Expiratory CT scans for chronic airway disease: Correlation with pulmonary function test results

OBJECTIVE. The purpose of our study was to correlate findings on expiratory CT scans with results of pulmonary function tests (PFTs) and to determine whether these techniques may be complementary in assessing airway obstruction. MATERIALS AND METHODS. Seventy-four patients with suspected chronic airway disease and 10 healthy nonsmokers underwent inspiratory and expiratory CT scans and PFTs. An air trapping score, corresponding to the ratio of the cross-sectional air trapping area versus the total cross-sectional lung area on expiratory CT, and a reduction score, representing the change in cross-sectional lung area at inspiration and expiration, were calculated using a quantitative grid. The two scores were then correlated with the results of the PFTs. RESULTS, Expiratory air trapping was seen in 18 (51%) of 35 patients with severe airway obstruction (forced expiratory volume in 1 sec [FEV1]:vital capacity < 80%) (group A), in 21 (72%) of 29 patients with predominantly small airways obstruction (abnormal flow-volume curve and FEV1:vital capacity greater than or equal to 80%) (group B1), and in four (40%) of 10 patients with normal PFT results (group B2). Expiratory air trapping was never seen in the 10 healthy subjects. Air trapping scores were 27%, 12%, and 8% for groups A, B1, and B2, respectively, with significant negative correlations with FEV1 (r = -.45), FEV1:vital capacity (r = -.31), and forced expiratory flow at 25% of vital capacity (r = -.57). Reduction scores were 18%, 30%, 35%, and 43%, for the groups A, B1, B2, and the healthy group, respectively, with significant correlations with all the PFT indexes (r = .35 to .66) except total lung capacity. CONCLUSION. Air trapping may permit detection of airway obstruction in patients with clinically suspected chronic airway disease even when PFTs are normal. Furthermore, expiratory CT allows one to calculate a reduction score for a cross-sectional lung area that appears to be better correlated with the degree of airway obstruction measured on PFTs.