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Original Research |

Quantitative CT measures of bronchiectasis in smokers

Alejandro A. Diaz, M.D., M.P.H.; Thomas P. Young, B.Sc.; Diego J. Maselli, M.D.; Carlos H. Martinez, M.D., M.P.H.; Ritu Gill, M.D., M.P.H.; Pietro Nardelli, Ph.D.; Wei Wang, Ph.D.; Gregory L. Kinney, Ph.D.; John E. Hokanson, Ph.D.; George R. Washko, M.D.; Raul San Jose Estepar, Ph.D.
Author and Funding Information

Conflict of Interest

Drs Diaz, Maselli, Martinez, Gill, Nardelli, Wang, Kinney, Hokanson, Washko, and San Jose and Mr. Young have no conflict of interest to disclose related to this manuscript. Dr. Diaz has received speaker fees from Novartis Inc. unrelated to this manuscript.

Funding

This work was supported by NIH Grants: COPDGene, R01HL089897, R01HL089856; Washko, R01 HL116473 and R01 HL107246; Dr. San José Estépar, R01 HL116473; Dr. Diaz, K01HL118714-01; Dr. Diaz is also supported by the Brigham and Women’s Hospital Minority Faculty Career Development Award.

ClinicalTrials.gov; NCT00608764

1Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

2Division of Pulmonary Diseases & Critical Care, University of Texas Health Science Center, San Antonio TX

3Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, Ann Arbor MI

4Division of Sleep Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA

5Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston MA

6Colorado School of Public Health, University of Colorado-Denver, Aurora CO

Corresponding Author: Alejandro A. Diaz, M.D. Division of Pulmonary and Critical Care Medicine Department of Medicine Brigham and Women’s Hospital 75 Francis Street Boston, MA 02115.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.11.024
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Abstract

Background  Bronchiectasis is frequent in smokers with COPD, however there is only limited data on objective assessments of this process.

Objective  To objectively assess bronchovascular morphology, calculate the ratio of the diameters of bronchial lumen and adjacent artery (BA ratio), and identify those measurements able to discriminate bronchiectasis.

Methods  We collected quantitative computed tomography (QCT) measures of BA ratios, peak wall attenuation, wall thickness (WT), wall area, and wall area percent (WA%) at matched 4th-6th airway generations in 21 ever smokers with bronchiectasis (cases) and 21 never-smoking controls (control airways). In cases, measurements were collected at both bronchiectatic and non-bronchiectatic airways. Logistic analysis and the area under receiver operating characteristic curve (AUC) were used to assess the predictive ability of QCT measurements for bronchiectasis.

Results  The whole-lung and 4th-6th airway generations BA ratio, WT, and WA% were significantly greater in bronchiectasis cases than controls. The AUCs for the BA ratio to predict bronchiectasis ranged from 0.90 (whole-lung) to 0.79 (4th-generation). AUCs for WT and WA% ranged from 0.72 to 0.75 and from 0.71 to 0.75. The artery diameters but not bronchial diameters were smaller in bronchiectatic than both non-bronchiectatic and control airways (P<0.01 for both).

Conclusions  Smoking related increases in the BA ratio appear to be driven by reductions in vascular caliber. QCT measures of BA ratio, WT, and WA% may be useful to objectively identify and quantify bronchiectasis in smokers.


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