Jinkyeong Park1, Brian D Hobbs2, James D Crapo3, Barry J Make3, Elizabeth A Regan3, Stephen Humphries4, Vincent J Carey5, David A Lynch4, Edwin K Silverman6. 1. Channing Division of Network Medicine, Boston, MA; Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang-Si, Gyeonggi-do, South Korea. 2. Channing Division of Network Medicine, Boston, MA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. 3. Department of Medicine, National Jewish Health, Denver, CO. 4. Department of Radiology, National Jewish Health, Denver, CO. 5. Channing Division of Network Medicine, Boston, MA. 6. Channing Division of Network Medicine, Boston, MA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Electronic address: ed.silverman@channing.harvard.edu.
Abstract
BACKGROUND: Multiple studies have identified COPD subtypes by using visual or quantitative evaluation of CT images. However, there has been no systematic assessment of a combined visual and quantitative CT imaging classification. We integrated visually defined patterns of emphysema with quantitative imaging features and spirometry data to produce a set of 10 nonoverlapping CT imaging subtypes, and we assessed differences between subtypes in demographic features, physiological characteristics, longitudinal disease progression, and mortality. METHODS: We evaluated 9,080 current and former smokers in the COPDGene study who had available volumetric inspiratory and expiratory CT images obtained using a standardized imaging protocol. We defined 10 discrete, nonoverlapping CT imaging subtypes: no CT imaging abnormality, paraseptal emphysema (PSE), bronchial disease, small airway disease, mild emphysema, upper lobe predominant centrilobular emphysema (CLE), lower lobe predominant CLE, diffuse CLE, visual without quantitative emphysema, and quantitative without visual emphysema. Baseline and 5-year longitudinal characteristics and mortality were compared across these CT imaging subtypes. RESULTS: The overall mortality differed significantly between groups (P < .01) and was highest in the 3 moderate to severe CLE groups. Subjects having quantitative but not visual emphysema and subjects with visual but not quantitative emphysema were unique groups with mild COPD, at risk for progression, and with likely different underlying mechanisms. Subjects with PSE and/or moderate to severe CLE had substantial progression of emphysema over 5 years compared with findings in subjects with no CT imaging abnormality (P < .01). CONCLUSIONS: The combination of visual and quantitative CT imaging features reflects different underlying pathological processes in the heterogeneous COPD syndrome and provides a useful approach to reclassify types of COPD. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.
BACKGROUND: Multiple studies have identified COPD subtypes by using visual or quantitative evaluation of CT images. However, there has been no systematic assessment of a combined visual and quantitative CT imaging classification. We integrated visually defined patterns of emphysema with quantitative imaging features and spirometry data to produce a set of 10 nonoverlapping CT imaging subtypes, and we assessed differences between subtypes in demographic features, physiological characteristics, longitudinal disease progression, and mortality. METHODS: We evaluated 9,080 current and former smokers in the COPDGene study who had available volumetric inspiratory and expiratory CT images obtained using a standardized imaging protocol. We defined 10 discrete, nonoverlapping CT imaging subtypes: no CT imaging abnormality, paraseptal emphysema (PSE), bronchial disease, small airway disease, mild emphysema, upper lobe predominant centrilobular emphysema (CLE), lower lobe predominant CLE, diffuse CLE, visual without quantitative emphysema, and quantitative without visual emphysema. Baseline and 5-year longitudinal characteristics and mortality were compared across these CT imaging subtypes. RESULTS: The overall mortality differed significantly between groups (P < .01) and was highest in the 3 moderate to severe CLE groups. Subjects having quantitative but not visual emphysema and subjects with visual but not quantitative emphysema were unique groups with mild COPD, at risk for progression, and with likely different underlying mechanisms. Subjects with PSE and/or moderate to severe CLE had substantial progression of emphysema over 5 years compared with findings in subjects with no CT imaging abnormality (P < .01). CONCLUSIONS: The combination of visual and quantitative CT imaging features reflects different underlying pathological processes in the heterogeneous COPD syndrome and provides a useful approach to reclassify types of COPD. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.
