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Ritchie AI, Donaldson GC, Hoffman EA, Allinson JP, Bloom CI, Bolton CE, Choudhury G, Gerard SE, Guo J, Alves-Moreira L, McGarvey L, Sapey E, Stockley RA, Yip KP, Singh D, Wilkinson T, Fageras M, Ostridge K, Jöns O, Bucchioni E, Compton CH, Jones P, Mezzi K, Vestbo J, Calverley PMA, Wedzicha JA. Structural Predictors of Lung Function Decline in Young Smokers with Normal Spirometry. Am J Respir Crit Care Med 2024; 209:1208-1218. [PMID: 38175920 DOI: 10.1164/rccm.202307-1203oc] [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: 07/14/2023] [Accepted: 01/04/2024] [Indexed: 01/06/2024] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) due to tobacco smoking commonly presents when extensive lung damage has occurred. Objectives: We hypothesized that structural change would be detected early in the natural history of COPD and would relate to loss of lung function with time. Methods: We recruited 431 current smokers (median age, 39 yr; 16 pack-years smoked) and recorded symptoms using the COPD Assessment Test (CAT), spirometry, and quantitative thoracic computed tomography (QCT) scans at study entry. These scan results were compared with those from 67 never-smoking control subjects. Three hundred sixty-eight participants were followed every six months with measurement of postbronchodilator spirometry for a median of 32 months. The rate of FEV1 decline, adjusted for current smoking status, age, and sex, was related to the initial QCT appearances and symptoms, measured using the CAT. Measurements and Main Results: There were no material differences in demography or subjective CT appearances between the young smokers and control subjects, but 55.7% of the former had CAT scores greater than 10, and 24.2% reported chronic bronchitis. QCT assessments of disease probability-defined functional small airway disease, ground-glass opacification, bronchovascular prominence, and ratio of small blood vessel volume to total pulmonary vessel volume were increased compared with control subjects and were all associated with a faster FEV1 decline, as was a higher CAT score. Conclusions: Radiological abnormalities on CT are already established in young smokers with normal lung function and are associated with FEV1 loss independently of the impact of symptoms. Structural abnormalities are present early in the natural history of COPD and are markers of disease progression. Clinical trial registered with www.clinicaltrials.gov (NCT03480347).
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Affiliation(s)
- Andrew I Ritchie
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- AstraZeneca, Cambridge, United Kingdom
| | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Eric A Hoffman
- Department of Radiology and
- Roy J. Carver Department of Biomedical Engineering, Medicine and Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | - James P Allinson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton Hospital, London, United Kingdom
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Charlotte E Bolton
- NIHR Nottingham Biomedical Research Centre
- Centre for Respiratory Research, NIHR Nottingham, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Gourab Choudhury
- ELEGI and COLT Laboratories, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Sarah E Gerard
- Roy J. Carver Department of Biomedical Engineering, Medicine and Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | | | - Luana Alves-Moreira
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Robert A Stockley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - K P Yip
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Dave Singh
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Tom Wilkinson
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- National Institute for Health and Care Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdom
| | | | - Kristoffer Ostridge
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- AstraZeneca, Gothenburg, Sweden
| | - Olaf Jöns
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | | | - Paul Jones
- GlaxoSmithKline, Brentford, United Kingdom
| | | | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Peter M A Calverley
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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2
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Vameghestahbanati M, Kingdom L, Hoffman EA, Kirby M, Allen NB, Angelini E, Bertoni A, Hamid Q, Hogg JC, Jacobs DR, Laine A, Maltais F, Michos ED, Sack C, Sin D, Watson KE, Wysoczanksi A, Couper D, Cooper C, Han M, Woodruff P, Tan WC, Bourbeau J, Barr RG, Smith BM. Airway tree caliber heterogeneity and airflow obstruction among older adults. J Appl Physiol (1985) 2024; 136:1144-1156. [PMID: 38420676 DOI: 10.1152/japplphysiol.00694.2022] [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: 11/15/2022] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
Smaller mean airway tree caliber is associated with airflow obstruction and chronic obstructive pulmonary disease (COPD). We investigated whether airway tree caliber heterogeneity was associated with airflow obstruction and COPD. Two community-based cohorts (MESA Lung, CanCOLD) and a longitudinal case-control study of COPD (SPIROMICS) performed spirometry and computed tomography measurements of airway lumen diameters at standard anatomical locations (trachea-to-subsegments) and total lung volume. Percent-predicted airway lumen diameters were calculated using sex-specific reference equations accounting for age, height, and lung volume. The association of airway tree caliber heterogeneity, quantified as the standard deviation (SD) of percent-predicted airway lumen diameters, with baseline forced expired volume in 1-second (FEV1), FEV1/forced vital capacity (FEV1/FVC) and COPD, as well as longitudinal spirometry, were assessed using regression models adjusted for age, sex, height, race-ethnicity, and mean airway tree caliber. Among 2,505 MESA Lung participants (means ± SD age: 69 ± 9 yr; 53% female, mean airway tree caliber: 99 ± 10% predicted, airway tree caliber heterogeneity: 14 ± 5%; median follow-up: 6.1 yr), participants in the highest quartile of airway tree caliber heterogeneity exhibited lower FEV1 (adjusted mean difference: -125 mL, 95%CI: -171,-79), lower FEV1/FVC (adjusted mean difference: -0.01, 95%CI: -0.02,-0.01), and higher odds of COPD (adjusted odds ratio: 1.42, 95%CI: 1.01-2.02) when compared with the lowest quartile, whereas longitudinal changes in FEV1 and FEV1/FVC did not differ significantly. Observations in CanCOLD and SPIROMICS were consistent. Among older adults, airway tree caliber heterogeneity was associated with airflow obstruction and COPD at baseline but was not associated with longitudinal changes in spirometry.NEW & NOTEWORTHY In this study, by leveraging two community-based samples and a case-control study of heavy smokers, we show that among older adults, airway tree caliber heterogeneity quantified by CT is associated with airflow obstruction and COPD independent of age, sex, height, race-ethnicity, and dysanapsis. These observations suggest that airway tree caliber heterogeneity is a structural trait associated with low baseline lung function and normal decline trajectory that is relevant to COPD.
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Affiliation(s)
| | - Leina Kingdom
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Norrina B Allen
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, United States
| | - Elsa Angelini
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Medicine, Columbia University, New York, New York, United States
| | - Alain Bertoni
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, United States
| | - Qutayba Hamid
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R Jacobs
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
| | - Andrew Laine
- Department of Medicine, Columbia University, New York, New York, United States
| | - Francois Maltais
- Faculty of Medicine , University of Laval, Laval, Quebec, Canada
| | - Erin D Michos
- Faculty of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Coralynn Sack
- Department of Medicine, University of Washington, Seattle, Washington, United States
| | - Don Sin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karol E Watson
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Artur Wysoczanksi
- Department of Medicine, Columbia University, New York, New York, United States
| | - David Couper
- Department of Biostatistics, University of North Carolina, North Carolina, United States
| | - Christopher Cooper
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Meilan Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Prescott Woodruff
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, United States
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, New York, United States
| | - Benjamin M Smith
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Columbia University, New York, New York, United States
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3
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Ichikawa K, Wang R, McClelland RL, Manubolu VS, Susarla S, Lee D, Pourafkari L, Fazlalizadeh H, Bitar JA, Robin R, Kinninger A, Roy S, Post WS, Budoff M. Thoracic versus coronary calcification for atherosclerotic cardiovascular disease events prediction. Heart 2024:heartjnl-2023-323838. [PMID: 38627022 DOI: 10.1136/heartjnl-2023-323838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
This study compared the prognostic value of quantified thoracic artery calcium (TAC) including aortic arch on chest CT and coronary artery calcium (CAC) score on ECG-gated cardiac CT. METHODS A total of 2412 participants who underwent both chest CT and ECG-gated cardiac CT at the same period were included in the Multi-Ethnic Study of Atherosclerosis Exam 5. All participants were monitored for incident atherosclerotic cardiovascular disease (ASCVD) events. TAC is defined as calcification in the ascending aorta, aortic arch and descending aorta on chest CT. The quantification of TAC was measured using the Agatston method. Time-dependent receiver-operating characteristic (ROC) curves were used to compare the prognostic value of TAC and CAC scores. RESULTS Participants were 69±9 years of age and 47% were male. The Spearman correlation between TAC and CAC scores was 0.46 (p<0.001). During the median follow-up period of 8.8 years, 234 participants (9.7%) experienced ASCVD events. In multivariable Cox regression analysis, TAC score was independently associated with increased risk of ASCVD events (HR 1.31, 95% CI 1.09 to 1.58) as well as CAC score (HR 1.82, 95% CI 1.53 to 2.17). However, the area under the time-dependent ROC curve for CAC score was greater than that for TAC score in all participants (0.698 and 0.641, p=0.031). This was particularly pronounced in participants with borderline/intermediate and high 10-year ASCVD risk scores. CONCLUSION Our study demonstrated a significant association between TAC and CAC scores but a superior prognostic value of CAC score for ASCVD events. These findings suggest TAC on chest CT provides supplementary data to estimate ASCVD risk but does not replace CAC on ECG-gated cardiac CT.
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Affiliation(s)
| | - Rui Wang
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | | | | | - Duo Lee
- The Lundquist Institute, Torrance, California, USA
| | | | | | | | - Rick Robin
- The Lundquist Institute, Torrance, California, USA
| | | | - Sion Roy
- The Lundquist Institute, Torrance, California, USA
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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4
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Samant M, Krings JG, Lew D, Goss CW, Koch T, McGregor MC, Boomer J, Hall CS, Schechtman KB, Sheshadri A, Peterson S, Erzurum S, DePew Z, Morrow LE, Hogarth DK, Tejedor R, Trevor J, Wechsler ME, Sam A, Shi X, Choi J, Castro M. Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders. Chest 2024; 165:775-784. [PMID: 38123124 PMCID: PMC11026166 DOI: 10.1016/j.chest.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are defined poorly. RESEARCH QUESTION Do baseline radiographic and clinical characteristics exist that predict response to BT? STUDY DESIGN AND METHODS We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across eight academic medical centers. Participants received three separate BT treatments and were monitored at 3-month intervals for 1 year after BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test results of ≥ 3 or Asthma Quality of Life Questionnaire of ≥ 0.5. Regression analyses were used to evaluate the association between pretreatment clinical and quantitative CT scan measures with subsequent BT response. RESULTS From 2006 through 2017, 88 participants received BT, with 70 participants (79.5%) identified as responders by Asthma Control Test or Asthma Quality of Life Questionnaire criteria. Responders were less likely to undergo an asthma-related ICU admission in the prior year (3% vs 25%; P = .01). On baseline quantitative CT imaging, BT responders showed less air trapping percentage (OR, 0.90; 95% CI, 0.82-0.99; P = .03), a greater Jacobian determinant (OR, 1.49; 95% CI, 1.05-2.11), greater SD of the Jacobian determinant (OR, 1.84; 95% CI, 1.04-3.26), and greater anisotropic deformation index (OR, 3.06; 95% CI, 1.06-8.86). INTERPRETATION To our knowledge, this is the largest study to evaluate baseline quantitative CT imaging and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on quantitative CT imaging, were predictors of future BT response. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01185275; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Maanasi Samant
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - James G Krings
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Daphne Lew
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Charles W Goss
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Tammy Koch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Mary Clare McGregor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Jonathan Boomer
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Chase S Hall
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Ken B Schechtman
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Ajay Sheshadri
- Division of Pulmonary Critical Care Medicine, Department of Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Serpil Erzurum
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Zachary DePew
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Creighton University Medical Center, Omaha, NE
| | - Lee E Morrow
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Creighton University Medical Center, Omaha, NE
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - Richard Tejedor
- Division of Pulmonary and Critical Care, Department of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Jennifer Trevor
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Afshin Sam
- Division of Pulmonary and Critical Care, Department of Medicine, University of Arizona, Tuscon, AZ
| | - Xiaosong Shi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Jiwoong Choi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS.
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5
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Choe J, Choi HY, Lee SM, Oh SY, Hwang HJ, Kim N, Yun J, Lee JS, Oh YM, Yu D, Kim B, Seo JB. Evaluation of retrieval accuracy and visual similarity in content-based image retrieval of chest CT for obstructive lung disease. Sci Rep 2024; 14:4587. [PMID: 38403628 PMCID: PMC10894863 DOI: 10.1038/s41598-024-54954-5] [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: 06/17/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
The aim of our study was to assess the performance of content-based image retrieval (CBIR) for similar chest computed tomography (CT) in obstructive lung disease. This retrospective study included patients with obstructive lung disease who underwent volumetric chest CT scans. The CBIR database included 600 chest CT scans from 541 patients. To assess the system performance, follow-up chest CT scans of 50 patients were evaluated as query cases, which showed the stability of the CT findings between baseline and follow-up chest CT, as confirmed by thoracic radiologists. The CBIR system retrieved the top five similar CT scans for each query case from the database by quantifying and comparing emphysema extent and size, airway wall thickness, and peripheral pulmonary vasculatures in descending order from the database. The rates of retrieval of the same pairs of query CT scans in the top 1-5 retrievals were assessed. Two expert chest radiologists evaluated the visual similarities between the query and retrieved CT scans using a five-point scale grading system. The rates of retrieving the same pairs of query CTs were 60.0% (30/50) and 68.0% (34/50) for top-three and top-five retrievals. Radiologists rated 64.8% (95% confidence interval 58.8-70.4) of the retrieved CT scans with a visual similarity score of four or five and at least one case scored five points in 74% (74/100) of all query cases. The proposed CBIR system for obstructive lung disease integrating quantitative CT measures demonstrated potential for retrieving chest CT scans with similar imaging phenotypes. Further refinement and validation in this field would be valuable.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
| | - Hye Young Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine Kyung, Hee University, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea.
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
| | - Hye Jeon Hwang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
- Department of Convergence Medicine, Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihye Yun
- Department of Convergence Medicine, Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
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6
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Friedlander Y, Munidasa S, Thakar A, Ragunayakam N, Venegas C, Kjarsgaard M, Zanette B, Capaldi DPI, Santyr G, Nair P, Svenningsen S. Phase-Resolved Functional Lung (PREFUL) MRI to Quantify Ventilation: Feasibility and Physiological Relevance in Severe Asthma. Acad Radiol 2024:S1076-6332(24)00061-8. [PMID: 38378325 DOI: 10.1016/j.acra.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/28/2024] [Accepted: 01/28/2024] [Indexed: 02/22/2024]
Abstract
RATIONALE AND OBJECTIVES Emergent evidence in several respiratory diseases supports translational potential for Phase-Resolved Functional Lung (PREFUL) MRI to spatially quantify ventilation but its feasibility and physiological relevance have not been demonstrated in patients with asthma. This study compares PREFUL-derived ventilation defect percent (VDP) in severe asthma patients to healthy controls and measures its responsiveness to bronchodilator therapy and relation to established measures of airways disease. MATERIALS AND METHODS Forty-one adults with severe asthma and seven healthy controls performed same-day free-breathing 1H MRI, 129Xe MRI, spirometry, and oscillometry. A subset of participants (n = 23) performed chest CT and another subset of participants with asthma (n = 19) repeated 1H MRI following the administration of a bronchodilator. VDP was calculated for both PREFUL and 129Xe MRI. Additionally, the percent of functional small airways disease was determined from CT parametric response maps (PRMfSAD). RESULTS PREFUL VDP measured pre-bronchodilator (19.1% [7.4-43.3], p = 0.0002) and post-bronchodilator (16.9% [6.1-38.4], p = 0.0007) were significantly greater than that of healthy controls (7.5% [3.7-15.5]) and was significantly decreased post-bronchodilator (from 21.9% [10.1-36.9] to 16.9% [6.1-38.4], p = 0.0053). PREFUL VDP was correlated with spirometry (FEV1%pred: r = -0.46, p = 0.0023; FVC%pred: r = -0.35, p = 0.024, FEV1/FVC: r = -0.46, p = 0.0028), 129Xe MRI VDP (r = 0.39, p = 0.013), and metrics of small airway disease (CT PRMfSAD: r = 0.55, p = 0.021; Xrs5 Hz: r = -0.44, p = 0.0046, and AX: r = 0.32, p = 0.044). CONCLUSION PREFUL-derived VDP is responsive to bronchodilator therapy in asthma and is associated with measures of airflow obstruction and small airway dysfunction. These findings validate PREFUL VDP as a physiologically relevant and accessible ventilation imaging outcome measure in asthma.
