Wassim W Labaki1, Tian Gu2, Susan Murray2, Charles R Hatt3, Craig J Galbán4, Brian D Ross5, Carlos H Martinez1, Jeffrey L Curtis6, Eric A Hoffman7, Esther Pompe8, David A Lynch9, Ella A Kazerooni4, Fernando J Martinez10, MeiLan K Han11. 1. Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI. 2. Department of Biostatistics, University of Michigan, Ann Arbor, Michigan. 3. Imbio LLC, Minneapolis, Minnesota. 4. Department of Radiology, University of Michigan, Ann Arbor, Michigan. 5. Imbio LLC, Minneapolis, Minnesota; Department of Radiology, University of Michigan, Ann Arbor, Michigan. 6. Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI; Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan. 7. Department of Radiology, University of Iowa, Iowa City, Iowa. 8. Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. 9. Department of Radiology, National Jewish Health, Denver, Colorado. 10. Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI; Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York. 11. Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI. Electronic address: mrking@umich.edu.
Abstract
RATIONALE AND OBJECTIVES: Chronic obstructive pulmonary disease is a heterogeneous disease characterized by small airway abnormality and emphysema. We hypothesized that a voxel-wise computed tomography analytic approach would identify patterns of disease progression in smokers. MATERIALS AND METHODS: We analyzed 725 smokers in spirometric GOLD stages 0-4 with two chest CTs 5 years apart. Baseline inspiration, follow-up inspiration and follow-up expiration images were spatially registered to baseline expiration so that each voxel had correspondences across all time points and respiratory phases. Voxel-wise Parametric Response Mapping (PRM) was then generated for the baseline and follow-up scans. PRM classifies lung as normal, functional small airway disease (PRMfSAD), and emphysema (PRMEMPH). RESULTS: Subjects with low baseline PRMfSAD and PRMEMPH predominantly had an increase in PRMfSAD on follow-up; those with higher baseline PRMfSAD and PRMEMPH mostly had increases in PRMEMPH. For GOLD 0 participants (n = 419), mean 5-year increases in PRMfSAD and PRMEMPH were 0.3% for both; for GOLD 1-4 participants (n = 306), they were 0.6% and 1.6%, respectively. Eighty GOLD 0 subjects (19.1%) had overall radiologic progression (30.0% to PRMfSAD, 52.5% to PRMEMPH, and 17.5% to both); 153 GOLD 1-4 subjects (50.0%) experienced progression (17.6% to PRMfSAD, 48.4% to PRMEMPH, and 34.0% to both). In a multivariable model, both baseline PRMfSAD and PRMEMPH were associated with development of PRMEMPH on follow-up, although this relationship was diminished at higher levels of baseline PRMEMPH. CONCLUSION: A voxel-wise longitudinal PRM analytic approach can identify patterns of disease progression in smokers with and without chronic obstructive pulmonary disease.
RATIONALE AND OBJECTIVES:Chronic obstructive pulmonary disease is a heterogeneous disease characterized by small airway abnormality and emphysema. We hypothesized that a voxel-wise computed tomography analytic approach would identify patterns of disease progression in smokers. MATERIALS AND METHODS: We analyzed 725 smokers in spirometric GOLD stages 0-4 with two chest CTs 5 years apart. Baseline inspiration, follow-up inspiration and follow-up expiration images were spatially registered to baseline expiration so that each voxel had correspondences across all time points and respiratory phases. Voxel-wise Parametric Response Mapping (PRM) was then generated for the baseline and follow-up scans. PRM classifies lung as normal, functional small airway disease (PRMfSAD), and emphysema (PRMEMPH). RESULTS: Subjects with low baseline PRMfSAD and PRMEMPH predominantly had an increase in PRMfSAD on follow-up; those with higher baseline PRMfSAD and PRMEMPH mostly had increases in PRMEMPH. For GOLD 0 participants (n = 419), mean 5-year increases in PRMfSAD and PRMEMPH were 0.3% for both; for GOLD 1-4 participants (n = 306), they were 0.6% and 1.6%, respectively. Eighty GOLD 0 subjects (19.1%) had overall radiologic progression (30.0% to PRMfSAD, 52.5% to PRMEMPH, and 17.5% to both); 153 GOLD 1-4 subjects (50.0%) experienced progression (17.6% to PRMfSAD, 48.4% to PRMEMPH, and 34.0% to both). In a multivariable model, both baseline PRMfSAD and PRMEMPH were associated with development of PRMEMPH on follow-up, although this relationship was diminished at higher levels of baseline PRMEMPH. CONCLUSION: A voxel-wise longitudinal PRM analytic approach can identify patterns of disease progression in smokers with and without chronic obstructive pulmonary disease.
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