INTRODUCTION:Systemic juvenile idiopathic arthritis-associated lung disease (SJIA-LD) is increasingly recognized and associated with potentially life-threatening complications. Diagnosis is challenging as SJIA-LD is complex and frequently presents with subtle or no respiratory symptoms, necessitating CT imaging or other tests to detect budding dysfunction. We hypothesized that xenon and proton lung MRI could identify SJIA-LD-associated structural changes and functional deficits. METHODS:Thirty-one participants aged 5-15 (16 healthy, 7 SJIA without diagnosed lung disease [SJIA-non-LD], 8 SJIA-LD) underwent MRI for this cross-sectional study. Participants underwent xenon ventilation MRI (14 healthy/6 SJIA-non-LD/7 SJIA-LD), xenon gas-exchange MRI (12 healthy/3 SJIA-non-LD/5 SJIA-LD), and/or proton ultrashort echo time (UTE) MRI (12 healthy/5 SJIA-non-LD/7 SJIA-LD). Ventilation defect percentage (VDP) and ratios of xenon signal in alveolar membrane (Membrane), red blood cells (RBC), and gas were calculated from xenon MR images. CTs and PFTs were obtained from participant medical records where available for comparison. RESULTS:RBC/Membrane differed significantly (p = 0.014) between healthy individuals and SJIA-LD patients, and corresponded with DLCO results in a limited sample of participants with both measurements. VDP did not differ significantly between groups (p = 0.30), but was abnormally high in 3/7 SJIA-LD patients. SJIA-LD pattern findings in UTE MRI were detected in 4/7 SJIA-LD patients and in no healthy or SJIA-non-LD participants (p < 0.001). CONCLUSION:Xenon and proton lung MRI can identify SJIA-LD-associated pulmonary abnormalities, with RBC/Membrane showing particular promise for characterization of pulmonary diffusion limitation in SJIA-LD. Future studies will evaluate lung MRI for SJIA-LD phenotyping and longitudinal monitoring of SJIA-associated lung function changes.

RATIONALE AND OBJECTIVES:Hyperpolarized 129Xe magnetic resonance imaging (MRI) can sensitively detect subtle abnormalities in subjects with pulmonary disease. In this work, we assess lung disease progression and treatment response to Lumacaftor/Ivacaftor in patients with cystic fibrosis. METHODS:18 cystic fibrosis (CF) patients underwent a longitudinal study: nine subjects (8.7±2.4years, 3M/6F) initiated lumacaftor/ivacaftor therapy (48±51days post-Visit 1), and 9 (15.3±4.3years, 5M/4F) served as controls. Spirometry, multiple breath washout (Lung Clearance Index, LCI2.5), and 129Xe MRI were acquired at baseline, short-term (6±3months), and long-term (15±4months) follow-ups. Changes in spirometry measurements, LCI, ventilation defect percentage (VDP), and defect distribution index (DDI) assessed by 129Xe MRI, were compared between groups using non-parametric tests. RESULTS:The control group was significantly older (P=0.0028) and trended toward higher initial VDP (14.7±8.1% vs 6.9±6.0%) and DDI (14.4±24.7 vs 4.7±4.3). Baseline spirometry and LCI showed no differences between groups. In the treatment group, VDP and DDI remained stable after treatment (ΔVDP12= -0.56±2.1%, ΔDDI12= 1.1±4.0) but the change was significantly lower than in controls (ΔVDP12= 2.75±2.82%, P=0.018; DDI12= 8.88±7.42, P=0.007). From Visit-2 to Visit-3, VDP increased significantly in the treatment group (ΔVDP23 = 3.33±2.79%, P=0.025) versus controls (ΔVDP23= -1.7±4.8%). No significant changes occurred in spirometry or LCI. CONCLUSION:129Xe MRI demonstrated high sensitivity in detecting functional changes between pediatric CF patients on and off modulator therapy. In the short term, 129Xe ventilation measures remained stable with modulator therapy and demonstrated declines in the 2 years following. These findings highlight 129Xe MRI's potential as a valuable clinical tool for monitoring lung function and disease progression, even with small cohorts of patients.

