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Sotoudeh-Paima S, Segars WP, Ghosh D, Luo S, Samei E, Abadi E. A systematic assessment and optimization of photon-counting CT for lung density quantifications. Med Phys 2024; 51:2893-2904. [PMID: 38368605 PMCID: PMC11055522 DOI: 10.1002/mp.16987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Photon-counting computed tomography (PCCT) has recently emerged into clinical use; however, its optimum imaging protocols and added benefits remains unknown in terms of providing more accurate lung density quantification compared to energy-integrating computed tomography (EICT) scanners. PURPOSE To systematically assess the performance of a clinical PCCT scanner for lung density quantifications and compare it against EICT. METHODS This cross-sectional study involved a retrospective analysis of subjects scanned (August-December 2021) using a clinical PCCT system. The influence of altering reconstruction parameters was studied (reconstruction kernel, pixel size, slice thickness). A virtual CT dataset of anthropomorphic virtual subjects was acquired to demonstrate the correspondence of findings to clinical dataset, and to perform systematic imaging experiments, not possible using human subjects. The virtual subjects were imaged using a validated, scanner-specific CT simulator of a PCCT and two EICT (defined as EICT A and B) scanners. The images were evaluated using mean absolute error (MAE) of lung and emphysema density against their corresponding ground truth. RESULTS Clinical and virtual PCCT datasets showed similar trends, with sharper kernels and smaller voxel sizes increasing percentage of low-attenuation areas below -950 HU (LAA-950) by up to 15.7 ± 6.9% and 11.8 ± 5.5%, respectively. Under the conditions studied, higher doses, thinner slices, smaller pixel sizes, iterative reconstructions, and quantitative kernels with medium sharpness resulted in lower lung MAE values. While using these settings for PCCT, changes in the dose level (13 to 1.3 mGy), slice thickness (0.4 to 1.5 mm), pixel size (0.49 to 0.98 mm), reconstruction technique (70 keV-VMI to wFBP), and kernel (Qr48 to Qr60) increased lung MAE by 15.3 ± 2.0, 1.4 ± 0.6, 2.2 ± 0.3, 4.2 ± 0.8, and 9.1 ± 1.6 HU, respectively. At the optimum settings identified per scanner, PCCT images exhibited lower lung and emphysema MAE than those of EICT scanners (by 2.6 ± 1.0 and 9.6 ± 3.4 HU, compared to EICT A, and by 4.8 ± 0.8 and 7.4 ± 2.3 HU, compared to EICT B). The accuracy of lung density measurements was correlated with subjects' mean lung density (p < 0.05), measured by PCCT at optimum setting under the conditions studied. CONCLUSION Photon-counting CT demonstrated superior performance in density quantifications, with its influences of imaging parameters in line with energy-integrating CT scanners. The technology offers improvement in lung quantifications, thus demonstrating potential toward more objective assessment of respiratory conditions.
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Affiliation(s)
- Saman Sotoudeh-Paima
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, USA
- Department of Electrical & Computer Engineering, Duke University, Durham, USA
| | - W. Paul Segars
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, USA
- Medical Physics Graduate Program, Duke University, Durham, USA
- Department of Biomedical Engineering, Duke University, Durham, USA
| | - Dhrubajyoti Ghosh
- Department of Biostatistics and Bioinformatics, Duke University, Durham, USA
| | - Sheng Luo
- Department of Biostatistics and Bioinformatics, Duke University, Durham, USA
| | - Ehsan Samei
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, USA
- Department of Electrical & Computer Engineering, Duke University, Durham, USA
- Medical Physics Graduate Program, Duke University, Durham, USA
- Department of Biomedical Engineering, Duke University, Durham, USA
- Department of Physics, Duke University, Durham, USA
| | - Ehsan Abadi
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, USA
- Department of Electrical & Computer Engineering, Duke University, Durham, USA
- Medical Physics Graduate Program, Duke University, Durham, USA
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2
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Vegas Sánchez-Ferrero G, Díaz AA, Ash SY, Baraghoshi D, Strand M, Crapo JD, Silverman EK, Humphries SM, Washko GR, Lynch DA, San José Estépar R. Quantification of Emphysema Progression at CT Using Simultaneous Volume, Noise, and Bias Lung Density Correction. Radiology 2024; 310:e231632. [PMID: 38165244 PMCID: PMC10831481 DOI: 10.1148/radiol.231632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
