Tracheal collapsibility in healthy volunteers during forced expiration: assessment with multidetector CT.
OBJECTIVE
To assess forced expiratory tracheal collapsibility in healthy volunteers by using multidetector computed tomography and to compare the results with the current diagnostic criterion for tracheomalacia.


METHODS
An institutional review board approved this HIPAA-compliant study. After informed consent was obtained, 51 healthy volunteers (age range, 25-75 years) with normal spirometry results and no history of smoking or risk factors for tracheomalacia were prospectively studied. Volunteers were imaged with a 64-detector row scanner, with spirometric monitoring at total lung capacity and during forced exhalation, with 40 mAs, 120 kVp, and 0.625-mm detector collimation. Cross-sectional area and sagittal and coronal diameters of the trachea were measured 1 cm above the aortic arch and 1 cm above the carina. The percentage of expiratory collapse, the reduction in sagittal and coronal diameters, and the number of participants exceeding the current diagnostic criterion (>50% expiratory reduction in cross-sectional area) for tracheomalacia were calculated.


RESULTS
The final study population included 25 men and 26 women (mean age, 50 years). The mean percentage of expiratory reduction in tracheal lumen cross-sectional area was 54.34% +/- 18.6 (standard deviation) in the upper trachea and 56.14% +/- 19.3 in the lower trachea. Forty (78%) participants exceeded the current diagnostic criterion for tracheomalacia in the upper and/or lower trachea. Decreases in cross-sectional area of the upper and lower trachea correlated well with decreases in sagittal (r = 0.807 and 0.688, respectively) and coronal (r = 0.779 and 0.751, respectively) diameters (P < .001 for each correlation).


CONCLUSIONS
Healthy volunteers demonstrate a wide range of forced expiratory tracheal collapse, frequently exceeding the current diagnostic criterion for tracheomalacia.
Boiselle
Phillip M
PM
Center for Airway Imaging, Departments of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA. pboisell@bidmc.harvard.edu
O'Donnell
Carl R
CR
Bankier
Alexander A
AA
Ernst
Armin
A
Millet
Mary E
ME
Potemkin
Alexis
A
Loring
Stephen H
SH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055090:Tracheomalacia / Q000000981:diagnostic imaging* / Q000503:physiopathology*