Rationale: Systemic juvenile idiopathic arthritis-associated lung disease (SJIA-LD) is increasingly common and associated with significant and potentially life-threatening complications. Diagnosis is challenging as patients frequently present with mild respiratory symptoms, and pulmonary function testing for screening is difficult in young children. Xenon (Xe) ventilation magnetic resonance imaging (MRI) measures regional airflow obstruction, and Xe gas-exchange MRI is a spectroscopic imaging technique that discriminates Xe in the airspaces from Xe diffused in interstitial tissue and/or blood plasma or bound to hemoglobin, akin to a spatially-resolved diffusion-capacity measurement. We hypothesized Xe MRI would reveal abnormal ventilation and gas-exchange features in children with SJIA-LD. Methods: Twenty-two participants – 14 healthy (6 female, 5ꟷ13 years) and 8 with SJIA-LD (6 female, 5ꟷ15 years) – underwent Xe ventilation MRI using a 2D multi-slice Cartesian sequence at 3T. Eighteen participants (12 healthy and 6 with SJIA-LD) underwent Xe gas-exchange MRI using a 3D radial sequence. Ventilation defect percentage (VDP) was defined as the percent of voxels with intensity lower than 60% of the mean intensity in segmented, bias-corrected Xe ventilation images. Images of Xe as free gas in the alveoli (Gas), diffused in alveolar membrane (Mbr), and bound to hemoglobin in red blood cells (RBC) were reconstructed from gas-exchange data and normalized to one another to produce images of Mbr/Gas, RBC/Gas, and RBC/Mbr. Groups were compared using Wilcoxon rank-sum tests. Results: VDP was statistically significantly higher (p = 0.015) in the SJIA-LD group (median = 2.0%; interquartile range = 11%) than in the healthy group (1.1%; 0.7%). RBC/Mbr was statistically significantly lower (p = 0.024) in the SJIA-LD group (0.40; 0.07) than in the healthy group (0.49; 0.11). No statistically significant groupwise differences in Mbr/Gas (p = 0.96) or RBC/Gas (p = 0.34) were observed. The figure shows example Xe ventilation and RBC/Mbr images for each of the two groups, as well as boxplots comparing these two outcomes between the groups. Ventilation defects and low RBC/Mbr were observed in the SJIA-LD participant compared to the healthy participant. Conclusion: Xe MRI revealed differences in ventilation and diffusion between healthy children and those with SJIA-LD, similar to reported features in adult interstitial lung diseases. Lower RBC/Mbr in SJIA-LD suggests abnormalities such as interstitial inflammation and/or fibrosis that allow increased accumulation of Xe in the diffusion barrier, impeding transfer to RBCs. Ongoing work aims to develop Xe MRI biomarkers to screen children with SJIA for early lung disease.

PURPOSE:Hyperpolarized 129Xe MRI presents opportunities to assess regional pulmonary microstructure and function. Ongoing advancements in hardware, sequences, and image processing have helped it become increasingly adopted for both research and clinical use. As the number of applications and users increase, standardization becomes crucial. To that end, this study developed an executable, open-source 129Xe image processing pipeline (XIPline) to provide a user-friendly, graphical user interface-based analysis pipeline to analyze and visualize 129Xe MR data, including scanner calibration, ventilation, diffusion-weighted, and gas exchange images. METHODS:The customizable XIPline is designed in MATLAB to analyze data from all three major scanner platforms. Calibration data is processed to calculate optimal flip angle and determine129Xe frequency offset. Data processing includes loading, reconstructing, registering, segmenting, and post-processing images. Ventilation analysis incorporates three common algorithms to calculate ventilation defect percentage and novel techniques to assess defect distribution and ventilation texture. Diffusion analysis features ADC mapping, modified linear binning to account for ADC age-dependence, and common diffusion morphometry methods. Gas exchange processing uses a generalized linear binning for data acquired using 1-point Dixon imaging. RESULTS:The XIPline workflow is demonstrated using analysis from representative calibration, ventilation, diffusion, and gas exchange data. CONCLUSION:The application will reduce redundant effort when implementing new techniques across research sites by providing an open-source framework for developers. In its current form, it offers a robust and adaptable platform for 129Xe MRI analysis to ensure methodological consistency, transparency, and support for collaborative research across multiple sites and MRI manufacturers.