Background CT attenuation is affected by lung volume, dosage, and scanner bias, leading to inaccurate emphysema progression measurements in multicenter studies. Purpose To develop and validate a method that simultaneously corrects volume, noise, and interscanner bias for lung density change estimation in emphysema progression at CT in a longitudinal multicenter study. Materials and Methods In this secondary analysis of the prospective Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study, lung function data were obtained from participants who completed baseline and 5-year follow-up visits from January 2008 to August 2017. CT emphysema progression was measured with volume-adjusted lung density (VALD) and compared with the joint volume-noise-bias-adjusted lung density (VNB-ALD). Reproducibility was studied under change of dosage protocol and scanner model with repeated acquisitions. Emphysema progression was visually scored in 102 randomly selected participants. A stratified analysis of clinical characteristics was performed that considered groups based on their combined lung density change measured by VALD and VNB-ALD. Results A total of 4954 COPDGene participants (mean age, 60 years ± 9 [SD]; 2511 male, 2443 female) were analyzed (1329 with repeated reduced-dose acquisition in the follow-up visit). Mean repeatability coefficients were 30 g/L ± 0.46 for VALD and 14 g/L ± 0.34 for VNB-ALD. VALD measurements showed no evidence of differences between nonprogressors and progressors (mean, -5.5 g/L ± 9.5 vs -8.6 g/L ± 9.6; P = .11), while VNB-ALD agreed with visual readings and showed a difference (mean, -0.67 g/L ± 4.8 vs -4.2 g/L ± 5.5; P < .001). Analysis of progression showed that VNB-ALD progressors had a greater decline in forced expiratory volume in 1 second (-42 mL per year vs -32 mL per year; Tukey-adjusted P = .002). Conclusion Simultaneously correcting volume, noise, and interscanner bias for lung density change estimation in emphysema progression at CT improved repeatability analyses and agreed with visual readings. It distinguished between progressors and nonprogressors and was associated with a greater decline in lung function metrics. Clinical trial registration no. NCT00608764 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Goo in this issue.
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Affiliation(s)
- Gonzalo Vegas Sánchez-Ferrero
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Alejandro A. Díaz
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Samuel Y. Ash
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - David Baraghoshi
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Matthew Strand
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - James D. Crapo
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Edwin K. Silverman
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Stephen M. Humphries
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - George R. Washko
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - David A. Lynch
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Raúl San José Estépar
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
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3
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Kim JS, Montesi SB, Adegunsoye A, Humphries SM, Salisbury ML, Hariri LP, Kropski JA, Richeldi L, Wells AU, Walsh S, Jenkins RG, Rosas I, Noth I, Hunninghake GM, Martinez FJ, Podolanczuk AJ. Approach to Clinical Trials for the Prevention of Pulmonary Fibrosis. Ann Am Thorac Soc 2023; 20:1683-1693. [PMID: 37703509 PMCID: PMC10704236 DOI: 10.1513/annalsats.202303-188ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/13/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- John S. Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | | | - Ayodeji Adegunsoye
- Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | | | - Margaret L. Salisbury
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine, and
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan A. Kropski
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Luca Richeldi
- Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Athol U. Wells
- Department of Radiology, and
- Interstitial Lung Disease Service, Royal Brompton Hospital, London, United Kingdom
| | - Simon Walsh
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - R. Gisli Jenkins
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ivan Rosas
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Gary M. Hunninghake
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Anna J. Podolanczuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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4
