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CT Trachea Lumen Volumetry in Patients with Scleroderma: Association with Lung Function Testing
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A2339 - CT Trachea Lumen Volumetry in Patients with Scleroderma: Association with Lung Function Testing
Author Block: B. Rangel1, R. Rodrigues2, A. R. Carvalho3, A. Guimarães2, V. Vilela1, R. Levy1, C. H. Costa4, R. Rufino5, A. Lopes1; 1Rio de Janeiro State University, Rio de Janeiro, Brazil, 2Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 3Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 4Pneumologia, Rio de Janeiro State University, Rio de Janeiro, Brazil, 5Rio de Janeiro State University, Rio De Janeiro 22261-020, Brazil.
Introduction: The trachea has been a “forgotten zone” in the study of various disease conditions because the pathological processes involving this structure have not been given the necessary clinical recognition. Nonetheless, little is known about the involvement of the trachea in patients with systemic sclerosis (SSc).
Objectives: To identify and quantify morphological chances in the trachea of SSc patients through CT and, secondarily, to correlate these findings with the lung function.
Methods: This was a cross-sectional study in which 28 non-smoking SSc patients and 15 control subjects underwent CT trachea lumen volumetry with subsequent segmentation and skeletonization of the images. In addition, all participants performed spirometry following ATS recommendations. On the CT scans, the sinuosity index was calculated from the sum of the Euclidean distance of each tracheal segment, with a distance equivalent to the thickness of each cross-section of the original CT image, divided by the Euclidean distance of the points at the extremities of the trachea. On the CT scans, the eccentricity is a value between 0 and 1, where 1 is a line segment, and 0 is a circle.
Results: The mean values of FVC, FEV1, PEF, FEF25-75% and FEF50%/FIF50% was 77 ± 20.9 % predicted, 75.8 ± 19.6 % predicted, 91.4 ± 32.9 L/s, 79.5 ± 28.6 % predicted e 1.32 ± 0.62 %, respectively. Regarding the trachea volumetry of the control subjects, SSc patients showed higher values of area (212.5 ± 47.3 vs. 207.6 ± 32.6 mm2, P = 0.023), eccentricity (0.52 ± 0.08 vs. 0.46 ± 0.04, P = 0.015) and sinuosity index (1.04 ± 0.01 vs. 1.02 ± 0.01, P = 0.016). The tracheal area was negatively correlated with FEF50%/FIF50% ratio (r = -0.32; P = 0.03). The eccentricity was negatively correlated with FVC (r = -0.42; P = 0.01) and FEV1 (r = -0.32; P = 0.03). Furthermore, a negative correlation of the sinuosity index with PEF (-0.31, P = 0.04) and FEF25-75% (-0.30, P = 0.04) was also found.
Conclusion: SSc patients exhibit tracheal sinuosity and higher tracheal area. Moreover, the greater the tracheal tortuosity, lower is the airflow in this patients. Although our findings require further investigation, the proposed indexes based on the segmentation and skeletonization of the images provides a new perspective for incorporating of this technique in the assessment of the airways of SSc patients.
Author Block: B. Rangel1, R. Rodrigues2, A. R. Carvalho3, A. Guimarães2, V. Vilela1, R. Levy1, C. H. Costa4, R. Rufino5, A. Lopes1; 1Rio de Janeiro State University, Rio de Janeiro, Brazil, 2Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 3Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 4Pneumologia, Rio de Janeiro State University, Rio de Janeiro, Brazil, 5Rio de Janeiro State University, Rio De Janeiro 22261-020, Brazil.
Introduction: The trachea has been a “forgotten zone” in the study of various disease conditions because the pathological processes involving this structure have not been given the necessary clinical recognition. Nonetheless, little is known about the involvement of the trachea in patients with systemic sclerosis (SSc).
Objectives: To identify and quantify morphological chances in the trachea of SSc patients through CT and, secondarily, to correlate these findings with the lung function.
Methods: This was a cross-sectional study in which 28 non-smoking SSc patients and 15 control subjects underwent CT trachea lumen volumetry with subsequent segmentation and skeletonization of the images. In addition, all participants performed spirometry following ATS recommendations. On the CT scans, the sinuosity index was calculated from the sum of the Euclidean distance of each tracheal segment, with a distance equivalent to the thickness of each cross-section of the original CT image, divided by the Euclidean distance of the points at the extremities of the trachea. On the CT scans, the eccentricity is a value between 0 and 1, where 1 is a line segment, and 0 is a circle.
Results: The mean values of FVC, FEV1, PEF, FEF25-75% and FEF50%/FIF50% was 77 ± 20.9 % predicted, 75.8 ± 19.6 % predicted, 91.4 ± 32.9 L/s, 79.5 ± 28.6 % predicted e 1.32 ± 0.62 %, respectively. Regarding the trachea volumetry of the control subjects, SSc patients showed higher values of area (212.5 ± 47.3 vs. 207.6 ± 32.6 mm2, P = 0.023), eccentricity (0.52 ± 0.08 vs. 0.46 ± 0.04, P = 0.015) and sinuosity index (1.04 ± 0.01 vs. 1.02 ± 0.01, P = 0.016). The tracheal area was negatively correlated with FEF50%/FIF50% ratio (r = -0.32; P = 0.03). The eccentricity was negatively correlated with FVC (r = -0.42; P = 0.01) and FEV1 (r = -0.32; P = 0.03). Furthermore, a negative correlation of the sinuosity index with PEF (-0.31, P = 0.04) and FEF25-75% (-0.30, P = 0.04) was also found.
Conclusion: SSc patients exhibit tracheal sinuosity and higher tracheal area. Moreover, the greater the tracheal tortuosity, lower is the airflow in this patients. Although our findings require further investigation, the proposed indexes based on the segmentation and skeletonization of the images provides a new perspective for incorporating of this technique in the assessment of the airways of SSc patients.
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