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Quantitative Computed Tomography Assessment of Airway Wall Dimensions

Current Status and Potential Applications for Phenotyping Chronic Obstructive Pulmonary Disease

¹ Department of Radiology, Vancouver General Hospital, The James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, University of British Columbia, Providence Heart + Lung Institute, St. Paul's Hospital, Vancouver, British Columbia, Canada

Correspondence and requests for reprints should be addressed to Harvey O. Coxson, Ph.D., Department of Radiology - Vancouver General Hospital, 855 West 12th Ave, Room 3350 JPN, Vancouver, BC, V5Z 1M9 Canada. E-mail: harvey.coxson{at}vch.ca

ABSTRACT

Airway remodeling is extremely important in the pathophysiology of chronic obstructive pulmonary disease (COPD). Since the site and nature of airflow obstruction was described by Hogg, Thurlbeck, and Macklem, investigators have been looking for methods to noninvasively measure the airway wall dimensions in subjects with and at risk for COPD. The advent and proliferation of computed tomography (CT) initially allowed investigators to quantify changes in lung parenchymal structure in subjects with emphysema, and more recently attention has turned to the measurement of airway wall dimensions. Unfortunately, while the lung density is relatively easy to quantify, reliable airway measurements have proven to be more difficult to obtain. However, recent advances in CT technology and new computer algorithms have changed the way investigators have measured airways using CT, and it is now hoped that many of the early issues surrounding airway measurements can be resolved. The measurement of airway wall dimensions is important because it is well known that chronic airflow limitation can be caused by a combination of airway and parenchymal changes. The phenotypic expression of these different subtypes of COPD is vital because a therapy designed to modulate the inflammation in airways may be contraindicated in subjects with the emphysema phenotype and visa versa. Therefore, these new imaging techniques are very likely to play a front-line role in the study of COPD and will, hopefully, allow clinicians to phenotype individuals, thereby personalizing their treatment.

Key Words: computed tomography • airways • emphysema • chronic obstructive pulmonary disease