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Crapo JD, Gupta A, Lynch DA, Turner AM, Mroz RM, Janssens W, Ludwig-Sengpiel A, Koegler H, Eleftheraki A, Risse F, Diefenbach C. Baseline characteristics from a 3-year longitudinal study to phenotype subjects with COPD: the FOOTPRINTS study. Respir Res 2023; 24:290. [PMID: 37978492 PMCID: PMC10656819 DOI: 10.1186/s12931-023-02584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND FOOTPRINTS® is a prospective, longitudinal, 3-year study assessing the association between biomarkers of inflammation/lung tissue destruction and chronic obstructive pulmonary disease (COPD) severity and progression in ex-smokers with mild-to-severe COPD. Here, we present baseline characteristics and select biomarkers of study subjects. METHODS The methodology of FOOTPRINTS® has been published previously. The study population included ex-smokers with a range of COPD severities (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages 1-3), ex-smokers with COPD and alpha-1-antitrypsin deficiency (A1ATD) and a control group of ex-smokers without airflow limitation (EwAL). At study entry, data were collected for: demographics, disease characteristics, history of comorbidities and COPD exacerbations, symptoms, lung function and volume, exercise capacity, soluble biomarkers, and quantitative and qualitative computed tomography. Baseline data are presented with descriptive statistical comparisons for soluble biomarkers in the individual GOLD and A1ATD groups versus EwAL. RESULTS In total, 463 subjects were enrolled. The per-protocol set comprised 456 subjects, mostly male (64.5%). The mean (standard deviation) age was 60.7 (6.9) years. At baseline, increasing pulmonary symptoms, worse lung function, increased residual volume, reduced diffusing capacity of the lung for carbon monoxide (DLco) and greater prevalence of centrilobular emphysema were observed with increasing disease severity amongst GOLD 1-3 subjects. Subjects with A1ATD (n = 19) had similar lung function parameters to GOLD 2-3 subjects, a high residual volume comparable to GOLD 3 subjects, and similar air trapping to GOLD 2 subjects. Compared with EwAL (n = 61), subjects with A1ATD had worse lung function, increased residual volume, reduced DLco, and a greater prevalence of confluent or advanced destructive emphysema. The soluble inflammatory biomarkers white blood cell count, fibrinogen, high-sensitivity C-reactive protein and plasma surfactant protein were higher in GOLD 1-3 groups than in the EwAL group. Interleukin-6 was expressed less often in EwAL subjects compared with subjects in the GOLD and A1ATD groups. Soluble receptor for advanced glycation end product was lowest in GOLD 3 subjects, indicative of more severe emphysema. CONCLUSIONS These findings provide context for upcoming results from FOOTPRINTS®, which aims to establish correlations between biomarkers and disease progression in a representative COPD population. TRIAL REGISTRATION NUMBER NCT02719184, study start date 13/04/2016.
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Affiliation(s)
- James D Crapo
- Department of Medicine, National Jewish Health, Denver, CO, USA.
| | - Abhya Gupta
- TA Inflammation Medicine, Boehringer Ingelheim International GmbH, Biberach an Der Riss, Germany
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Robert M Mroz
- 2nd Department of Lung Diseases and Tuberculosis, Bialystok Medical University, Bialystok, Poland
| | - Wim Janssens
- Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATH), University Hospital Leuven, Louvain, KU, Belgium
| | | | - Harald Koegler
- TA Inflammation Medicine, Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Anastasia Eleftheraki
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Frank Risse
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Claudia Diefenbach
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
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5
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Castaldi PJ, Xu Z, Young KA, Hokanson JE, Lynch DA, Humphries SM, Ross JC, Cho MH, Hersh CP, Crapo JD, Strand M, Silverman EK. Heterogeneity and Progression of Chronic Obstructive Pulmonary Disease: Emphysema-Predominant and Non-Emphysema-Predominant Disease. Am J Epidemiol 2023; 192:1647-1658. [PMID: 37160347 PMCID: PMC11063557 DOI: 10.1093/aje/kwad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/20/2022] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
While variation in emphysema severity between patients with chronic obstructive pulmonary disease (COPD) is well-recognized, clinically applicable definitions of the emphysema-predominant disease (EPD) and non-emphysema-predominant disease (NEPD) subtypes have not been established. To study the clinical relevance of the EPD and NEPD subtypes, we tested the association of these subtypes with prospective decline in forced expiratory volume in 1 second (FEV1) and mortality among 3,427 subjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric grade 2-4 COPD at baseline in the Genetic Epidemiology of COPD (COPDGene) Study, an ongoing national multicenter study that started in 2007. NEPD was defined as airflow obstruction with less than 5% computed tomography (CT) quantitative densitometric emphysema at -950 Hounsfield units, and EPD was defined as airflow obstruction with 10% or greater CT emphysema. Mixed-effects models for FEV1 demonstrated larger average annual FEV1 loss in EPD subjects