BackgroundMRI with xenon‐129 gas (Xe MRI) can assess airflow obstruction and heterogeneity in lung diseases. Specifically, Xe MRI may represent a sensitive modality for future therapeutic trials of cystic fibrosis (CF) therapies. The reproducibility of Xe MRI has not yet been assessed in the context of a multi‐site study.PurposeTo determine the same‐day repeatability and 28‐day reproducibility of Xe MRI in children with CF.Study TypeFour‐center prospective, longitudinal.PopulationThirty‐eight children (18 females, 47%), median interquartile range (IQR) age 12 (9–14) years old, with mild CF (forced expiratory volume in 1 second (FEV1) ≥85% predicted).Field Strength/Sequence3‐T, two‐dimensional (2D) gradient‐echo (GRE) sequence.AssessmentXe MRI, FEV1, and nitrogen multiple‐breath wash‐out for lung‐clearance index (LCI2.5) were performed. To assess same‐day reproducibility, Xe MRI was performed twice within the first visit, and procedures were repeated at 28 days. Xe hypoventilation was quantified using ventilation‐defect percentage (VDP) and reader‐defect volume (RDV). For VDP, hypoventilated voxels from segmented images were identified using a threshold of <60% mean whole‐lung signal and expressed as a percentage of the lung volume. For RDV, hypoventilation was identified by two trained readers and expressed as a percentage.Statistical TestsInter‐site comparisons were conducted using Kruskal–Wallis nonparametric tests with Dunn's multiple‐comparisons tests. Differences for individuals were assessed using Wilcoxon matched‐pairs tests. Bland–Altman tests were used to evaluate same‐day repeatability, 28‐day reproducibility, and inter‐reader agreement. A P‐value ≤0.05 was considered significant.ResultsMedian FEV1 %‐predicted was 96.8% (86%–106%), and median LCI2.5 was 6.6 (6.3–7.4). Xe MRI had high same‐day reproducibility (mean VDP difference 0.12%, 95% limits of agreement [−3.2, 3.4]; mean RDV difference 0.42% [−2.5, 3.3]). At 28 days, 26/31 participants (84%) fell within the same‐day 95% limits of agreement.Data ConclusionXe MRI may offer excellent same‐day and short‐term reproducibility.Evidence Level2Technical EfficacyStage 2

RATIONALE:Organ size matching is an important determinant of successful allocation and outcomes in lung transplantation. While computed tomography (CT) is the gold standard, it is rarely used in an organ-donor context, and chest X-ray (CXR) may offer a practical and accurate solution in estimating lung volumes for donor and recipient size matching. We compared CXR lung measurements to CT-measured lung volumes and traditional estimates of lung volume in the same subjects. METHODS:Our retrospective study analyzed clinically obtained CXR and CT lung images of 250 subjects without evidence of lung disease (mean age 9.9 ± 7.8 years; 129 M/121F). From CT, each lung was semi-automatically segmented and total lung volumes were quantified. From anterior-posterior CXR view, each lung was manually segmented and areas were measured. Lung lengths from the apices to the mid-basal regions of each lung were measured from CXR. Quantified CT lung volumes were compared to the corresponding CXR lung lengths, CXR lung areas, height, weight, and predicted total lung capacity (pTLC). RESULTS:There are strong and significant correlations between CT volumes and CXR lung areas in the right lung (R2  = .89, p < .0001), left lung (R2  = .87, p < .0001), and combined lungs (R2  = .89, p < .0001). Similar correlations were seen between CT volumes and CXR measured lung lengths in the right lung (R2  = .79, p < .0001) and left lung (R2  = .81, p < .0001). This correlation between anatomical lung volume (CT) and CXR was stronger than lung-volume correlation to height (R2  = .66, p < .0001), weight (R2  = .43, p < .0001), or pTLC (R2  = .66, p < .0001). CONCLUSION:CXR measures correlate much more strongly with true lung volumes than height, weight, or pTLC. The ability to obtain efficient and more accurate lung volume via CXR has the potential to change our current listing practices of using height as a surrogate for lung size, with a case example provided.

