RESUMO
PURPOSE: To determine the effect of bronchodilation on airway indexes reflecting airway disease in patients with chronic obstructive pulmonary disease (COPD) and to determine the minimum number of segmental and subsegmental airways required. MATERIALS AND METHODS: This study was approved by the local ethical committee, and written informed consent was obtained from all subjects. Twenty patients with COPD who had undergone pre- and postbronchodilator pulmonary function tests and computed tomographic (CT) examinations were prospectively included. Eight healthy volunteers underwent two CT examinations. Luminal area and wall thickness (WT) of third- and fourth-generation airways were measured twice by three readers. The percentage of total airway area occupied by the wall and the square root of wall area at an internal perimeter of 10 mm (âWAPi10) were calculated. The effects of pathologic status, session, reader, bronchodilation, and CT examination were assessed by using mixed linear model analyses. The number of airways to measure for a definite percentage error of âWAPi10 was computed by using a bootstrap method. RESULTS: There were no significant session, reader, or bronchodilation effects on WT in third-generation airways and âWAPi10 in patients with COPD (P values ranging from .187 to >.999). WT in third-generation airways and âWAPi10 were significantly different in patients with COPD and control subjects (P = .018 and <.001, respectively). Measuring 12 third- or fourth-generation airways ensured a maximal 10% error of âWAPi10. CONCLUSION: WT in third-generation airways and âWAPi10 are not significantly different before and after bronchodilation and are different in patients with COPD and control subjects. Twelve is the minimum number of third- or fourth-generation airways required to ensure a maximal 10% error of âWAPi10. (©) RSNA, 2015 Clinical trial registration no. NCT01142531 Online supplemental material is available for this article.
Assuntos
Brônquios/patologia , Broncodilatadores/farmacologia , Broncografia , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Brônquios/efeitos dos fármacos , Feminino , Humanos , Ipratrópio/farmacologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função RespiratóriaRESUMO
RATIONALE AND OBJECTIVES: Computed tomography (CT) airways measurements can be used as surrogates to spirometric measurements for assessing bronchodilation in a particular patient with chronic obstructive pulmonary disease. Although spirometric measurements show variations within the opening hours of a hospital department, we aimed to compare the variability of CT airways measurements between morning and afternoon in patients with chronic obstructive pulmonary disease to that of spirometric measurements. MATERIALS AND METHODS: Twenty patients had pulmonary function tests and CT around 8 am and 4 pm. Luminal area (LA) and wall thickness (WT) of third and fourth generation airways were measured twice by three readers. The percentage of airway area occupied by the wall (WA%) and the square root of wall area at an internal perimeter of 10 mm (âWAPi10) were calculated. The effects of examination time, reader, and measurement session on CT airways measurements were assessed, and the variability of these measurements was compared to that of spirometric measurements. RESULTS: Variability of LA3rd and LA4th was greater than that of spirometric measurements (P values ranging from <.001 to .033). There was no examination time effect on âWAPi10, WT3rd, LA4th, or WA%4th (P values ranging from .102 to .712). There was a reader effect on all CT airways measurements (P values ranging from <.001 to .028), except in WT3rd (P> .999). There was no effect of measurement session on any CT airway measurement (P values ranging from .535 to >.999). CONCLUSION: As the variability of LA3rd and LA4th is greater than that of spirometric measurements, clinical studies should include cohorts with larger numbers of patients when considering LA than when considering spirometric measurements as end points.
Assuntos
Brônquios/diagnóstico por imagem , Brônquios/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espirometria , Fatores de TempoRESUMO
PURPOSE: The aim of the study was to compare radiation dose and image quality between the "average" and the "very strong" automatic exposure control (AEC) strength curves. MATERIALS AND METHODS: Images reconstructed with filtered back-projection techniques and radiation dose data of unenhanced helical chest computed tomography (CT) examinations obtained at 2 hospitals (hospital A, hospital B) using the same scanner devices and acquisition protocols but different AEC strength curves were evaluated over a 3-month period. The selected AEC strength curve applied to "slim" patients (diameter <32 cm estimated from the attenuation automatically measured on the topogram) was "average" and "very strong" in hospital A and hospital B, respectively. Two radiologists with 13 and 24 years of experience scored the image quality of the lung parenchyma and the mediastinum on a 5-point scale. The patients' effective diameter, the delivered CT dose index volume, and dose-length products were recorded. RESULTS: A total of 410 patients were included. The average body mass index was 24.0 kg/m in hospital A and 24.8 kg/m in hospital B. There was no significant difference between hospitals with respect to age, sex ratio, weight, height, body mass index, effective diameters, and image quality scores for each radiologist (P ranging from 0.050 to 1.000). The mean CT dose index volume for the entire population was 2.0 mGy and was significantly lower in hospital B with the "very strong" AEC curve as compared with hospital A (-11%, P=0.001). The mean dose-length product delivered in this 70 kg-weight population was 68 mGy cm, corresponding to an effective dose of 0.95 mSv. CONCLUSION: Changing the AEC strength curve from "average" to "very strong" for slim patients maintains image quality and reduces the radiation dose to <1 mSv in routine chest CT examinations reconstructed with filtered back-projection techniques.