than in NEPD subjects (-10.2 mL/year; P < 0.001), and subtype-specific associations with FEV1 decline were identified. Cox proportional hazards models showed higher risk of mortality among EPD patients versus NEPD patients (hazard ratio = 1.46, 95% confidence interval: 1.34, 1.60; P < 0.001). To determine whether the NEPD/EPD dichotomy is captured by previously described COPDGene subtypes, we used logistic regression and receiver operating characteristic (ROC) curve analysis to predict NEPD/EPD membership using these previous subtype definitions. The analysis generally showed excellent discrimination, with areas under the ROC curve greater than 0.9. The NEPD and EPD COPD subtypes capture important aspects of COPD heterogeneity and are associated with different rates of disease progression and mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Edwin K Silverman
- Correspondence to Dr. Edwin K. Silverman, Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 (e-mail: )
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6
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Motahari A, Barr RG, Han MK, Anderson WH, Barjaktarevic I, Bleecker ER, Comellas AP, Cooper CB, Couper DJ, Hansel NN, Kanner RE, Kazerooni EA, Lynch DA, Martinez FJ, Newell JD, Schroeder JD, Smith BM, Woodruff PG, Hoffman EA. Repeatability of Pulmonary Quantitative Computed Tomography Measurements in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:657-665. [PMID: 37490608 PMCID: PMC10515564 DOI: 10.1164/rccm.202209-1698pp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 07/24/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
| | - R. Graham Barr
- Department of Medicine and
- Department of Epidemiology, Columbia University College of Medicine, New York, New York
| | | | - Wayne H. Anderson
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, University of California Los Angeles Medical Center, Los Angeles, California
| | | | - Alejandro P. Comellas
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Christopher B. Cooper
- Department of Medicine and
- Department of Physiology, University of California Los Angeles, Los Angeles, California
| | - David J. Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nadia N. Hansel
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | | | - Ella A. Kazerooni
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | | | - John D. Newell
- Department of Radiology and
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | | | - Benjamin M. Smith
- Department of Medicine and
- Department of Epidemiology, Columbia University College of Medicine, New York, New York
- Department of Medicine, McGill University, Montreal, Quebec, Canada; and
| | - Prescott G. Woodruff
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Eric A. Hoffman
- Department of Radiology and
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
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7
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Rose CS, Zell-Baran LM, Cool C, Moore CM, Wolff J, Oh AS, Koelsch T, Richards JC, Krefft SD, Wilson CG, Lynch DA. Findings on High Resolution Computed Tomography in Symptomatic Veterans with Deployment-Related Lung Disease. J Thorac Imaging 2023; 38:00005382-990000000-00093. [PMID: 37732711 PMCID: PMC10940183 DOI: 10.1097/rti.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE Military deployment to dusty, austere environments in Southwest Asia and Afghanistan is associated with symptomatic airways diseases including asthma and bronchiolitis. The utility of chest high-resolution computed tomographic (HRCT) imaging in lung disease diagnosis in this population is poorly understood. We investigated visual assessment of HRCT for identifying deployment-related lung disease compared with healthy controls. MATERIALS AND METHODS Chest HRCT images from 46 healthy controls and 45 symptomatic deployed military personnel with clinically confirmed asthma and/or biopsy-confirmed distal lung disease were scored by 3 independent thoracic radiologists. We compared demographic and clinical characteristics and frequency of imaging findings between deployers and controls, and between deployers with asthma and those with biopsy-confirmed distal lung disease, using χ2, Fisher exact or t tests, and logistic regression where appropriate. We also analyzed inter-rater agreement for imaging findings. RESULTS Expiratory air trapping was the only chest CT imaging finding that was significantly more frequent in deployers compared with controls. None of the 24 deployers with biopsy-confirmed bronchiolitis and/or granulomatous pneumonitis had HRCT findings of inspiratory mosaic attenuation or centrilobular nodularity. Only 2 of 21 with biopsy-proven emphysema had emphysema on HRCT. CONCLUSIONS Compared with surgical lung biopsy, visual assessment of HRCT showed few abnormalities in this small cohort of previously deployed symptomatic veterans with normal or near-normal spirometry.