Patients who suffer OHCA are at risk for early onset pneumonia due to loss of airway protection, emergency airway access and intubation, CPR, mechanical ventilation, among other complications. It is difficult to accurately diagnose early onset pneumonia post OHCA due to multi-organ dysfunction post arrest and radiography findings confounded by non-infectious inflammation from CPR and aspiration. As a result, a substantial number of patients receive empiric antibiotics. A bronchoalveolar lavage (BAL) can screen for the presence of bacteria in the lungs and aid in identifying the incidence of early onset pneumonia after OHCA. We implemented a quality improvement (QI) initiative to collect a BAL on initial patient presentation to our hospital in May 2018. We conducted an observational, retrospective study to assess the impact of BAL implementation on empiric antibiotic prescribing. We used a rigorous study definition of pneumonia requiring at least two of the following positive within the same 24-hour period: BAL, chest radiography, and/or a fever >38°C. We compared rates of antibiotic prescription in the first 7 days of hospitalization for patients receiving a BAL to those without, as well as rates of antibiotic prescriptions before and after implementation of the BAL QI initiative. Implementation of initial BAL collection was successful and resulted in a 66% increase of BALs (from 44 to 73 BALs) collected compared to an average from the prior 2 years. We hypothesized rates of antibiotic prescription would decrease post-implementation of BAL collection; however, there was no statistically significant change in rate of antibiotic prescription (Figure 1) over the initial 7-day hospitalization period X 2 ( Df = 1, N = 3247) = 0.68, p = 0.54. Over 80% of patients with pneumonia received antibiotics, roughly 60% of OHCA patients received antibiotics despite no pneumonia diagnosis by any definition. Further study is needed to alter these practices and reduce antibiotic overuse.

Results: Viscoelasticity was not statistically significantly different between CF and non-CF samples ( p = 0.44), which was corroborated by the absence of a statistically significant difference in solid fraction ( p = 0.62).In contrast, critical stress, and thus mucus ability to flow, was statistically significantly different ( p = 0.003) between the populations, the average critical stress of CF sputum being lower than that of non-CF CMOD (15 Pa vs. 22 Pa) (Figure 1).Conclusions: There was no statistically significant difference in mucus rheology between people with CF and people with non-CF CMOD, despite the distinct origin of the pathology and the fact that CF sputa appear much more heterogeneous than non-CF sputa.The rheological marker of "flowability," σ c , is statistically distinct, and we hypothesize that it is a signature of the distinct inflammation level between pathologies, because eosinophilic inflammation has been previously correlated with flowability in CMOD [2].

