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Randomized Controlled Trial
. 2023 Sep;22(5):916-925.
doi: 10.1016/j.jcf.2023.05.013. Epub 2023 May 26.

Automatic bronchus and artery analysis on chest computed tomography to evaluate the effect of inhaled hypertonic saline in children aged 3-6 years with cystic fibrosis in a randomized clinical trial

Yuxin Chen  1 , Qianting Lv  1 , Eleni-Rosalina Andrinopoulou  2 , Leticia Gallardo-Estrella  3 , Jean-Paul Charbonnier  3 , Daan Caudri  4 , Stephanie D Davis  5 , Margaret Rosenfeld  6 , Felix Ratjen  7 , Richard A Kronmal  8 , Karen D Hinckley Stukovsky  8 , Stephen Stick  9 , Harm A W M Tiddens  10 ; on behalf the SHIP-CT study group
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Free article
Randomized Controlled Trial

Automatic bronchus and artery analysis on chest computed tomography to evaluate the effect of inhaled hypertonic saline in children aged 3-6 years with cystic fibrosis in a randomized clinical trial

Yuxin Chen et al. J Cyst Fibros. 2023 Sep.
Free article

Abstract

Background: SHIP-CT showed that 48-week treatment with inhaled 7% hypertonic saline (HS) reduced airway abnormalities on chest CT using the manual PRAGMA-CF method relative to isotonic saline (IS) in children aged 3-6 years with cystic fibrosis (CF). An algorithm was developed and validated to automatically measure bronchus and artery (BA) dimensions of BA-pairs on chest CT. Aim of the study was to assess the effect of HS on bronchial wall thickening and bronchial widening using the BA-analysis.

Methods: The BA-analysis (LungQ, version 2.1.0.1, Thirona, Netherlands) automatically segments the bronchial tree and identifies the segmental bronchi (G0) and distal generations (G1-G10). Dimensions of each BA-pair are measured: diameters of bronchial outer wall (Bout), bronchial inner wall (Bin), bronchial wall thickness (Bwt), and artery (A). BA-ratios are computed: Bout/A and Bin/A to detect bronchial widening and Bwt/A and Bwa/Boa (=bronchial wall area/bronchial outer area) to detect bronchial wall thickening.

Results: 113 baseline and 102 48-week scans of 115 SHIP-CT participants were analysed. LungQ measured at baseline and 48-weeks respectively 6,073 and 7,407 BA-pairs in the IS-group and 6,363 and 6,840 BA-pairs in the HS-group. At 48 weeks, Bwt/A (mean difference 0.011; 95%CI, 0.0017 to 0.020) and Bwa/Boa (mean difference 0.030; 95% 0.009 to 0.052) was significantly higher (worse) in the IS-group compared to the HS-group representing more severe bronchial wall thickening in the IS-group (p=0.025 and p=0.019 respectively). Bwt/A and Bwa/Boa decreased and Bin/A remained stable from baseline to 48 weeks in the HS while it declined in the IS-group (all p<0.001). There was no difference in progression of Bout/A between two treatment groups.

Conclusion: The automatic BA-analysis showed a positive impact of inhaled HS on bronchial lumen and wall thickness, but no treatment effect on progression of bronchial widening over 48 weeks.

Keywords: Artificial intelligence; Bronchial wall thickening; Computed tomography; Cystic fibrosis; Hypertonic saline; Structural airway disease.

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Conflict of interest statement

Declaration of Competing Interest HAWMT reports grants from the Cystic Fibrosis Foundation and Health Holland, has received in the last 5 years multiple grants from the following public and institutional grant institutions for lung structure and function research: NHMRC, NIH, CFF, ECFS, IMI, Sophia Foundation and unconditional grants for investigator-initiated research from Chiesi, Vectura, Novartis, and Insmed, has acted as consultant for Insmed, TBIO, Thirona, Neupharma and Boehringer, has a part time position as chief medical officer for Thirona, functions as vice chair and faculty for the Advance course sponsored by Vertex, and owns no shares. Erasmus MC and Telethon Kids Institute have licensed the use of PRAGMA-CF to Thirona and Resonance Health. LGE is a scientist working at Thirona. JPC is Co-founder and shareholder at Thirona. DC is director of the Erasmus MC- LungAnalysis laboratory. SDD reports grants from Cystic Fibrosis Foundation. MR reports grants from Cystic Fibrosis Foundation. FR serves as consultant for Vertex, Bayer, Roche, Genentech, and Proteostasis. RAK reports grants from Cystic Fibrosis Foundation. KDHS reports grants from Cystic Fibrosis Foundation. SMS reports grants from the Cystic Fibrosis Foundation and National Health and Medical Research Foundation and Erasmus MC and Telethon Kids Institute have licensed the use of PRAGMA-CF to Thirona and Resonance Health. All other authors declare no competing interests.

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