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Wielpütz, Mark O.; Eberhardt, Ralf; Puderbach, Michael; Weinheimer, Oliver; Kauczor, Hans-Ulrich; Heussel, Claus P.

Simultaneous Assessment of Airway Instability and Respiratory Dynamics with Low-Dose 4D-CT in Chronic Obstructive Pulmonary Disease: A Technical Note

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  • Medientyp: E-Artikel
  • Titel: Simultaneous Assessment of Airway Instability and Respiratory Dynamics with Low-Dose 4D-CT in Chronic Obstructive Pulmonary Disease: A Technical Note
  • Beteiligte: Wielpütz, Mark O.; Eberhardt, Ralf; Puderbach, Michael; Weinheimer, Oliver; Kauczor, Hans-Ulrich; Heussel, Claus P.
  • Erschienen: S. Karger AG, 2014
  • Erschienen in: Respiration
  • Sprache: Englisch
  • DOI: 10.1159/000357448
  • ISSN: 0025-7931; 1423-0356
  • Schlagwörter: Pulmonary and Respiratory Medicine
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:p>&lt;b&gt;&lt;i&gt;Background: &lt;/i&gt;&lt;/b&gt;Advanced-stage chronic obstructive pulmonary disease (COPD) is associated with severely altered respiratory dynamics. Dynamic airway instability is usually diagnosed by invasive bronchoscopy. Cine-computed tomography (CT) may be used alternatively, but is limited to predefined anatomical positions. Also, a paradoxical diaphragmatic motion has been described in patients with emphysema. &lt;b&gt;&lt;i&gt;Objectives:&lt;/i&gt;&lt;/b&gt; As the airways and chest wall show inherently high contrast to airway lumen and lung tissue, low-dose CT acquisitions potentially suffice for depicting tracheobronchial and chest wall motion. Therefore, we propose low-dose dynamic respiratory-gated multidetector CT (4D-CT) of the whole chest as a new method to assess respiratory dynamics. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; 4D-CT was performed in 3 patients (52, 62 and 76 years old) with suspected tracheal instability due to COPD or tracheal stenosis at minimal pitch (0.09) and radiation exposure (1.4-1.9 mSv) during regular tidal breathing registered by a belt system. Image reconstruction involved a raw data-based iterative algorithm (1.5-mm slice thickness, 1.0-mm z-axis increment, 5% respiratory increment), resulting in a stack of 6,700 images, which were evaluated with a 4D-viewing tool. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; An excessive dynamic collapse of the trachea in combination with tracheobronchomalacia (TBM) of the main-stem and segmental bronchi, and a paradoxical diaphragmatic motion were demonstrated in 1 case. Moreover, we detected a saber-sheath trachea and main-stem TBM in another case. The third case showed a fixed tracheal stenosis. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; 4D-CT provides unprecedented z-axis coverage and time-resolved volumetric datasets of the whole chest. Airway instability, stenosis and paradoxical diaphragmatic motion may be assessed simultaneously, preceding interventions such as airway stabilization or lung volume reduction.</jats:p>