Labaki Wassim W, Gu Tian, Murray Susan, Hatt Charles R, Galbán Craig J, Ross Brian D, Martinez Carlos H, Curtis Jeffrey L, Hoffman Eric A, Pompe Esther, Lynch David A, Kazerooni Ella A, Martinez Fernando J, Han MeiLan K
Division of Pulmonary and Critical Care Medicine, University of Michigan, 3916 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI.
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
Acad Radiol. 2019 Mar;26(3):306-312. doi: 10.1016/j.acra.2019.02.003. Epub 2019 Feb 18.
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.
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 (PRM), and emphysema (PRM).
Subjects with low baseline PRM and PRM predominantly had an increase in PRM on follow-up; those with higher baseline PRM and PRM mostly had increases in PRM. For GOLD 0 participants (n = 419), mean 5-year increases in PRM and PRM 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 PRM, 52.5% to PRM, and 17.5% to both); 153 GOLD 1-4 subjects (50.0%) experienced progression (17.6% to PRM, 48.4% to PRM, and 34.0% to both). In a multivariable model, both baseline PRM and PRM were associated with development of PRM on follow-up, although this relationship was diminished at higher levels of baseline PRM.
A voxel-wise longitudinal PRM analytic approach can identify patterns of disease progression in smokers with and without chronic obstructive pulmonary disease.
慢性阻塞性肺疾病是一种以小气道异常和肺气肿为特征的异质性疾病。我们假设基于体素的计算机断层扫描分析方法能够识别吸烟者的疾病进展模式。
我们分析了725名处于肺功能分级（GOLD）0 - 4级的吸烟者，他们间隔5年进行了两次胸部CT扫描。将基线吸气、随访吸气和随访呼气图像在空间上配准到基线呼气图像，以便每个体素在所有时间点和呼吸阶段都有对应关系。然后针对基线和随访扫描生成基于体素的参数反应映射（PRM）。PRM将肺部分为正常、功能性小气道疾病（PRM）和肺气肿（PRM）。
基线PRM和PRM较低的受试者在随访时PRM主要增加；基线PRM和PRM较高的受试者大多PRM增加。对于GOLD 0级参与者（n = 419），PRM和PRM的5年平均增加率均为0.3%；对于GOLD 1 - 4级参与者（n = 306），分别为0.6%和1.6%。80名GOLD 0级受试者（19.1%）有总体影像学进展（30.0%进展为PRM，52.5%进展为PRM，17.5%两者均有进展）；153名GOLD 1 - 4级受试者（50.0%）出现进展（17.6%进展为PRM，48.4%进展为PRM，34.0%两者均有进展）。在多变量模型中，基线PRM和PRM均与随访时PRM的发展相关，尽管在基线PRM较高水平时这种关系减弱。
基于体素的纵向PRM分析方法能够识别患有和未患有慢性阻塞性肺疾病的吸烟者的疾病进展模式。
