Computed Tomography–Based Quantitative Morphometry Reveals Distinct Airway Remodelling in COVID-19 versus Community-Acquired Pneumonia
DOI:
https://doi.org/10.51152/jbarbiomed.v11i1.254Keywords:
COVID-19, airway remodelling, computed tomography, bronchial geometry, pneumoniaAbstract
Purpose: To quantitatively characterize airway structural changes in COVID-19 and compare them to those observed in community-acquired pneumonia (CAP), using computed tomography (CT)-based Morphometry. The study aims to evaluate whether COVID-19 and CAP produce distinct patterns of airway remodelling across multiple geometric metrics. Materials and methods: High-resolution chest CT scans from 80 COVID-19 patients (stratified into low- and high-severity subgroups), 38 CAP patients, and 28 healthy controls were analysed. Airway parameters—hydraulic diameter (Dh (mm)), hydraulic ratio (Xh), airway circularity (Cr), and airway thickness (TA (mm))—were measured across the first 5–6 bronchial generations using 3D reconstruction and geodesic labelling. Statistical comparisons employed Kruskal–Wallis and regression analyses. Results: COVID-19 exhibited proximal airway enlargement but distal narrowing, contrasting with CAP’s uniform reduction in airway efficiency (p < 0.01). Xh gradients revealed compensatory adaptation in COVID-19’s major airways (steeper slope in severe cases, p = 0.013) but significant distal dysfunction (−12% Xh vs. CAP, p < 0.001). Circularity showed focal geometric distortion in COVID-19 versus CAP’s homogeneous expansion (p < 0.001). TA (mm) analysis identified diffuse thinning in COVID-19 (vs. CAP’s mild thickening, p = 0.189), with superimposed focal thromboinflammatory thickenings. Conclusions: COVID-19 and CAP induce fundamentally different patterns of airway remodelling. COVID-19 is associated with proximal airway dilation and disrupted distal tapering, whereas CAP results in uniform narrowing. These morphometric profiles may contribute to differences in airflow limitation and ventilation–perfusion mismatch, which could inform disease-specific monitoring, prognostication, and selection of therapeutic strategies. Future research should explore the relationship between these structural signatures and clinical outcomes, including recovery trajectory and long-term pulmonary function.
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