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Affiliation(s)
- Yonni Friedlander
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Samal Munidasa
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Ashutosh Thakar
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Carmen Venegas
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Melanie Kjarsgaard
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Brandon Zanette
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada
| | - Dante P I Capaldi
- Department of Radiation Oncology, Division of Physics, University of California, San Francisco, CA
| | - Giles Santyr
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Parameswaran Nair
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Sarah Svenningsen
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada.
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7
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Koch AL, Shing TL, Namen A, Couper D, Smith B, Barr RG, Bhatt S, Putcha N, Baugh A, Saha AK, Zeidler M, Comellas A, Cooper CB, Barjaktarevic I, Bowler RP, Han MK, Kim V, Paine, III R, Kanner RE, Krishnan JA, Martinez FJ, Woodruff PG, Hansel NN, Hoffman EA, Peters SP, Ortega VE. Lung Structure and Risk of Sleep Apnea in SPIROMICS. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2024; 11:26-36. [PMID: 37931592 PMCID: PMC10913931 DOI: 10.15326/jcopdf.2023.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
Rationale The SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) is a prospective cohort study that enrolled 2981 participants with the goal of identifying new chronic obstructive pulmonary disease (COPD) subgroups and intermediate markers of disease progression. Individuals with COPD and obstructive sleep apnea (OSA) experience impaired quality of life and more frequent exacerbations. COPD severity also associates with computed tomography scan-based emphysema and alterations in airway dimensions. Objectives The objective was to determine whether the combination of lung function and structure influences the risk of OSA among current and former smokers. Methods Using 2 OSA risk scores, the Berlin Sleep Questionnaire (BSQ), and the DOISNORE50 (Diseases, Observed apnea, Insomnia, Snoring, Neck circumference > 18 inches, Obesity with body mass index [BMI] > 32, R = are you male, Excessive daytime sleepiness, 50 = age ≥ 50) (DIS), 1767 current and former smokers were evaluated for an association of lung structure and function with OSA risk. Measurements and Main Results The study cohort's mean age was 63 years, BMI was 28 kg/m2, and forced expiratory volume in 1 second (FEV1) was 74.8% predicted. The majority were male (55%), White (77%), former smokers (59%), and had COPD (63%). A high-risk OSA score was reported in 36% and 61% using DIS and BSQ respectively. There was a 9% increased odds of a high-risk DIS score (odds ratio [OR]=1.09, 95% confidence interval [CI]:1.03-1.14) and nominally increased odds of a high-risk BSQ score for every 10% decrease in FEV1 %predicted (OR=1.04, 95%CI: 0.998-1.09). Lung function-OSA risk associations persisted after additionally adjusting for lung structure measurements (%emphysema, %air trapping, parametric response mapping for functional small airways disease, , mean segmental wall area, tracheal %wall area, dysanapsis) for DIS (OR=1.12, 95%CI:1.03-1.22) and BSQ (OR=1.09, 95%CI:1.01-1.18). Conclusions Lower lung function independently associates with having high risk for OSA in current and former smokers. Lung structural elements, especially dysanapsis, functional small airways disease, and tracheal %wall area strengthened the effects on OSA risk.
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Affiliation(s)
- Abigail L. Koch
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
| | - Tracie L. Shing
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Andrew Namen
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
| | - David Couper
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Benjamin Smith
- Department of Medicine, Columbia University Medical Center, New York, New York, United States
| | - R. Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, New York, United States
| | - Surya Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Aaron Baugh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States
| | - Amit K. Saha
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
| | - Michelle Zeidler
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
| | - Alejandro Comellas
- Departments of Radiology, Medicine, and Bioengineering, University of Iowa, Iowa City, Iowa, United States
| | - Christopher B. Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
| | - Russell P. Bowler
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Victor Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
| | - Robert Paine, III
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Richard E. Kanner
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Jerry A. Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, United States
| | - Prescott G Woodruff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Eric A. Hoffman
- Departments of Radiology, Medicine, and Bioengineering, University of Iowa, Iowa City, Iowa, United States
| | - Stephen P. Peters
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
| | - Victor E. Ortega
- Department of Internal Medicine, Division of Respiratory Diseases, Center for Individualized Medicine, Mayo Clinic, Scottsdale, Arizona, United States
| | - for the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) Investigators
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
- Department of Medicine, Columbia University Medical Center, New York, New York, United States
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
- Departments of Radiology, Medicine, and Bioengineering, University of Iowa, Iowa City, Iowa, United States
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, United States
- Department of Internal Medicine, Division of Respiratory Diseases, Center for Individualized Medicine, Mayo Clinic, Scottsdale, Arizona, United States
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8
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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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9
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Ibad HA, Hathaway QA, Bluemke DA, Kasaeian A, Klein JG, Budoff MJ, Barr RG, Allison M, Post WS, Lima JAC, Demehri S. CT-derived pectoralis composition and incident pneumonia hospitalization using fully automated deep-learning algorithm: multi-ethnic study of atherosclerosis. Eur Radiol 2023:10.1007/s00330-023-10372-1. [PMID: 37951855 DOI: 10.1007/s00330-023-10372-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Pneumonia-related hospitalization may be associated with advanced skeletal muscle loss due to aging (i.e., sarcopenia) or chronic illnesses (i.e., cachexia). Early detection of muscle loss may now be feasible using deep-learning algorithms applied on conventional chest CT. OBJECTIVES To implement a fully automated deep-learning algorithm for pectoralis muscle measures from conventional chest CT and investigate longitudinal associations between these measures and incident pneumonia hospitalization according to Chronic Obstructive Pulmonary Disease (COPD) status. MATERIALS AND METHODS This analysis from the Multi-Ethnic Study of Atherosclerosis included participants with available chest CT examinations between 2010 and 2012. We implemented pectoralis muscle composition measures from a fully automated deep-learning algorithm (Mask R-CNN, built on the Faster Region Proposal Network (R-) Convolutional Neural Network (CNN) with an extension for mask identification) for two-dimensional segmentation. Associations between CT-derived measures and incident pneumonia hospitalizations were evaluated using Cox proportional hazards models adjusted for multiple confounders which include but are not limited to age, sex, race, smoking, BMI, physical activity, and forced-expiratory-volume-at-1 s-to-functional-vital-capacity ratio. Stratification analyses were conducted based on baseline COPD status. RESULTS This study included 2595 participants (51% female; median age: 68 (IQR: 61, 76)) CT examinations for whom we implemented deep learning-derived measures for longitudinal analyses. Eighty-six incident pneumonia hospitalizations occurred during a median 6.67-year follow-up. Overall, pectoralis muscle composition measures did not predict incident pneumonia. However, in fully-adjusted models, only among participants with COPD (N = 507), CT measures like extramyocellular fat index (hazard ratio: 1.98, 95% CI: 1.22, 3.21, p value: 0.02), were independently associated with incident pneumonia. CONCLUSION Reliable deep learning-derived pectoralis muscle measures could predict incident pneumonia hospitalization only among participants with known COPD. CLINICAL RELEVANCE STATEMENT Pectoralis muscle measures obtainable at zero additional cost or radiation exposure from any chest CT may have independent predictive value for clinical outcomes in chronic obstructive pulmonary disease patients. KEY POINTS •Identification of independent and modifiable risk factors of pneumonia can have important clinical impact on patients with chronic obstructive pulmonary disease. •Opportunistic CT measures of adipose tissue within pectoralis muscles using deep-learning algorithms can be quickly obtainable at zero additional cost or radiation exposure. •Deep learning-derived pectoralis muscle measurements of intermuscular fat and its subcomponents are independently associated with subsequent incident pneumonia hospitalization.
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Affiliation(s)
- Hamza A Ibad
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA
| | - Quincy A Hathaway
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA
- West Virginia University School of Medicine, Heart and Vascular Institute, Morgantown, WV, USA
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI, USA
| | - Arta Kasaeian
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA
| | - Joshua G Klein
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA
| | - Matthew J Budoff
- Harbor-UCLA Medical Center, Division of Cardiology, Torrance, CA, USA
| | - R Graham Barr
- Columbia University, Division of General Medicine, New York, NY, USA
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Wendy S Post
- Johns Hopkins University School of Medicine, Division of Cardiology, Baltimore, MD, USA
| | - João A C Lima
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Division of Cardiology, Baltimore, MD, USA
| | - Shadpour Demehri
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA.
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10
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Saha PK, Nadeem SA, Comellas AP. A Survey on Artificial Intelligence in Pulmonary Imaging. WILEY INTERDISCIPLINARY REVIEWS. DATA MINING AND KNOWLEDGE DISCOVERY 2023; 13:e1510. [PMID: 38249785 PMCID: PMC10796150 DOI: 10.1002/widm.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/21/2023] [Indexed: 01/23/2024]
Abstract
Over the last decade, deep learning (DL) has contributed a paradigm shift in computer vision and image recognition creating widespread opportunities of using artificial intelligence in research as well as industrial applications. DL has been extensively studied in medical imaging applications, including those related to pulmonary diseases. Chronic obstructive pulmonary disease, asthma, lung cancer, pneumonia, and, more recently, COVID-19 are common lung diseases affecting nearly 7.4% of world population. Pulmonary imaging has been widely investigated toward improving our understanding of disease etiologies and early diagnosis and assessment of disease progression and clinical outcomes. DL has been broadly applied to solve various pulmonary image processing challenges including classification, recognition, registration, and segmentation. This paper presents a survey of pulmonary diseases, roles of imaging in translational and clinical pulmonary research, and applications of different DL architectures and methods in pulmonary imaging with emphasis on DL-based segmentation of major pulmonary anatomies such as lung volumes, lung lobes, pulmonary vessels, and airways as well as thoracic musculoskeletal anatomies related to pulmonary diseases.
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Affiliation(s)
- Punam K Saha
- Departments of Radiology and Electrical and Computer Engineering, University of Iowa, Iowa City, IA, 52242
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11
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Angelini ED, Yang J, Balte PP, Hoffman EA, Manichaikul AW, Sun Y, Shen W, Austin JHM, Allen NB, Bleecker ER, Bowler R, Cho MH, Cooper CS, Couper D, Dransfield MT, Garcia CK, Han MK, Hansel NN, Hughes E, Jacobs DR, Kasela S, Kaufman JD, Kim JS, Lappalainen T, Lima J, Malinsky D, Martinez FJ, Oelsner EC, Ortega VE, Paine R, Post W, Pottinger TD, Prince MR, Rich SS, Silverman EK, Smith BM, Swift AJ, Watson KE, Woodruff PG, Laine AF, Barr RG. Pulmonary emphysema subtypes defined by unsupervised machine learning on CT scans. Thorax 2023; 78:1067-1079. [PMID: 37268414 PMCID: PMC10592007 DOI: 10.1136/thorax-2022-219158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/03/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Treatment and preventative advances for chronic obstructive pulmonary disease (COPD) have been slow due, in part, to limited subphenotypes. We tested if unsupervised machine learning on CT images would discover CT emphysema subtypes with distinct characteristics, prognoses and genetic associations. METHODS New CT emphysema subtypes were identified by unsupervised machine learning on only the texture and location of emphysematous regions on CT scans from 2853 participants in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), a COPD case-control study, followed by data reduction. Subtypes were compared with symptoms and physiology among 2949 participants in the population-based Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study and with prognosis among 6658 MESA participants. Associations with genome-wide single-nucleotide-polymorphisms were examined. RESULTS The algorithm discovered six reproducible (interlearner intraclass correlation coefficient, 0.91-1.00) CT emphysema subtypes. The most common subtype in SPIROMICS, the combined bronchitis-apical subtype, was associated with chronic bronchitis, accelerated lung function decline, hospitalisations, deaths, incident airflow limitation and a gene variant near DRD1, which is implicated in mucin hypersecretion (p=1.1 ×10-8). The second, the diffuse subtype was associated with lower weight, respiratory hospitalisations and deaths, and incident airflow limitation. The third was associated with age only. The fourth and fifth visually resembled combined pulmonary fibrosis emphysema and had distinct symptoms, physiology, prognosis and genetic associations. The sixth visually resembled vanishing lung syndrome. CONCLUSION Large-scale unsupervised machine learning on CT scans defined six reproducible, familiar CT emphysema subtypes that suggest paths to specific diagnosis and personalised therapies in COPD and pre-COPD.
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Affiliation(s)
- Elsa D Angelini
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
- LTCI, Institut Polytechnique de Paris, Telecom Paris, Palaiseau, France
- NIHR Imperial Biomedical Research Centre, ITMAT Data Science Group, Imperial College, London, UK
| | - Jie Yang
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Pallavi P Balte
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric A Hoffman
- Departments of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Ani W Manichaikul
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Yifei Sun
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Wei Shen
- Department of Pediatrics, Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York, USA
- Columbia Magnetic Resonance Research Center (CMRRC), Columbia University Irving Medical Center, New York, New York, USA
| | - John H M Austin
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Norrina B Allen
- Institute for Public Health and Medicine (IPHAM) - Center for Epidemiology and Population Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Eugene R Bleecker
- Department of Medicine, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - David Couper
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Christine Kim Garcia
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - MeiLan K Han
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emlyn Hughes
- Department of Physics, Columbia University, New York, New York, USA
| | - David R Jacobs
- Division of Epidemiology and Community Public Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Silva Kasela
- Department of Systems Biology, Columbia University Irving Medical Center, New York, New York, USA
- New York Genome Center, New York, New York, USA
| | - Joel Daniel Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - John Shinn Kim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Tuuli Lappalainen
- Department of Systems Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Joao Lima
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel Malinsky
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Fernando J Martinez
- Department of Medicine, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Victor E Ortega
- Department of Pulmonary Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Wendy Post
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tess D Pottinger
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin R Prince
- Department of Radiology, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Benjamin M Smith
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew J Swift
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Karol E Watson
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Prescott G Woodruff
- Department of Medicine, University of California, San Francisco, California, USA
| | - Andrew F Laine
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
- Columbia Magnetic Resonance Research Center (CMRRC), Columbia University Irving Medical Center, New York, New York, USA
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
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12
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Kirby M, Smith BM. Quantitative CT Scan Imaging of the Airways for Diagnosis and Management of Lung Disease. Chest 2023; 164:1150-1158. [PMID: 36871841 PMCID: PMC10792293 DOI: 10.1016/j.chest.2023.02.044] [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: 11/16/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
CT scan imaging provides high-resolution images of the lungs in patients with chronic respiratory diseases. Extensive research over the last several decades has focused on developing novel quantitative CT scan airway measurements that reflect abnormal airway structure. Despite many observational studies demonstrating that associations between CT scan airway measurements and clinically important outcomes such as morbidity, mortality, and lung function decline, few quantitative CT scan measurements are applied in clinical practice. This article provides an overview of the relevant methodologic considerations for implementing quantitative CT scan airway analyses and provides a review of the scientific literature involving quantitative CT scan airway measurements used in clinical or randomized trials and observational studies of humans. We also discuss emerging evidence for the clinical usefulness of quantitative CT scan imaging of the airways and discuss what is required to bridge the gap between research and clinical application. CT scan airway measurements continue to improve our understanding of disease pathophysiologic features, diagnosis, and outcomes. However, a literature review revealed a need for studies evaluating clinical benefit when quantitative CT scan imaging is applied in the clinical setting. Technical standards for quantitative CT scan imaging of the airways and high-quality evidence of clinical benefit from management guided by quantitative CT scan imaging of the airways are required.