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Affiliation(s)
- Cecile S Rose
- National Jewish Health, Division of Environmental and Occupational Health Sciences
- School of Medicine, University of Colorado
| | - Lauren M Zell-Baran
- National Jewish Health, Division of Environmental and Occupational Health Sciences
| | - Carlyne Cool
- National Jewish Health, Division of Environmental and Occupational Health Sciences
- School of Medicine, University of Colorado
| | - Camille M Moore
- National Jewish Health, Center for Genes, Environment and Health
- Department of Biostatistics and Informatics, University of Colorado
| | - Jenna Wolff
- National Jewish Health, Division of Environmental and Occupational Health Sciences
| | - Andrea S Oh
- National Jewish Health, Department of Radiology
| | | | - John C Richards
- National Jewish Health, Department of Radiology
- Radiology Imaging Associates
| | - Silpa D Krefft
- National Jewish Health, Division of Environmental and Occupational Health Sciences
- Veterans Administration Eastern Colorado Health Care System, Division of Pulmonary and Critical Care Medicine, Aurora, CO
| | - Carla G Wilson
- National Jewish Health, Research Informatics Services, Denver
| | - David A Lynch
- National Jewish Health, Department of Radiology
- School of Medicine, University of Colorado
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8
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Amudala Puchakayala PR, Sthanam VL, Nakhmani A, Chaudhary MFA, Kizhakke Puliyakote A, Reinhardt JM, Zhang C, Bhatt SP, Bodduluri S. Radiomics for Improved Detection of Chronic Obstructive Pulmonary Disease in Low-Dose and Standard-Dose Chest CT Scans. Radiology 2023; 307:e222998. [PMID: 37338355 PMCID: PMC10315520 DOI: 10.1148/radiol.222998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 06/21/2023]
Abstract
Background Approximately half of adults with chronic obstructive pulmonary disease (COPD) remain undiagnosed. Chest CT scans are frequently acquired in clinical practice and present an opportunity to detect COPD. Purpose To assess the performance of radiomics features in COPD diagnosis using standard-dose and low-dose CT models. Materials and Methods This secondary analysis included participants enrolled in the Genetic Epidemiology of COPD, or COPDGene, study at baseline (visit 1) and 10 years after baseline (visit 3). COPD was defined by a forced expiratory volume in the 1st second of expiration to forced vital capacity ratio less than 0.70 at spirometry. The performance of demographics, CT emphysema percentage, radiomics features, and a combined feature set derived from inspiratory CT alone was evaluated. CatBoost (Yandex), a gradient boosting algorithm, was used to perform two classification experiments to detect COPD; the two models were trained and tested on standard-dose CT data from visit 1 (model I) and low-dose CT data from visit 3 (model II). Classification performance of the models was evaluated using area under the receiver operating characteristic curve (AUC) and precision-recall curve analysis. Results A total of 8878 participants (mean age, 57 years ± 9 [SD]; 4180 female, 4698 male) were evaluated. Radiomics features in model I achieved an AUC of 0.90 (95% CI: 0.88, 0.91) in the standard-dose CT test cohort versus demographics (AUC, 0.73; 95% CI: 0.71, 0.76; P < .001), emphysema percentage (AUC, 0.82; 95% CI 0.80, 0.84; P < .001), and combined features (AUC, 0.90; 95% CI: 0.89, 0.92; P = .16). Model II, trained on low-dose CT scans, achieved an AUC of 0.87 (95% CI: 0.83, 0.91) on the 20% held-out test set for radiomics features compared with demographics (AUC, 0.70; 95% CI: 0.64, 0.75; P = .001), emphysema percentage (AUC, 0.74; 95% CI: 0.69, 0.79; P = .002), and combined features (AUC, 0.88; 95% CI: 0.85, 0.92; P = .32). Density and texture features were the majority of the top 10 features in the standard-dose model, whereas shape features of lungs and airways were significant contributors in the low-dose CT model. Conclusion A combination of features representing parenchymal texture and lung and airway shape on inspiratory CT scans can be used to accurately detect COPD. ClinicalTrials.gov registration no. NCT00608764 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Vliegenthart in this issue.
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Affiliation(s)
- Praneeth Reddy Amudala Puchakayala
- From the UAB Lung Imaging Lab (P.R.A.P., V.L.S., A.N., A.K.P.,
S.P.B., S.B.), Department of Computer Science (P.R.A.P., C.Z.), Department of
Electrical and Computer Engineering (V.L.S., A.N.), and Division of Pulmonary,
Allergy and Critical Care Medicine (A.K.P., S.P.B., S.B.), University of Alabama
at Birmingham, 1720 2nd Ave S, THT 422, Birmingham, AL 35294; and The Roy
J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City,
Iowa (M.F.A.C., J.M.R.)
| | - Venkata L. Sthanam
- From the UAB Lung Imaging Lab (P.R.A.P., V.L.S., A.N., A.K.P.,
S.P.B., S.B.), Department of Computer Science (P.R.A.P., C.Z.), Department of
Electrical and Computer Engineering (V.L.S., A.N.), and Division of Pulmonary,
Allergy and Critical Care Medicine (A.K.P., S.P.B., S.B.), University of Alabama
at Birmingham, 1720 2nd Ave S, THT 422, Birmingham, AL 35294; and The Roy
J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City,
Iowa (M.F.A.C., J.M.R.)
