OJMI  Vol.7 No.3 , September 2017
Tracheal Stenosis Caused by Thoracic Malignancy: Correlation between CT-Based Tracheal Measurement and Spirometric Values before and after Tracheal Stenting
ABSTRACT
Background: The correlation between computed tomography (CT)-based tracheal size and spirometry values is unknown in patients with tracheal stenosis by thoracic malignancy, which is often treated by tracheal stenting. Objectives: To evaluate the correlation between the tracheal cross-sectional area (CSA) and spirometric values before and after tracheal stenting, and to confirm that greater improvement in tracheal CSA leads to a larger improvement in spirometry values. Methods: A total of 32 patients with malignant tracheal stenosis underwent tracheal stenting. Before (n = 32) and after (n = 27) treatment, patients underwent chest CT, measuring mean and minimum tracheal CSA values, and spirometry. The correlation between tracheal CSA and each spirometric value was evaluated using Spearman rank correlation analysis. Differences in the pre- and posttreatment tracheal CSA and spirometric values were evaluated using the Wilcoxon matched-pairs test. Results: Significant improvement in the minimum tracheal CSA and in spirometric values was observed after stenting (P < 0.001). Pretreatment analysis revealed significant correlations between the minimum tracheal CSA and various spirometric values (P < 0.01), but posttreatment analysis showed weak or insignificant correlations. The increase in the minimum tracheal CSA obtained by stenting was significantly correlated with improvement in multiple spirometric values (P < 0.05). Conclusions: The tracheal size measured on chest CT correlates with patients’ spirometric values, particularly at the prestenting examination, in patients with malignant tracheal stenosis. The increase in the minimum tracheal CSA after stenting on CT is a predictor for improved spirometric values, which is first demonstrated by this study.
Cite this paper
Azagami, S. , Yamashiro, T. , Handa, H. , Inoue, T. , Matsuoka, S. , Miyazawa, T. and Mineshita, M. (2017) Tracheal Stenosis Caused by Thoracic Malignancy: Correlation between CT-Based Tracheal Measurement and Spirometric Values before and after Tracheal Stenting. Open Journal of Medical Imaging, 7, 63-76. doi: 10.4236/ojmi.2017.73007.
References
[1]   Luomanen, R.K.J. and Watson, W.L. (1968) Autopsy Findings. In: Watson, L., Ed., Lung Cancer: A Study of Five Thousand Memorial Hospital Cases, Mosby, Co., St. Louis, 504-510.

[2]   Brouns, M., Jayaraju, S.T., Lacor, C., De Mey, J., Noppen, M., Vincken, W. and Verbanck, S. (2007) Tracheal Stenosis: A Flow Dynamics Study. Journal of Applied Physiology, 102, 1178-1184.
https://doi.org/10.1152/japplphysiol.01063.2006

[3]   Nishine, H., Hiramoto, T., Kida H., Matsuoka, S., Mineshita, M., Kurimoto, N. and Miyazawa, T. (2012) Assessing the Site of Maximal Obstruction in the Trachea Using Lateral Pressure Measurement during Bronchoscopy. American Journal of Respiratory and Critical Care Medicine, 185, 24-33.
https://doi.org/10.1164/rccm.201104-0701OC

[4]   Ernst, A., Feller-Kopman, D., Becker, H.D. and Mehta, A.C. (2004) Central Airway Obstruction. American Journal of Respiratory and Critical Care Medicine, 169, 1278-1297.
https://doi.org/10.1164/rccm.200210-1181SO

[5]   Razi, S.S., Lebovics, R.S., Schwartz, G., Sancheti, M., Belsley, S., Connery, C.P. and Bhora, F.Y. (2010) Timely Airway Stenting Improves Survival in Patients with Malignant Central Airway Obstruction. The Annals of Thoracic Surgery, 90, 1088-1093.
https://doi.org/10.1016/j.athoracsur.2010.06.093