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Affiliation(s)
- Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada; iBEST, St. Michael's Hospital, Toronto, ON, Canada.
| | - Benjamin M Smith
- Department of Medicine, McGill University, Montreal, QC, Canada; Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
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13
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Svenningsen S, Kjarsgaard M, Haider E, Venegas C, Konyer N, Friedlander Y, Nasir N, Boylan C, Kirby M, Nair P. Effects of Dupilumab on Mucus Plugging and Ventilation Defects in Patients with Moderate-to-Severe Asthma: A Randomized, Double-Blind, Placebo-Controlled Trial. Am J Respir Crit Care Med 2023; 208:995-997. [PMID: 37603097 DOI: 10.1164/rccm.202306-1102le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/18/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Sarah Svenningsen
- Firestone Institute for Respiratory Health and
- Imaging Research Center, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Medicine and
| | - Melanie Kjarsgaard
- Firestone Institute for Respiratory Health and
- Department of Medicine and
| | - Ehsan Haider
- Imaging Research Center, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada; and
| | - Carmen Venegas
- Firestone Institute for Respiratory Health and
- Department of Medicine and
| | - Norman Konyer
- Imaging Research Center, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Yonni Friedlander
- Firestone Institute for Respiratory Health and
- Imaging Research Center, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Neha Nasir
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Colm Boylan
- Imaging Research Center, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada; and
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Parameswaran Nair
- Firestone Institute for Respiratory Health and
- Department of Medicine and
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14
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Hathaway Q, Ibad HA, Bluemke DA, Pishgar F, Kasaiean A, Klein JG, Cogswell R, Allison M, Budoff MJ, Barr RG, Post W, Bredella MA, Lima JAC, Demehri S. Predictive Value of Deep Learning-derived CT Pectoralis Muscle and Adipose Measurements for Incident Heart Failure: Multi-Ethnic Study of Atherosclerosis. Radiol Cardiothorac Imaging 2023; 5:e230146. [PMID: 37908549 PMCID: PMC10613925 DOI: 10.1148/ryct.230146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Purpose To develop a deep learning algorithm capable of extracting pectoralis muscle and adipose measurements and to longitudinally investigate associations between these measurements and incident heart failure (HF) in participants from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods MESA is a prospective study of subclinical cardiovascular disease characteristics and risk factors for progression to clinically overt disease approved by institutional review boards of six participating centers (ClinicalTrials.gov identifier: NCT00005487). All participants with adequate imaging and clinical data from the fifth examination of MESA were included in this study. Hence, in this secondary analysis, manual segmentations of 600 chest CT examinations (between the years 2010 and 2012) were used to train and validate a convolutional neural network, which subsequently extracted pectoralis muscle and adipose (intermuscular adipose tissue (IMAT), perimuscular adipose tissue (PAT), extramyocellular lipids and subcutaneous adipose tissue) area measurements from 3031 CT examinations using individualized thresholds for adipose segmentation. Next, 1781 participants without baseline HF were longitudinally investigated for associations between baseline pectoralis muscle and adipose measurements and incident HF using crude and adjusted Cox proportional hazards models. The full models were adjusted for variables in categories of demographic (age, race, sex, income), clinical/laboratory (including physical activity, BMI, and smoking), CT (coronary artery calcium score), and cardiac MRI (left ventricular ejection fraction and mass (% of predicted)) data. Results In 1781 participants (median age, 68 (IQR,61, 75) years; 907 [51%] females), 41 incident HF events occurred over a median 6.5-year follow-up. IMAT predicted incident HF in unadjusted (hazard ratio [HR]:1.14; 95% CI: 1.03-1.26) and fully adjusted (HR:1.16, 95% CI: 1.03-1.31) models. PAT also predicted incident HF in crude (HR:1.19; 95% CI: 1.06-1.35) and fully adjusted (HR:1.25; 95% CI: 1.07-1.46) models. Conclusion The study demonstrates that fast and reliable deep learning-derived pectoralis muscle and adipose measurements are obtainable from conventional chest CT, which may be predictive of incident HF.©RSNA, 2023.
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Affiliation(s)
| | | | - David A. Bluemke
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Farhad Pishgar
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Arta Kasaiean
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Joshua G. Klein
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Rebecca Cogswell
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Matthew Allison
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Matthew J. Budoff
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - R. Graham Barr
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Wendy Post
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Miriam A. Bredella
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - João A. C. Lima
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Shadpour Demehri
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
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15
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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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16
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Althof ZW, Gerard SE, Eskandari A, Galizia MS, Hoffman EA, Reinhardt JM. Attention U-net for automated pulmonary fissure integrity analysis in lung computed tomography images. Sci Rep 2023; 13:14135. [PMID: 37644125 PMCID: PMC10465516 DOI: 10.1038/s41598-023-41322-y] [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: 02/01/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023] Open
Abstract
Computed Tomography (CT) imaging is routinely used for imaging of the lungs. Deep learning can effectively automate complex and laborious tasks in medical imaging. In this work, a deep learning technique is utilized to assess lobar fissure completeness (also known as fissure integrity) from pulmonary CT images. The human lungs are divided into five separate lobes, divided by the lobar fissures. Fissure integrity assessment is important to endobronchial valve treatment screening. Fissure integrity is known to be a biomarker of collateral ventilation between lobes impacting the efficacy of valves designed to block airflow to diseased lung regions. Fissure integrity is also likely to impact lobar sliding which has recently been shown to affect lung biomechanics. Further widescale study of fissure integrity's impact on disease susceptibility and progression requires rapid, reproducible, and noninvasive fissure integrity assessment. In this paper we describe IntegrityNet, an attention U-Net based automatic fissure integrity analysis tool. IntegrityNet is able to predict fissure integrity with an accuracy of 95.8%, 96.1%, and 89.8% for left oblique, right oblique, and right horizontal fissures, compared to manual analysis on a dataset of 82 subjects. We also show that our method is robust to COPD severity and reproducible across subject scans acquired at different time points.
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Affiliation(s)
- Zachary W Althof
- 5601 Seamans Center for the Engineering Arts and Sciences, University of Iowa Roy J. Carver Department of Biomedical Engineering, Iowa City, IA, 52242, USA
| | - Sarah E Gerard
- University of Iowa Department of Radiology, Iowa City, IA, USA
| | - Ali Eskandari
- University of Iowa Department of Radiology, Iowa City, IA, USA
| | | | - Eric A Hoffman
- 5601 Seamans Center for the Engineering Arts and Sciences, University of Iowa Roy J. Carver Department of Biomedical Engineering, Iowa City, IA, 52242, USA
- University of Iowa Department of Radiology, Iowa City, IA, USA
| | - Joseph M Reinhardt
- 5601 Seamans Center for the Engineering Arts and Sciences, University of Iowa Roy J. Carver Department of Biomedical Engineering, Iowa City, IA, 52242, USA.
- University of Iowa Department of Radiology, Iowa City, IA, USA.
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17
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McKleroy W, Shing T, Anderson WH, Arjomandi M, Awan HA, Barjaktarevic I, Barr RG, Bleecker ER, Boscardin J, Bowler RP, Buhr RG, Criner GJ, Comellas AP, Curtis JL, Dransfield M, Doerschuk CM, Dolezal BA, Drummond MB, Han MK, Hansel NN, Helton K, Hoffman EA, Kaner RJ, Kanner RE, Krishnan JA, Lazarus SC, Martinez FJ, Ohar J, Ortega VE, Paine R, Peters SP, Reinhardt JM, Rennard S, Smith BM, Tashkin DP, Couper D, Cooper CB, Woodruff PG. Longitudinal Follow-Up of Participants With Tobacco Exposure and Preserved Spirometry. JAMA 2023; 330:442-453. [PMID: 37526720 PMCID: PMC10394572 DOI: 10.1001/jama.2023.11676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/20/2023] [Indexed: 08/02/2023]
Abstract
Importance People who smoked cigarettes may experience respiratory symptoms without spirometric airflow obstruction. These individuals are typically excluded from chronic obstructive pulmonary disease (COPD) trials and lack evidence-based therapies. Objective To define the natural history of persons with tobacco exposure and preserved spirometry (TEPS) and symptoms (symptomatic TEPS). Design, Setting, and Participants SPIROMICS II was an extension of SPIROMICS I, a multicenter study of persons aged 40 to 80 years who smoked cigarettes (>20 pack-years) with or without COPD and controls without tobacco exposure or airflow obstruction. Participants were enrolled in SPIROMICS I and II from November 10, 2010, through July 31, 2015, and followed up through July 31, 2021. Exposures Participants in SPIROMICS I underwent spirometry, 6-minute walk distance testing, assessment of respiratory symptoms, and computed tomography of the chest at yearly visits for 3 to 4 years. Participants in SPIROMICS II had 1 additional in-person visit 5 to 7 years after enrollment in SPIROMICS I. Respiratory symptoms were assessed with the COPD Assessment Test (range, 0 to 40; higher scores indicate more severe symptoms). Participants with symptomatic TEPS had normal spirometry (postbronchodilator ratio of forced expiratory volume in the first second [FEV1] to forced vital capacity >0.70) and COPD Assessment Test scores of 10 or greater. Participants with asymptomatic TEPS had normal spirometry and COPD Assessment Test scores of less than 10. Patient-reported respiratory symptoms and exacerbations were assessed every 4 months via phone calls. Main Outcomes and Measures The primary outcome was assessment for accelerated decline in lung function (FEV1) in participants with symptomatic TEPS vs asymptomatic TEPS. Secondary outcomes included development of COPD defined by spirometry, respiratory symptoms, rates of respiratory exacerbations, and progression of computed tomographic-defined airway wall thickening or emphysema. Results Of 1397 study participants, 226 had symptomatic TEPS (mean age, 60.1 [SD, 9.8] years; 134 were women [59%]) and 269 had asymptomatic TEPS (mean age, 63.1 [SD, 9.1] years; 134 were women [50%]). At a median follow-up of 5.76 years, the decline in FEV1 was -31.3 mL/y for participants with symptomatic TEPS vs -38.8 mL/y for those with asymptomatic TEPS (between-group difference, -7.5 mL/y [95% CI, -16.6 to 1.6 mL/y]). The cumulative incidence of COPD was 33.0% among participants with symptomatic TEPS vs 31.6% among those with asymptomatic TEPS (hazard ratio, 1.05 [95% CI, 0.76 to 1.46]). Participants with symptomatic TEPS had significantly more respiratory exacerbations than those with asymptomatic TEPS (0.23 vs 0.08 exacerbations per person-year, respectively; rate ratio, 2.38 [95% CI, 1.71 to 3.31], P < .001). Conclusions and Relevance Participants with symptomatic TEPS did not have accelerated rates of decline in FEV1 or increased incidence of COPD vs those with asymptomatic TEPS, but participants with symptomatic TEPS did experience significantly more respiratory exacerbations over a median follow-up of 5.8 years.
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Affiliation(s)
- William McKleroy
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, School of Medicine, University of California, San Francisco
- Now with Department of Pulmonary and Critical Care Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Tracie Shing
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Wayne H Anderson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - Mehrdad Arjomandi
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, School of Medicine, University of California, San Francisco
- Division of Pulmonary and Critical Care Medicine, Medical Service, San Francisco VA Medical Center, San Francisco, California
| | - Hira Anees Awan
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - R Graham Barr
- Divisions of General Medicine and Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York
- Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - Eugene R Bleecker
- Division of Genetics, Genomics, and Precision Medicine, Department of Medicine, College of Medicine, University of Arizona, Tucson
- Division of Pharmacogenomics, Center for Applied Genetics and Genomic Medicine, University of Arizona, Tucson
| | - John Boscardin
- Department of Medicine and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | - Russell P Bowler
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Russell G Buhr
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Gerard J Criner
- Division of Thoracic Medicine and Surgery, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Michigan, Ann Arbor
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Mark Dransfield
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama, Birmingham
| | - Claire M Doerschuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - Brett A Dolezal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - M Bradley Drummond
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Michigan, Ann Arbor
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kinsey Helton
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Eric A Hoffman
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City
- Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City
| | - Robert J Kaner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Richard E Kanner
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Medicine, School of Medicine, University of Utah, Salt Lake City
| | - Jerry A Krishnan
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago
| | - Stephen C Lazarus
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, School of Medicine, University of California, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jill Ohar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Victor E Ortega
- Division of Pulmonary Medicine, Department of Medicine, Mayo Clinic, Phoenix, Arizona
| | - Robert Paine
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Medicine, School of Medicine, University of Utah, Salt Lake City
| | - Stephen P Peters
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Joseph M Reinhardt
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City
| | - Stephen Rennard
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, College of Medicine, University of Nebraska, Omaha
| | - Benjamin M Smith
- Divisions of General Medicine and Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - David Couper
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, School of Medicine, University of California, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
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Barjaktarevic I, Cooper CB, Shing T, Buhr RG, Hoffman EA, Woodruff PG, Drummond MB, Kanner RE, Han MK, Hansel NN, Bowler RP, Kinney GL, Jacobson S, Morris MA, Martinez FJ, Ohar J, Couper D, Tashkin DP. Impact of Marijuana Smoking on COPD Progression in a Cohort of Middle-Aged and Older Persons. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:234-247. [PMID: 37199732 PMCID: PMC10484485 DOI: 10.15326/jcopdf.2022.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 05/19/2023]
Abstract
Background Limited data are available regarding marijuana smoking's impact on the development or progression of chronic obstructive pulmonary disease (COPD) in middle-aged or older adults with a variable history of tobacco cigarette smoking. Methods We divided ever-tobacco smoking participants in the SubPopulations and InteRmediate Outcomes In COPD Study (SPIROMICS) into 3 groups based on self-reported marijuana use: current, former, or never marijuana smokers (CMSs, FMSs or NMSs, respectively). Longitudinal data were analyzed in participants with ≥2 visits over a period of ≥52 weeks. Measurements We compared CMSs, FMSs, and NMSs, and those with varying amounts of lifetime marijuana use. Mixed effects linear regression models were used to analyze changes in spirometry, symptoms, health status, and radiographic metrics; zero-inflated negative binomial models were used for exacerbation rates. All models were adjusted for age, sex, race, baseline tobacco smoking amount, and forced expiratory volume in 1 second (FEV1) %predicted. Results Most participants were followed for ≥4 years. Annual rates of change in FEV1, incident COPD, respiratory symptoms, health status, radiographic extent of emphysema or air trapping, and total or severe exacerbations were not different between CMSs or FMSs versus NMSs or between those with any lifetime amount of marijuana use versus NMSs. Conclusions Among SPIROMICS participants with or without COPD, neither former nor current marijuana smoking of any lifetime amount was associated with evidence of COPD progression or its development. Because of our study's limitations, these findings underscore the need for further studies to better understand longer-term effects of marijuana smoking in COPD.
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Affiliation(s)
- Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
| | - Christopher B. Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
| | - Tracie Shing
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Russell G. Buhr
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, United States
| | - Eric A. Hoffman
- Departments of Radiology, Medicine and Bioengineering, University of Iowa, Iowa City, Iowa, United States
| | - Prescott G. Woodruff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States
| | - M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Richard E. Kanner
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Russell P. Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
| | - Gregory L. Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Sean Jacobson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Madeline A. Morris
- College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, United States
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, United States
| | - Jill Ohar
- Division of Pulmonary, Critical Care, Allergy and Immunology, School of Medicine, Wake Forest University, Wake Forest, North Carolina, United States
| | - David Couper
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Donald P. Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
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19
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Izquierdo M, Marion CR, Genese F, Newell JD, O'Neal WK, Li X, Hawkins GA, Barjaktarevic I, Barr RG, Christenson S, Cooper CB, Couper D, Curtis J, Han MK, Hansel NN, Kanner RE, Martinez FJ, Paine III R, Tejwani V, Woodruff PG, Zein JG, Hoffman EA, Peters SP, Meyers DA, Bleecker ER, Ortega VE. Impact of Bronchiectasis on COPD Severity and Alpha-1 Antitrypsin Deficiency as a Risk Factor in Individuals with a Heavy Smoking History. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:199-210. [PMID: 37199731 PMCID: PMC10484491 DOI: 10.15326/jcopdf.2023.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 07/29/2023]
Abstract
Rationale Bronchiectasis is common among those with heavy smoking histories, but risk factors for bronchiectasis, including alpha-1 antitrypsin deficiency, and its implications for COPD severity are uncharacterized in such individuals. Objectives To characterize the impact of bronchiectasis on COPD and explore alpha-1antitrypsin as a risk factor for bronchiectasis. Methods SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) participants (N=914; ages 40-80 years; ≥20-pack-year smoking) had high-resolution computed tomography (CT) scans interpreted visually for bronchiectasis, based on airway dilation without fibrosis or cicatrization. We performed regression-based models of bronchiectasis with clinical outcomes and quantitative CT measures. We deeply sequenced the gene encoding -alpha-1 antitrypsin, SERPINA1, in 835 participants to test for rare variants, focusing on the PiZ genotype (Glu366Lys, rs28929474). Measurements and Main Results We identified bronchiectasis in 365 (40%) participants, more frequently in women (45% versus 36%, p=0.0045), older participants (mean age=66[standard deviation (SD)=8.3] versus 64[SD=9.1] years, p=0.0083), and those with lower lung function (forced expiratory volume in 1 second [FEV1 ] percentage predicted=66%[SD=27] versus 77%[SD=25], p<0.0001; FEV1 to forced vital capacity [FVC] ratio=0.54[0.17] versus 0.63[SD=0.16], p<0.0001). Participants with bronchiectasis had greater emphysema (%voxels ≤-950 Hounsfield units, 11%[SD=12] versus 6.3%[SD=9], p<0.0001) and parametric response mapping functional small airways disease (26[SD=15] versus 19[SD=15], p<0.0001). Bronchiectasis was more frequent in the combined PiZZ and PiMZ genotype groups compared to those without PiZ, PiS, or other rare pathogenic variants (N=21 of 40 [52%] versus N=283 of 707[40%], odds ratio [OR]=1.97; 95% confidence interval [CI]=1.002, 3.90, p=0.049), an association attributed to White individuals (OR=1.98; 95%CI = 0.9956, 3.9; p=0.051). Conclusions Bronchiectasis was common in those with heavy smoking histories and was associated with detrimental clinical and radiographic outcomes. Our findings support alpha-1antitrypsin guideline recommendations to screen for alpha-1 antitrypsin deficiency in an appropriate bronchiectasis subgroup with a significant smoking history.