| | - Arie Nakhmani
- From the UAB Lung Imaging Lab (P.R.A.P., V.L.S., A.N., A.K.P.,
S.P.B., S.B.), Department of Computer Science (P.R.A.P., C.Z.), Department of
Electrical and Computer Engineering (V.L.S., A.N.), and Division of Pulmonary,
Allergy and Critical Care Medicine (A.K.P., S.P.B., S.B.), University of Alabama
at Birmingham, 1720 2nd Ave S, THT 422, Birmingham, AL 35294; and The Roy
J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City,
Iowa (M.F.A.C., J.M.R.)
| | - Muhammad F. A. Chaudhary
- From the UAB Lung Imaging Lab (P.R.A.P., V.L.S., A.N., A.K.P.,
S.P.B., S.B.), Department of Computer Science (P.R.A.P., C.Z.), Department of
Electrical and Computer Engineering (V.L.S., A.N.), and Division of Pulmonary,
Allergy and Critical Care Medicine (A.K.P., S.P.B., S.B.), University of Alabama
at Birmingham, 1720 2nd Ave S, THT 422, Birmingham, AL 35294; and The Roy
J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City,
Iowa (M.F.A.C., J.M.R.)
| | - Abhilash Kizhakke Puliyakote
- From the UAB Lung Imaging Lab (P.R.A.P., V.L.S., A.N., A.K.P.,
S.P.B., S.B.), Department of Computer Science (P.R.A.P., C.Z.), Department of
Electrical and Computer Engineering (V.L.S., A.N.), and Division of Pulmonary,
Allergy and Critical Care Medicine (A.K.P., S.P.B., S.B.), University of Alabama
at Birmingham, 1720 2nd Ave S, THT 422, Birmingham, AL 35294; and The Roy
J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City,
Iowa (M.F.A.C., J.M.R.)
| | - Joseph M. Reinhardt
- From the UAB Lung Imaging Lab (P.R.A.P., V.L.S., A.N., A.K.P.,
S.P.B., S.B.), Department of Computer Science (P.R.A.P., C.Z.), Department of
Electrical and Computer Engineering (V.L.S., A.N.), and Division of Pulmonary,
Allergy and Critical Care Medicine (A.K.P., S.P.B., S.B.), University of Alabama
at Birmingham, 1720 2nd Ave S, THT 422, Birmingham, AL 35294; and The Roy
J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City,
Iowa (M.F.A.C., J.M.R.)
| | - Chengcui Zhang
- From the UAB Lung Imaging Lab (P.R.A.P., V.L.S., A.N., A.K.P.,
S.P.B., S.B.), Department of Computer Science (P.R.A.P., C.Z.), Department of
Electrical and Computer Engineering (V.L.S., A.N.), and Division of Pulmonary,
Allergy and Critical Care Medicine (A.K.P., S.P.B., S.B.), University of Alabama
at Birmingham, 1720 2nd Ave S, THT 422, Birmingham, AL 35294; and The Roy
J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City,
Iowa (M.F.A.C., J.M.R.)
