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Original Research: COPD |

Accurate Measurement of Small Airways on Low-Dose Thoracic CT Scans in SmokersCT Scan Measurement of Small Airways

Barbara A. Lutey, MD; Susan H. Conradi, PhD; Jeffrey J. Atkinson, MD; Jie Zheng, PhD; Kenneth B. Schechtman, PhD; Robert M. Senior, MD; David S. Gierada, MD
Author and Funding Information

From the Division of Medical Education (Dr Lutey), Mallinckrodt Institute of Radiology (Drs Conradi and Gierada), Division of Pulmonary and Critical Care Medicine (Drs Atkinson and Senior), and Division of Biostatistics (Drs Zheng and Schechtman), Washington University School of Medicine, St Louis, MO.

Correspondence to: Barbara A. Lutey, MD, Division of Medical Education, Washington University School of Medicine, Campus Box 8121, 660 S Euclid Ave, St Louis, MO 63110; e-mail: blutey@dom.wustl.edu


Funding/Support: This research was supported by contracts from the Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services; National Institutes of Health [Grant P50 HL084922]; and the Edith and Alan Wolff Charitable Trust, Barnes-Jewish Hospital Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(5):1321-1329. doi:10.1378/chest.12-0034
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Background:  Partial volume averaging and tilt relative to the scan plane on transverse images limit the accuracy of airway wall thickness measurements on CT scan, confounding assessment of the relationship between airway remodeling and clinical status in COPD. The purpose of this study was to assess the effect of partial volume averaging and tilt corrections on airway wall thickness measurement accuracy and on relationships between airway wall thickening and clinical status in COPD.

Methods:  Airway wall thickness measurements in 80 heavy smokers were obtained on transverse images from low-dose CT scan using the open-source program Airway Inspector. Measurements were corrected for partial volume averaging and tilt effects using an attenuation- and geometry-based algorithm and compared with functional status.

Results:  The algorithm reduced wall thickness measurements of smaller airways to a greater degree than larger airways, increasing the overall range. When restricted to analyses of airways with an inner diameter < 3.0 mm, for a theoretical airway of 2.0 mm inner diameter, the wall thickness decreased from 1.07 ± 0.07 to 0.29 ± 0.10 mm, and the square root of the wall area decreased from 3.34 ± 0.15 to 1.58 ± 0.29 mm, comparable to histologic measurement studies. Corrected measurements had higher correlation with FEV1, differed more between BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index scores, and explained a greater proportion of FEV1 variability in multivariate models.

Conclusions:  Correcting for partial volume averaging improves accuracy of airway wall thickness estimation, allowing direct measurement of the small airways to better define their role in COPD.

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