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Affiliation(s)
- Manuel Izquierdo
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
| | - Chad R. Marion
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
| | - Frank Genese
- Department of Pulmonary Disease, Rochester General Hospital, Rochester, New York, United States
| | - John D. Newell
- Departments of Radiology, Medicine, and Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Wanda K. O'Neal
- Marisco Lung Institute, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Xingnan Li
- Department of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Gregory A. Hawkins
- Center for Precision Medicine, Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Igor Barjaktarevic
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California, United States
| | - R. Graham Barr
- Columbia University Medical Center, New York City, New York, United States
| | - Stephanie Christenson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California, United States
| | - Christopher B. Cooper
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California, United States
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Jeffrey Curtis
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
- Division of Pulmonary and Critical Care Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Meilan K. Han
- Division of Pulmonary and Critical Care Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Nadia N. Hansel
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Richard E. Kanner
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, United States
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College of Cornell University, New York City, New York, United States
| | - Robert Paine III
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, United States
| | - Vickram Tejwani
- Respiratory Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Prescott G. Woodruff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California, United States
| | - Joe G. Zein
- Respiratory Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Eric A. Hoffman
- Departments of Radiology, Medicine, and Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Stephen P. Peters
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
| | - Deborah A. Meyers
- Department of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Eugene R. Bleecker
- Department of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Victor E. Ortega
- Department of Internal Medicine, Division of Respiratory Diseases, Center for Individualized Medicine, Mayo Clinic, Scottsdale, Arizona, United States
| | - for the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) investigators.
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
- Department of Pulmonary Disease, Rochester General Hospital, Rochester, New York, United States
- Departments of Radiology, Medicine, and Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
- Marisco Lung Institute, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Department of Medicine, University of Arizona, Tucson, Arizona, United States
- Center for Precision Medicine, Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California, United States
- Columbia University Medical Center, New York City, New York, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California, United States
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
- Division of Pulmonary and Critical Care Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College of Cornell University, New York City, New York, United States
- Respiratory Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States
- Department of Internal Medicine, Division of Respiratory Diseases, Center for Individualized Medicine, Mayo Clinic, Scottsdale, Arizona, United States
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20
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Rous JS, Lees PSJ, Koehler K, Buckley JP, Quirós-Alcalá L, Han MK, Hoffman EA, Labaki W, Barr RG, Peters SP, Paine R, Pirozzi C, Cooper CB, Dransfield MT, Comellas AP, Kanner RE, Drummond MB, Putcha N, Hansel NN, Paulin LM. Association of Occupational Exposures and Chronic Obstructive Pulmonary Disease Morbidity. J Occup Environ Med 2023; 65:e443-e452. [PMID: 36977360 PMCID: PMC10330008 DOI: 10.1097/jom.0000000000002850] [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] [Indexed: 03/30/2023]
Abstract
OBJECTIVE The aim of the study is to determine whether aggregate measures of occupational exposures are associated with chronic obstructive pulmonary disease (COPD) outcomes in the Subpopulations and Intermediate Outcome Measures in COPD study cohort. METHODS Individuals were assigned to six predetermined exposure hazard categories based on self-reported employment history. Multivariable regression, adjusted for age, sex, race, current smoking status, and smoking pack-years determined the association of such exposures to odds of COPD and morbidity measures. We compared these with the results of a single summary question regarding occupational exposure. RESULTS A total of 2772 individuals were included. Some exposure estimates, including "gases and vapors" and "dust and fumes" exposures resulted in associations with effect estimates over two times the estimated effect size when compared with a single summary question. CONCLUSIONS Use of occupational hazard categories can identify important associations with COPD morbidity while use of single-point measures may underestimate important differences in health risks.
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Affiliation(s)
- Jennifer S Rous
- From the Region VIII, Occupational Safety and Health Administration, Department of Labor, Denver, Colorado (J.S.R.); Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.S.R., P.S.J.L., K.K., J.P.B., L.Q.-A.); Department of Medicine, University of Michigan, Ann Arbor, Michigan (M.K.H., W.L.); Department of Radiology, University of Iowa, Iowa City, Iowa (E.A.H.); Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York (R.G.B.); Department of Medicine, Wake Forest University, Winston-Salem, North Carolina (S.P.P.); Department of Medicine, University of Utah, Salt Lake City, Utah (R.P., C.P., R.E.K.); Department of Medicine, University of California, Los Angeles, Los Angeles, California (C.B.C.); Department of Medicine, University of Alabama, Birmingham, Alabama (M.T.D..); Department of Medicine, University of Iowa, Iowa City, Iowa (A.P.C.); Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (M.B.D.); Department of Medicine, Johns Hopkins University, Baltimore, Maryland (N.P., N.N.H.); and Department of Medicine, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (L.M.P.)
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Kim JS, Manichaikul AW, Hoffman EA, Balte P, Anderson MR, Bernstein EJ, Madahar P, Oelsner EC, Kawut SM, Wysoczanski A, Laine AF, Adegunsoye A, Ma JZ, Taub MA, Mathias RA, Rich SS, Rotter JI, Noth I, Garcia CK, Barr RG, Podolanczuk AJ. MUC5B, telomere length and longitudinal quantitative interstitial lung changes: the MESA Lung Study. Thorax 2023; 78:566-573. [PMID: 36690926 PMCID: PMC9899287 DOI: 10.1136/thorax-2021-218139] [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: 08/26/2021] [Accepted: 07/11/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The MUC5B promoter variant (rs35705950) and telomere length are linked to pulmonary fibrosis and CT-based qualitative assessments of interstitial abnormalities, but their associations with longitudinal quantitative changes of the lung interstitium among community-dwelling adults are unknown. METHODS We used data from participants in the Multi-Ethnic Study of Atherosclerosis with high-attenuation areas (HAAs, Examinations 1-6 (2000-2018)) and MUC5B genotype (n=4552) and telomere length (n=4488) assessments. HAA was defined as the per cent of imaged lung with attenuation of -600 to -250 Hounsfield units. We used linear mixed-effects models to examine associations of MUC5B risk allele (T) and telomere length with longitudinal changes in HAAs. Joint models were used to examine associations of longitudinal changes in HAAs with death and interstitial lung disease (ILD). RESULTS The MUC5B risk allele (T) was associated with an absolute change in HAAs of 2.60% (95% CI 0.36% to 4.86%) per 10 years overall. This association was stronger among those with a telomere length below an age-adjusted percentile of 5% (p value for interaction=0.008). A 1% increase in HAAs per year was associated with 7% increase in mortality risk (rate ratio (RR)=1.07, 95% CI 1.02 to 1.12) for overall death and 34% increase in ILD (RR=1.34, 95% CI 1.20 to 1.50). Longer baseline telomere length was cross-sectionally associated with less HAAs from baseline scans, but not with longitudinal changes in HAAs. CONCLUSIONS Longitudinal increases in HAAs were associated with the MUC5B risk allele and a higher risk of death and ILD.
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Affiliation(s)
- John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ani W Manichaikul
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Pallavi Balte
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Michaela R Anderson
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elana J Bernstein
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Purnema Madahar
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics and Epidemiology, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Artur Wysoczanski
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew F Laine
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | | | - Jennie Z Ma
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Margaret A Taub
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rasika A Mathias
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen S Rich
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jerome I Rotter
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA
- The Institute for Translational Genomics and Population Sciences, The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Imre Noth
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Christine Kim Garcia
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Anna J Podolanczuk
- Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, New York, USA
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22
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Abadi E, Jadick G, Lynch DA, Segars WP, Samei E. Emphysema Quantifications With CT Scan: Assessing the Effects of Acquisition Protocols and Imaging Parameters Using Virtual Imaging Trials. Chest 2023; 163:1084-1100. [PMID: 36462532 PMCID: PMC10206513 DOI: 10.1016/j.chest.2022.11.033] [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: 04/17/2022] [Revised: 11/01/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND CT scan has notable potential to quantify the severity and progression of emphysema in patients. Such quantification should ideally reflect the true attributes and pathologic conditions of subjects, not scanner parameters. To achieve such an objective, the effects of the scanner conditions need to be understood so the influence can be mitigated. RESEARCH QUESTION How do CT scan imaging parameters affect the accuracy of emphysema-based quantifications and biomarkers? STUDY DESIGN AND METHODS Twenty anthropomorphic digital phantoms were developed with diverse anatomic attributes and emphysema abnormalities informed by a real COPD cohort. The phantoms were input to a validated CT scan simulator (DukeSim), modeling a commercial scanner (Siemens Flash). Virtual images were acquired under various clinical conditions of dose levels, tube current modulations (TCM), and reconstruction techniques and kernels. The images were analyzed to evaluate the effects of imaging parameters on the accuracy of density-based quantifications (percent of lung voxels with HU < -950 [LAA-950] and 15th percentile of lung histogram HU [Perc15]) across varied subjects. Paired t tests were performed to explore statistical differences between any two imaging conditions. RESULTS The most accurate imaging condition corresponded to the highest acquired dose (100 mAs) and iterative reconstruction (SAFIRE) with the smooth kernel of I31, where the measurement errors (difference between measurement and ground truth) were 35 ± 3 Hounsfield Units (HU), -4% ± 5%, and 26 ± 10 HU (average ± SD), for the mean lung HU, LAA-950, and Perc15, respectively. Without TCM and at the I31 kernel, increase of dose (20 to 100 mAs) improved the lung mean absolute error (MAE) by 4.2 ± 2.3 HU (average ± SD). TCM did not contribute to a systematic improvement of lung MAE. INTERPRETATION The results highlight that although CT scan quantification is possible, its reliability is impacted by the choice of imaging parameters. The developed virtual imaging trial platform in this study enables comprehensive evaluation of CT scan methods in reliable quantifications, an effort that cannot be readily made with patient images or simplistic physical phantoms.
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Affiliation(s)
- Ehsan Abadi
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, NC; Department of Electrical & Computer Engineering, Duke University, Durham, NC; Medical Physics Graduate Program, Duke University, Durham, NC.
| | - Giavanna Jadick
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, NC
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - W Paul Segars
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, NC; Medical Physics Graduate Program, Duke University, Durham, NC; Department of Biomedical Engineering, Duke University, Durham, NC
| | - Ehsan Samei
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, NC; Department of Electrical & Computer Engineering, Duke University, Durham, NC; Medical Physics Graduate Program, Duke University, Durham, NC; Department of Biomedical Engineering, Duke University, Durham, NC; Department of Physics, Duke University, Durham, NC
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23
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Kim JS, Azarbarzin A, Podolanczuk AJ, Anderson MR, Cade BE, Kawut SM, Wysoczanski A, Laine AF, Hoffman EA, Gottlieb DJ, Garcia CK, Barr RG, Redline S. Obstructive Sleep Apnea and Longitudinal Changes in Interstitial Lung Imaging and Lung Function: The MESA Study. Ann Am Thorac Soc 2023; 20:728-737. [PMID: 36790913 PMCID: PMC10174121 DOI: 10.1513/annalsats.202208-719oc] [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: 08/20/2022] [Accepted: 02/15/2023] [Indexed: 02/16/2023] Open
Abstract
Rationale: Obstructive sleep apnea (OSA) has been hypothesized to be a risk factor in interstitial lung disease (ILD) and is associated with radiological markers that may represent the earlier stages of ILD. Prior studies have been limited by their cross-sectional design and potential confounding by body habitus. Objectives: To test the hypothesis that OSA severity is associated with more high-attenuation areas (HAAs) on computed tomography and worse lung function over time among older community-dwelling adults. Methods: We used data from participants in the MESA (Multi-Ethnic Study of Atherosclerosis) who had apnea-hypopnea index (AHI) measured from polysomnography (2010-2013), high attenuation areas (HAAs, -600 to -250 Hounsfield units, n = 784), assessments from exams 5 (2010-2012) and 6 (2016-2018) full-lung computed tomography scans, and spirometry assessments (n = 677). Linear mixed-effects models with random intercept were used to examine associations of OSA severity (i.e., AHI and hypoxic burden) with changes in HAAs, total lung volumes, and forced vital capacity (FVC) between exams 5 and 6. Potential confounders were adjusted for in the model, including age, sex, smoking history, height, and weight. Results: Among those with a higher AHI there were more men and a higher body mass index. Participants with AHI ⩾ 15 events/h and in the highest hypoxic burden quartile each had increases in HAAs of 11.30% (95% confidence interval [CI], 3.74-19.35%) and 9.85% (95% CI, 1.40-19.01%) per 10 years, respectively. There was a more rapid decline in total lung volumes imaged and FVC among those with AHI ⩾ 15 events/h of 220.2 ml (95% CI, 47.8-392.5 ml) and 3.63% (95% CI, 0.43-6.83%) per 10 years, respectively. Conclusions: A greater burden of hypoxia related to obstructive events during sleep was associated with increased lung densities over time and a more rapid decline in lung volumes regardless of body habitus. Our findings suggest OSA may be a contributing factor in the early stages of ILD.
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Affiliation(s)
- John S. Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ali Azarbarzin
- Division of Sleep and Circadian Sleep Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anna J. Podolanczuk
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, New York, New York
| | | | - Brian E. Cade
- Division of Sleep and Circadian Sleep Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Steven M. Kawut
- Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Artur Wysoczanski
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Andrew F. Laine
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Eric A. Hoffman
- Department of Radiology
- Department of Medicine, and
- Department of Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Daniel J. Gottlieb
- Veterans Affairs Boston Healthcare System, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christine Kim Garcia
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - R. Graham Barr
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, New York, New York; and
| | - Susan Redline
- Division of Sleep and Circadian Sleep Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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24
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Wang JM, Labaki WW, Murray S, Martinez FJ, Curtis JL, Hoffman EA, Ram S, Bell AJ, Galban CJ, Han MK, Hatt C. Machine learning for screening of at-risk, mild and moderate COPD patients at risk of FEV 1 decline: results from COPDGene and SPIROMICS. Front Physiol 2023; 14:1144192. [PMID: 37153221 PMCID: PMC10161244 DOI: 10.3389/fphys.2023.1144192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose: The purpose of this study was to train and validate machine learning models for predicting rapid decline of forced expiratory volume in 1 s (FEV1) in individuals with a smoking history at-risk-for chronic obstructive pulmonary disease (COPD), Global Initiative for Chronic Obstructive Lung Disease (GOLD 0), or with mild-to-moderate (GOLD 1-2) COPD. We trained multiple models to predict rapid FEV1 decline using demographic, clinical and radiologic biomarker data. Training and internal validation data were obtained from the COPDGene study and prediction models were validated against the SPIROMICS cohort. Methods: We used GOLD 0-2 participants (n = 3,821) from COPDGene (60.0 ± 8.8 years, 49.9% male) for variable selection and model training. Accelerated lung function decline was defined as a mean drop in FEV1% predicted of > 1.5%/year at 5-year follow-up. We built logistic regression models predicting accelerated decline based on 22 chest CT imaging biomarker, pulmonary function, symptom, and demographic features. Models were validated using n = 885 SPIROMICS subjects (63.6 ± 8.6 years, 47.8% male). Results: The most important variables for predicting FEV1 decline in GOLD 0 participants were bronchodilator responsiveness (BDR), post bronchodilator FEV1% predicted (FEV1.pp.post), and CT-derived expiratory lung volume; among GOLD 1 and 2 subjects, they were BDR, age, and PRMlower lobes fSAD. In the validation cohort, GOLD 0 and GOLD 1-2 full variable models had significant predictive performance with AUCs of 0.620 ± 0.081 (p = 0.041) and 0.640 ± 0.059 (p < 0.001). Subjects with higher model-derived risk scores had significantly greater odds of FEV1 decline than those with lower scores. Conclusion: Predicting FEV1 decline in at-risk patients remains challenging but a combination of clinical, physiologic and imaging variables provided the best performance across two COPD cohorts.
