Abstract
BACKGROUND: Trachea structural abnormalities occur in patients with chronic obstructive pulmonary disease (COPD), yet there are few methods for quantifying trachea surface topology. PURPOSE: To develop a method to quantify trachea surface roughness on CT imaging and investigate the association with airflow limitation and symptoms in COPD. MATERIALS AND METHODS: Participants from the multicenter prospective Canadian Cohort Obstructive Lung Disease study between 2009 and 2015 underwent CT imaging and analysis. Established CT measurements included: tracheal index (TI), defined as the smallest ratio of coronal-to-sagittal trachea diameter, low attenuation areas below -950 HU, and wall thickness of a theoretical 10-mm airway. Trachea surface roughness shape (SR(S)) was calculated as the percent fraction of the measurement box filled by the surface mesh. Multivariable regression models were used to determine association for CT measurements with forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC), and Medical Research Council dyspnea scale (MRC)≥3, adjusting for covariates. RESULTS: A total of 1253 participants (mean age, 66 ± 10 years; 727 men) from 9 centers were investigated: n = 267 never smokers, n = 369 ever smokers, n = 352 mild COPD, and n = 265 moderate-to-severe COPD. There were no differences between groups for age or race (P < .05). In models including SR(S) and TI, a 1-standard deviation (SD) increase in SR(S) was independently associated with a 0.11-SD decrease in FEV(1) (β = -0.11; P < .001) and a 0.16-SD decrease in FEV(1)/FVC (β = -0.16; P < .001); a 1-point increase in SR(S) was associated with a 13% increased likelihood of MRC ≥ 3 (odds ratio = 1.13; P = .003). In models including SR(S), low attenuation areas below -950 HU and wall thickness of a theoretical 10-mm airway, a 1-SD increase in SR(S) was associated with a 0.21-SD decrease in FEV(1) (β = -0.21; P < .001) and a 0.13-SD decrease in FEV(1)/FVC (β = -0.13; P < .001); a 1-point increase in SR(S) was associated with a 12% increased likelihood of MRC ≥ 3 (odds ratio = 1.12; P = .006). CONCLUSION: Increased trachea surface shape roughness is independently associated with worse airflow and increased symptom burden in COPD.