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Airway Wall Thickness in Cigarette Smokers: Quantitative Thin-Section CT Assessment¹

¹ From the Laboratoire de Physiologie Cellulaire Respiratoire (Institut National de la Santé et de la Recherche Médicale E-0356), Université Victor Ségalen, Bordeaux, France (P.B., J.M.T.d.L., R.M., F.L.); and Unité d’Imagerie Thoracique et Cardiovasculaire, Hôpital Cardiologique Haut-Lévêque, Avenue de Magellan, 33604 Pessac, France (V.P., P.D., F.L.). Received January 26, 2004; revision requested April 2; final revision received August 12; accepted September 15. Supported by grants from Programme Hospitalier de Recherche Clinique in 1997 and 2002. Address correspondence to F.L. (e-mail: francois.laurent@chu-bordeaux.fr).

PURPOSE: To design and validate a dedicated software tool to measure airway dimensions on thin-section computed tomographic (CT) images and to use the tool to prospectively compare airway wall thickness in nonsmokers with normal lung function with that in smokers with and without chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS: All subjects gave written informed consent. The study was approved by local ethics committee. With Laplacian of Gaussian algorithm, software was tested in phantom and excised sheep lung fixed in inflation and validated with Bland-Altman analysis. Study prospectively included nine nonsmokers (six women, three men; mean age, 53 years ± 5.6 [standard error of the mean]) with normal lung function (group 1), seven smokers (three women, four men; mean age, 56 years ± 5.6) with normal lung function (group 2), and eight smokers (zero women, eight men; mean age, 65 years ± 4.0) with COPD. Calculations were determined with spirometrically gated CT: For each selected bronchus, the wall area (WA), internal area (IA), airway caliber (sum of IA and WA), and WA/IA ratio were calculated. For each patient, summation of WA to summation of IA (WA/IA) ratio, which reflected normalized airway wall thickness, was calculated. Groups were compared by using analysis of variance with generalized linear model and unpaired t test. Pearson correlation coefficient was used to assess correlation between software measurements and pulmonary function test results.

RESULTS: Comparison of measurements in phantom and excised sheep lung with algorithm measurements revealed that the latter were reliable and repeatable. In clinical study, WA/IA ratio was significantly different among three groups (P < .001). Normalized airway wall thickness and IA were significantly related to lung function test data, including forced expiratory volume in 1 second (r = –0.54, P = .006), specific airway conductance (r = –0.45, P = .03), and forced expiratory flow between 25% and 75% of vital capacity (r = –0.65, P < .001).

CONCLUSION: This software provides accurate and reproducible measurements of IA and WA of bronchi on thin-section CT images and demonstrates that in vivo normalized airway wall thickness was larger in smokers with COPD than it was in smokers or nonsmokers without COPD.

© RSNA, 2005

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