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Aim: Bronchiectasis (BE) is a disease defined by irreversible dilatation of the airway. Computed tomography (CT) plays an important role in the detection and quantification of BE. The aim of this study was three-fold: 1) to assess bronchus-artery (BA) dimensions using fully automated software in a cohort of BE disease patients; 2) to compare BA dimensions with semi-quantitative BEST-CT (Bronchiectasis Scoring Technique for CT) scores for BE and bronchial wall thickening; and 3) to explore the structure-function relationship between BA-method lumen dimensions and spirometry outcomes., Methods: Baseline CTs of BE patients who participated in a clinical trial were collected retrospectively. CTs were analysed manually with the BEST-CT scoring system and automatically using LungQ (v.2.1.0.1, Thirona, The Netherlands), which measures the following BA dimensions: diameters of bronchial outer wall (B out ), bronchial inner wall (B in ) and artery (A), and bronchial wall thickness (B wt ) and computes BA ratios (B out /A and B in /A) to assess bronchial widening. To assess bronchial wall thickness, we used the B wt /A ratio and the ratio between the bronchus wall area (B wa ) and the area defined by the outer airway (B oa ) (B wa /B oa )., Results: In total, 65 patients and 16 900 BA pairs were analysed by the automated BA method. The median (range) percentage of BA pairs defined as widened was 69 (55-84)% per CT using a cut-off value of 1.5 for B out /A, and 53 (42-65)% of bronchial wall were thickened using a cut-off value of 0.14 for B wt /A. BA dimensions were correlated with comparable outcomes for the BEST-CT scoring method with a correlation coefficient varying between 0.21 to 0.51. The major CT BA determinants of airflow obstruction were bronchial wall thickness (p=0.001) and a narrower bronchial inner diameter (p=0.003)., Conclusion: The automated BA method, which is an accurate and sensitive tool, demonstrates a stronger correlation between visual and automated assessment and lung function when using a higher cut-off value to define bronchiectasis., Competing Interests: Author contributions: A.L.P. Pieters contributed to the design of the work, data collection and drafted the manuscript up to the final version. Q. Lv contributed to the data collection, analyses and gave final approval for the manuscript. J.J. Meerburg contributed to the data collection for her previous studies. E-R. Andrinopoulou contributed to the analyses and gave final approval for the manuscript. H.A.W.M. Tiddens contributed to the design and analyses of the work and gave final approval for the manuscript. T. van der Veer, P. Ciet, J.D. Chalmers, M.R. Loebinger, C.S. Haworth and J.S. Elborn contributed to the design of the work and gave final approval for the manuscript. Conflict of interest: A.L.P. Pieters, Q. Lv, T. van der Veer, J.J. Meerburg, J.S. Elborn and E-R. Andrinopoulou declare no conflict of interest. Conflict of interest: P. Ciet has received grants or contract fees from NOW-Dutch Research Council and Horizon Pathfinder; and has received payment or honoraria for lectures, presentations etc. from Chiesi and Vertex, and travel support from the European Respiratory Society. He holds a leadership role as Chair of the Thoracic Group of the Cardiothoracic Taskforce of the European Society of Pediatric Radiology. Conflict of interest: J.D. Chalmers has received research grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences, Grifols, Novartis, Insmed and Trudell; has received consultancy or speaker fees from Antabio, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Janssen, Novartis, Pfizer, Trudell and Zambon; and is an associate editor of this journal. Conflict of interest: M.R. Loebinger has received consulting fees from Armata, 30T, AstraZeneca, Parion, Ismed, Chiesi, Zambon, Electromed, Recode and Boehringer Ingelheim; and has received payment or honoraria for lectures, presentations etc. from Chiesi, Insmed, Mylan and Zambon. Conflict of interest: C.S. Haworth has received consulting fees from 30 Technology, CSL Behring, Chiesi, Ismed, Janssen, LifeArc, Meiji, Mylan, Pneumagen, Shionogi, Vertex and Zambon; and has received payment or honoraria for lectures, presentations etc. from Chiesi, Ismed, Mylan and Zambon. Conflict of interest: H.A.W.M. Tiddens is professor emeritus at Erasmus MC and the CMO of Thirona; he has received consulting fees for Insmed, Chiesi and Boehringer, a provides paid courses for Vertex., (Copyright ©The authors 2024.)