Background: Airway clearance therapy (ACT) with a high-frequency chest wall oscillation (HFCWO) vest is a common but time-consuming treatment. Its benefit to quality of life for cystic fibrosis (CF) patients is well established but has been questioned recently as new highly-effective modulator therapies begin to change the treatment landscape. 129 Xe ventilation MRI has been shown to be very sensitive to lung obstruction in mild CF disease, making it an ideal tool to identify and quantify subtle, regional changes. Methods: 20 CF patients (ages 20.7 +/- 5.1 years) refrained from performing ACT before arriving for a single-day visit. Multiple-breath washout (MBW), spirometry, Xe MRI, and ultrashort echo-time (UTE) MRI were obtained twice-before and after patients performed ACT using their prescribed HFCWO vests (average 4.7 +/- 0.5 h). UTE MRIs were scored for structural abnormalities, and standard functional metrics were obtained from MBW, spirometry, and Xe MRI-FEV 1,pp , LCI 2.5 , and VDP N4 , respectively.Results: Spirometry and Xe MRI detected significant improvements in lung function post-ACT. 15/20 patients showed improvements from a baseline median of 92% FEV 1,pp . Similarly, 16/20 patients showed improvements in Xe MRI from a baseline median of 15.2% VDP N4 . Average individual changes were + 2.6% in FEV 1,pp and -1.3% in VDP N4 , but without spatial correlations to easily-identifiable causative structural defects (e.g. mucus plugs or bronchiectasis) on UTE MRI.Conclusions: Lung function improved after a single instance of HFCWO-vest ACT and was detectable by spirometry and Xe MRI. The only common structural abnormalities were mucus plugs, which corresponded to ventilation defects, but ventilation defects were often present without visible abnormalities.(c) 2023 Published by Elsevier B.V. on behalf of European Cystic Fibrosis Society.

Rationale: There is no agreed upon method for quantifying ventilation defect percentage (VDP) with high sensitivity and specificity from hyperpolarized (HP) gas ventilation MR images in multiple pulmonary diseases for both pediatrics and adults, yet identifying such methods will be necessary for future multi-site trials. Most HP gas MRI ventilation research focuses on a specific pulmonary disease and utilizes one quantification scheme for determining VDP. Here we sought to determine the potential of different methods for quantifying VDP from HP Xe-129 images in multiple pulmonary diseases through comparison of the most utilized quantification schemes: linear binning and thresholding. Materials and Methods: HP Xe-129 MRI was performed in a total of 176 subjects (125 pediatrics and 51 adults, age 20.98 +/- 16.48 years) who were either healthy controls (n = 23) or clinically diagnosed with cystic fibrosis (CF) (n = 37), lymphangioleiomyomatosis (LAM) (n = 29), asthma (n = 22), systemic juvenile idiopathic arthritis (sJIA) (n = 11), interstitial lung disease (ILD) (n = 7), or were bone marrow transplant (BMT) recipients (n = 47). HP Xe-129 ventilation images were acquired during a <= 16 second breath-hold using a 2D multi-slice gradient echo sequence on a 3T Philips scanner (TR/TE 8.0/4.0ms, FA 10-12 degrees, FOV 300 x 300mm, voxel size approximate to 3 x 3 x 15mm). Images were analyzed using 5 different methods to quantify VDPs: linear binning (histogram normalization with binning into 6 clusters) following either linear or a variant of a nonparametric nonuniform intensity normalization algorithm (N4ITK) bias-field correction, thresholding <= 60% of the mean signal intensity with linear bias-field correction, and thresholding <= 60% and <= 75% of the mean signal intensity following N4ITK bias-field correction. Spirometry was successfully obtained in 84% of subjects. Results: All quantification schemes were able to label visually identifiable ventilation defects in similar regions within all subjects. The VDPs of control subjects were significantly lower (p<0.05) compared to BMT, CF, LAM, and ILD subjects for most of the quantification methods. No one quantification scheme was better able to differentiate individual disease groups from the control group. Advanced statistical modeling of the VDP quantification schemes revealed that in comparing controls to the combined disease group, N4ITK bias-field corrected 60% thresholding had the highest predictive efficacy, sensitivity, and specificity at the VDP cut-point of 2.3%. However, compared to the thresholding quantification schemes, linear binning was able to capture and label subtle low-ventilation regions in subjects with milder obstruction, such as subjects with asthma. Conclusion: The difference in VDP between healthy controls and patients varied between the different disease states for all quantification methods. Although N4ITK bias-field corrected 60% thresholding was superior in separating the combined diseased group from controls, linear binning is able to better label low-ventilation regions unlike the current, 60% thresholding scheme. For future clinical trials, a consensus will need to be reached on which VDP scheme to utilize, as there are subtle advantages for each for specific disease.

