Invited Review: Understanding airway pathophysiology with computed tomograpy

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Abstract
Conventional pulmonary function tests are limited in the mechanistic insight that they can provide by the fact that they can only provide average measures of lung function. For example, a measurement of decreased expiratory flow assessed with conventional spirometry could result from narrowed large airways, narrowed small airways, closed airways, altered elasticity, or regional heterogeneities in parenchyma or airways. To examine specific mechanisms and pathology in the airways, a method is required that can actually look at specific individual airways. Over the past decade, several more direct methods of assessing specific mechanisms and structural alterations in normal airways and airway pathology in asthma have become available for such purposes. One such method is high-resolution computed tomography (HRCT), a method that allows the study of multiple individual airways during either contraction to closure or relaxation in real time, as well as changes in airway size with changes in lung volume. Although other imaging modalities have the potential to image airways in vivo, none presently has the convenience and the accessibility coupled with the resolution required to visualize the parenchymal airways in vivo. Although HRCT may never be widely utilized for routine measurements or screening, because of radiation exposure, cost issues, and a limited ability to follow changes over extended time periods, the method has distinct and unique advantages in quantifying the behavior of airways in vivo. In this mini-review, we focus on these capabilities of HRCT by briefly reviewing highlights of experimental results from several canine and human studies.