Abstract
This study obtained approval from the Institutional Review Board. The craniocaudal dimensions of inspiratory and expiratory chest CT scans of 83 patients were examined by an experienced radiologist (MS with 20 years of experience). The difference between the two measurements, called the Slice Level Difference (SLD), was calculated. Mosaic attenuation on inspiratory images and air trapping on expiratory images were quantified, as well as the change in grade between the two series. Age and gender were compared to degree of expiratory effort.
Highlights
Inspiratory chest CT scan is the standard method for viewing the lung parenchyma
Comparing slice level difference (SLD) between inspiratory and expiratory images can help determine if there was greater than average expiratory effort to potentially exclude the diagnosis of small airways disease
Often there is no evidence of mosaic attenuation on inspiratory CT scans when subsequent expiratory images demonstrate air trapping [1,2,3]
Summary
Inspiratory chest CT scan is the standard method for viewing the lung parenchyma. Inspiratory images are insufficient for the diagnosis of air trapping. Often there is no evidence of mosaic attenuation on inspiratory CT scans when subsequent expiratory images demonstrate air trapping [1,2,3]. Limited sensitivity for mosaic attenuation on inspiratory CT scans supports the use of expiratory imaging when air trapping is suspected [4,5,6,7]. A pitfall of expiratory imaging is its dependence on patient effort, and reproducibility. Obstacles in obtaining images based on optimal expiratory effort may occur when the patient is unable to hear or understand breathing instructions. Inability or unwillingness to follow directions can result in non-diagnostic images, with increased radiation dose and no added benefit
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