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Affiliation(s)
- Jennifer M. Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Susan Murray
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | | | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Alexander J. Bell
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Craig J. Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Charles Hatt
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Imbio Inc., Minneapolis, MN, United States
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25
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Vazquez Guillamet R, Rjob A, Bierhals A, Tague L, Marklin G, Halverson L, Witt C, Byers D, Hachem R, Gierada D, Brody SL, Takahashi T, Nava R, Kreisel D, Puri V, Trulock EP. Potential Role of Computed Tomography Volumetry in Size Matching in Lung Transplantation. Transplant Proc 2023; 55:432-439. [PMID: 36914438 PMCID: PMC10225152 DOI: 10.1016/j.transproceed.2023.02.016] [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: 11/21/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Accumulated knowledge on the outcomes related to size mismatch in lung transplantation derives from predicted total lung capacity equations rather than individualized measurements of donors and recipients. The increasing availability of computed tomography (CT) makes it possible to measure the lung volumes of donors and recipients before transplantation. We hypothesize that CT-derived lung volumes predict a need for surgical graft reduction and primary graft dysfunction. METHODS Donors from the local organ procurement organization and recipients from our hospital from 2012 to 2018 were included if their CT exams were available. The CT lung volumes and plethysmography total lung capacity were measured and compared with predicted total lung capacity using Bland Altman methods. We used logistic regression to predict the need for surgical graft reduction and ordinal logistic regression to stratify the risk for primary graft dysfunction. RESULTS A total of 315 transplant candidates with 575 CT scans and 379 donors with 379 CT scans were included. The CT lung volumes closely approximated plethysmography lung volumes and differed from the predicted total lung capacity in transplant candidates. In donors, CT lung volumes systematically underestimated predicted total lung capacity. Ninety-four donors and recipients were matched and transplanted locally. Larger donor and smaller recipient lung volumes estimated by CT predicted a need for surgical graft reduction and were associated with higher primary graft dysfunction grade. CONCLUSION The CT lung volumes predicted the need for surgical graft reduction and primary graft dysfunction grade. Adding CT-derived lung volumes to the donor-recipient matching process may improve recipients' outcomes.
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Affiliation(s)
- Rodrigo Vazquez Guillamet
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri.
| | - Ashraf Rjob
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Andrew Bierhals
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri
| | - Laneshia Tague
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Gary Marklin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Laura Halverson
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Chad Witt
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Derek Byers
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Ramsey Hachem
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - David Gierada
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri
| | - Steven L Brody
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri; Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri
| | - Tsuyoshi Takahashi
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Ruben Nava
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Daniel Kreisel
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Varun Puri
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Elbert P Trulock
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
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26
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Kizhakke Puliyakote AS, Stapleton EM, Durairaj K, Karuppusamy K, Kathiresan GB, Shanmugam K, Abdul Rahim S, Navaneethakrishnan S, Bilas M, Huang R, Metwali N, Jeronimo M, Chan KS, Guo J, Nagpal P, Peters TM, Thorne PS, Comellas AP, Hoffman EA. Imaging-based assessment of lung function in a population cooking indoors with biomass fuel: a pilot study. J Appl Physiol (1985) 2023; 134:710-721. [PMID: 36759166 PMCID: PMC10027118 DOI: 10.1152/japplphysiol.00286.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Biomass fuels (wood) are commonly used indoors in underventilated environments for cooking in the developing world, but the impact on lung physiology is poorly understood. Quantitative computed tomography (qCT) can provide sensitive metrics to compare the lungs of women cooking with wood vs. liquified petroleum gas (LPG). We prospectively assessed (qCT and spirometry) 23 primary female cooks (18 biomass, 5 LPG) with no history of cardiopulmonary disease in Thanjavur, India. CT was obtained at coached total lung capacity (TLC) and residual volume (RV). qCT assessment included texture-derived ground glass opacity [GGO: Adaptive Multiple Feature Method (AMFM)], air-trapping (expiratory voxels ≤ -856HU) and image registration-based assessment [Disease Probability Measure (DPM)] of emphysema, functional small airways disease (%AirTrapDPM), and regional lung mechanics. In addition, within-kitchen exposure assessments included particulate matter <2.5 μm(PM2.5), black carbon, β-(1, 3)-d-glucan (surrogate for fungi), and endotoxin. Air-trapping went undetected at RV via the threshold-based measure (voxels ≤ -856HU), possibly due to density shifts in the presence of inflammation. However, DPM, utilizing image-matching, demonstrated significant air-trapping in biomass vs. LPG cooks (P = 0.049). A subset of biomass cooks (6/18), identified using k-means clustering, had markedly altered DPM-metrics: greater air-trapping (P < 0.001), lower TLC-RV volume change (P < 0.001), a lower mean anisotropic deformation index (ADI; P < 0.001), and elevated % GGO (P < 0.02). Across all subjects, a texture measure of bronchovascular bundles was correlated to the log-transformed β-(1, 3)-d-glucan concentration (P = 0.026, R = 0.46), and black carbon (P = 0.04, R = 0.44). This pilot study identified environmental links with qCT-based lung pathologies and a cluster of biomass cooks (33%) with significant small airways disease.NEW & NOTEWORTHY Quantitative computed tomography has identified a cluster of women (33%) cooking with biomass fuels (wood) with image-based markers of functional small airways disease and associated alterations in regional lung mechanics. Texture and image registration-based metrics of lung function may allow for early detection of potential inflammatory processes that may arise in response to inhaled biomass smoke, and help identify phenotypes of chronic lung disease prevalent in nonsmoking women in the developing world.
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Affiliation(s)
- Abhilash S Kizhakke Puliyakote
- Department of Radiology, University of California, San Diego, La Jolla, California, United States
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Emma M Stapleton
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Kumar Durairaj
- Department of Physics, Periyar Maniammai Institute of Science and Technology, Thanjavur, India
| | - Kesavan Karuppusamy
- Department of Physics, Periyar Maniammai Institute of Science and Technology, Thanjavur, India
| | - Geetha B Kathiresan
- Department of Electronics and Communication Engineering, Periyar Maniammai Institute of Science and Technology, Thanjavur, India
| | - Kumaran Shanmugam
- Department of Biotechnology, Periyar Maniammai Institute of Science and Technology, Thanjavur, India
| | | | | | - Monalisa Bilas
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
| | - Rui Huang
- School of Economics, Nanjing University, Nanjing, People's Republic of China
| | - Nervana Metwali
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, United States
| | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kung-Sik Chan
- Department of Statistics and Actuarial Science, University of Iowa, Iowa City, Iowa, United States
| | - Junfeng Guo
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
| | - Prashant Nagpal
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Thomas M Peters
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, United States
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, United States
| | - Alejandro P Comellas
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Eric A Hoffman
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
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27
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Fortis S, Quibrera PM, Comellas AP, Bhatt SP, Tashkin DP, Hoffman EA, Criner GJ, Han MK, Barr RG, Arjomandi M, Dransfield MB, Peters SP, Dolezal BA, Kim V, Putcha N, Rennard SI, Paine R, Kanner RE, Curtis JL, Bowler RP, Martinez FJ, Hansel NN, Krishnan JA, Woodruff PG, Barjaktarevic IZ, Couper D, Anderson WH, Cooper CB. Bronchodilator Responsiveness in Tobacco-Exposed People With or Without COPD. Chest 2023; 163:502-514. [PMID: 36395858 PMCID: PMC9993341 DOI: 10.1016/j.chest.2022.11.009] [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: 06/07/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Bronchodilator responsiveness (BDR) in obstructive lung disease varies over time and may be associated with distinct clinical features. RESEARCH QUESTION Is consistent BDR over time (always present) differentially associated with obstructive lung disease features relative to inconsistent (sometimes present) or never (never present) BDR in tobacco-exposed people with or without COPD? STUDY DESIGN AND METHODS We retrospectively analyzed data from 2,269 tobacco-exposed participants in the Subpopulations and Intermediate Outcome Measures in COPD Study with or without COPD. We used various BDR definitions: change of ≥ 200 mL and ≥ 12% in FEV1 (FEV1-BDR), change in FVC (FVC-BDR), and change in in FEV1, FVC or both (ATS-BDR). Using generalized linear models adjusted for demographics, smoking history, FEV1 % predicted after bronchodilator administration, and number of visits that the participant completed, we assessed the association of BDR group: (1) consistent BDR, (2) inconsistent BDR, and (3) never BDR with asthma, CT scan features, blood eosinophil levels, and FEV1 decline in participants without COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 0) and the entire cohort (participants with or without COPD). RESULTS Both consistent and inconsistent ATS-BDR were associated with asthma history and greater small airways disease (%parametric response mapping functional small airways disease) relative to never ATS-BDR in participants with GOLD stage 0 disease and the entire cohort. We observed similar findings using FEV1-BDR and FVC-BDR definitions. Eosinophils did not vary consistently among BDR groups. Consistent BDR was associated with FEV1 decline over time relative to never BDR in the entire cohort. In participants with GOLD stage 0 disease, both the inconsistent ATS-BDR group (OR, 3.20; 95% CI, 2.21-4.66; P < .001) and consistent ATS-BDR group (OR, 9.48; 95% CI, 3.77-29.12; P < .001) were associated with progression to COPD relative to the never ATS-BDR group. INTERPRETATION Demonstration of BDR, even once, describes an obstructive lung disease phenotype with a history of asthma and greater small airways disease. Consistent demonstration of BDR indicated a high risk of lung function decline over time in the entire cohort and was associated with higher risk of progression to COPD in patients with GOLD stage 0 disease.
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Affiliation(s)
- Spyridon Fortis
- Center for Access & Delivery Research & Evaluation, Iowa City VA Health Care System, Iowa City, IA; Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA.
| | - Pedro M Quibrera
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham VA Medical Center, Birmingham, AL
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Eric A Hoffman
- Departments of Radiology, Biomedical Engineering and Medicine, University of Iowa, Iowa City, IA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Mehrdad Arjomandi
- Department of Medicine, University of California, San Francisco, CA; San Francisco Veterans Affairs Healthcare System, San Francisco, CA
| | - Mark B Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham VA Medical Center, Birmingham, AL; Division of Pulmonary and Critical Care Medicine, Birmingham VA Medical Center, Birmingham, AL
| | - Stephen P Peters
- Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Brett A Dolezal
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephen I Rennard
- Division of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Robert Paine
- Division of Respiratory, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Richard E Kanner
- Division of Respiratory, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI; Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Russell P Bowler
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO
| | - Fernando J Martinez
- Departments of Medicine and Genetic Medicine, Weill Cornell Medicine, New York, NY
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL
| | | | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Wayne H Anderson
- Division of Pulmonary and Critical Care Medicine, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
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Tattersall MC, Lee KE, Tsuchiya N, Osman F, Korcarz CE, Hansen KM, Peters MC, Fahy JV, Longhurst CA, Dunican E, Wentzel SE, Leader JK, Israel E, Levy BD, Castro M, Erzurum SC, Lempel J, Moore WC, Bleecker ER, Phillips BR, Mauger DT, Hoffman EA, Fain SB, Reeder SB, Sorkness RL, Jarjour NN, Denlinger LC, Schiebler ML. Skeletal Muscle Adiposity and Lung Function Trajectory in the Severe Asthma Research Program. Am J Respir Crit Care Med 2023; 207:475-484. [PMID: 36194556 PMCID: PMC9940151 DOI: 10.1164/rccm.202203-0597oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/04/2022] [Indexed: 01/05/2023] Open
Abstract
Rationale: Extrapulmonary manifestations of asthma, including fatty infiltration in tissues, may reflect systemic inflammation and influence lung function and disease severity. Objectives: To determine if skeletal muscle adiposity predicts lung function trajectory in asthma. Methods: Adult SARP III (Severe Asthma Research Program III) participants with baseline computed tomography imaging and longitudinal postbronchodilator FEV1% predicted (median follow-up 5 years [1,132 person-years]) were evaluated. The mean of left and right paraspinous muscle density (PSMD) at the 12th thoracic vertebral body was calculated (Hounsfield units [HU]). Lower PSMD reflects higher muscle adiposity. We derived PSMD reference ranges from healthy control subjects without asthma. A linear multivariable mixed-effects model was constructed to evaluate associations of baseline PSMD and lung function trajectory stratified by sex. Measurements and Main Results: Participants included 219 with asthma (67% women; mean [SD] body mass index, 32.3 [8.8] kg/m2) and 37 control subjects (51% women; mean [SD] body mass index, 26.3 [4.7] kg/m2). Participants with asthma had lower adjusted PSMD than control subjects (42.2 vs. 55.8 HU; P < 0.001). In adjusted models, PSMD predicted lung function trajectory in women with asthma (β = -0.47 Δ slope per 10-HU decrease; P = 0.03) but not men (β = 0.11 Δ slope per 10-HU decrease; P = 0.77). The highest PSMD tertile predicted a 2.9% improvement whereas the lowest tertile predicted a 1.8% decline in FEV1% predicted among women with asthma over 5 years. Conclusions: Participants with asthma have lower PSMD, reflecting greater muscle fat infiltration. Baseline PSMD predicted lung function decline among women with asthma but not men. These data support an important role of metabolic dysfunction in lung function decline.
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Affiliation(s)
| | | | - Nanae Tsuchiya
- Division of Cardiothoracic Imaging, Department of Radiology, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
- Department of Radiology, School of Medicine, University of the Ryukyus, Nishihara, Japan
| | | | | | | | - Michael C. Peters
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - John V. Fahy
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Eleanor Dunican
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland
- St. Vincent’s Hospital Elm Park, Dublin, Ireland
| | - Sally E. Wentzel
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, and
| | - Joseph K. Leader
- Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elliot Israel
- Division of Pulmonary and Critical Care and
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Jason Lempel
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Wendy C. Moore
- Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Eugene R. Bleecker
- Division of Genetics and
- Division of Pharmacokinetics, Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Brenda R. Phillips
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania; and
| | - David T. Mauger
- Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania; and
| | - Eric A. Hoffman
- Department of Biomedical Engineering
- Department of Radiology, and
- Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | | | | | - Nizar N. Jarjour
- Division of Pulmonary Medicine and Critical Care
- Department of Medicine
| | | | - Mark L. Schiebler
- Division of Cardiothoracic Imaging, Department of Radiology, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
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Chaudhary MFA, Hoffman EA, Guo J, Comellas AP, Newell JD, Nagpal P, Fortis S, Christensen GE, Gerard SE, Pan Y, Wang D, Abtin F, Barjaktarevic IZ, Barr RG, Bhatt SP, Bodduluri S, Cooper CB, Gravens-Mueller L, Han MK, Kazerooni EA, Martinez FJ, Menchaca MG, Ortega VE, Iii RP, Schroeder JD, Woodruff PG, Reinhardt JM. Predicting severe chronic obstructive pulmonary disease exacerbations using quantitative CT: a retrospective model development and external validation study. Lancet Digit Health 2023; 5:e83-e92. [PMID: 36707189 PMCID: PMC9896720 DOI: 10.1016/s2589-7500(22)00232-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/30/2022] [Accepted: 11/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Quantitative CT is becoming increasingly common for the characterisation of lung disease; however, its added potential as a clinical tool for predicting severe exacerbations remains understudied. We aimed to develop and validate quantitative CT-based models for predicting severe chronic obstructive pulmonary disease (COPD) exacerbations. METHODS We analysed the Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS) cohort, a multicentre study done at 12 clinical sites across the USA, of individuals aged 40-80 years from four strata: individuals who never smoked, individuals who smoked but had normal spirometry, individuals who smoked and had mild to moderate COPD, and individuals who smoked and had severe COPD. We used 3-year follow-up data to develop logistic regression classifiers for predicting severe exacerbations. Predictors included age, sex, race, BMI, pulmonary function, exacerbation history, smoking status, respiratory quality of life, and CT-based measures of density gradient texture and airway structure. We externally validated our models in a subset from the Genetic Epidemiology of COPD (COPDGene) cohort. Discriminative model performance was assessed using the area under the receiver operating characteristic curve (AUC), which was also compared with other predictors, including exacerbation history and the BMI, airflow obstruction, dyspnoea, and exercise capacity (BODE) index. We evaluated model calibration using calibration plots and Brier scores. FINDINGS Participants in SPIROMICS were enrolled between Nov 12, 2010, and July 31, 2015. Participants in COPDGene were enrolled between Jan 10, 2008, and April 15, 2011. We included 1956 participants from the SPIROMICS cohort who had complete 3-year follow-up data: the mean age of the cohort was 63·1 years (SD 9·2) and 1017 (52%) were men and 939 (48%) were women. Among the 1956 participants, 434 (22%) had a history of at least one severe exacerbation. For the CT-based models, the AUC was 0·854 (95% CI 0·852-0·855) for at least one severe exacerbation within 3 years and 0·931 (0·930-0·933) for consistent exacerbations (defined as ≥1 acute episode in each of the 3 years). Models were well calibrated with low Brier scores (0·121 for at least one severe exacerbation; 0·039 for consistent exacerbations). For the prediction of at least one severe event during 3-year follow-up, AUCs were significantly higher with CT biomarkers (0·854 [0·852-0·855]) than exacerbation history (0·823 [0·822-0·825]) and BODE index 0·812 [0·811-0·814]). 6965 participants were included in the external validation cohort, with a mean age of 60·5 years (SD 8·9). In this cohort, AUC for at least one severe exacerbation was 0·768 (0·767-0·769; Brier score 0·088). INTERPRETATION CT-based prediction models can be used for identification of patients with COPD who are at high risk of severe exacerbations. The newly identified CT biomarkers could potentially enable investigation into underlying disease mechanisms responsible for exacerbations. FUNDING National Institutes of Health and the National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Muhammad F A Chaudhary
- The Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA, USA; The Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Junfeng Guo
- Department of Radiology, University of Iowa, Iowa City, IA, USA; The Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA, USA
| | - John D Newell
- Department of Radiology, University of Iowa, Iowa City, IA, USA; The Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa, Iowa City, IA, USA; Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Spyridon Fortis
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA, USA
| | - Gary E Christensen
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA; Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Sarah E Gerard
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Yue Pan
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Di Wang
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Fereidoun Abtin
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Graham Barr
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Surya P Bhatt
- UAB Lung Imaging Lab, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandeep Bodduluri
- UAB Lung Imaging Lab, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher B Cooper
- Department of Physiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lisa Gravens-Mueller
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ella A Kazerooni
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Fernando J Martinez
- Division of Pulmonary Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Martha G Menchaca
- Department of Radiology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Victor E Ortega
- Department of Internal Medicine, Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Robert Paine Iii
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT, USA
| | - Joyce D Schroeder
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Prescott G Woodruff
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph M Reinhardt
- Department of Radiology, University of Iowa, Iowa City, IA, USA; The Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA.
