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High-Resolution CT Quantification of Bronchiectasis: Clinical and Functional Correlation¹

¹ From the Departments of Diagnostic Radiology (G.C.O., P.L.K.) and Medicine (M.C.Y., J.C.M.H., W.K.L., K.W.T.T.), University of Hong Kong, Queen Mary Hospital, 806, Administration Block, Hong Kong SAR, China; and Faculty of Medicine, University of Hong Kong (P.K.S.C., J.C.K.L.). Received September 24, 2001; revision requested November 26; final revision received March 27, 2002; accepted April 29. Supported by a Committee for Research and Conference grant from the University of Hong Kong. Address correspondence to K.W.T.T. (e-mail: kwttsang@hku.hk).

View larger version (76K): [in a new window]   Figure 1. Schematic diagram depicts four grades of bronchial wall thickening scores.

View larger version (117K): [in a new window]   Figure 2a. Transverse high-resolution CT scans obtained in a 40-year-old man with bronchiectasis. (a) Scan shows small-airway disease denoted by centrilobular and tree-in-bud (black arrows) opacities and bronchiolectasis in the left upper lobe. Bronchiectasis in the upper lobe was assigned a grade of 1, with grade 1 (white arrows) bronchial wall thickening. In the apical segments of the lower lobes, grade 2 (arrowheads) bronchial wall thickening also is present. (b) Scan shows a combination of grade 1 (arrows) and 2 (arrowheads) bronchial wall thickening in the basal segments of the lower lobes with an overall bronchial wall thickening score of 1.5. The extent of bronchiectasis was evaluated as grade 3 in the right lower lobe and grade 2 in the left lower lobe. (c) Scan shows mosaic attenuation in both upper lobes. (d) Expiratory scan shows air trapping. The hypoattenuating areas (*) were confirmed to be caused by air trapping in d.

View larger version (114K): [in a new window]   Figure 2b. Transverse high-resolution CT scans obtained in a 40-year-old man with bronchiectasis. (a) Scan shows small-airway disease denoted by centrilobular and tree-in-bud (black arrows) opacities and bronchiolectasis in the left upper lobe. Bronchiectasis in the upper lobe was assigned a grade of 1, with grade 1 (white arrows) bronchial wall thickening. In the apical segments of the lower lobes, grade 2 (arrowheads) bronchial wall thickening also is present. (b) Scan shows a combination of grade 1 (arrows) and 2 (arrowheads) bronchial wall thickening in the basal segments of the lower lobes with an overall bronchial wall thickening score of 1.5. The extent of bronchiectasis was evaluated as grade 3 in the right lower lobe and grade 2 in the left lower lobe. (c) Scan shows mosaic attenuation in both upper lobes. (d) Expiratory scan shows air trapping. The hypoattenuating areas (*) were confirmed to be caused by air trapping in d.

View larger version (109K): [in a new window]   Figure 2c. Transverse high-resolution CT scans obtained in a 40-year-old man with bronchiectasis. (a) Scan shows small-airway disease denoted by centrilobular and tree-in-bud (black arrows) opacities and bronchiolectasis in the left upper lobe. Bronchiectasis in the upper lobe was assigned a grade of 1, with grade 1 (white arrows) bronchial wall thickening. In the apical segments of the lower lobes, grade 2 (arrowheads) bronchial wall thickening also is present. (b) Scan shows a combination of grade 1 (arrows) and 2 (arrowheads) bronchial wall thickening in the basal segments of the lower lobes with an overall bronchial wall thickening score of 1.5. The extent of bronchiectasis was evaluated as grade 3 in the right lower lobe and grade 2 in the left lower lobe. (c) Scan shows mosaic attenuation in both upper lobes. (d) Expiratory scan shows air trapping. The hypoattenuating areas (*) were confirmed to be caused by air trapping in d.

