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Airway tapering as a biomarker for bronchiectasis was assessed on spirometer-guided inspiratory CTs from 12 patients with bronchiectasis and 12 age- and sex-matched controls. Semi-automatic image analysis software was used to quantify intra-branch tapering (reduction in airway diameter along the branch), inter-branch tapering (reduction in airway diameter before and after bifurcation) and airway-artery ratios on chest CTs. Biomarkers were further stratified in small, medium and large airways based on three equal groups of the accompanying vessel size.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Control subjects showed intra-branch tapering of 1% and inter-branch tapering of 24\u201339%. Subjects with bronchiectasis showed significantly reduced intra-branch of 0.8% and inter-branch tapering of 19\u201332% and increased airway\u2013artery ratios compared with controls (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.01). Tapering measurements were significantly different between diseased and controls across all airway sizes. Difference in airway\u2013artery ratio was only significant in small airways.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Paediatric normal values for airway tapering were established in control subjects. Tapering showed to be a promising biomarker for bronchiectasis as subjects with bronchiectasis show significantly less airway tapering across all airway sizes compared with controls. Detecting less tapering in larger airways could potentially lead to earlier diagnosis of bronchiectasis. Additionally, compared with the conventional airway\u2013artery ratio, this novel biomarker has the advantage that it does not require pairing with pulmonary arteries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>Tapering is a promising objective image biomarker for bronchiectasis that can be extracted semi-automatically and has good correlation with validated visual scoring methods.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>Less airway tapering was observed in patients with bronchiectasis and can be observed sensitively throughout the bronchial tree, even in the more central airways.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>Tapering values seemed to be less influenced by variety in scanning protocols and lung volume making it a more robust biomarker for bronchiectasis detection.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-019-06606-w","type":"journal-article","created":{"date-parts":[[2020,2,5]],"date-time":"2020-02-05T10:03:38Z","timestamp":1580897018000},"page":"2703-2711","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Airway tapering: an objective image biomarker for bronchiectasis"],"prefix":"10.1007","volume":"30","author":[{"name":"on behalf of the Normal Chest CT study group","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wieying","family":"Kuo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adria","family":"Perez-Rovira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harm","family":"Tiddens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6328-902X","authenticated-orcid":false,"given":"Marleen","family":"de Bruijne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,2,5]]},"reference":[{"key":"6606_CR1","doi-asserted-by":"publisher","first-page":"4680","DOI":"10.1007\/s00330-017-4819-7","volume":"27","author":"W Kuo","year":"2017","unstructured":"Kuo W, De Bruijne M, Petersen J et al (2017) Diagnosis of bronchiectasis and airway wall thickening in children with cystic fibrosis: objective airway-artery quantification. 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From the 180 subjects analysed in our manuscript, 24 have been previously reported (1\u20133). These previous publications reported airway\u2013artery ratios that were measured manually (1) or automatically (2), and compared with visual scores (CFCT and PRAGMA) (3). Additionally, 156 control CTs were part of the Normal Chest CT study group. This collaboration was established in order to establish normative data of the airways on chest CT in a paediatric population. Previous work included normative data of the central airway dimensions (4). Copies of all published manuscripts added with submission. The difference with this current manuscript is that this study describes the automatically acquired airway dimensions and most importantly focuses on tapering values, which has not been described in such a population before. It estimates the tapering value in a control paediatric population and compares tapering values between patients with known bronchiectasis and control subjects1. Kuo W, De Bruijne M, Petersen J, Nasserinejad K, Ozturk H, Chen Y, et al. Diagnosis of bronchiectasis and airway wall thickening in children with cystic fibrosis: Objective airway-artery quantification. Eur Radiol. European Radiology; 2017;27:4680\u20139.2. Perez-Rovira A, Kuo W, Petersen J, Tiddens HA, de Bruijne M. Automatic airway\u2013artery analysis on lung CT to quantify airway wall thickening and bronchiectasis. Med Phys. 2016;43(10):5736\u201344.3. Kuo W, Andrinopoulou E-R, Perez-Rovira A, Ozturk H, de Bruijne M, Tiddens HAWM. Objective airway artery dimensions compared to CT scoring methods assessing structural cystic fibrosis lung disease. J Cyst Fibros. European Cystic Fibrosis Society.; 2017;16(1):116\u201323.4. Kuo W, Ciet P, Andrinopoulou E-R et al. Reference Values for Central Airway Dimensions on CT Images of Children and Adolescents. AJR Am J Roentgenol. American Roentgen Ray Society; 2018 Feb 20;210(2):423\u201330.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 Retrospective\u2022 Diagnostic or prognostic study\u2022 Multicentre study","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}