Background: In adults with severe asthma (SA) bronchial wall thickening, bronchiectasis and low attenuation regions (LAR) have been described on chest computed tomography (CT) scans. The extent to which these structural abnormalities are present in children with SA is largely unknown. Our aim was to study the presence and extent of airway abnormalities on chest CT of children with SA., Methods: 161 inspiratory and expiratory CT scans, either spirometer-controlled or technician-controlled, obtained in 131 children with SA (mean±SD age 11.0±3.8 years) were collected retrospectively. Inspiratory scans were analysed manually using a semi-quantitative score and automatically using LungQ (v2.1.0.1; Thirona B.V., Nijmegen, the Netherlands). LungQ segments the bronchial tree, identifies the generation for each bronchus-artery (BA) pair and measures the following BA dimensions: outer bronchial wall diameter (B out ), adjacent artery diameter (A) and bronchial wall thickness (B wt ). Bronchiectasis was defined as B out /A ≥1.1, bronchial wall thickening as B wt /A ≥0.14. LAR, reflecting small airways disease (SAD), was measured automatically on inspiratory and expiratory scans and manually on expiratory scans. Functional SAD was defined as FEF 25-75 and/or FEF 75 z-scores <-1.645. Results are shown as median and interquartile range., Results: Bronchiectasis was present on 95.8% and bronchial wall thickening on all CTs using the automated method. Bronchiectasis was present on 28% and bronchial wall thickening on 88.8% of the CTs using the manual semi-quantitative analysis. The percentage of BA pairs defined as bronchiectasis was 24.62% (12.7-39.3%) and bronchial wall thickening was 41.7% (24.0-79.8%) per CT using the automated method. LAR was observed on all CTs using the automatic analysis and on 82.9% using the manual semi-quantitative analysis. Patients with LAR or functional SAD had more thickened bronchi than patients without., Conclusion: Despite a large discrepancy between the automated and the manual semi-quantitative analysis, bronchiectasis and bronchial wall thickening are present on most CT scans of children with SA. SAD is related to bronchial wall thickening., Competing Interests: Conflict of interest: W.B. van den Bosch reports an unconditional research grant for a PhD from Vectura Group PLC during the conduct of the study (contract was signed in 2018 for the duration of 4 years). Conflict of interest: Q. Lv and E-R. Andrinopoulou have nothing to disclose. Conflict of interest: M.W.H. Pijnenburg reports support from Sanofi and Novartis outside the submitted work. Conflict of interest: P. Ciet reports personal fees from Vertex, Chiesi Pharmaceuticals BV and Editamed SRL, and grants from the Dutch Research Council, outside the submitted work. Conflict of interest: H.M. Janssens reports grants and other support from Vertex Pharmaceuticals outside the submitted work. Conflict of interest: H.A.W.M. Tiddens reports personal fees from Thirona BV during the conduct of the study; and grants and other support from Novartis, personal fees from Vertex and Insmed, and grants from Vectura Group PLC, outside the submitted work. In addition, H.A.W.M. Tiddens has a patent for the PRAGMA-CF scoring system licensed and Sophia Research BV of the Erasmus MC–Sophia Children's Hospital has, in the past 3 years received unconditional research grants from Novartis and Vectura Group PLC, research grants from IMI, CFF, ECFS and the Sophia Foundation, and honoraria and travel expenses for lectures and participation on expert panels from Novartis, Insmed and Vertex. He heads the Erasmus MC core laboratory LungAnalysis which is a not-for-profit core image analysis laboratory. The financial aspects of the laboratory are handled by Erasmus MC., (Copyright ©The authors 2024.)