Background: Measurement of regional lung ventilation with hyperpolarized Xe-129 magnetic resonance imaging (Xe-129 MRI) in pediatric asthma is poised to advance our understanding of disease mechanisms and pathophysiology in a disorder with diverse clinical phenotypes. Xe-129 MRI has not been investigated in a pediatric asthma cohort. Objective: We hypothesized that Xe-129 MRI is feasible and can demonstrate ventilation defects that relate to and predict clinical severity in a pediatric asthma cohort. Methods: Thirty-seven children (13 with severe asthma, 8 with mild/moderate asthma, 16 age-matched healthy controls) aged 6 to 17 years old were imaged with Xe-129 MRI. Ventilation defect percentage (VDP) and image reader score were calculated and compared with clinical measures at baseline and at follow-up. Results: Children with asthma had higher VDP (P=.002) and number of defects per image slice (defects/slice) (P=.0001) than children without asthma. Children with clinically severe asthma had significantly higher VDP and number of defects/slice than healthy controls. Children with asthma who had a higher number of defects/slice had a higher rate of health care utilization (r=0.48; P=.03) and oral corticosteroid use (r=0.43; P=.05) at baseline. Receiver-operating characteristic analysis demonstrated that the VDP and number of defects/slice were predictive of increased health care utilization, asthma, and severe asthma. VDP correlated with FEV1 (r=20.35; P=.04) and FEV1/forced vital capacity ratio (r=20.41; P=.01). Conclusions: Xe-129 MRI correlates with asthma severity, health care utilization, and oral corticosteroid use. Because delineation of clinical severity is often difficult in children, Xe-129 MRI may be an important biomarker for severity, with potential to identify children at higher risk for exacerbations and improve outcomes.

Background: Two functional measurements (multiple breath washout [MBW] and hyperpolarized Xe-129 ventilation magnetic resonance imaging [Xe-129 MRI]) have been shown to be more sensitive to cystic fibrosis (CF) lung obstruction than traditional spirometry. However, functional techniques may be sensitive to different underlying structural abnormalities. The purpose of this study was to determine relationships between these functional markers, their pathophysiology, and 1-year clinical outcomes. Methods: Spirometry, MBW, Xe-129 MRI, and ultrashort echo-time (UTE) MRI were obtained in a same-day assessment of 27 pediatric CF patients (ages 11.5 +/- 5.0) who had not begun CFTR modulator therapies. UTE MRI was scored for structural abnormalities and functional metrics obtained via spirometry, MBW and Xe-129 MRI. 1-year outcomes (Delta FEV1 and pulmonary exacerbations), during which approximate to 50% initiated modulator therapy, were obtained from the electronic medical record. Results: MBW, Xe-129 MRI, and UTE MRI detected clinically significant disease in more subjects (>78%) compared to spirometry (<30%). UTE MRI suggests increased odds of bronchial changes when mucus plugging is present in the same lobe. MBW and Xe-129 MRI correlated best with mucus plugging, while spirometry correlated best with consolidations. Bronchial abnormalities were associated with future pulmonary exacerbations. Conclusions: MBW, Xe-129 MRI, and UTE MRI are more sensitive for detection of pediatric CF lung disease when compared to spirometry. MBW and Xe-129 MRI correlated with structural abnormalities which occur in early CF disease, suggesting MBW and Xe-129 MRI are valuable tools in mild CF lung disease that can guide clinical decision making. (c) 2020 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

