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Observational Study
. 2024 Apr;165(4):775-784.
doi: 10.1016/j.chest.2023.12.015. Epub 2023 Dec 18.

Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders

Maanasi Samant  1 , James G Krings  1 , Daphne Lew  2 , Charles W Goss  2 , Tammy Koch  1 , Mary Clare McGregor  1 , Jonathan Boomer  3 , Chase S Hall  3 , Ken B Schechtman  2 , Ajay Sheshadri  4 , Samuel Peterson  5 , Serpil Erzurum  6 , Zachary DePew  7 , Lee E Morrow  7 , D Kyle Hogarth  8 , Richard Tejedor  9 , Jennifer Trevor  10 , Michael E Wechsler  11 , Afshin Sam  12 , Xiaosong Shi  3 , Jiwoong Choi  3 , Mario Castro  13
Affiliations
Observational Study

Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders

Maanasi Samant et al. Chest. 2024 Apr.

Abstract

Background: Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are defined poorly.

Research question: Do baseline radiographic and clinical characteristics exist that predict response to BT?

Study design and methods: We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across eight academic medical centers. Participants received three separate BT treatments and were monitored at 3-month intervals for 1 year after BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test results of ≥ 3 or Asthma Quality of Life Questionnaire of ≥ 0.5. Regression analyses were used to evaluate the association between pretreatment clinical and quantitative CT scan measures with subsequent BT response.

Results: From 2006 through 2017, 88 participants received BT, with 70 participants (79.5%) identified as responders by Asthma Control Test or Asthma Quality of Life Questionnaire criteria. Responders were less likely to undergo an asthma-related ICU admission in the prior year (3% vs 25%; P = .01). On baseline quantitative CT imaging, BT responders showed less air trapping percentage (OR, 0.90; 95% CI, 0.82-0.99; P = .03), a greater Jacobian determinant (OR, 1.49; 95% CI, 1.05-2.11), greater SD of the Jacobian determinant (OR, 1.84; 95% CI, 1.04-3.26), and greater anisotropic deformation index (OR, 3.06; 95% CI, 1.06-8.86).

Interpretation: To our knowledge, this is the largest study to evaluate baseline quantitative CT imaging and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on quantitative CT imaging, were predictors of future BT response.

Trial registry: ClinicalTrials.gov; No.: NCT01185275; URL: www.

Clinicaltrials: gov.

Keywords: air trapping; bronchial thermoplasty; lung deformation; quantitative CT; severe asthma.

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Conflict of interest statement

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: J. G. K. reports personal fees and nonfinancial support from Genentech and Sanofi. C. S. H. has received speaking fees from VIDA, Boehringer Ingelheim, Polarean. A. S. has received consulting fees from Entana Pharmaceuticals. S. P. is an employee and stock option holder of VIDA. D. K. H. is a consultant for Boston Scientific. J. T. is on the Astra Zeneca Study steering committee. M. E. W. has received consulting, advisory, or speaking honoraria from Amgen, AstraZeneca, Avalo Therapeutics, Boehringer Ingelheim, Cerecor, Cohero Health, Cytoreason, Eli Lilly, Equillium, Glaxosmithkline, Incyte, Kinaset, Novartis, Om Pharma, Overtone Therapeutics/Foresite Labs, Phylaxis, Pulmatrix, Rapt Therapeutics, Regeneron, Restorbio, Roche/Genentech, Sanofi/Genzyme, Sentien, Sound Biologics, Tetherex Pharmaceuticals, Teva, and Upstream Bio. M. C. reports institutional grant funding from the National Institutes of Health, American Lung Association, Patient Centered Outcomes Research Institute, AstraZeneca, GSK, Novartis, Pulmatrix, Sanofi-Aventis, and Shionogi; consulting fees from Genentech, Teva, Sanofi-Aventis, Merck, Novartis, Arrowhead OM Pharma, and Allakos; payment for speaker’s bureau activities for Amgen, AstraZeneca, Genentech, GSK, Regeneron, Sanofi-Aventis, and Teva; and royalties from Elsevier. None declared (M. S., D. L., C. W. G., T. K., M. C. M., J. B., K. B. S., S. E., Z. D. L. E. M., R. T., A. S., X. S., J. C.).

Figures

Figure 1
Figure 1
Study flow diagram. BT = bronchial thermoplasty; LSU = LSU Health Sciences Center; qCT = quantitative CT; QOL = quality of life; U of Alabama = University of Alabama; U of Arizona = University of Arizona; U of Chicago = University of Chicago; Wash U = Washington University.
Figure 2
Figure 2
A, B, Sample quantitatively analyzed CT scans showing coronal and sagittal views of a BT responder (A) and BT nonresponder (B). The top row for each part shows disease probability mapping values tinted on a red-to-yellow scale based on hyperinflation (red) or air trapping (yellow) predominance. Furthermore, in these images, the degree of normality of the tissue at the voxel level is indicated by the transparency wherein normal pixels have no coloration (ie, purely gray scale). The bottom row for each section demonstrates lung deformation values tinted on a red-to-yellow scale based on the anisotropic deformation index (ADI) value, with red demonstrating an ADI value of 0.0 (perfectly isotropic deformation) and yellow having an ADI of 1.0. In this section, the transparency is indicated by the Jacobian determinant value wherein a Jacobian determinant of 1.0 has pure coloration (no gray scale) and a Jacobian determinant of 2.5 has no coloration (ie, purely gray scale). Images were made in collaboration with VIDA Imaging (VIDA Diagnostics, Inc.). BT = bronchial thermoplasty.
See this image and copyright information in PMC

Comment in

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