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Mahdavi MMB, Arabfard M, Rafati M, Ghanei M. A Computer-based Analysis for Identification and Quantification of Small Airway Disease in Lung Computed Tomography Images: A Comprehensive Review for Radiologists. J Thorac Imaging 2023; 38:W1-W18. [PMID: 36206107 DOI: 10.1097/rti.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Computed tomography (CT) imaging is being increasingly used in clinical practice for detailed characterization of lung diseases. Respiratory diseases involve various components of the lung, including the small airways. Evaluation of small airway disease on CT images is challenging as the airways cannot be visualized directly by a CT scanner. Small airway disease can manifest as pulmonary air trapping (AT). Although AT may be sometimes seen as mosaic attenuation on expiratory CT images, it is difficult to identify diffuse AT visually. Computer technology advances over the past decades have provided methods for objective quantification of small airway disease on CT images. Quantitative CT (QCT) methods are being rapidly developed to quantify underlying lung diseases with greater precision than subjective visual assessment of CT images. A growing body of evidence suggests that QCT methods can be practical tools in the clinical setting to identify and quantify abnormal regions of the lung accurately and reproducibly. This review aimed to describe the available methods for the identification and quantification of small airway disease on CT images and to discuss the challenges of implementing QCT metrics in clinical care for patients with small airway disease.
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Affiliation(s)
- Mohammad Mehdi Baradaran Mahdavi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran
| | - Masoud Arabfard
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran
| | - Mehravar Rafati
- Department of Medical Physics and Radiology, Faculty of paramedicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran
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31
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Schiebler ML, Tsuchiya N, Hahn A, Fain S, Denlinger L, Jarjour N, Hoffman EA. Imaging Regional Airway Involvement of Asthma: Heterogeneity in Ventilation, Mucus Plugs and Remodeling. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:163-184. [PMID: 37464121 DOI: 10.1007/978-3-031-32259-4_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
The imaging of asthma using chest computed tomography (CT) is well-established (Jarjour et al., Am J Respir Crit Care Med 185(4):356-62, 2012; Castro et al., J Allergy Clin Immunol 128:467-78, 2011). Moreover, recent advances in functional imaging of the lungs with advanced computer analysis of both CT and magnetic resonance images (MRI) of the lungs have begun to play a role in quantifying regional obstruction. Specifically, quantitative measurements of the airways for bronchial wall thickening, luminal narrowing and distortion, the amount of mucus plugging, parenchymal density, and ventilation defects that could contribute to the patient's disease course are instructive for the entire care team. In this chapter, we will review common imaging methods and findings that relate to the heterogeneity of asthma. This information can help to guide treatment decisions. We will discuss mucous plugging, quantitative assessment of bronchial wall thickening, delta lumen phenomenon, parenchymal low-density lung on CT, and ventilation defect percentage on MRI as metrics for assessing regional ventilatory dysfunction.
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Affiliation(s)
- Mark L Schiebler
- Cardiothoracic imaging, Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
| | - Nanae Tsuchiya
- Department of Radiology, School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Andrew Hahn
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Sean Fain
- Department of Radiology, Biomedical Engineering, and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Loren Denlinger
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Nizar Jarjour
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Eric A Hoffman
- Departments of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, IA, USA
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32
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Kim JS, Kim J, Yin X, Hiura GT, Anderson MR, Hoffman EA, Raghu G, Noth I, Manichaikul A, Rich SS, Smith BM, Podolanczuk AJ, Garcia CK, Barr RG, Prince MR, Oelsner EC. Associations of hiatus hernia with CT-based interstitial lung changes: the MESA Lung Study. Eur Respir J 2023; 61:2103173. [PMID: 35777776 PMCID: PMC10203882 DOI: 10.1183/13993003.03173-2021] [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: 12/17/2021] [Accepted: 06/02/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hiatus hernia (HH) is prevalent in adults with pulmonary fibrosis. We hypothesised that HH would be associated with markers of lung inflammation and fibrosis among community-dwelling adults and stronger among MUC5B (rs35705950) risk allele carriers. METHODS In the Multi-Ethnic Study of Atherosclerosis, HH was assessed from cardiac and full-lung computed tomography (CT) scans performed at Exam 1 (2000-2002, n=3342) and Exam 5 (2010-2012, n=3091), respectively. Percentage of high attenuation areas (HAAs; percentage of voxels with attenuation between -600 and -250 HU) was measured from cardiac and lung scans. Interstitial lung abnormalities (ILAs) were examined from Exam 5 scans (n=2380). Regression models were used to examine the associations of HH with HAAs, ILAs and serum matrix metalloproteinase-7 (MMP-7), and adjusted for age, sex, race/ethnicity, educational attainment, smoking, height, weight and scanner parameters for HAA analysis. RESULTS HH detected from Exam 5 scans was associated with a mean percentage difference in HAAs of 2.23% (95% CI 0.57-3.93%) and an increase of 0.48% (95% CI 0.07-0.89%) per year, particularly in MUC5B risk allele carriers (p-value for interaction=0.02). HH was associated with ILAs among those <80 years of age (OR for ILAs 1.78, 95% CI 1.14-2.80) and higher serum MMP-7 level among smokers (p-value for smoking interaction=0.04). CONCLUSIONS HH was associated with more HAAs over time, particularly among MUC5B risk allele carriers, and ILAs in younger adults, and may be a risk factor in the early stages of interstitial lung disease.
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Affiliation(s)
- John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jinhye Kim
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
- Department of Radiology, Westchester Medical Center, Valhalla, NY, USA
| | - Xiaorui Yin
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Grant T Hiura
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Eric A Hoffman
- Department of Radiology, Carver School of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ganesh Raghu
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Imre Noth
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ani Manichaikul
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Stephen S Rich
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Benjamin M Smith
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Anna J Podolanczuk
- Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, NY, USA
| | - Christine Kim Garcia
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Nadeem SA, Comellas AP, Hoffman EA, Saha PK. Airway Detection in COPD at Low-Dose CT Using Deep Learning and Multiparametric Freeze and Grow. Radiol Cardiothorac Imaging 2022; 4:e210311. [PMID: 36601453 PMCID: PMC9806731 DOI: 10.1148/ryct.210311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 09/27/2022] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE To present and validate a fully automated airway detection method at low-dose CT in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS In this retrospective study, deep learning (DL) and freeze-and-grow (FG) methods were optimized and applied to automatically detect airways at low-dose CT. Four data sets were used: two data sets consisting of matching standard- and low-dose CT scans from the Genetic Epidemiology of COPD (COPDGene) phase II (2014-2017) cohort (n = 2 × 236; mean age ± SD, 70 years ± 9; 123 women); one data set consisting of low-dose CT scans from the COPDGene phase III (2018-2020) cohort (n = 335; mean age ± SD, 73 years ± 8; 173 women); and one data set consisting of low-dose, anonymized CT scans from the 2003 Dutch-Belgian Randomized Lung Cancer Screening trial (n = 55) acquired by using different CT scanners. Performance measures for different methods were computed and compared by using the Wilcoxon signed rank test. RESULTS At low-dose CT, 56 294 of 62 480 (90.1%) airways of the reference total airway count (TAC) and 32 109 of 37 864 (84.8%) airways of the peripheral TAC (TACp), detected at standard-dose CT, were detected. Significant losses (P < .001) of 14 526 of 76 453 (19.0%) airways and 884 of 6908 (12.8%) airways in the TAC and 12 256 of 43 462 (28.2%) airways and 699 of 3882 (18.0%) airways in the TACp were observed, respectively, for the multiprotocol and multiscanner data without retraining. When using the automated low-dose CT method, TAC values of 347, 342, 323, and 266 and TACp values of 205, 202, 289, and 141 were observed for those who have never smoked and participants at Global Initiative for Chronic Obstructive Lung Disease stages 0, 1, and 2, respectively, which were superior to the respective values previously reported for matching groups when using a semiautomated method at standard-dose CT. CONCLUSION A low-cost, automated CT-based airway detection method was suitable for investigation of airway phenotypes at low-dose CT.Keywords: Airway, Airway Count, Airway Detection, Chronic Obstructive Pulmonary Disease, CT, Deep Learning, Generalizability, Low-Dose CT, Segmentation, Thorax, LungClinical trial registration no. NCT00608764 Supplemental material is available for this article. © RSNA, 2022.
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Choe J, Lee SM, Hwang HJ, Lee SM, Yun J, Kim N, Seo JB. Artificial Intelligence in Lung Imaging. Semin Respir Crit Care Med 2022; 43:946-960. [PMID: 36174647 DOI: 10.1055/s-0042-1755571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recently, interest and advances in artificial intelligence (AI) including deep learning for medical images have surged. As imaging plays a major role in the assessment of pulmonary diseases, various AI algorithms have been developed for chest imaging. Some of these have been approved by governments and are now commercially available in the marketplace. In the field of chest radiology, there are various tasks and purposes that are suitable for AI: initial evaluation/triage of certain diseases, detection and diagnosis, quantitative assessment of disease severity and monitoring, and prediction for decision support. While AI is a powerful technology that can be applied to medical imaging and is expected to improve our current clinical practice, some obstacles must be addressed for the successful implementation of AI in workflows. Understanding and becoming familiar with the current status and potential clinical applications of AI in chest imaging, as well as remaining challenges, would be essential for radiologists and clinicians in the era of AI. This review introduces the potential clinical applications of AI in chest imaging and also discusses the challenges for the implementation of AI in daily clinical practice and future directions in chest imaging.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hye Jeon Hwang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jihye Yun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,Department of Convergence Medicine, Biomedical Engineering Research Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Pan Y, Wang D, Chaudhary MFA, Shao W, Gerard SE, Durumeric OC, Bhatt SP, Barr RG, Hoffman EA, Reinhardt JM, Christensen GE. Robust Measures of Image-Registration-Derived Lung Biomechanics in SPIROMICS. J Imaging 2022; 8:309. [PMID: 36422058 PMCID: PMC9693030 DOI: 10.3390/jimaging8110309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an umbrella term used to define a collection of inflammatory lung diseases that cause airflow obstruction and severe damage to the lung parenchyma. This study investigated the robustness of image-registration-based local biomechanical properties of the lung in individuals with COPD as a function of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Image registration was used to estimate the pointwise correspondences between the inspiration (total lung capacity) and expiration (residual volume) computed tomography (CT) images of the lung for each subject. In total, three biomechanical measures were computed from the correspondence map: the Jacobian determinant; the anisotropic deformation index (ADI); and the slab-rod index (SRI). CT scans from 245 subjects with varying GOLD stages were analyzed from the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS). Results show monotonic increasing or decreasing trends in the three biomechanical measures as a function of GOLD stage for the entire lung and on a lobe-by-lobe basis. Furthermore, these trends held across all five image registration algorithms. The consistency of the five image registration algorithms on a per individual basis is shown using Bland-Altman plots.
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Affiliation(s)
- Yue Pan
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Di Wang
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Muhammad F. A. Chaudhary
- The Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Wei Shao
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Sarah E. Gerard
- The Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Oguz C. Durumeric
- Department of Mathematics, University of Iowa, Iowa City, IA 52242, USA
| | - Surya P. Bhatt
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - R. Graham Barr
- Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY 10032, USA
| | - Eric A. Hoffman
- The Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA
| | - Joseph M. Reinhardt
- The Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA
| | - Gary E. Christensen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA 52242, USA
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA
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36
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Taskiran NP, Hiura GT, Zhang X, Barr RG, Dashnaw SM, Hoffman EA, Malinsky D, Oelsner EC, Prince MR, Smith BM, Sun Y, Sun Y, Wild JM, Shen W, Hughes EW. Mapping Alveolar Oxygen Partial Pressure in COPD Using Hyperpolarized Helium-3: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study. Tomography 2022; 8:2268-2284. [PMID: 36136886 PMCID: PMC9498778 DOI: 10.3390/tomography8050190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/05/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and emphysema are characterized by functional and structural damage which increases the spaces for gaseous diffusion and impairs oxygen exchange. Here we explore the potential for hyperpolarized (HP) 3He MRI to characterize lung structure and function in a large-scale population-based study. Participants (n = 54) from the Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study, a nested case-control study of COPD among participants with 10+ packyears underwent HP 3He MRI measuring pAO2, apparent diffusion coefficient (ADC), and ventilation. HP MRI measures were compared to full-lung CT and pulmonary function testing. High ADC values (>0.4 cm2/s) correlated with emphysema and heterogeneity in pAO2 measurements. Strong correlations were found between the heterogeneity of global pAO2 as summarized by its standard deviation (SD) (p < 0.0002) and non-physiologic pAO2 values (p < 0.0001) with percent emphysema on CT. A regional study revealed a strong association between pAO2 SD and visual emphysema severity (p < 0.003) and an association with the paraseptal emphysema subtype (p < 0.04) after adjustment for demographics and smoking status. HP noble gas pAO2 heterogeneity and the fraction of non-physiological pAO2 results increase in mild to moderate COPD. Measurements of pAO2 are sensitive to regional emphysematous damage detected by CT and may be used to probe pulmonary emphysema subtypes. HP noble gas lung MRI provides non-invasive information about COPD severity and lung function without ionizing radiation.
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Affiliation(s)
- Naz P. Taskiran
- Department of Chemical Engineering, Columbia University, New York, NY 10027, USA
- Correspondence: (N.P.T.); (E.W.H.); Tel.: +1-347-3693052 (N.P.T.); +1-626-4838731 (E.W.H.)
| | - Grant T. Hiura
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
| | - Xuzhe Zhang
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - R. Graham Barr
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
| | - Stephen M. Dashnaw
- Neurological Institute, Radiology, Columbia University, New York, NY 10032, USA
| | - Eric A. Hoffman
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Daniel Malinsky
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Elizabeth C. Oelsner
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
| | - Martin R. Prince
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Benjamin M. Smith
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
- Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | - Yanping Sun
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
| | - Yifei Sun
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Jim M. Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK
| | - Wei Shen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Institute of Human Nutrition, College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
- Columbia Magnetic Resonance Research Center (CMRRC), Columbia University, New York, NY 10027, USA
| | - Emlyn W. Hughes
- Department of Physics, Columbia University, New York, NY 10027, USA
- Correspondence: (N.P.T.); (E.W.H.); Tel.: +1-347-3693052 (N.P.T.); +1-626-4838731 (E.W.H.)
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Quantitative Computed Tomography: What Clinical Questions Can it Answer in Chronic Lung Disease? Lung 2022; 200:447-455. [PMID: 35751660 PMCID: PMC9378468 DOI: 10.1007/s00408-022-00550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/07/2022] [Indexed: 01/27/2023]
Abstract
Quantitative computed tomography (QCT) has recently gained an important role in the functional assessment of chronic lung disease. Its capacity in diagnostic, staging, and prognostic evaluation in this setting is similar to that of traditional pulmonary function testing. Furthermore, it can demonstrate lung injury before the alteration of pulmonary function test parameters, and it enables the classification of disease phenotypes, contributing to the customization of therapy and performance of comparative studies without the intra- and inter-observer variation that occurs with qualitative analysis. In this review, we address technical issues with QCT analysis and demonstrate the ability of this modality to answer clinical questions encountered in daily practice in the management of patients with chronic lung disease.
