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Im, Jin, Han, and Kim: CT Quantification of Central Airway in Tracheobronchomalacia
Chest Radiology
Original Article

Journal of the Korean Society of Radiology 2016; 74(5): 299-307.

Published online: 26 April 2016

DOI: https://doi.org/10.3348/jksr.2016.74.5.299

CT Quantification of Central Airway in Tracheobronchomalacia

Won Hyeong Im, MD1, Gong Yong Jin, MD1, 2, 3, Young Min Han, MD1, 2, 3, Eun Young Kim, MD1, 3

1Department of Radiology, Chonbuk National University Hospital, Jeonju, Korea.

2Department of Radiology, Chonbuk National University School of Medicine, Jeonju, Korea.

3Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.

Corresponding author: Gong Yong Jin, MD. Department of Radiology, Chonbuk National University Hospital, Chonbuk National University School of Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea. Tel. 82-63-250-2307, Fax. 82-63-272-0481, gyjin@jbnu.ac.kr

Received 10 July 2015       Revised 22 December 2015       Accepted 30 January 2016

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To know which factors help to diagnose tracheobronchomalacia (TBM) using CT quantification of central airway.

Materials and Methods

From April 2013 to July 2014, 19 patients (68.0 ± 15.0 years; 6 male, 13 female) were diagnosed as TBM on CT. As case-matching, 38 normal subjects (65.5 ± 21.5 years; 6 male, 13 female) were selected. All 57 subjects underwent CT with end-inspiration and end-expiration. Airway parameters of trachea and both main bronchus were assessed using software (VIDA diagnostic). Airway parameters of TBM patients and normal subjects were compared using the Student t-test.

Results

In expiration, both wall perimeter and wall thickness in TBM patients were significantly smaller than normal subjects (wall perimeter: trachea, 43.97 mm vs. 49.04 mm, p = 0.020; right main bronchus, 33.52 mm vs. 42.69 mm, p < 0.001; left main bronchus, 26.76 mm vs. 31.88 mm, p = 0.012; wall thickness: trachea, 1.89 mm vs. 2.22 mm, p = 0.017; right main bronchus, 1.64 mm vs. 1.83 mm, p = 0.021; left main bronchus, 1.61 mm vs. 1.75 mm, p = 0.016).

Conclusion

Wall thinning and decreased perimeter of central airway of expiration by CT quantification would be a new diagnostic indicators in TBM.

Keywords: Tracheobronchomalacia, CT, Airway Remodeling, Quantitative Evaluation

Figures and Tables

Fig. 1

CT (axial plane) and three-dimensional reconstructed VIDA images (axial and coronal view) of normal and tracheobronchomalacia group. Inspiration (A) and expiration (B) of normal subjects: there is no significant change of tracheal luminal area on inspiration and expiration. Inspiration (C) and expiration (D) of tracheobronchomalacia patients: the luminal area of the trachea on reduces on exhalation, as compared with inhalation.

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Fig. 2

Quantified four airway parameters of normal 37-year-old woman at inspiration.

A. Minimal luminal area: 145.91 mm2.
B. Luminal perimeter: 43.36 mm.
C. Wall thickness between outer and inner margin (arrow): 2.69 mm.
D. Wall to total area ratio: 0.49.
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Fig. 3

A 61-year-old woman complained of dyspnea of 2 months duration. She was diagnosed as tracheobronchomalacia by HRCT and bronchoscopy. CT and bronchoscopy images in (A) inspiration and (B) expiration. Luminal area of trachea at expiration is significantly decreased, compared with inspiration. 3D reconstructed VIDA images from HRCT images in (C) inspiration and (D) expiration. All luminal areas, wall thickness and luminal perimeter were calculated automatically by 3D reconstruction. Calculated parameters for inspiration vs. expiration are as follows - minimal luminal area: 108.90 mm2 vs. 21.23 mm2; luminal perimeter: 43.72 mm vs. 23.52 mm; wall thickness: 1.65 mm vs. 1.49 mm; wall to total area ratio: 0.37 vs. 0.54.

HRCT = high-resolution computed tomography, 3D = three-dimensional
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Table 1

Demographics of TBM Patients

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Patient No. Age (yr) Sex BMI Smoking Clinical History PFT Bronchoscopy
1 36 F 15.12 Non-smoker Dyspnea, old TBc Restrictive O
2 51 F 17.39 Non-smoker Dyspnea, asthma, old TBc Obstructive O
3 52 F 24.00 Non-smoker Dyspnea, asthma X X
4 60 F 21.21 Non-smoker Dyspnea, asthma Normal O*
5 61 F 25.85 Non-smoker Chronic cough Normal O
6 63 F 31.01 Non-smoker Dyspnea, asthma Normal O
7 66 F 28.18 Non-smoker Dyspnea, bronchiectasis Normal O
8 67 F 16.89 Current smoker (20 PYS) Dyspnea, asthma Mixed X
9 68 F 36.74 Non-smoker Chronic cough Restrictive O*
10 73 F 26.67 Non-smoker Dyspnea, asthma Mixed X
11 74 F 25.80 Non-smoker Dyspnea, old TBc Normal X
12 77 F 18.81 Non-smoker Dyspnea, chronic bronchitis Restrictive O
13 78 F 33.77 Non-smoker HF, chronic cough Obstructive O
14 64 M 20.05 Ex-smoker (10 PYS) Dyspnea, emphysema Obstructive O
15 75 M 30.20 Ex-smoker (30 PYS) Chronic bronchitis, emphysema Mixed X
16 75 M 23.03 Ex-smoker (30 PYS) Dyspnea, asthma Mixed X
17 78 M 26.35 Ex-smoker (50 PYS) Chronic bronchitis, emphysema Obstructive X
18 82 M 20.20 Current smoker (15 PYS) Dyspnea, chronic bronchitis Mixed O*
19 83 M 26.13 Ex-smoker (2.5 PYS) Dyspnea, asthma Mixed X