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9
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Vegas Sanchez-Ferrero G, San José Estépar R. The Value of Virtual Clinical Trials for the Assessment of the Effect of Acquisition Protocols in Emphysema Quantification. Chest 2023; 163:1001-1002. [PMID: 37164565 DOI: 10.1016/j.chest.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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10
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Baraghoshi D, Strand M, Humphries SM, San José Estépar R, Vegas Sanchez-Ferrero G, Charbonnier JP, Latisenko R, Silverman EK, Crapo JD, Lynch DA. Quantitative CT Evaluation of Emphysema Progression over 10 Years in the COPDGene Study. Radiology 2023; 307:e222786. [PMID: 37039685 PMCID: PMC10286952 DOI: 10.1148/radiol.222786] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 04/12/2023]
Abstract
Background Long-term studies of chronic obstructive pulmonary disease (COPD) can evaluate emphysema progression. Adjustment for differences in equipment and scanning protocols of individual CT examinations have not been studied extensively. Purpose To evaluate emphysema progression in current and former smokers in the COPDGene cohort over three imaging points obtained at 5-year intervals accounting for individual CT parameters. Materials and Methods Current and former cigarette smokers enrolled between 2008 and 2011 from the COPDGene study were prospectively followed for 10 years between 2008 and 2020. Extent of emphysema as adjusted lung density (ALD) from quantitative CT was measured at baseline and at 5- and 10-year follow-up. Linear mixed models adjusted for CT technical characteristics were constructed to evaluate emphysema progression. Mean annual changes in ALD over consecutive 5-year study periods were estimated by smoking status and baseline emphysema. Results Of 8431 participants at baseline (mean age, 60 years ± 9 [SD]; 3905 female participants), 4913 were at 5-year follow-up and 1544 participants were at 10-year follow-up. There were 4134 (49%) participants who were current smokers, and 4449 (53%) participants had more than trace emphysema at baseline. Current smokers with more than trace emphysema showed the largest decline in ALD, with mean annual decreases of 1.4 g/L (95% CI: 1.2, 1.5) in the first 5 years and 0.9 g/L (95% CI: 0.7, 1.2) in the second 5 years. Accounting for CT noise, field of view, and scanner model improved model fit for estimation of emphysema progression (P < .001 by likelihood ratio test). Conclusion Evaluation at CT of emphysema progression in the COPDGene study showed that, during the span of 10 years, participants with pre-existing emphysema who continued smoking had the largest decline in ALD. Adjusting for CT equipment and protocol factors improved these longitudinal estimates. Clinical trial registration no. NCT00608764 © RSNA, 2023 Supplemental material is available for this article. See the editorial by Parraga and Kirby in this issue.
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Affiliation(s)
- David Baraghoshi
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Matthew Strand
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Stephen M. Humphries
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Raúl San José Estépar
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Gonzalo Vegas Sanchez-Ferrero
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Jean-Paul Charbonnier
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Rudolfs Latisenko
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Edwin K. Silverman
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - James D. Crapo
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - David A. Lynch
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
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11
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Zell-Baran LM, Humphries SM, Moore CM, Lynch DA, Charbonnier JP, Oh AS, Rose CS. Quantitative imaging analysis detects subtle airway abnormalities in symptomatic military deployers. BMC Pulm Med 2022; 22:163. [PMID: 35477425 PMCID: PMC9047334 DOI: 10.1186/s12890-022-01960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Exposure to inhalational hazards during post-9/11 deployment to Southwest Asia and Afghanistan puts military personnel at risk for respiratory symptoms and disease. Pulmonary function and qualitative chest high resolution computed tomography (HRCT) are often normal in “deployers” with persistent respiratory symptoms. We explored the utility of quantitative HRCT imaging markers of large and small airways abnormalities, including airway wall thickness, emphysema, and air trapping, in symptomatic deployers with clinically-confirmed lung disease compared to controls. Methods Chest HRCT images from 45 healthy controls and 82 symptomatic deployers with asthma, distal lung disease or both were analyzed using Thirona Lung quantification software to calculate airway wall thickness (by Pi10), emphysema (by percentage of lung volume with attenuation < -950 Hounsfield units [LAA%-950]), and three parameters of air trapping (expiratory/inspiratory total lung volume and mean lung density ratios, and LAA%-856). SAS v.9.4 was used to compare demographic and clinical characteristics between deployers and controls using Chi-Square, Fisher Exact or t-tests. Linear regression was used to assess relationships between pulmonary function and quantitative imaging findings. Results Gender and smoking status were not statistically significantly different between groups, but deployers were significantly younger than controls (42 vs 58 years, p < 0.0001), had higher body mass index (31 vs 28 kg/m2, p = 0.01), and had fewer total smoking pack-years (8 vs. 26, p = 0.007). Spirometric measures were not statistically significantly different between groups. Pi10 and LAA%-950 were significantly elevated in deployers compared to controls in unadjusted analyses, with the emphysema measure remaining significantly higher in deployers after adjustment for age, sex, smoking, BMI, and expiratory total lung volume. Air trapping parameters were more common in control images, likely due to differences in age and smoking between groups. Among deployers, LAA%-950 and Pi10 were significantly correlated with spirometric markers of obstruction based on ratio of forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) and/or percent predicted FEV1. Conclusions Quantitative chest HRCT imaging analysis identifies emphysema in deployers with asthma and distal lung disease, and may be useful in detecting and monitoring deployment-related lung disease in a population where spirometry is typically normal.
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Affiliation(s)
- Lauren M Zell-Baran
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO, USA.
| | | | - Camille M Moore
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA.,Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Andrea S Oh
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
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