1,721,019 research outputs found
Chest radiography and computed tomography imaging in cystic fibrosis: current challenges and new perspectives
Full text linkImaging plays a pivotal role in the noninvasive assessment of cystic fibrosis (CF)-related lung damage, which remains the main cause of morbidity and mortality in children with CF. The development of new imaging techniques has significantly changed clinical practice, and advances in therapies have posed diagnostic and monitoring challenges. The authors summarise these challenges and offer new perspectives in the use of imaging for children with CF for both clinicians and radiologists. This article focuses on chest radiography and CT, which are the two main radiologic techniques used in most cystic fibrosis centres. Advantages and disadvantages of radiography and CT for imaging in CF are described, with attention to new developments in these techniques, such as the use of artificial intelligence (AI) image analysis strategies to improve the sensitivity of radiography and CT and the introduction of the photon-counting detector CT scanner to increase spatial resolution at no dose expense
Effect of inspiratory lung volume on bronchial and arterial dimensions and ratios on chest computed tomography in patients with chronic obstructive pulmonary disease
Full text linkBackground: The assessment of bronchus–artery (BA) metrics on chest CT is important for detecting airway abnormalities. It is less clear how BA metrics are dependent on lung volume. Methods: CTs were obtained from a COPDGene substudy investigating the impact of radiation dose on lung density. Patients with chronic obstructive pulmonary disease underwent a full-dose and a reduced-dose CT in the same imaging session. CTs were automatically analyzed by measuring diameters of the bronchial outer edge (Bout), bronchial inner wall (Bin), artery (A), and bronchial wall thickness (Bwt) from segmental (G0) and distal generations. BA ratios were computed: Bout/A, Bin/A, Bwt/A, and bronchial wall area/bronchial outer area (Bwa/Boa). The total lung volume of the CT (TLC-CT) was computed. Differences between the volumes between the two CTs were expressed as % of the highest TLC-CT (ΔTLC-CT%). For the BA metrics of each CT, we computed the median of measurements in G1–6. Mixed-effect models were used to investigate the influence of TLC-CT on BA metrics adjusted for dose protocol. Results: One thousand three hundred nineteen patients with a mean (SD) age of 64.4 (8.7) years were included. Three hundred twenty-nine (124) BA pairs were analyzed per CT. No significant difference was found for TLC-CT in relation to dose (p = 0.17). A ΔTLC-CT% of >10% (found in 121, 9%) led to 0.03 and 0.05 decreases in Bout/A and Bin/A and 0.008 and 0.11 decrease in log (Bwt/A) and log (Bwa/Boa), and a 0.03 increase in Bin and 0.06, 0.12, and 0.04 decrease in Bout, log (Bwt), and log (A) (all p < 0.001). Conclusions: Variations in TLC over 10% between time points significantly influence bronchial dimensions, affecting BA metrics. Standardizing volumes is recommended for sensitive tracking of airway disease changes over time. Key Points: Question Are BA metrics dependent on total lung capacity (TLC), and if so, how? Findings TLC variations over 10% between time points significantly influence bronchial dimensions, affecting BA metrics. Variations below 10% between CT scans have little effect on BA metrics. Clinical relevance Small lung volume differences between chest CTs have little impact on bronchus and artery metrics; it is imperative to standardize chest CT lung volumes to ensure precise diagnosis and monitoring of airway disease
Imaging of Cystic Fibrosis Lung Disease
No full textImaging of the lung has become increasingly important to detect and monitor structural lung damage related to CF lung disease. Initially, chest radiography was the most important technique used. However, the sensitivity and specificity of chest radiography to detect relevant structural lung changes in the setting of CF lung disease is suboptimal. For this reason, many CF centers now use chest computed tomography (CT) and/or magnetic resonance imaging (MRI) as part of the annual check-up to diagnose and monitor structural lung changes starting in the pre-school age. Scoring systems and automated image analysis software are now available to quantify clinically relevant structural changes, such as bronchiectasis and airway wall thickening on chest CT. Investigators have utilized chest CT outcomes for primary outcome measures in clinical studies. Chest MRI is used as a radiation-free alternative for CT to image structural lung changes. Chest MRI also allows assessment of functional qualiti..
