TY - JOUR
T1 - CT-based visual classification of emphysema
T2 - Association with mortality in the COPDGene study
AU - Genetic Epidemiology of COPD (COPDGene) Investigators
AU - Lynch, David A.
AU - Moore, Camille M.
AU - Wilson, Carla
AU - Nevrekar, Dipti
AU - Jennermann, Theodore
AU - Humphries, Stephen M.
AU - Austin, John H.M.
AU - Grenier, Philippe A.
AU - Kauczor, Hans Ulrich
AU - Han, Mei Lan K.
AU - Regan, Elizabeth A.
AU - Make, Barry J.
AU - Bowler, Russell P.
AU - Beaty, Terri H.
AU - Curran-Everett, Douglas
AU - Hokanson, John E.
AU - Curtis, Jeffrey L.
AU - Silverman, Edwin K.
AU - Crapo, James D.
N1 - Funding Information:
The project described was supported by Award Number U01 HL089897 and Award Number U01 HL089856 from the National Heart, Lung, and Blood Institute. The COPDGene project is also supported by the COPD Foundation through contributions made to an Industry Advisory Board composed of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, No-vartis, Pfizer, Siemens, and Sunovion.
Funding Information:
Supported by the National Heart, Lung, and Blood Institute (R01HL089856, R01HL089897). The COPDGene project is also supported by the COPD Foundation Industry Advisory Board (with contributions from AstraZeneca, Boehringer Ingelheim, Novartis, Pfizer, Siemens, Sunovion, and GlaxoSmithKline).
Publisher Copyright:
© RSNA, 2018
PY - 2018/9
Y1 - 2018/9
N2 - Purpose: To determine whether visually assessed patterns of emphysema at CT might provide a simple assessment of mortality risk among cigarette smokers. Materials and Methods: Of the first 4000 cigarette smokers consecutively enrolled between 2007 and 2011 in this COPDGene study, 3171 had data available for both visual emphysema CT scores and survival. Each CT scan was retrospectively visually scored by two analysts using the Fleischner Society classification system. Severity of emphysema was also evaluated quantitatively by using percentage lung volume occupied by low-attenuation areas (voxels with attenuation of 2950 HU or less) (LAA-950). Median duration of follow-up was 7.4 years. Regression analysis for the relationship between imaging patterns and survival was based on the Cox proportional hazards model, with adjustment for age, race, sex, height, weight, pack-years of cigarette smoking, current smoking status, educational level, LAA-950, and (in a second model) forced expiratory volume in 1 second (FEV1). Results: Observer agreement in visual scoring was good (weighted k values, 0.71-0.80). There were 519 deaths in the study cohort. Compared with subjects who did not have visible emphysema, mortality was greater in those with any grade of emphysema beyond trace (adjusted hazard ratios, 1.7, 2.5, 5.0, and 4.1, respectively, for mild centrilobular emphysema, moderate centrilobular emphysema, confluent emphysema, and advanced destructive emphysema, P , .001). This increased mortality generally persisted after adjusting for LAA-950. Conclusion: The visual presence and severity of emphysema is associated with significantly increased mortality risk, independent of the quantitative severity of emphysema.
AB - Purpose: To determine whether visually assessed patterns of emphysema at CT might provide a simple assessment of mortality risk among cigarette smokers. Materials and Methods: Of the first 4000 cigarette smokers consecutively enrolled between 2007 and 2011 in this COPDGene study, 3171 had data available for both visual emphysema CT scores and survival. Each CT scan was retrospectively visually scored by two analysts using the Fleischner Society classification system. Severity of emphysema was also evaluated quantitatively by using percentage lung volume occupied by low-attenuation areas (voxels with attenuation of 2950 HU or less) (LAA-950). Median duration of follow-up was 7.4 years. Regression analysis for the relationship between imaging patterns and survival was based on the Cox proportional hazards model, with adjustment for age, race, sex, height, weight, pack-years of cigarette smoking, current smoking status, educational level, LAA-950, and (in a second model) forced expiratory volume in 1 second (FEV1). Results: Observer agreement in visual scoring was good (weighted k values, 0.71-0.80). There were 519 deaths in the study cohort. Compared with subjects who did not have visible emphysema, mortality was greater in those with any grade of emphysema beyond trace (adjusted hazard ratios, 1.7, 2.5, 5.0, and 4.1, respectively, for mild centrilobular emphysema, moderate centrilobular emphysema, confluent emphysema, and advanced destructive emphysema, P , .001). This increased mortality generally persisted after adjusting for LAA-950. Conclusion: The visual presence and severity of emphysema is associated with significantly increased mortality risk, independent of the quantitative severity of emphysema.
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U2 - 10.1148/radiol.2018172294
DO - 10.1148/radiol.2018172294
M3 - Article
C2 - 29762095
AN - SCOPUS:85052662429
VL - 288
SP - 859
EP - 866
JO - Radiology
JF - Radiology
SN - 0033-8419
IS - 3
ER -