[6]   Williamson, J.P., Phillips, M.J., Hillman, D.R. and Eastwood, P.R. (2010) Managing Obstruction of the Central Airways. Internal Medicine Journal, 40, 399-410.
https://doi.org/10.1111/j.1445-5994.2009.02113.x

[7]   Miyazawa, T. and Arita, K. (1998) Airway Stenting in Japan. Respirology, 3, 229-234.
https://doi.org/10.1111/j.1440-1843.1998.tb00127.x

[8]   Miyazawa, T., Yamakido, M., Ikeda, S., Furukawa, K., Takiguchi, Y., Tada, H. and Shirakusa, T. (2000) Implantation of Ultraflex Nitinol Stents in Malignant Tracheobronchial Stenosis. Chest, 118, 959-965.
https://doi.org/10.1378/chest.118.4.959

[9]   Serrano, C., Laborda, A., Lozano, J.M., Caballero, H., Sebastián, A., Lopera, J. and de Gregorio, M.A. (2013) Metallic stents for Tracheobronchial Pathology Treatment. CardioVascular and Interventional Radiology, 36, 1614-1623.
https://doi.org/10.1007/s00270-013-0602-6

[10]   Mehta, A.C. (2008) AERO Self-Expanding Hybrid Stent for Airway Stenosis. Expert Review of Medical Devices, 5, 553-557.
https://doi.org/10.1586/17434440.5.5.553

[11]   Miyazawa, T., Miyazu, Y., Iwamoto, Y., Ishida, A., Kanoh, K., Sumiyoshi, H., Doi, M. and Kurimoto, N. (2004) Stenting at the Flow-Limiting Segment in Tracheobronchial Stenosis Due to Lung Cancer. American Journal of Respiratory and Critical Care Medicine, 169, 1096-1102.
https://doi.org/10.1164/rccm.200312-1784OC

[12]   Miller, R.D. and Hyatt, R.E. (1973) Evaluation of Obstructing Lesions of the Trachea and Larynx by Flow-Volume Loops. American Review of Respiratory Disease, 108, 475-481.

[13]   Rotman, H.H., Liss, H.P. and Weg, J.G. (1975) Diagnosis of Upper Airway Obstruction by Pulmonary Function Testing. Chest, 68, 796-799.
https://doi.org/10.1378/chest.68.6.796

[14]   Vergnon, J.M., Costes, F., Bayon, M.C. and Emonot, A. (1995) Efficacy of Tracheal and Bronchial Stent Placement on Respiratory Functional Tests. Chest, 107, 741-746.
https://doi.org/10.1378/chest.107.3.741

[15]   Acres, J.C. and Kryger, M.H. (1981) Clinical Significance of Pulmonary Function Tests: Upper Airway Obstruction. Chest, 80, 207-211.
https://doi.org/10.1378/chest.80.2.207

[16]   Hyatt, R.E. and Black, L.F. (1973) The Flow-Volume Curve: A Current Perspective. American Review of Respiratory Disease, 107, 191-199.

[17]   Usuba, A., Yamashiro, T., Handa, H., Matsuoka, S., Yamano, Y., Mineshita, M. and Miyazawa, T. (2015) Quantitative Computed Tomography Measurement of Tracheal Cross-Sectional Areas in Relapsing Polychondritis: Correlations with Spirometric Values. Respiration, 90, 468-473.
https://doi.org/10.1159/000441303

[18]   Matsuoka, S., Kurihara, Y., Yagihashi, K., Hoshino, M. and Nakajima, Y. (2008) Airway Dimensions at Inspiratory and Expiratory Multisection CT in Chronic Obstructive Pulmonary Disease: Correlation with Airflow Limitation. Radiology, 248, 1042-1049.
https://doi.org/10.1148/radiol.2491071650

