Quantitative computed tomography-derived clusters: Redefining airway remodeling in asthmatic patients

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:133

Article

Gupta, Sumit^1,2  Hartley, Ruth¹  Khan, Umair T.¹  Singapuri, Amisha¹  Hargadon, Beverly¹  Monteiro, William¹  Pavord, Ian D.¹  Sousa, Ana R.³  Marshall, Richard P.³  Subramanian, Deepak⁴  Parr, David⁴  Entwisle, James J.⁵  Siddiqui, Salman¹  Raj, Vimal²  Brightling, Christopher E.¹ 

[1] Univ Leicester, Inst Lung Hlth, Dept Infect Inflammat & Immun, Leicester LE3 9QP, Leics, England

[2] Univ Hosp Leicester NHS Trust, Glenfield Hosp, Dept Radiol, Leicester, Leics, England

[3] GlaxoSmithKline, Resp Therapy Unit, Uxbridge, Middx, England

[4] Univ Hosp Coventry & Warwickshire, Dept Resp Med, Coventry, W Midlands, England

[5] Capital & Coast Dist Hlth Board, Wellington Hosp, Dept Radiol, Wellington, New Zealand

关键词: Asthma;    airway remodeling;    distal airway;    CT;    quantitative imaging;    phenotypes;    cluster analysis;    fractal analysis;   

DOI  :  10.1016/j.jaci.2013.09.039

来源: Elsevier

【 摘 要 】

Background: Asthma heterogeneity is multidimensional and requires additional tools to unravel its complexity. Computed tomography (CT)-assessed proximal airway remodeling and air trapping in asthmatic patients might provide new insights into underlying disease mechanisms. Objectives: The aim of this study was to explore novel, quantitative, CT-determined asthma phenotypes. Methods: Sixty-five asthmatic patients and 30 healthy subjects underwent detailed clinical, physiologic characterization and quantitative CT analysis. Factor and cluster analysis techniques were used to determine 3 novel, quantitative, CT-based asthma phenotypes. Results: Patients with severe and mild-to-moderate asthma demonstrated smaller mean right upper lobe apical segmental bronchus (RB1) lumen volume (LV) in comparison with healthy control subjects (272.3 mm(3) [SD, 112.6 mm(3)], 259.0 mm(3) [SD, 53.3 mm(3)], 366.4 mm(3) [SD, 195.3 mm(3)], respectively; P = .007) but no difference in RB1 wall volume (WV). Air trapping measured based on mean lung density expiratory/inspiratory ratio was greater in patients with severe and mild-to-moderate asthma compared with that seen in healthy control subjects (0.861 [SD, 0.05)], 0.866 [SD, 0.07], and 0.830 [SD, 0.06], respectively; P = .04). The fractal dimension of the segmented airway tree was less in asthmatic patients compared with that seen in control subjects (P = .007). Three novel, quantitative, CT-based asthma clusters were identified, all of which demonstrated air trapping. Cluster 1 demonstrates increased RB1 WV and RB1 LV but decreased RB1 percentage WV. On the contrary, cluster 3 subjects have the smallest RB1 WV and LV values but the highest RB1 percentage WV values. There is a lack of proximal airway remodeling in cluster 2 subjects. Conclusions: Quantitative CT analysis provides a new perspective in asthma phenotyping, which might prove useful in patient selection for novel therapies.

【 授权许可】

Free