In bronchoscopy, O means that bronchoscopic examination was done, but TBM was not diagnosed at bronchoscopy, X means that bronchoscopic examination was not done, O* means that bronchoscopic examination was done and TBM was diagnosed at bronchoscopy.

BMI = body mass index, HF = heart failure, PFT = pulmonary function test, PYS = pack-years, TBc = tuberculosis, TBM = tracheobronchomalacia

Table 2

Quantification of Central Airway on CT in TBM Patients and Normal Subjects

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Variables Inspiration Expiration
TBM Normal p TBM Normal p
Trachea
 MLA (mm2) 180.02 ± 67.36 184.06 ± 65.00 0.828 108.80 ± 43.26 169.12 ± 53.60 0.000
 LP (mm) 51.77 ± 9.22 51.92 ± 8.27 0.951 43.97 ± 8.75 49.04 ± 6.82 0.020
 WT (mm) 2.21 ± 0.50 2.38 ± 0.36 0.184 1.89 ± 0.48 2.22 ± 0.48 0.017
 WTAR 0.40 ± 0.04 0.42 ± 0.04 0.140 0.41 ± 0.05 0.40 ± 0.04 0.454
Right main bronchus
 MLA (mm2) 124.60 ± 45.55 141.45 ± 32.59 0.114 58.54 ± 31.97 120.22 ± 23.31 0.000
 LP (mm) 43.05 ± 8.37 45.54 ± 5.02 0.244 33.52 ± 7.91 42.69 ± 4.82 0.000
 WT (mm) 1.99 ± 0.50 2.13 ± 0.40 0.243 1.64 ± 0.25 1.83 ± 0.37 0.021
 WTAR 0.43 ± 0.04 0.42 ± 0.04 0.775 0.48 ± 0.07 0.41 ± 0.04 0.000
Left main bronchus
 MLA (mm2) 86.37 ± 44.01 82.46 ± 23.55 0.720 40.42 ± 26.42 71.49 ± 20.41 0.000
 LP (mm) 35.05 ± 8.43 34.06 ± 4.36 0.637 26.76 ± 7.66 31.88 ± 4.27 0.012
 WT (mm) 1.83 ± 0.42 1.76 ± 0.20 0.350 1.61 ± 0.18 1.75 ± 0.21 0.016
 WTAR 0.45 ± 0.05 0.44 ± 0.03 0.466 0.52 ± 0.07 0.46 ± 0.03 0.002

LP = luminal perimeter, MLA = minimal luminal area, TBM = tracheobronchomalacia, WT = wall thickness, WTAR = wall to total area ratio

Table 3

Comparison of Variable Changes between Inspiration and Expiration in TBM Patients and Normal Subjects

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Variables TBM Normal p
Trachea
 MLA (%) 39.77 ± 18.61 5.26 ± 18.13 0.000
 LP (%) 14.69 ± 12.07 5.12 ± 5.61 0.003
 WT (%) 9.75 ± 31.96 6.69 ± 13.39 0.693
 WTAR (%) -6.18 ± 18.90 1.11 ± 10.47 0.131
Right main bronchus
 MLA (%) 51.79 ± 21.60 13.59 ± 10.93 0.000
 LP (%) 21.52 ± 15.20 6.06 ± 6.22 0.000
 WT (%) 12.67 ± 26.67 12.04 ± 17.34 0.915
 WTAR (%) -12.59 ± 22.54 3.61 ± 10.70 0.007
Left main bronchus
 MLA (%) 50.74 ± 23.43 12.61 ± 11.67 0.000
 LP (%) 23.16 ± 14.67 6.27 ± 6.23 0.000
 WT (%) 9.44 ± 15.13 -0.01 ± 8.01 0.018
 WTAR (%) -16.23 ± 14.97 -5.20 ± 5.73 0.006

LP = luminal perimeter, MLA = minimal luminal area, TBM = tracheobronchomalacia, WT = wall thickness, WTAR = wall to total area ratio

Table 4

p Values Comparison of Variable Changes among Trachea, RMB, LMB in Tracheobronchomalacia Patients

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Variables Trachea & RMB Trachea & LMB RMB & LMB
MLA 0.074 0.119 0.887
LP 0.134 0.060 0.738
WT 0.761 0.971 0.649
WTAR 0.348 0.078 0.561

LMB = left main bronchus, LP = luminal perimeter, MLA = minimal luminal area, RMB = right main bronchus, WT = wall thickness, WTAR = wall to total area ratio

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