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Detection of Air Trapping on Inspiratory and Expiratory Phase Images Obtained by 0.3-Second Cine CT in the Lungs of Free-Breathing Young Children

¹ Both authors: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-2 dong, Songpa-gu, Seoul 138-736, South Korea.

View larger version (77K): [in a new window]   Fig. 1A —17-month-old girl with air trapping in right middle lobe and mediastinal embryonal sarcoma that had recurred. For lung densitometry, rectangular regions of interest are placed at peripheral portions of right middle lobe (area with air trapping, white rectangle) and right lower lobe (normal area, black rectangle). Pair of inspiratory (A) and expiratory (B) phase CT images show air trapping in right middle lobe might be due to enlarged metastatic lymph node.

View larger version (72K): [in a new window]   Fig. 1B —17-month-old girl with air trapping in right middle lobe and mediastinal embryonal sarcoma that had recurred. For lung densitometry, rectangular regions of interest are placed at peripheral portions of right middle lobe (area with air trapping, white rectangle) and right lower lobe (normal area, black rectangle). Pair of inspiratory (A) and expiratory (B) phase CT images show air trapping in right middle lobe might be due to enlarged metastatic lymph node.

View larger version (10K): [in a new window]   Fig. 2 —Bar graph shows lung density differences between inspiration and expiration among three area categories: lung with air trapping, abnormal lung without air trapping, and normal lung. Lung density differences were significantly smaller in areas with air trapping (mean ± SD, -19 ± 34 H) than in abnormal areas without air trapping (138 ± 36 H) (star, p < 0.001) and in normal areas (111 ± 49 H) (star, p < 0.001).

View larger version (70K): [in a new window]   Fig. 3A —21-month-old girl with diffuse air trapping in both lungs who underwent Rastelli operation due to pulmonary atresia and ventricular septal defect. Inspiratory (A) and expiratory (B) phase CT images reveal almost no changes in lung density and volume through respiratory cycle. Measured lung densities at inspiration and expiration were 855 and 854 H, respectively.

View larger version (72K): [in a new window]   Fig. 3B —21-month-old girl with diffuse air trapping in both lungs who underwent Rastelli operation due to pulmonary atresia and ventricular septal defect. Inspiratory (A) and expiratory (B) phase CT images reveal almost no changes in lung density and volume through respiratory cycle. Measured lung densities at inspiration and expiration were 855 and 854 H, respectively.

View larger version (141K): [in a new window]   Fig. 3C —21-month-old girl with diffuse air trapping in both lungs who underwent Rastelli operation due to pulmonary atresia and ventricular septal defect. Three-dimensional CT image of lungs and airways (threshold, -150 H) shows severe irregular narrowing of central airways as cause of diffuse air trapping. Cause of airway stenoses was thought to be vascular compression, and stenoses were improved after aortopexy.

View larger version (9K): [in a new window]   Fig. 4 —Bar graph shows lung density difference percentages between air trapping and no-air trapping groups. Density difference percentages were significantly smaller in air trapping group (mean ± SD, -27% ± 54%) than in no-air trapping group (120% ± 87%) (star, p < 0.001).

View larger version (14K): [in a new window]   Fig. 5 —Bar graph shows lung density differences between abnormal and normal areas in air trapping and no-air trapping groups. Lung density differences were significantly larger at expiration (gray bars) (mean ± SD, 260 ± 77 H) than at inspiration (black bars) (129 ± 69 H) in air trapping group (star, p < 0.001), whereas there was no significant difference in no-air trapping group (207 ± 105 H at inspiration, 213 ± 186 H at expiration) (p > 0.05).

View larger version (74K): [in a new window]   Fig. 6A —21-month-old boy with bronchial asthma. Inspiratory phase CT image reveals subsegmental atelectasis (arrow) in apicoposterior segment of left upper lobe and bronchial wall thickening in right upper lobe. Areas with air trapping are barely visible, and lung parenchyma seems to be almost homogeneous in density.

View larger version (82K): [in a new window]   Fig. 6B —21-month-old boy with bronchial asthma. In contrast to inspiratory phase CT image (A), expiratory phase CT image unveils mosaic lung attenuation (arrowheads) due to air trapping in both upper lobes. Normal concavity (arrow) is noticeable at posterior membranous portion of trachea at expiration.

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