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Updated: Jul 5, 2025
Multi-modal Pulmonary Imaging: Using Complementary Information from CT and Hyperpolarized 129Xe MRI to Evaluate Lung Structure-Function
Published on: April 12, 2024
Children with severe asthma have substantial structural airway changes on computed tomography
Wytse B van den Bosch1,2, Qianting Lv1,2, Eleni-Rosalina Andrinopoulou3,4
1Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Department of Paediatrics, division of Respiratory Medicine and Allergology, Rotterdam, the Netherlands.
Insights
Severe asthma in children shows significant airway abnormalities like bronchial wall thickening and bronchiectasis on CT scans. Small airways disease is linked to thickened bronchi in pediatric severe asthma patients.
Area of Science:
- Pulmonary Medicine
- Pediatric Pulmonology
- Radiology
Background:
- Severe asthma (SA) in adults is associated with bronchial wall thickening, bronchiectasis, and low attenuation regions (LAR) on chest computed tomography (CT).
- The prevalence and extent of these structural airway abnormalities in children with SA are not well understood.
- This study aimed to investigate airway abnormalities in children diagnosed with SA using chest CT.
Purpose of the Study:
- To assess the presence and extent of bronchial wall thickening, bronchiectasis, and low attenuation regions (LAR) in children with severe asthma.
- To compare findings between automated and manual CT analysis methods.
- To explore the relationship between small airways disease (SAD) and bronchial wall thickening.
Main Methods:
- Retrospective analysis of 161 inspiratory and expiratory CT scans from 131 children with SA (mean age 11.0 years).
- Automated analysis using LungQ software for bronchial tree segmentation and measurement of bronchial wall thickness and bronchiectasis (defined by bronchus-artery ratio).
- Manual semi-quantitative scoring and assessment of LAR and functional small airways disease (SAD) based on spirometry.
Main Results:
- Automated analysis revealed bronchiectasis in 95.8% and bronchial wall thickening in all CT scans.
- Manual analysis showed bronchiectasis in 28% and bronchial wall thickening in 88.8% of CTs.
- Low attenuation regions (LAR) were observed in all CTs via automatic analysis and 82.9% via manual analysis; LAR or functional SAD correlated with increased bronchial wall thickness.
Conclusions:
- Bronchiectasis and bronchial wall thickening are common structural abnormalities in children with severe asthma, evident on chest CT scans.
- A significant discrepancy exists between automated and manual CT analysis methods for these findings.
- Small airways disease (SAD) is associated with bronchial wall thickening in pediatric severe asthma.
Background:
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.
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