Lung structure and function on MRI in preterm born school children with and without BPD: A feasibility study
Full text linkBackground and Objective The most common respiratory complication of prematurity is bronchopulmonary dysplasia (BPD), leading to structural lung changes and impaired respiratory outcomes. However, also preterm children without BPD may show similar adverse respiratory outcomes. There is a need for a safe imaging modality for preterm children with and without BPD for disease severity assessment and risk stratification. Our objective was to develop a magnetic resonance imaging (MRI) protocol in preterm children with and without BPD at school age. Methods Nine healthy volunteers (median age 11.6 [range: 8.8–12.8] years), 11 preterm children with BPD (11.0 [7.2–15.6] years), and 9 without BPD (11.1 [10.7–12.6] years) underwent MRI. Images were scored on hypo- and hyperintense abnormalities, bronchopathy, and architectural distortion. MRI data were correlated to spirometry. Ventilation and perfusion defects were analyzed using Fourier Decomposition (FD) MRI. Results On MRI, children with BPD had higher %diseased lung (9.1 (interquartile range [IQR] 5.9–11.6)%) compared to preterm children without BPD (3.4 (IQR 2.5–5.4)%, p < 0.001) and healthy volunteers (0.4 (IQR 0.1–0.8)%, p < 0.001). %Diseased lung correlated negatively with %predicted FEV1 (r = −0.40, p = 0.04), FEV1/FVC (r = −0.49, p = 0.009) and FEF75 (r = −0.63, p < 0.001). Ventilation and perfusion defects on FD sequence corresponded to hypointense regions on expiratory MRI. Conclusion Chest MRI can identify structural and functional lung damage at school age in preterm children with and without BPD, showing a good correlation with spirometry. We propose MRI as a sensitive and safe imaging method (without ionizing radiation, contrast agents, or the use of anesthesia) for the long-term follow-up of preterm children
Children with severe asthma have substantial structural airway changes on computed tomography
Full text linkBackground In adults with severe asthma (SA) bronchial wall thickening, bronchiectasis and low attenuation regions (LAR) have been described on chest computed tomography (CT) scans. The extent to which these structural abnormalities are present in children with SA is largely unknown. Our aim was to study the presence and extent of airway abnormalities on chest CT of children with SA. Methods 161 inspiratory and expiratory CT scans, either spirometer-controlled or technician-controlled, obtained in 131 children with SA (mean±SD age 11.0±3.8 years) were collected retrospectively. Inspiratory scans were analysed manually using a semi-quantitative score and automatically using LungQ (v2.1.0.1; Thirona B.V., Nijmegen, the Netherlands). LungQ segments the bronchial tree, identifies the generation for each bronchus–artery (BA) pair and measures the following BA dimensions: outer bronchial wall diameter (Bout), adjacent artery diameter (A) and bronchial wall thickness (Bwt). Bronchiectasis was defined as Bout/A ⩾1.1, bronchial wall thickening as Bwt/A ⩾0.14. LAR, reflecting small airways disease (SAD), was measured automatically on inspiratory and expiratory scans and manually on expiratory scans. Functional SAD was defined as FEF25–75 and/or FEF75 z-scores <−1.645. Results are shown as median and interquartile range. Results Bronchiectasis was present on 95.8% and bronchial wall thickening on all CTs using the automated method. Bronchiectasis was present on 28% and bronchial wall thickening on 88.8% of the CTs using the manual semi-quantitative analysis. The percentage of BA pairs defined as bronchiectasis was 24.62% (12.7–39.3%) and bronchial wall thickening was 41.7% (24.0–79.8%) per CT using the automated method. LAR was observed on all CTs using the automatic analysis and on 82.9% using the manual semi-quantitative analysis. Patients with LAR or functional SAD had more thickened bronchi than patients without. Conclusion Despite a large discrepancy between the automated and the manual semi-quantitative analysis, bronchiectasis and bronchial wall thickening are present on most CT scans of children with SA. SAD is related to bronchial wall thickening.</p
Diffusion weighted imaging in cystic fibrosis disease: beyond morphological imaging
Full text linkTo explore the feasibility of diffusion-weighted imaging (DWI) to assess inflammatory lung changes in patients with Cystic Fibrosis (CF) METHODS: CF patients referred for their annual check-up had spirometry, chest-CT and MRI on the same day. MRI was performed in a 1.5 T scanner with BLADE and EPI-DWI sequences (b = 0-600 s/mm(2)). End-inspiratory and end-expiratory scans were acquired in multi-row scanners. DWI was scored with an established semi-quantitative scoring system. DWI score was correlated to CT sub-scores for bronchiectasis (CF-CTBE), mucus (CF-CTmucus), total score (CF-CTtotal-score), FEV1, and BMI. T-test was used to assess differences between patients with and without DWI-hotspots
Unlocking the potential of photon counting detector CT for paediatric imaging: a pictorial essay
Full text linkRecent advancements in CT technology have introduced a revolutionary innovation to practice known as the Photon-Counting detector (PCD) CT imaging. The pivotal hardware enhancement of the PCD-CT scanner lies in its detectors, which consist of smaller pixels than standard detectors and allow direct conversion of individual X-rays to electrical signals. As a result, CT images are reconstructed at higher spatial resolution (as low as 0.2 mm) and reduced overall noise, at no expense of an increased radiation dose. These features are crucial for paediatric imaging, especially for infants and young children, where anatomical structures are notably smaller than in adults and in whom keeping dose as low as possible is especially relevant. Since January 2022, our hospital has had the opportunity to work with PCD-CT technology for paediatric imaging. This pictorial review will showcase clinical examples of PCD-CT imaging in children. The aim of this pictorial review is to outline the potential paediatric applications of PCD-CT across different anatomical regions, as well as to discuss the benefits in utilizing PCD-CT in comparison to conventional standard energy integrating detector CT
Assessment of CF lung disease using motion corrected PROPELLER MRI: a comparison with CT
Full text linkObjectives To date, PROPELLER MRI, a breathing-motioninsensitive
technique, has not been assessed for cystic fibrosis
(CF) lung disease. We compared this technique to CT for
assessing CF lung disease in children and adults.