Authors: Peter J Castaldi; Jennifer Dy; James Ross; Yale Chang; George R Washko; Douglas Curran-Everett; Andre Williams; David A Lynch; Barry J Make; James D Crapo; Russ P Bowler; Elizabeth A Regan; John E Hokanson; Greg L Kinney; Meilan K Han; Xavier Soler; Joseph W Ramsdell; R Graham Barr; Marilyn Foreman; Edwin van Beek; Richard Casaburi; Gerald J Criner; Sharon M Lutz; Steven I Rennard; Stephanie Santorico; Frank C Sciurba; Dawn L DeMeo; Craig P Hersh; Edwin K Silverman; Michael H Cho Journal: Thorax Date: 2014-02-21 Impact factor: 9.139
Authors: Tetsuro Araki; Mizuki Nishino; Wei Gao; Josée Dupuis; Rachel K Putman; George R Washko; Gary M Hunninghake; George T O'Connor; Hiroto Hatabu Journal: Thorax Date: 2015-10-29 Impact factor: 9.139
Authors: Elizabeth A Regan; John E Hokanson; James R Murphy; Barry Make; David A Lynch; Terri H Beaty; Douglas Curran-Everett; Edwin K Silverman; James D Crapo Journal: COPD Date: 2010-02 Impact factor: 2.409
Authors: Benjamin M Smith; John H M Austin; John D Newell; Belinda M D'Souza; Anna Rozenshtein; Eric A Hoffman; Firas Ahmed; R Graham Barr Journal: Am J Med Date: 2013-10-09 Impact factor: 4.965
Authors: Peter J Castaldi; Raúl San José Estépar; Carlos S Mendoza; Craig P Hersh; Nan Laird; James D Crapo; David A Lynch; Edwin K Silverman; George R Washko Journal: Am J Respir Crit Care Med Date: 2013-11-01 Impact factor: 21.405
Authors: Kristoffer Ostridge; Nicholas Williams; Viktoriya Kim; Stephen Harden; Simon Bourne; Ngaire A Coombs; Paul T Elkington; Raul San Jose Estepar; George Washko; Karl J Staples; Tom M A Wilkinson Journal: Respir Res Date: 2016-07-26
Authors: David A Lynch; Camille M Moore; Carla Wilson; Dipti Nevrekar; Theodore Jennermann; Stephen M Humphries; John H M Austin; Philippe A Grenier; Hans-Ulrich Kauczor; MeiLan K Han; Elizabeth A Regan; Barry J Make; Russell P Bowler; Terri H Beaty; Douglas Curran-Everett; John E Hokanson; Jeffrey L Curtis; Edwin K Silverman; James D Crapo Journal: Radiology Date: 2018-05-15 Impact factor: 11.105
Authors: Alvar Agusti; Lisa D Edwards; Bartolomé Celli; William Macnee; Peter M A Calverley; Hana Müllerova; David A Lomas; Emiel Wouters; Per Bakke; Steve Rennard; Courtney Crim; Bruce E Miller; Harvey O Coxson; Julie C Yates; Ruth Tal-Singer; Jørgen Vestbo Journal: Eur Respir J Date: 2013-06-13 Impact factor: 16.671
Authors: Aravind A Menon; Rachel K Putman; Jason L Sanders; Takuya Hino; Akinori Hata; Mizuki Nishino; Auyon J Ghosh; Samuel Y Ash; Ivan O Rosas; Michael H Cho; David A Lynch; George R Washko; Edwin K Silverman; Hiroto Hatabu; Gary M Hunninghake Journal: Chest Date: 2021-11-03 Impact factor: 9.410
Authors: Andrea S Oh; David Baraghoshi; David A Lynch; Samuel Y Ash; James D Crapo; Stephen M Humphries Journal: Radiology Date: 2022-05-17 Impact factor: 29.146
Authors: Matthew Moll; Phuwanat Sakornsakolpat; Nick Shrine; Brian D Hobbs; Dawn L DeMeo; Catherine John; Anna L Guyatt; Michael J McGeachie; Sina A Gharib; Ma'en Obeidat; Lies Lahousse; Sara R A Wijnant; Guy Brusselle; Deborah A Meyers; Eugene R Bleecker; Xingnan Li; Ruth Tal-Singer; Ani Manichaikul; Stephen S Rich; Sungho Won; Woo Jin Kim; Ah Ra Do; George R Washko; R Graham Barr; Bruce M Psaty; Traci M Bartz; Nadia N Hansel; Kathleen Barnes; John E Hokanson; James D Crapo; David Lynch; Per Bakke; Amund Gulsvik; Ian P Hall; Louise Wain; Scott T Weiss; Edwin K Silverman; Frank Dudbridge; Martin D Tobin; Michael H Cho Journal: Lancet Respir Med Date: 2020-07 Impact factor: 102.642