Goitre-induced ventilation impairment

Hoeben, B.W. (2015) Goitre-induced ventilation impairment.

Abstract:Goitre-induced trachea compression (GITC) may increase airway resistance to such an extent that ventilation capacity is impaired and physical performance is reduced. Objective assessment of these ventilation impairments may help to strengthen the indications for goire reduction. The aim of this thesis was to devise a model for objective assessment of GITC and define how these results should be interpreted. First an automated segmentation tool was devised for objective assessment of trachea dimension in CT-data. A novel model for the interpretation of these dimensions was devised using simplified fluid dynamics. Obtained trachea dimensions were used to calculate airway resistance and its effects on maximal achievable airflow. Ventilation capacity of the trachea was expressed as maximal ventilation capacity (MVC), defined as the calculated peak flow in the diseased state divided by the calculated peak flow in the healthy state. The MVC reflects the patient�s potential ventilation capacity in the absence of cardiac or pulmonary disease, and this is the key to assess the limitations in daily life activities exclusively causes by a compressive goitre. First this model was applied to pre- and post-operative CT-scan data from 10 patients with varying degrees of trachea narrowing to test its applicability. Preliminary results of this pilot study suggested the MVC might be a valuable tool for the assessment of clinical impact of GITC. Thereafter a retrospective study was initiated, this study identified potential other useful Radiological Parameters such as the minimal cross-sectional area (CSAm) and percentage trachea constriction (- TC). Reference values for these additional RP and MVC were established using CT-data of 55 control patients. Thereafter the correlation between these RP and reported sensations dyspnea was tested in 72 patients with varying degrees of GITC. It was recognised that quality of these reported symptoms were suboptimal, therefore a exploratory prospective study was initiated. This exploratory study identified other potential measures which could be used to validate the RP proposed during the retrospective study and how they should be applied. Based on the results of this exploratory study a follow-up prospective study was initiated aimed to identify the most relevant measures for assessment of GITC. Due to the low sample size this study has not been able to generate conclusive statements regarding the assessment of GITC. However, preliminary results suggest that will change with the conclusion of additional patients.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/69018
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