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Wang D, Pan Y, Durumeric OC, Reinhardt JM, Hoffman EA, Schroeder JD, Christensen GE. PLOSL: Population learning followed by one shot learning pulmonary image registration using tissue volume preserving and vesselness constraints. Med Image Anal 2022; 79:102434. [PMID: 35430476 DOI: 10.1016/j.media.2022.102434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/30/2022] [Accepted: 03/21/2022] [Indexed: 01/12/2023]
Abstract
This paper presents the Population Learning followed by One Shot Learning (PLOSL) pulmonary image registration method. PLOSL is a fast unsupervised learning-based framework for 3D-CT pulmonary image registration algorithm based on combining population learning (PL) and one-shot learning (OSL). The PLOSL image registration has the advantages of the PL and OSL approaches while reducing their respective drawbacks. The advantages of PLOSL include improved performance over PL, substantially reducing OSL training time and reducing the likelihood of OSL getting stuck in local minima. PLOSL pulmonary image registration uses tissue volume preserving and vesselness constraints for registration of inspiration-to-expiration and expiration-to-inspiration pulmonary CT images. A coarse-to-fine convolution encoder-decoder CNN architecture is used to register large and small shape features. During training, the sum of squared tissue volume difference (SSTVD) compensates for intensity differences between inspiration and expiration computed tomography (CT) images and the sum of squared vesselness measure difference (SSVMD) helps match the lung vessel tree. Results show that the PLOSL (SSTVD+SSVMD) algorithm achieved subvoxel landmark error while preserving pulmonary topology on the SPIROMICS data set, the public DIR-LAB COPDGene and 4DCT data sets.
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Affiliation(s)
- Di Wang
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Yue Pan
- Elekta Inc., St. Charles City, MO 63303, USA
| | - Oguz C Durumeric
- Department of Mathematics, University of Iowa, Iowa City, IA 52242, USA
| | - Joseph M Reinhardt
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA; Department of Radiology, University of Iowa, Iowa City, IA 52242, USA
| | - Eric A Hoffman
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA; Department of Radiology, University of Iowa, Iowa City, IA 52242, USA
| | - Joyce D Schroeder
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA
| | - Gary E Christensen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA 52242, USA; Department of Radiology Oncology, University of Iowa, Iowa City, IA 52242, USA.
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The role of medical physicists in clinical trials across Europe. Phys Med 2022; 100:31-38. [PMID: 35717777 DOI: 10.1016/j.ejmp.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/11/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The roles and responsibilities of medical physicists (MPs) are growing together with the evolving science and technology. The complexity of today's clinical trials requires the skills and knowledge of MPs for their safe and efficient implementation. However, it is unclear to what extent the skillsets offered by MPs are being exploited in clinical trials across Europe. METHODS The EFOMP Working Group on the role of Medical Physics Experts in Clinical Trials has designed a survey that targeted all 36 current National Member Organisations, receiving a response from 31 countries. The survey included both quantitative and qualitative queries regarding the involvement of MPs in trial design, setup, and coordination, either as trial team members or principal investigators. RESULTS The extent of MPs involvement in clinical trials greatly varies across European countries. The results showed disparities between the roles played by MPs in trial design, conduct or data processing. Similarly, differences among the 31 European countries that responded to the survey were found regarding the existence of national bodies responsible for trials or the available training offered to MPs. The role of principal investigator or co-investigator was reported by 12 countries (39%), a sign of efficient collaboration with medical doctors in designing and implementing clinical studies. CONCLUSION Organisation of specific training courses and guideline development for clinical trial design and conduct would encourage the involvement of a larger number of MPs in all stages of trials across Europe, leading to a better standardisation of clinical practice.
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Haase V, Hahn K, Schöndube H, Stierstorfer K, Maier A, Noo F. Single material beam hardening correction via an analytical energy response model for diagnostic CT. Med Phys 2022; 49:5014-5037. [PMID: 35651302 PMCID: PMC9388575 DOI: 10.1002/mp.15787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Various clinical studies show the potential for a wider quantitative role of diagnostic X-ray computed tomography (CT) beyond size measurements. Currently, the clinical use of attenuation values is however limited due to their lack of robustness. This issue can be observed even on the same scanner across patient size and positioning. There are different causes for the lack of robustness in the attenuation values; one possible source of error is beam hardening of the X-ray source spectrum. The conventional and well-established approach to address this issue is a calibration-based single material beam hardening correction (BHC) using a water cylinder. PURPOSE We investigate an alternative approach for single material BHC with the aim of producing a more robust result for the attenuation values. The underlying hypothesis of this investigation is that calibration based BHC automatically corrects for scattered radiation in a manner that is sub-optimal in terms of bias as soon as the scanned object strongly deviates from the water cylinder used for calibration. METHODS The approach we propose performs BHC via an analytical energy response model that is embedded into a correction pipeline that efficiently estimates and subtracts scattered radiation in a patient-specific manner prior to BHC. The estimation of scattered radiation is based on minimizing, in average, the squared difference between our corrected data and the vendor-calibrated data. The used energy response model is considering the spectral effects of the detector response and of the pre-filtration of the source spectrum including a beam-shaping bowtie filter. The performance of the correction pipeline is first characterized with computer simulated data. Afterwards, it is tested using real 3-D CT data sets of two different phantoms, with various kV settings and phantom positions, assuming a circular data acquisition. The results are compared in the image domain to those from the scanner. RESULTS For experiments with a water cylinder, the proposed correction pipeline leads to similar results as the vendor. For reconstructions of a QRM liver phantom with extension ring, the proposed correction pipeline achieved a more uniform and stable outcome in the attenuation values of homogeneous materials within the phantom. For example, the root mean squared deviation between centered and off-centered phantom positioning was reduced from 6.6 HU to 1.8 HU in one profile. CONCLUSIONS We have introduced a patient-specific approach for single material BHC in diagnostic CT via the use of an analytical energy response model. This approach shows promising improvements in terms of robustness of attenuation values for large patient sizes. Our results contribute towards improving CT images so as to make CT attenuation values more reliable for use in clinical practice. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Viktor Haase
- Siemens Healthcare GmbH, Siemensstr. 3, Forchheim, 91301, Germany.,Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstr. 3, Erlangen, 91058, Germany
| | - Katharina Hahn
- Siemens Healthcare GmbH, Siemensstr. 3, Forchheim, 91301, Germany
| | - Harald Schöndube
- Siemens Healthcare GmbH, Siemensstr. 3, Forchheim, 91301, Germany
| | | | - Andreas Maier
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstr. 3, Erlangen, 91058, Germany
| | - Frédéric Noo
- Department of Radiology and Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, Utah, 84108, USA
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Trivedi AP, Hall C, Goss CW, Lew D, Krings JG, McGregor MC, Samant M, Sieren JP, Li H, Schechtman KB, Schirm J, McEleney S, Peterson S, Moore WC, Bleecker ER, Meyers DA, Israel E, Washko GR, Levy BD, Leader JK, Wenzel SE, Fahy JV, Schiebler ML, Fain SB, Jarjour NN, Mauger DT, Reinhardt JM, Newell JD, Hoffman EA, Castro M, Sheshadri A, Levy B, Cernadas M, Washko GR, Haley K, Cardet JC, Duvall M, Forth V, Le M, Fandozzi E, O'Neill A, Gentile K, Cinelli M, Tulchinsky A, Lawrance G, Czajkowski R, Lemole P, Antunes W, McGinnis A, Klokeid K, Phipatanakul W, Sheehan W, Bartnikas L, Baxi S, Crestani E, Etsy B, Gaffin J, Hauptman M, Kantor D, Lai P, Louisias M, Nelson K, Permaul P, Schneider L, Wright L, Minnicozzi S, Maciag M, Haktanir-Abul M, Gunnlaugsson S, Burke-Roberts E, Cunningham A, Ansel-Kelly E, Waskosky S, Ramsey A, Feloney L, Wenzel S, Fajt M, Celedon J, Larkin A, Di P, Chu HW, Gauthier M, Wu W, Jain S, Camiolo M, Rauscher C, Luyster F, Rebovich P, Demas J, Wunderley R, Vitari C, Ilnicki M, Srollo D, Takosky C, Lanzo R, Leader J, Lapic DM, Etling E, Rhodes D, Burger J, Glover E, Peters A, Smith C, Bonfiglio N, Trudeau J, Bang SJ, Lin Q, Liu CH, Kupul S, Jarjour N, Denlinger L, Lemanske R, Fain S, Viswanathan R, Moss M, Jackson D, Sorkness R, Ramratnam S, Tattersall M, Crisafi G, Klaus D, Wollet L, Bach J, Johansson M, Schiebler M, Esnault S, Mathur S, Yakey J, Floerke H, Guadarrama A, Maddox A, Peters B, Beaman K, Sumino K, Castro M, Bacharier L, Gierada D, Woods J, Schechtman K, Patterson B, Sheshadri A, Coverstone A, Shifren A, Quirk J, Byers D, Krings J, McGregor MC, Samant M, Tarsi J, Koch T, Curtis V, Yin-Declue H, Boomer J, Saylor M, Frei S, Rowe L, Sajol G, Kozlowski J, Hoffman E, Allard E, Atha J, Ching-Long L, Fahy J, Woodruff P, Ly N, Bhakta N, Peters M, Moreno C, Baum A, Liu D, Kalra A, Orain X, Charbit A, Njoku N, Dunican E, Teague WG, Greenwald R, DeBoer M, Wavell K, deRonde K, Erzurum S, Carl J, Khatri S, Dweik R, Comhair S, Sharp J, Lempel J, Farha S, Taliercio R, Aronica M, Zein J, Koo M, Painter TA, Hopkins K, Lawrence J, Abi-Saleh S, Labadia M, Qirjaz E, Wehrmann R, Arbruster D, Markle T, Matuska B, Baicker-McKee S, Wyszynski P, Fitzgerald K, Ross K, Gaston B, Myers R, Craven D, Roesch E, Thomas R, Logan L, Veri L, Gluvna A, Wallace J, Pryor M, Smith S, Allerton P, Emrich T, Hilliard J, Krenicky J, Smith L, Ferrebee M, Moore W, Bleecker E, Meyers D, Peters S, Li X, Hastie A, Ortega V, Hawkins G, Krings J, Ampleford E, Pippins A, Field P, Rector B, Sprissler R, Fransway B, Fitzpatrick A, Stephenson S, Mauger DT, Phillips B. Quantitative CT Characteristics of Cluster Phenotypes in the Severe Asthma Research Program Cohorts. Radiology 2022; 304:450-459. [PMID: 35471111 PMCID: PMC9340243 DOI: 10.1148/radiol.210363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Clustering key clinical characteristics of participants in the Severe Asthma Research Program (SARP), a large, multicenter prospective observational study of patients with asthma and healthy controls, has led to the identification of novel asthma phenotypes. Purpose To determine whether quantitative CT (qCT) could help distinguish between clinical asthma phenotypes. Materials and Methods A retrospective cross-sectional analysis was conducted with the use of qCT images (maximal bronchodilation at total lung capacity [TLC], or inspiration, and functional residual capacity [FRC], or expiration) from the cluster phenotypes of SARP participants (cluster 1: minimal disease; cluster 2: mild, reversible; cluster 3: obese asthma; cluster 4: severe, reversible; cluster 5: severe, irreversible) enrolled between September 2001 and December 2015. Airway morphometry was performed along standard paths (RB1, RB4, RB10, LB1, and LB10). Corresponding voxels from TLC and FRC images were mapped with use of deformable image registration to characterize disease probability maps (DPMs) of functional small airway disease (fSAD), voxel-level volume changes (Jacobian), and isotropy (anisotropic deformation index [ADI]). The association between cluster assignment and qCT measures was evaluated using linear mixed models. Results A total of 455 participants were evaluated with cluster assignments and CT (mean age ± SD, 42.1 years ± 14.7; 270 women). Airway morphometry had limited ability to help discern between clusters. DPM fSAD was highest in cluster 5 (cluster 1 in SARP III: 19.0% ± 20.6; cluster 2: 18.9% ± 13.3; cluster 3: 24.9% ± 13.1; cluster 4: 24.1% ± 8.4; cluster 5: 38.8% ± 14.4; P < .001). Lower whole-lung Jacobian and ADI values were associated with greater cluster severity. Compared to cluster 1, cluster 5 lung expansion was 31% smaller (Jacobian in SARP III cohort: 2.31 ± 0.6 vs 1.61 ± 0.3, respectively, P < .001) and 34% more isotropic (ADI in SARP III cohort: 0.40 ± 0.1 vs 0.61 ± 0.2, P < .001). Within-lung Jacobian and ADI SDs decreased as severity worsened (Jacobian SD in SARP III cohort: 0.90 ± 0.4 for cluster 1; 0.79 ± 0.3 for cluster 2; 0.62 ± 0.2 for cluster 3; 0.63 ± 0.2 for cluster 4; and 0.41 ± 0.2 for cluster 5; P < .001). Conclusion Quantitative CT assessments of the degree and intraindividual regional variability of lung expansion distinguished between well-established clinical phenotypes among participants with asthma from the Severe Asthma Research Program study. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Verschakelen in this issue.
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Hoffman EA. Origins of and lessons from quantitative functional X-ray computed tomography of the lung. Br J Radiol 2022; 95:20211364. [PMID: 35193364 PMCID: PMC9153696 DOI: 10.1259/bjr.20211364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 12/16/2022] Open
Abstract
Functional CT of the lung has emerged from quantitative CT (qCT). Structural details extracted at multiple lung volumes offer indices of function. Additionally, single volumetric images, if acquired at standardized lung volumes and body posture, can be used to model function by employing such engineering techniques as computational fluid dynamics. With the emergence of multispectral CT imaging including dual energy from energy integrating CT scanners and multienergy binning using the newly released photon counting CT technology, function is tagged via use of contrast agents. Lung disease phenotypes have previously been lumped together by the limitations of spirometry and plethysmography. QCT and its functional embodiment have been imbedded into studies seeking to characterize chronic obstructive pulmonary disease, severe asthma, interstitial lung disease and more. Reductions in radiation dose by an order of magnitude or more have been achieved. At the same time, we have seen significant increases in spatial and density resolution along with methodologic validations of extracted metrics. Together, these have allowed attention to turn towards more mild forms of disease and younger populations. In early applications, clinical CT offered anatomic details of the lung. Functional CT offers regional measures of lung mechanics, the assessment of functional small airways disease, as well as regional ventilation-perfusion matching (V/Q) and more. This paper will focus on the use of quantitative/functional CT for the non-invasive exploration of dynamic three-dimensional functioning of the breathing lung and beating heart within the unique negative pressure intrathoracic environment of the closed chest.
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Affiliation(s)
- Eric A Hoffman
- Departments of Radiology, Internal Medicine and Biomedical Engineering University of Iowa, Iowa, United States
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Kim JS, Axelsson GT, Moll M, Anderson MR, Bernstein EJ, Putman RK, Hida T, Hatabu H, Hoffman EA, Raghu G, Kawut SM, Doyle MF, Tracy R, Launer LJ, Manichaikul A, Rich SS, Lederer DJ, Gudnason V, Hobbs BD, Cho MH, Hunninghake GM, Garcia CK, Gudmundsson G, Barr RG, Podolanczuk AJ. Associations of Monocyte Count and Other Immune Cell Types with Interstitial Lung Abnormalities. Am J Respir Crit Care Med 2022; 205:795-805. [PMID: 34929108 PMCID: PMC10394677 DOI: 10.1164/rccm.202108-1967oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Higher blood monocyte counts are associated with worse survival in adults with clinically diagnosed pulmonary fibrosis. Their association with the development and progression of interstitial lung abnormalities (ILA) in humans is unknown. Objectives: We evaluated the associations of blood monocyte count, and other immune cell types, with ILA, high-attenuation areas, and FVC in four independent cohorts. Methods: We included participants with measured monocyte counts and computed tomographic (CT) imaging enrolled in MESA (Multi-Ethnic Study of Atherosclerosis, n = 484), AGES-Reykjavik (Age/Gene Environment Susceptibility Study, n = 3,547), COPDGene (Genetic Epidemiology of COPD, n = 2,719), and the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points, n = 646). Measurements and Main Results: After adjustment for covariates, a 1-SD increment in blood monocyte count was associated with ILA in MESA (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.8), AGES-Reykjavik (OR, 1.2; 95% CI, 1.1-1.3), COPDGene (OR, 1.3; 95% CI, 1.2-1.4), and ECLIPSE (OR, 1.2; 95% CI, 1.0-1.4). A higher monocyte count was associated with ILA progression over 5 years in AGES-Reykjavik (OR, 1.2; 95% CI, 1.0-1.3). Compared with participants without ILA, there was a higher percentage of activated monocytes among those with ILA in MESA. Higher monocyte count was associated with greater high-attenuation areas in MESA and lower FVC in MESA and COPDGene. Associations of other immune cell types were less consistent. Conclusions: Higher blood monocyte counts were associated with the presence and progression of interstitial lung abnormalities and lower FVC.