BACKGROUND:Smartphones are ubiquitous, and for some, an indispensable companion. In nursing education curricula and clinical healthcare settings, smartphones have the potential to augment student learning. Nursing students report significant benefits to smartphone use, which extend beyond learning, to include enhanced communication, clinical decision making and evidence-based practice. Despite these benefits, little is known about the negative impact of smartphones on student learning. OBJECTIVES:This integrative review aimed to synthesise findings from published research that referred to the detrimental direct or indirect effect of smartphone usage on nursing students. DESIGN:The integrative review was guided by the five-stage approach as conceptualised by Whittemore and Knafl (2005). METHODS:Seven electronic databases were systematically searched in consultation with a university librarian (CINAHL Plus, Ovid Medline ALL, Nursing and Allied Health Database, PsycINFO, PubMed, Scopus and ERIC) using a combination of key search terms and medical subject headings. A total of 646 articles were retrieved, and following removal of duplicates, screening of titles and abstracts, a final 27 articles met the inclusion criteria for this review. RESULTS:Studies in the review originated from Korea (n = 7), Turkey (n = 6), India (n = 4), Spain (n = 3), USA (n = 2), Spain/Portugal (n = 1), Iran (n = 1), France (n = 1), Canada (n = 1) and Egypt (n = 1). Personal smartphone use was reported to be a distraction within clinical and classroom learning, and considered as uncivil, and compromised professionalism. Frequently, smartphones were used for entertainment (e.g. social networking) rather than professional purposes. The studies identified a concerning level of nomophobia and smartphone addiction among nursing students that caused stress and anxiety, and adversely affected sleep, learning and academic performance. Recommendations were proposed for smartphone policies. CONCLUSIONS:Excessive smartphones use among nursing students may adversely affect physical and mental health and potentially impact on student learning within the classroom and clinical environment. Educators should consider the implementation of policies or guidance for the responsible use of smartphones by nursing students whilst in the classroom setting and during clinical placement, to mitigate the potential negative impact on health and academic performance.

Abstract Objective: Image scoring systems have been developed to assess the severity of specific lung abnormalities in patients diagnosed with various pulmonary diseases except for asthma. A comprehensive asthma imaging scoring system may identify specific abnormalities potentially linking these to inflammatory phenotypes. Methods: Computed tomography (CT) images of 88 children with asthma (50 M/38 F, mean age 7.8 ± 5.4 years) acquired within 12 months of bronchoscopic alveolar lavage fluid (BALF) sampling that assessed airway inflammation cell types were reviewed along with CT images of 49 controls (27 M/22 F, mean age 3.4 ± 2.2 years). Images were scored using a comprehensive scoring system to quantify bronchiectasis (BR), bronchial wall thickening (BWT), ground glass opacity, mucus plugging (MP), consolidations, linear densities (LD), and air trapping (AT). Each category was scored 0–2 in each of six lobar regions (with lingula separated from left upper lobe). Results: Absolute average overall scores of the controls and children with asthma were 0.72 ± 1.59 and 5.39 ± 5.83, respectively (P < 0.0001). Children with asthma scored significantly higher for BR (N = 20, 0.33 ± 0.80, P = 0.0002), BWT (N = 28, 0.72 ± 1.40, P < 0.0001), MP (N = 28, 0.37 ± 1.12, P = 0.0052), consolidation (N = 31, 0.67 ± 1.22, P < 0.0001), LD (N = 58, 1.12 ± 1.44, P < 0.0001), and AT (N = 52, 1.78 ± 2.31, P < 0.0001). There was a significant difference between the BR score of children with positive inflammatory response in BALF (N = 53) and those who were negative for airway inflammation cells (0.14 ± 0.36, P = 0.040). Conclusions: Significant lung structural abnormalities were readily identified on CT of children with asthma, with image differentiation of those with an inflammatory response on BALF. Chest imaging demonstrates potential as a noninvasive clinical tool for additional characterization of asthma phenotypes.