Objective: To evaluate the diagnostic value of ultra-high-resolution computed tomography (UHCT) in assessing small airway disease (SAD) in patients with emphysema and analyse its correlation with quantitative expiratory CT parameters, while comparing the performance of different CT systems. Methods: In this prospective study, 120 emphysema patients underwent CT scanning using 3 different systems: GE Revolution CT (256-slice), Philips IQon Elite Spectral CT, and GE Discovery CT750 HD (64-slice). Small airway measurements were performed from the third to seventh-generation airways, and quantitative CT parameters were analysed. Results: The GE Revolution CT (256-slice) enabled visualization of airways up to the seventh generation in 82% of cases, compared with 68% using Philips IQon Elite Spectral CT and 53% using GE Discovery CT750 HD ( P <0.001). Fourth-generation airway WA% showed strong negative correlation with FEV1% predicted ( r =−0.72, P <0.001). The GE Revolution CT (256-slice) demonstrated superior reproducibility for wall-area measurements and lower radiation doses while maintaining superior image quality. Conclusion: Ultra-high-resolution CT demonstrates superior capabilities in evaluating SAD in patients with emphysema, providing more precise and reproducible measurements compared with conventional CT systems. The strong correlations between structural and functional parameters validate the clinical relevance of these imaging biomarkers. The improved visualisation and quantification of distal airways, achieved with acceptable radiation exposure, represents an important advancement in SAD assessment.
Yang et al. (2026) studied this question.