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Lung Growth in Infants and Toddlers Assessed by Multi-slice Computed Tomography

Posted Aug 31, 2010 Updated Apr 7, 2023
By Laxmi Rao MD , Christina Tiller RRT , Cathy Coates RN , Risa Kimmel RN , Kimberly E. Applegate MD MS , Janice Granroth-Cook BS , Cheryl Denski MS , James Nguyen MS , Zhangsheng Yu PhD , Eric Hoffman MD , Robert S. Tepper MD PhD
11 min read

Rationale and Objectives

Postnatal lung growth and development have primarily been evaluated from a very limited number of autopsied lungs, but it remains unclear whether alveolarization of the lung is complete during infancy and whether the conducting airways grow proportionately. The purpose of this study was to evaluate lung growth and development in vivo in infants and toddlers using multislice computed tomography.

Materials and Methods

Thirty-eight subjects (14 male, 24 female) aged 17 to 142 weeks underwent low-dose volumetric high-resolution computed tomographic imaging at an inflation pressure of 20 cm H 2 O during an induced respiratory pause. Lung volume and weight were determined, as well as airway dimensions (inner and outer area and wall area) for the trachea and the next three to four generations.

Results

Lung volume, air volume, and tissue volume increased linearly with body length. The air and tissue components of the lung parenchyma increased at a constant rate with each other. In addition, airway caliber decreased with increasing generation from the trachea into each lobe. Airway caliber was also correlated with body length; however, there was no interaction effect between airway generation and body length on transformed airway size.

Conclusions

In vivo assessment suggests that the growth of the lung parenchyma in infants and toddlers occurred with a constant relationship between air volume and lung tissue, which is consistent with lung growth occurring primarily by the addition of alveoli rather than the expansion of alveoli. In addition, the central conducting airways grow proportionately in infants and toddlers. This information may be important for evaluating subjects with arrested lung development.

The lung undergoes significant growth and development early in life, with increases in lung volume and airway size. Increases in lung volume with somatic growth can occur by alveolarization or by expansion in size of existing alveoli. The former should produce a relatively constant relationship between the volume of air and parenchymal tissue, whereas the latter should produce a greater increase in volume relative to parenchymal tissue.

Most of our knowledge about lung structure for infants and toddlers has been derived from a very limited number of morphometric studies of autopsied lungs, which has provided conflicting results as to whether alveolarization of the lung is complete during infancy . In addition, morphometric studies have provided relatively limited data on growth of the conducting airways early in life . In contrast to assessing lung structure from autopsied lungs, in adults and cooperative older children, lung structure has been evaluated in vivo using high-resolution computed tomographic (HRCT) imaging, which can provide a quantitative assessment of the lung parenchyma, as well as airway dimensions .

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Materials and methods

Subjects

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Table 1

Subject Demographics

Subject Length (cm) Weight (kg) Age (wk) Gender Race Reason for CT Scan 1 64.8 5 17 F Non-Caucasian Sarcoma 2 66 7.3 24 F Non-Caucasian Hearing loss 3 67.5 7.8 26 M Caucasian Scoliosis 4 68 7.3 27 M Caucasian Abnormal skull shape 5 66.5 6.4 29 M Caucasian Microtia 6 66.8 7 30 F Caucasian Hearing loss 7 64.5 8.6 31 F Non-Caucasian Hearing loss 8 68.25 8.4 32 M Non-Caucasian Macrocephalus 9 72 8.2 40 M Caucasian Hearing loss 10 75.5 12.1 43 M Caucasian Dermoid cyst 11 70.6 9.09 43 F Caucasian Hearing loss 12 68 10 45 M Caucasian Craniosynostosis 13 72.5 9.5 46 M Non-Caucasian Sarcoma 14 75.8 9.6 47 M Non-Caucasian Hearing loss 15 75 9.5 49 M Caucasian Hearing loss 16 75 10.9 50 M Caucasian Hepatoma 17 78.2 10.9 51 M Non-Caucasian Abnormal skull shape 18 75.6 10 54 F Caucasian Torticollis 19 72.5 9 61 F Caucasian Preauditory tag 20 83 10.9 66 F Caucasian Histiocytosis 21 84 11.8 73 F Non-Caucasian Dermoid cyst 22 78.5 8.2 78 F Caucasian Sarcoma 23 81.5 10.9 79 F Non-Caucasian Synostosis 24 69.7 7.7 79 F Caucasian Hearing loss 25 81.3 11.8 80 F Caucasian Thrombocytopenia 26 80.5 11.8 86 M Non-Caucasian Plagiocephaly 27 88 12.7 87 F Caucasian Retinoblastoma 28 86 14.1 91 F Caucasian Neuroblastoma 29 83.6 11.3 93 F Non-Caucasian Hearing loss 30 84.3 15.1 99 F Non-Caucasian Neuroblastoma 31 83.8 14.6 100 F Caucasian Neuroblastoma 32 87.6 10.7 103 F Caucasian Microtia 33 86 11.3 105 F Non-Caucasian Rhabdomyosarcoma 34 90.5 12.5 113 F Caucasian Hearing loss 35 90 13.2 120 F Non-Caucasian Hearing loss 36 91.7 12.5 124 F Non-Caucasian Lymphangioma 37 88.5 12.3 125 F Non-Caucasian Hearing loss 38 92.25 14.5 142 M Caucasian Club feet

CT, computed tomographic.