View larger version (100K): [in a new window]   Figure 2d. Transverse high-resolution CT scans obtained in a 40-year-old man with bronchiectasis. (a) Scan shows small-airway disease denoted by centrilobular and tree-in-bud (black arrows) opacities and bronchiolectasis in the left upper lobe. Bronchiectasis in the upper lobe was assigned a grade of 1, with grade 1 (white arrows) bronchial wall thickening. In the apical segments of the lower lobes, grade 2 (arrowheads) bronchial wall thickening also is present. (b) Scan shows a combination of grade 1 (arrows) and 2 (arrowheads) bronchial wall thickening in the basal segments of the lower lobes with an overall bronchial wall thickening score of 1.5. The extent of bronchiectasis was evaluated as grade 3 in the right lower lobe and grade 2 in the left lower lobe. (c) Scan shows mosaic attenuation in both upper lobes. (d) Expiratory scan shows air trapping. The hypoattenuating areas (*) were confirmed to be caused by air trapping in d.

View larger version (74K): [in a new window]   Figure 3a. Transverse high-resolution CT scans obtained in a 64-year-old man with established bronchiectasis. (a) Inspiratory high-resolution CT scan shows mosaic attenuation (*) in the left upper lobe, which is accentuated on the (b) expiratory scan. Extent of bronchiectasis was evaluated as grade 3 in the left upper lobe.

View larger version (73K): [in a new window]   Figure 3b. Transverse high-resolution CT scans obtained in a 64-year-old man with established bronchiectasis. (a) Inspiratory high-resolution CT scan shows mosaic attenuation (*) in the left upper lobe, which is accentuated on the (b) expiratory scan. Extent of bronchiectasis was evaluated as grade 3 in the left upper lobe.

View larger version (94K): [in a new window]   Figure 4. Transverse high-resolution CT scan obtained in a 46-year-old man shows a combination of grades 1 (short arrow), 2 (long arrow), and 3 (arrowheads) bronchial wall thickening in the left lower lobe. Extent of bronchiectasis was evaluated as grade 1 in the right middle lobe and grade 2 in the left lower lobe. The right lower lobe was normal.

View larger version (15K): [in a new window]   Figure 5a. Scatterplots show the relationships between clinical and high-resolution CT parameters. (a) Scatterplot shows that increasing 24-hour sputum volume is associated with increasing small-airway abnormalities (r = 0.39, P = .004). (b) Scatterplot shows a similar relationship between exacerbation frequency and bronchial wall thickening (r = 0.29, P < .05).

View larger version (23K): [in a new window]   Figure 5b. Scatterplots show the relationships between clinical and high-resolution CT parameters. (a) Scatterplot shows that increasing 24-hour sputum volume is associated with increasing small-airway abnormalities (r = 0.39, P = .004). (b) Scatterplot shows a similar relationship between exacerbation frequency and bronchial wall thickening (r = 0.29, P < .05).

View larger version (22K): [in a new window]   Figure 6a. Scatterplots show the relationships between high-resolution CT and lung function parameters. An inverse relationship is shown between bronchial wall thickening and (a) FEV1 (r = -0.60, P <.001) and (b) FEF25%-75% (r = -0.57, P < .001), respectively. A similar relationship is shown between extent of bronchiectasis and (c) FEV1 (r = -0.55, P < .001)and (d) FEF25%-75% (r = -0.51, P < .001).

View larger version (22K): [in a new window]   Figure 6b. Scatterplots show the relationships between high-resolution CT and lung function parameters. An inverse relationship is shown between bronchial wall thickening and (a) FEV1 (r = -0.60, P <.001) and (b) FEF25%-75% (r = -0.57, P < .001), respectively. A similar relationship is shown between extent of bronchiectasis and (c) FEV1 (r = -0.55, P < .001)and (d) FEF25%-75% (r = -0.51, P < .001).

View larger version (22K): [in a new window]   Figure 6c. Scatterplots show the relationships between high-resolution CT and lung function parameters. An inverse relationship is shown between bronchial wall thickening and (a) FEV1 (r = -0.60, P <.001) and (b) FEF25%-75% (r = -0.57, P < .001), respectively. A similar relationship is shown between extent of bronchiectasis and (c) FEV1 (r = -0.55, P < .001)and (d) FEF25%-75% (r = -0.51, P < .001).

View larger version (22K): [in a new window]   Figure 6d. Scatterplots show the relationships between high-resolution CT and lung function parameters. An inverse relationship is shown between bronchial wall thickening and (a) FEV1 (r = -0.60, P <.001) and (b) FEF25%-75% (r = -0.57, P < .001), respectively. A similar relationship is shown between extent of bronchiectasis and (c) FEV1 (r = -0.55, P < .001)and (d) FEF25%-75% (r = -0.51, P < .001).