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Affiliation(s)
- John S Kim
- Department of Medicine, and.,Department of Medicine, Columbia University, New York, New York
| | - Gísli Thor Axelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Matthew Moll
- Division of Pulmonary and Critical Care and.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Tomoyuki Hida
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eric A Hoffman
- Department of Radiology.,Department of Medicine, and.,Department of Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ganesh Raghu
- Department of Medicine, University of Washington, Seattle, Washington
| | - Steven M Kawut
- Department of Medicine and.,Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret F Doyle
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont
| | - Russell Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute of on Aging, National Institutes of Health, Bethesda, Maryland
| | - Ani Manichaikul
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Stephen S Rich
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Brian D Hobbs
- Division of Pulmonary and Critical Care and.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael H Cho
- Division of Pulmonary and Critical Care and.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, New York.,Department of Epidemiology, Mailman School of Public Health, New York, New York; and
| | - Anna J Podolanczuk
- Department of Medicine, Columbia University, New York, New York.,Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, New York, New York
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Abstract
INTRODUCTION Hematologic malignancies are cancers of the blood, bone marrow and lymph nodes and represent a heterogenous group of diseases that affect people of all ages. Treatment generally involves chemotherapeutic or targeted agents that aim to kill malignant cells. In some cases, hematopoietic stem cell transplantation (HCT) is required to replenish the killed blood and stem cells. Both disease and therapies are associated with pulmonary complications. As survivors live longer with the disease and are treated with novel agents that may result in secondary immunodeficiency, airway diseases and respiratory infections will increasingly be encountered. To prevent airways diseases from adding to the morbidity of survivors or leading to long-term mortality, improved understanding of the pathogenesis and treatment of viral bronchiolitis, BOS, and bronchiectasis is necessary. AREAS COVERED This review focuses on viral bronchitis, BOS and bronchiectasis in people with hematological malignancy. Literature was reviewed from Pubmed for the areas covered. EXPERT OPINION Airway disease impacts significantly on hematologic malignancies. Viral bronchiolitis, BOS and bronchiectasis are common respiratory manifestations in hematological malignancy. Strategies to identify patients early in their disease course may improve the efficacy of treatment and halt progression of lung function decline and improve quality of life.
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Affiliation(s)
- Ricardo J. José
- Department of Respiratory Medicine, Host Defence, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW36NP, United Kingdom,Centre for Inflammation and Tissue Repair, UCL Respiratory, 5 University Street, London, WC1E6JF, United Kingdom
| | - Burton F. Dickey
- Department of Pulmonary Medicine, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, United States of America
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, United States of America
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45
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Niedbalski PJ, Choi J, Hall CS, Castro M. Imaging in Asthma Management. Semin Respir Crit Care Med 2022; 43:613-626. [PMID: 35211923 DOI: 10.1055/s-0042-1743289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Asthma is a heterogeneous disease characterized by chronic airway inflammation that affects more than 300 million people worldwide. Clinically, asthma has a widely variable presentation and is defined based on a history of respiratory symptoms alongside airflow limitation. Imaging is not needed to confirm a diagnosis of asthma, and thus the use of imaging in asthma has historically been limited to excluding alternative diagnoses. However, significant advances continue to be made in novel imaging methodologies, which have been increasingly used to better understand respiratory impairment in asthma. As a disease primarily impacting the airways, asthma is best understood by imaging methods with the ability to elucidate airway impairment. Techniques such as computed tomography, magnetic resonance imaging with gaseous contrast agents, and positron emission tomography enable assessment of the small airways. Others, such as optical coherence tomography and endobronchial ultrasound enable high-resolution imaging of the large airways accessible to bronchoscopy. These imaging techniques are providing new insights in the pathophysiology and treatments of asthma and are poised to impact the clinical management of asthma.
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Affiliation(s)
- Peter J Niedbalski
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Jiwoong Choi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Chase S Hall
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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Wu F, Jiang C, Zhou Y, Zheng Y, Tian H, Li H, Deng Z, Zhao N, Chen H, Ran P. Association of Total Airway Count on Computed Tomography with Pulmonary Function Decline in Early-Stage COPD: A Population-Based Prospective Cohort Study. Int J Chron Obstruct Pulmon Dis 2022; 16:3437-3448. [PMID: 34984001 PMCID: PMC8702985 DOI: 10.2147/copd.s339029] [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: 09/15/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background It has been found that the degree of terminal bronchiole destruction is associated with the severity of COPD. However, total airway count (TAC) of CT-visible and its relationship with COPD lung function severity and pulmonary function decline remains controversial. The present study aimed to determine whether TAC is significantly reduced in early-stage COPD (GOLD stage I–II) compared with healthy control subjects and whether TAC is associated with annual decline in pulmonary function in Chinese patients with early-stage COPD. Methods A total of 176 participants were enrolled in this study, of which 139 participants had undergone at least two spirometry measurements within 7 years (average 5.5 [standard deviation 0.8] years) after baseline data acquisition. CT-visible TAC was measured by summing all airway segments using semi-automated software. Average lumen diameter, average inner area, emphysema index, air trapping, and inspiratory Pi10 were also measured. Multivariable linear analysis was performed to evaluate variables that were significantly related to pulmonary function parameters and to evaluate the correlation between TAC and annual decline in longitudinal pulmonary function. Results Compared with healthy control subjects, CT-visible TAC was significantly reduced by 51% in GOLD II and by 31% in GOLD I after adjustment. TAC had the greatest impact on pre-bronchodilator FEV1, pre-bronchodilator FVC, post-bronchodilator FEV1, and post-bronchodilator FEV1/FVC (both p<0.001) among all CT indicators measured. TAC has the best correlation with inspiratory Pi10 (ρ=−0.751, p<0.001), an evaluation indicator of the degree of airway remodeling. TAC was independently associated with annual decline in pre-bronchodilator FEV1 (p=0.023), post-bronchodilator FEV1 (p=0.018), and post-bronchodilator FEV1/FVC (p<0.001). Conclusion This finding suggests that CT-visible TAC may be an evaluation indicator of the degree of airway remodeling, and was diminished in greater COPD lung function severity, and independently associated with disease progression. Early-stage COPD patients have already occurred lung structural changes and early intervention may be needed to ameliorate the progression of disease. Clinical Trial Registration ChiCTR-OO-14004264.
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Affiliation(s)
- Fan Wu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.,Guangzhou Laboratory, Bio-island, Guangzhou, People's Republic of China
| | - Changbin Jiang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yumin Zhou
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.,Guangzhou Laboratory, Bio-island, Guangzhou, People's Republic of China
| | - Youlan Zheng
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Heshen Tian
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Haiqing Li
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Zhishan Deng
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Ningning Zhao
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Huai Chen
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Pixin Ran
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.,Guangzhou Laboratory, Bio-island, Guangzhou, People's Republic of China
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47
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Ronish BE, Couper DJ, Barjaktarevic IZ, Cooper CB, Kanner RE, Pirozzi CS, Kim V, Wells JM, Han MK, Woodruff PG, Ortega VE, Peters SP, Hoffman EA, Buhr RG, Dolezal BA, Tashkin DP, Liou TG, Bateman LA, Schroeder JD, Martinez FJ, Barr RG, Hansel NN, Comellas AP, Rennard SI, Arjomandi M, Paine III R. Forced Expiratory Flow at 25%-75% Links COPD Physiology to Emphysema and Disease Severity in the SPIROMICS Cohort. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:111-121. [PMID: 35114743 PMCID: PMC9166328 DOI: 10.15326/jcopdf.2021.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Forced expiratory volume in 1 second (FEV1) is central to the diagnosis of chronic obstructive pulmonary disease (COPD) but is imprecise in classifying disease burden. We examined the potential of the maximal mid-expiratory flow rate (forced expiratory flow rate between 25% and 75% [FEF25%-75%]) as an additional tool for characterizing pathophysiology in COPD. OBJECTIVE To determine whether FEF25%-75% helps predict clinical and radiographic abnormalities in COPD. STUDY DESIGN AND METHODS The SubPopulations and InteRediate Outcome Measures In COPD Study (SPIROMICS) enrolled a prospective cohort of 2978 nonsmokers and ever-smokers, with and without COPD, to identify phenotypes and intermediate markers of disease progression. We used baseline data from 2771 ever-smokers from the SPIROMICS cohort to identify associations between percent predicted FEF25%-75% (%predFEF25%-75%) and both clinical markers and computed tomography (CT) findings of smoking-related lung disease. RESULTS Lower %predFEF25-75% was associated with more severe disease, manifested radiographically by increased functional small airways disease, emphysema (most notably with homogeneous distribution), CT-measured residual volume, total lung capacity (TLC), and airway wall thickness, and clinically by increased symptoms, decreased 6-minute walk distance, and increased bronchodilator responsiveness (BDR). A lower %predFEF25-75% remained significantly associated with increased emphysema, functional small airways disease, TLC, and BDR after adjustment for FEV1 or forced vital capacity (FVC). INTERPRETATION The %predFEF25-75% provides additional information about disease manifestation beyond FEV1. These associations may reflect loss of elastic recoil and air trapping from emphysema and intrinsic small airways disease. Thus, %predFEF25-75% helps link the anatomic pathology and deranged physiology of COPD.
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Affiliation(s)
- Bonnie E. Ronish
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
| | - David J. Couper
- Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Igor Z. Barjaktarevic
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles,California, United States
| | - Christopher B. Cooper
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles,California, United States,Department of Physiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
| | - Richard E. Kanner
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Cheryl S. Pirozzi
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, United States
| | - James M. Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Prescott G. Woodruff
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Victor E. Ortega
- Division of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Stephen P. Peters
- Division of Internal Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina, United States
| | - Eric A. Hoffman
- Division of Physiologic Imaging, Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Russell G. Buhr
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles,California, United States,Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Health Services Research and Development, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, United States
| | - Brett A. Dolezal
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles,California, United States
| | - Donald P. Tashkin
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles,California, United States
| | - Theodore G. Liou
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Lori A. Bateman
- Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Joyce D. Schroeder
- Division of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York, United States
| | - R. Graham Barr
- Department of Internal Medicine, Columbia University, New York, New York, United States
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Alejandro P. Comellas
- Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Stephen I. Rennard
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Mehrdad Arjomandi
- Department of Medicine, University of California San Francisco, San Francisco, California, United States,San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
| | - Robert Paine III
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
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Kim T, Kim WJ, Lee CH, Chae KJ, Bak SH, Kwon SO, Jin GY, Park EK, Choi S. Quantitative computed tomography imaging-based classification of cement dust-exposed subjects with an artificial neural network technique. Comput Biol Med 2021; 141:105162. [PMID: 34973583 DOI: 10.1016/j.compbiomed.2021.105162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/06/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Cement dust exposure is likely to affect the structural and functional alterations in segmental airways and parenchymal lungs. This study develops an artificial neural network (ANN) model for identifying cement dust-exposed (CDE) subjects using quantitative computed tomography-based airway structural and functional features. METHODS We obtained the airway features in five central and five sub-grouped segmental regions and the lung features in five lobar regions and one total lung region from 311 CDE and 298 non-CDE (NCDE) subjects. The five-fold cross-validation method was adopted to train the following classification models:ANN, support vector machine (SVM), logistic regression (LR), and decision tree (DT). For all the classification models, linear discriminant analysis (LDA) and genetic algorithm (GA) were applied for dimensional reduction and hyperparameterization, respectively. The ANN model without LDA was also optimized by the GA method to observe the effect of the dimensional reduction. RESULTS The genetically optimized ANN model without the LDA method was the best in terms of the classification accuracy. The accuracy, sensitivity, and specificity of the GA-ANN model with four layers were greater than those of the other classification models (i.e., ANN, SVM, LR, and DT using LDA and GA methods) in the five-fold cross-validation. The average values of accuracy, sensitivity, and specificity for the five-fold cross-validation were 97.0%, 98.7%, and 98.6%, respectively. CONCLUSIONS We demonstrated herein that a quantitative computed tomography-based ANN model could more effectively detect CDE subjects when compared to their counterpart models. By employing the model, the CDE subjects may be identified early for therapeutic intervention.
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Affiliation(s)
- Taewoo Kim
- School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Chang Hyun Lee
- Department of Radiology, College of Medicine, Seoul National University, Seoul, Republic of Korea; Department of Radiology, College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Kum Ju Chae
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - So Hyeon Bak
- Department of Radiology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Sung Ok Kwon
- Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, Republic of Korea
| | - Sanghun Choi
- School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea.
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Sieren JC, Schroeder KE, Guo J, Asosingh K, Erzurum S, Hoffman EA. Menstrual cycle impacts lung structure measures derived from quantitative computed tomography. Eur Radiol 2021; 32:2883-2890. [PMID: 34928413 PMCID: PMC9038622 DOI: 10.1007/s00330-021-08404-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/23/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Quantitative computed tomography (qCT) is being increasingly incorporated in research studies and clinical trials aimed at understanding lung disease risk, progression, exacerbations, and intervention response. Menstrual cycle-based changes in lung function are recognized; however, the impact on qCT measures is currently unknown. We hypothesize that the menstrual cycle impacts qCT-derived measures of lung structure in healthy women and that the degree of measurement change may be mitigated in subjects on cyclic hormonal birth control. METHODS Thirty-one non-smoking, healthy women with regular menstrual cycles (16 of which were on cyclic hormonal birth control) underwent pulmonary function testing and qCT imaging at both menses and early luteal phase time points. Data were evaluated to identify lung measurements which changed significantly across the two key time points and to compare degree of change across metrics for the sub-cohort with versus without birth control. RESULTS The segmental airway measurements were larger and mean lung density was higher at menses compared to the early luteal phase. The sub-cohort with cyclic hormonal birth control did not have less evidence of measurement difference over the menstrual cycle compared to the sub-cohort without hormonal birth control. CONCLUSIONS This study provides evidence that qCT-derived measures from the lung are impacted by the female menstrual cycle. This indicates studies seeking to use qCT as a more sensitive measure of cross-sectional differences or longitudinal changes in these derived lung measurements should consider acquiring data at a consistent time in the menstrual cycle for pre-menopausal women and warrants further exploration. KEY POINTS • Lung measurements from chest computed tomography are used in multicenter studies exploring lung disease progression and treatment response. • The menstrual cycle impacts lung structure measurements. • Cyclic variability should be considered when evaluating longitudinal change with CT in menstruating women.
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Affiliation(s)
- Jessica C Sieren
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA. .,Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA.
| | - Kimberly E Schroeder
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA
| | - Junfeng Guo
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA.,Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Kewal Asosingh
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Flow Cytometry Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serpil Erzurum
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA.,Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
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50
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Yang J, Angelini ED, Balte PP, Hoffman EA, Austin JHM, Smith BM, Barr RG, Laine AF. Novel Subtypes of Pulmonary Emphysema Based on Spatially-Informed Lung Texture Learning: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:3652-3662. [PMID: 34224349 PMCID: PMC8715521 DOI: 10.1109/tmi.2021.3094660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pulmonary emphysema overlaps considerably with chronic obstructive pulmonary disease (COPD), and is traditionally subcategorized into three subtypes previously identified on autopsy. Unsupervised learning of emphysema subtypes on computed tomography (CT) opens the way to new definitions of emphysema subtypes and eliminates the need of thorough manual labeling. However, CT-based emphysema subtypes have been limited to texture-based patterns without considering spatial location. In this work, we introduce a standardized spatial mapping of the lung for quantitative study of lung texture location and propose a novel framework for combining spatial and texture information to discover spatially-informed lung texture patterns (sLTPs) that represent novel emphysema subtype candidates. Exploiting two cohorts of full-lung CT scans from the MESA COPD (n = 317) and EMCAP (n = 22) studies, we first show that our spatial mapping enables population-wide study of emphysema spatial location. We then evaluate the characteristics of the sLTPs discovered on MESA COPD, and show that they are reproducible, able to encode standard emphysema subtypes, and associated with physiological symptoms.
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