Computed tomography in the assessment of diaphragm dysfunction: current evidence, comparison with ultrasound, and future perspectives

The diaphragm serves as a crucial respiratory muscle in the human body, contributing 60%–80% of the work of breathing at rest. Diaphragmatic dysfunction (DD) may arise from multiple factors, including prolonged mechanical ventilation, surgical trauma, and inflammatory responses. This dysfunction escalates respiratory effort, increases the incidence of pulmonary complications, and prolongs hospital stays. Even unilateral DD can cause ventilatory abnormalities and impaired gas exchange, complicating weaning processes in ICU patients and raising the incidence of ventilator-associated diaphragmatic dysfunction. Consequently, safeguarding and monitoring diaphragmatic function is essential, making the accurate identification of DD critical. Ultrasound is currently a widely employed tool for evaluating diaphragmatic function; however, clinical practice has uncovered certain limitations inherent to this method. Relevant studies were sourced from publicly accessible databases, such as PubMed and Web of Science, focusing on CT morphological parameters, diagnostic thresholds, and clinical applications in diverse patient populations. Recent findings indicate an increased application of CT in diaphragm assessment, offering complementary structural information to ultrasound. Despite this progress, existing literature lacks a comprehensive review of CT-based evaluations of DD and comparisons with ultrasound, which has led to the underutilization of CT's potential for rapid and accurate assessment of diaphragmatic function and subsequent guidance for diagnosis and treatment. This article aims to summarize the current applications of CT in assessing diaphragmatic function, compare these findings with ultrasound, analyze the potential advantages of CT, and outline future research directions in this area.