Continuous quantitative measurement of the main bronchial dimensions and lung density in the lateral position by four-dimensional dynamic-ventilation CT in smokers and COPD patients

Yukihiro Nagatani,1 Masayuki Hashimoto,2 Norihisa Nitta,1 Yasuhiko Oshio,2 Tsuneo Yamashiro,3 Shigetaka Sato,1 Shinsuke Tsukagoshi,4 Hiroshi Moriya,5 Tatsuya Kimoto,6 Tomoyuki Igarashi,2 Noritoshi Ushio,1 Akinaga Sonoda,1 Hideji Otani,1 Jun Hanaoka,2 Kiyoshi Murata1On behalf of investigators of the ACTIve Study Group1Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; 2Department of Surgery, Division of General Thoracic Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; 3Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan; 4CT System Division, Canon Medical Systems, Otawara, Tochigi 324-8550, Japan; 5Department of Radiology, Ohara General Hospital, Fukushima, Fukushima 960-8611, Japan; 6Healthcare IT Development Center, Canon Medical Systems, Otawara, Tochigi 324-8550, JapanPurpose: The purpose of this study was to measure changes in lung density and airway dimension in smokers in the lateral position using four-dimensional dynamic-ventilation computed tomography (CT) during free breathing and to evaluate their correlations with spirometric values.Materials and methods: Preoperative pleural adhesion assessments included dynamic-ventilation CT of 42 smokers (including 22 patients with COPD) in the lateral position, with the unoperated lung beneath (dependent lung). The scanned lungs’ mean lung density (MLD) and the bilateral main bronchi’s luminal areas (Ai) were measured automatically (13–18 continuous image frames, 0.35 seconds/frame). Calculations included cross-correlation coefficients (CCCs) between the MLD and Ai time curves, and correlations between the quantitative measurements and spirometric values were evaluated by using Spearman’s rank coefficient.Results: The ΔMLD1.05 (from the peak inspiration frame to the third expiratory frame, 1.05 seconds later) in the nondependent lung negatively correlated with FEV1/FVC (r=-0.417, P<0.01), suggesting that large expiratory movement of the nondependent lung would compensate limited expiratory movement of the dependent lung due to COPD. The ΔAi1.05 negatively correlated with the FEV1/FVC predicted in both the lungs (r=-0.465 and -0.311, P<0.05), suggesting that early expiratory collapses of the main bronchi indicate severe airflow limitation. The CCC correlated with FEV1/FVC in the dependent lung (r=-0.474, P<0.01), suggesting that reduced synchrony between the proximal airway and lung occurs in patients with severe airflow limitation.Conclusion: In COPD patients, in the lateral position, the following abnormal dynamic-ventilation CT findings are associated with airflow limitation: enhanced complementary ventilation in the nondependent lung, early expiratory airway collapses, and reduced synchrony between airway and lung movements in the dependent lung.Keywords: COPD, computed tomography, dynamic-ventilation CT, main bronchus, mean lung densit