibrosis; Tomography, X-ray computed.

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Figures

Figure 1
Figure 1
For obtaining airway measurements with the automated program, the first step is identification of the tracheal lumen (arrow), followed by segmentation (anatomical separation) of the tracheobronchial tree. A center line is calculated within the airway to identify the true axial plane of the bronchus, then the inner borders (dotted line) and outer borders (continuous line) are identified.
Figure 2
Figure 2
Examples of two CF patients, one from group I (A, FEV1% = 69.6) and another from group II (B, FEV1% = 34.5). Coronal CT scans with a lung window show greater bronchiectasis in the group II patient. The three-dimensional figures representing the automated bronchial segmentation illustrate that the number of bronchi found and analyzed was greater in the group II patient than in the group I patient (91 vs. 49).
Figure 3
Figure 3
Graphic illustrating the correlation between the RWT3-8 measured by CT and the FEV1% in group I patients (R = -0.62; p < 0.01).
See this image and copyright information in PMC

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