[19]   Yamashiro, T., San Jose Estepar, R., Matsuoka, S., Bartholmai, B.J., Ross, J.C., Diaz, A., Murayama, S., Silverman, E.K., Hatabu, H. and Washko, G.R. (2011) Intrathoracic Tracheal Volume and Collapsibility on Inspiratory and End-Expiratory CT Scans Correlations with Lung Volume and Pulmonary Function in 85 Smokers. Academic Radiology, 18, 299-305.
https://doi.org/10.1016/j.acra.2010.11.005

[20]   Ederle, J.R., Heussel, C.P., Hast, J., Fischer, B., Van Beek, E.J., Ley, S., Thelen, M. and Kauczor, H.U. (2003) Evaluation of Changes in Central Airway Dimensions, Lung Area and Mean Lung Density at Paired Inspiratory/Expiratory High-Resolution Computed Tomography. European Radiology, 13, 2454-2461.
https://doi.org/10.1007/s00330-003-1909-5

[21]   Koyama, H., Ohno, Y., Yamazaki, Y., Onishi, Y., Takenaka, D., Yoshikawa, T., Nishio, M., Matsumoto, S., Murase, K., Nishimura, Y. and Sugimura, K. (2012) Quantitative Bronchial Luminal Volumetric Assessment of Pulmonary Function Loss by Thin-Section MDCT in Pulmonary Emphysema Patients. European Journal of Radiology, 81, 384-388.
https://doi.org/10.1016/j.ejrad.2010.12.042

[22]   Miller, M.R., Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., Crapo, R., Enright, P., van der Grinten, C.P., Gustafsson, P., Jensen, R., Johnson, D.C., MacIntyre, N., McKay, R., Navajas, D., Pedersen, O.F., Pellegrino, R., Viegi, G. and Wanger, J. (2005) ATS/ERS Task Force: Standardization of Spirometry. European Respiratory Journal, 26, 319-338.
https://doi.org/10.1183/09031936.05.00034805

[23]   Handa, H., Miyazawa, T., Murgu, S.D., Nishine, H., Kurimoto, N., Huang, J. and Colt, H.G. (2012) Novel Multimodality Imaging and Physiologic Assessments Clarify Choke-Point Physiology and Airway Wall Structure in Expiratory Central Airway Collapse. Respiratory Care, 57, 634-641.

[24]   Handa, H., Huang, J., Murgu, S.D., Mineshita, M., Kurimoto, N., Colt, H.G. and Miyazawa, T. (2014) Assessment of Central Airway Obstruction Using Impulse Oscillometry before and after Interventional Bronchoscopy. Respiratory Care, 59, 231-240.
https://doi.org/10.4187/respcare.02094

[25]   Sakai, N., Mishima, M., Nishimura, K., Itoh, H. and Kuno, K. (1994) An Automated Method to Assess the Distribution of Low Attenuation Areas on Chest CT Scans in Chronic Pulmonary Emphysema Patients. Chest, 106, 1319-1325.
https://doi.org/10.1378/chest.106.5.1319

[26]   Yamashiro, T., Moriya, H., Tsubakimoto, M., Matsuoka, S. and Murayama, S. (2016) Continuous Quantitative Measurement of the Proximal Airway Dimensions and Lung Density on Four-Dimensional Dynamic-Ventilation CT in Smokers. International Journal of Chronic Obstructive Pulmonary Disease, 11, 755-764.
https://doi.org/10.2147/COPD.S100658

[27]   Miyazawa, T., Nobuyama, S., Nishine, H., Handa, H. and Mineshita, M. (2006) Choke Point Physiology in Airway Stenting: A Case Presentation and Discussion. Respiratory Investigation, 54, 237-240.
https://doi.org/10.1016/j.resinv.2016.02.006

[28]   Mineshita, M., Kida, H., Handa, H., Nishine, H., Furuya, N., Inoue, T., Matsuoka, S. and Miyazawa, T. (2016) Regional Lung Sound Asynchrony in Chronic Obstructive Pulmonary Disease Patients. Respiration, 92, 252-257.
https://doi.org/10.1159/000449255

 
 
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