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1 From the Department of Medicine, Pulmonary Division, National Jewish Center for Immunology and Respiratory Medicine and Department of Medicine, University of Colorado Health Sciences Center, Denver
2 From the Department of Radiology, National Jewish Center and Department of Radiology, University of Colorado Health Sciences Center, Denver
3 From the Department of Medicine, Pulmonary Division, National Jewish Center for Immunology and Respiratory Medicine and Department of Medicine, University of Colorado Health Sciences Center; and the Occupational and Environmental Medicine Division, National Jewish Center for Immunology and Respiratory Medicine, Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver
Objective: The purpose of this study was to prospectively see if quantitative computed tomography (QCT) could separate asthmatic patients from normal control subjects. The QCT results were also correlated with the pulmonary function tests (PFT) that were done on both the asthmatic patients and control subjects.
Subjects and methods: Eighteen adult nonsmoking asthmatics and 22 adult control subjects were entered into the study. Quantitative CT was performed at the level of the transverse aorta and just above the diaphragm at both end inspiration and end expiration in all patients and control subjects: 10-mm and 1.5-mm collimation using a high spatial frequency algorithm was used to obtain the QCT examinations. The percent of pixels below 
900 Hounsfeld units, pixel index, in each of the QCT axial images of the lungs was calculated for each asthmatic and control subject in the study. Pulmonary function testing was performed on both the asthmatics and control subjects and included determination of FEV1, FVC, FRC, RV, and TLC. Unpaired Student's t test analysis of the QCT data was done to statistically compare the asthmatics with the control subjects. Linear regression analysis was done to compare the QCT results with PFT data on the asthmatics and control subjects.
Results: When scans were performed at end expiration, at a level immediately superior to the diaphragm, the mean pixel index was significantly higher in asthmatic subjects compared with normal individuals on both CT (mean for normal subjects 0.16 vs 4.45 for asthmatics, p<0.004) and high-resolution CT (HRCT) images (mean for normal subjects 1.04 vs 10.03 in asthmatics, p<0.0001) indicating more areas of low attenuation in asthmatics. The CT and HRCT images from the lower lung zones that were performed at end expiration provided the best separation between the groups. The pixel index on expiration correlated with the degree of air trapping and airflow limitation in the asthmatic group based on FEV1, FRC, RV, and to a lesser extent, FVC.
Conclusion: Expiratory QCT is a useful method to assess air trapping in asthmatic patients. The percent of abnormal lung in asthmatics as determined by QCT has a significant correlation with the PFTs that reflect air trapping in asthmatic patients. Quantitative CT may be helpful in assessing degrees of air trapping present in other diseases affecting the airways.
Submitted on April 13, 1993
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