Quantitative CT Measures of Bronchiectasis in Smokers
Quantitative CT Measures of Bronchiectasis in Smokers
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DOI：
10.1016/j.chest.2016.11.024
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发表时间：
2017-06-01
期刊：
影响因子：
9.6
通讯作者：
Estepar, Raul San Jose
中科院分区：
文献类型：
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作者：
Diaz, Alejandro A.;Young, Thomas P.;Estepar, Raul San Jose
背景：支气管扩张在吸烟的COPD患者中很常见;然而，关于这一过程的客观评估数据有限。目的是评估支气管血管形态，计算支气管管腔直径与邻近动脉直径的比值（BA比率），并确定那些能够区分支气管扩张的测量。我们收集了定量CT（QCT）测量BA比率、峰值壁衰减、壁厚度（WT）、壁面积，在匹配的第四至第六代气道中，在21名曾经吸烟的支气管扩张症患者（例）和21名从不吸烟的对照患者（对照气道）中测量壁面积百分比（WA%）。在病例中，在支气管扩张和非支气管扩张气道收集测量值。Logistic分析和受试者工作特征曲线下面积（AUC）被用来评估QCT测量对支气管扩张症的预测能力。结果：支气管扩张症患者的全肺和第四至第六代气道BA比率、WT和WA%均显著高于对照组。预测支气管扩张的BA比率的AUC范围为0.90（全肺）至0.79（第四代）。WT和WA%的AUC范围为0.72 - 0.75和0.71 - 0.75。支气管扩张组的动脉直径小于非支气管扩张组和对照组（均P <0.01）。结论：吸烟相关的BA比率增加似乎是由血管口径减小引起的。QCT测量BA比率、WT和WA%可能有助于客观识别和量化吸烟者的支气管扩张。
BACKGROUND: Bronchiectasis is frequent in smokers with COPD; however, there are only limited data on objective assessments of this process. The objective was to assess bronchovascular morphology, calculate the ratio of the diameters of bronchial lumen and adjacent artery (BA ratio), and identify those measurements able to discriminate bronchiectasis.METHODS: We collected quantitative CT (QCT) measures of BA ratios, peak wall attenuation, wall thickness (WT), wall area, and wall area percent (WA%) at matched fourth through sixth airway generations in 21 ever smokers with bronchiectasis (cases) and 21 never-smoking control patients (control airways). In cases, measurements were collected at both bronchiectatic and nonbronchiectatic airways. Logistic analysis and the area under receiver operating characteristic curve (AUC) were used to assess the predictive ability of QCT measurements for bronchiectasis.RESULTS: The whole-lung and fourth through sixth airway generation BA ratio, WT, and WA% were significantly greater in bronchiectasis cases than control patients. The AUCs for the BA ratio to predict bronchiectasis ranged from 0.90 (whole lung) to 0.79 (fourth-generation). AUCs for WT and WA% ranged from 0.72 to 0.75 and from 0.71 to 0.75. The artery diameters but not bronchial diameters were smaller in bronchiectatic than both nonbronchiectatic and control airways (P < .01 for both).CONCLUSIONS: Smoking-related increases in the BA ratio appear to be driven by reductions in vascular caliber. QCT measures of BA ratio, WT, and WA% may be useful to objectively identify and quantify bronchiectasis in smokers.