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High-resolution Imaging

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Figure 1, Airway tree and nomenclature used for airway segments (20) .

Figure 2, Illustration of different views of Vida software (Vida Diagnostics, Iowa City, IA) for localizing airway segments and measurements of inner and outer airway dimensions.

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Statistical Analysis

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Results

Subjects

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Lung Parenchyma

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Figure 3, Total parenchymal lung volume (vol), parenchymal air volume, and parenchymal tissue volume versus body length. All three parameters increased significantly with increasing body length ( Table 3 ).

Table 2

Lung Volume and Weight Versus Body Length

Outcome Intercept SE Intercept Length (cm)P__R 2 n Total lung volume (cm 3 ) −718.62 151.47 17.07 <.0001 0.68 38 Air volume (cm 3 ) −613.40 133.23 13.90 <.0001 0.65 38 Tissue volume (cm 3 ) −105.22 29.11 3.17 <.0001 0.67 38 Lung tissue weight (g) −112.05 31.01 3.38 <.0001 0.67 38 Hounsfield units −651.94 45.49 −1.32 .0289 0.13 38

SE, standard error.

Figure 4, Lung tissue weight versus body length. Solid squares represent lung weights calculated from computed tomographic images and linear regression (solid line); open squares represent lung weights calculated from computed tomographic images adjusted for pulmonary blood volume and linear regression (dashed line); dotted line represents linear regression for weight from autopsied lungs.

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Figure 5, Parenchymal air volume increased linearly with parenchymal tissue weight. The slope of the linear regression, lung expansion, was 3.6 mL of air per gram of tissue.

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Airways

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Figure 6, Luminal cross-sectional area versus body length for airway generations. Individual data points are plotted, as well as the linear regression equations, which demonstrated significant increases in cross-sectional area with increasing body length ( Table 2 ). Solid circles and solid line represent the trachea; open circles and long-dashed line represent the right main bronchus (RMB); solid triangles and short-dashed line represent the bronchus intermedius (Bronint); open squares and long-dashed and short-dashed line represent RLL7; and crosses dotted line represent TriRLL.

Table 3

Airway Size Versus Body Length

Airway Outcome Intercept SE Intercept Length_P_ Length_R_ 2 n Trachea Inner area (mm 2 ) −28.10 9.01 0.91 <.0001 0.63 38 Outer area (mm 2 ) −27.17 15.36 1.34 <.0001 0.56 38 Wall area (mm 2 ) 0.92 8.67 0.43 .0004 0.29 38 Outer/inner area 0.39 0.06 0.00 .007 0.19 38 RMB Inner area (mm 2 ) −33.32 7.77 0.82 <.0001 0.65 38 Outer area (mm 2 ) −48.80 13.24 1.39 <.0001 0.65 38 Wall area (mm 2 ) −15.48 6.59 0.57 <.0001 0.56 38 Outer/inner area 0.38 0.05 0.00 .0098 0.17 38 Bronint Inner area (mm 2 ) −14.80 6.34 0.44 <.0001 0.45 38 Outer area (mm 2 ) −20.75 11.14 0.81 <.0001 0.47 38 Wall area (mm 2 ) −5.95 5.53 0.36 <.0001 0.42 38 Outer/inner area 0.33 0.05 0.00 .013 0.16 38 TriRLL7 Inner area (mm 2 ) −14.03 4.62 0.35 <.0001 0.5 37 Outer area (mm 2 ) −19.61 8.43 0.65 <.0001 0.51 37 Wall area (mm 2 ) −5.58 4.41 0.30 <.0001 0.46 37 Outer/inner area 0.24 0.05 0.00 .0014 0.26 37 TriRLL Inner area (mm 2 ) −5.49 4.06 0.21 .0003 0.33 35 Outer area (mm 2 ) −7.82 7.56 0.45 <.0001 0.4 35 Wall area (mm 2 ) −2.33 4.06 0.24 <.0001 0.39 35 Outer/inner area 0.30 0.06 0.00 .1378 0.07 35

Bronint, bronchus intermedius; RMB, right main bronchus; SE, standard error.

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Figure 7, Log-transformed luminal cross-sectional area versus airway generation for subjects grouped by body length into upper, middle, and lower thirds. Cross-sectional area decreased with increasing airway generation for each of the three height groups; there was no significant interaction between generation and body length. Bronint, bronchus intermedius; RMB, right main bronchus; TriRLL.

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Discussion

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Acknowledgments

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Academic Radiology, Volume 17, Issue 9
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