Improved CT-based Estimate of Pulmonary Gas Trapping Accounting for Scanner and Lung-Volume Variations in a Multicenter Asthmatic Study

J Appl Physiol (1985). 2014 Sep 15;117(6):593-603. doi: 10.1152/japplphysiol.00280.2014. Epub 2014 Aug 7.

Abstract

Lung air trapping is estimated via quantitative computed tomography (CT) using density threshold-based measures on an expiration scan. However, the effects of scanner differences and imaging protocol adherence on quantitative assessment are known to be problematic. This study investigates the effects of protocol differences, such as using different CT scanners and breath-hold coaches in a multicenter asthmatic study, and proposes new methods that can adjust intersite and intersubject variations. CT images of 50 healthy subjects and 42 nonsevere and 52 severe asthmatics at total lung capacity (TLC) and functional residual capacity (FRC) were acquired using three different scanners and two different coaching methods at three institutions. A fraction threshold-based approach based on the corrected Hounsfield unit of air with tracheal density was applied to quantify air trapping at FRC. The new air-trapping method was enhanced by adding a lung-shaped metric at TLC and the lobar ratio of air-volume change between TLC and FRC. The fraction-based air-trapping method is able to collapse air-trapping data of respective populations into distinct regression lines. Relative to a constant value-based clustering scheme, the slope-based clustering scheme shows the improved performance and reduced misclassification rate of healthy subjects. Furthermore, both lung shape and air-volume change are found to be discriminant variables for differentiating among three populations of healthy subjects and nonsevere and severe asthmatics. In conjunction with the lung shape and air-volume change, the fraction-based measure of air trapping enables differentiation of severe asthmatics from nonsevere asthmatics and nonsevere asthmatics from healthy subjects, critical for the development and evaluation of new therapeutic interventions.

Keywords: air trapping; asthma; lung mechanics; protocols; quantitative computed tomography.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Algorithms
  • Asthma / diagnostic imaging
  • Asthma / physiopathology*
  • Female
  • Forced Expiratory Volume
  • Functional Residual Capacity
  • Humans
  • Lung / diagnostic imaging
  • Lung / physiopathology*
  • Lung Volume Measurements / methods*
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Tomography, X-Ray Computed
  • Total Lung Capacity
  • Trachea / physiopathology