Methods Thirty-eight stable CF patients (median 21 years,
range 6-51 years, 22 female) underwent MRI and CT on the
same day. Study protocol included respiratory-triggered PROPELLER
MRI and volumetric CT end-inspiratory and -
expiratory acquisitions. Two observers scored the images
using the CF-MRI and CF-CTsystems. Scores were compared
with intra-class correlation coefficient (ICC) and Bland-
Altman plots. The sensitivity and specificity of MRI versus
CT were calculated.
Results MRI sensitivity for detecting severe CF bronchiectasis
was 0.33 (CI 0.09-0.57), while specificity was 100 % (CI
0.88-1). ICCs for bronchiectasis and trapped air were as follows:
MRI-bronchiectasis (0.79); CT-bronchiectasis (0.85);
MRI-trapped air (0.51); CT-trapped air (0.87). Bland-Altman
plots showed an MRI tendency to overestimate the severity of
bronchiectasis in mild CF disease and underestimate bronchiectasis
in severe disease.
Conclusions Motion correction in PROPELLER MRI does
not improve assessment of CF lung disease compared to CT.
However, the good inter- and intra-observer agreement and
the high specificity suggest that MRI might play a role in the
short-term follow-up of CF lung disease (i.e. pulmonary
exacerbations)
Automated method of bronchus and artery dimension measurement in an adult bronchiectasis population
Full text linkAimBronchiectasis (BE) is a disease defined by irreversible dilatation of the airway. Computed tomography (CT) plays an important role in the detection and quantification of BE. The aim of this study was three-fold: 1) to assess bronchus-artery (BA) dimensions using fully automated software in a cohort of BE disease patients; 2) to compare BA dimensions with semi-quantitative BEST-CT (Bronchiectasis Scoring Technique for CT) scores for BE and bronchial wall thickening; and 3) to explore the structure-function relationship between BA-method lumen dimensions and spirometry outcomes.MethodsBaseline CTs of BE patients who participated in a clinical trial were collected retrospectively. CTs were analysed manually with the BEST-CT scoring system and automatically using LungQ (v.2.1.0.1, Thirona, The Netherlands), which measures the following BA dimensions: diameters of bronchial outer wall (Bout), bronchial inner wall (Bin) and artery (A), and bronchial wall thickness (Bwt) and computes BA ratios (Bout/A and Bin/A) to assess bronchial widening. To assess bronchial wall thickness, we used the Bwt/A ratio and the ratio between the bronchus wall area (Bwa) and the area defined by the outer airway (Boa) (Bwa/Boa).ResultsIn total, 65 patients and 16 900 BA pairs were analysed by the automated BA method. The median (range) percentage of BA pairs defined as widened was 69 (55-84)% per CT using a cut-off value of 1.5 for Bout/A, and 53 (42-65)% of bronchial wall were thickened using a cut-off value of 0.14 for Bwt/A. BA dimensions were correlated with comparable outcomes for the BEST-CT scoring method with a correlation coefficient varying between 0.21 to 0.51. The major CT BA determinants of airflow obstruction were bronchial wall thickness (p=0.001) and a narrower bronchial inner diameter (p=0.003).ConclusionThe automated BA method, which is an accurate and sensitive tool, demonstrates a stronger correlation between visual and automated assessment and lung function when using a higher cut-off value to define bronchiectasis
- …
