BACKGROUND Multiple studies have identified COPD subtypes using visual or quantitative evaluation of CT images. However, there has been no systematic assessment of a combined visual and quantitative CT classification. We integrated visually defined patterns of emphysema with quantitative imaging features and spirometry data to produce a set of ten non-overlapping CT subtypes, and we assessed differences between subtypes in demographic features, physiology, longitudinal disease progression, and mortality. METHODS We evaluated 9,080 current and former smokers in the COPDGene study with available volumetric inspiratory and expiratory CT images obtained using a standardized imaging protocol. We defined ten discrete, non-overlapping CT subtypes: no CT abnormality, paraseptal emphysema, 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 five-year longitudinal characteristics, as well as mortality, were compared across these CT subtypes. RESULTS The overall mortality differed significantly between groups (P<0.01) and was highest in the three moderate-to-severe CLE groups. Subjects having quantitative but no visual emphysema and subjects with visual but not quantitative emphysema represent unique groups with mild COPD, at risk for progression, and with likely different underlying mechanisms. Paraseptal and moderate-to-severe CLE subjects showed substantial progression of emphysema over five years compared to individuals with no CT abnormality (P<0.05). CONCLUSIONS The combination of visual and quantitative CT features reflects different underlying pathological processes in the heterogeneous COPD syndrome and provides a useful approach to reclassify persons with COPD.

中文翻译：

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使用视觉和定量 CT 特征对 COPD 进行分型


背景技术多项研究已通过 CT 图像的视觉或定量评估来识别 COPD 亚型。然而，目前还没有对视觉和定量 CT 分类相结合的系统评估。我们将视觉定义的肺气肿模式与定量成像特征和肺活量测定数据相结合，产生一组十种不重叠的 CT 亚型，并评估了亚型之间在人口特征、生理学、纵向疾病进展和死亡率方面的差异。方法 我们在 COPDGene 研究中评估了 9,080 名当前和曾经吸烟者，并使用标准化成像协议获得了可用的容积吸气和呼气 CT 图像。我们定义了十种离散的、不重叠的 CT 亚型：无 CT 异常、间隔旁肺气肿、支气管疾病、小气道疾病、轻度肺气肿、上叶为主的小叶中心性肺气肿 (CLE)、下叶为主的 CLE、弥漫性 CLE、视觉无定量肺气肿、定量无视觉气肿。对这些 CT 亚型的基线和五年纵向特征以及死亡率进行了比较。结果 各组间总死亡率差异显着（P<0.01），其中三个中重度 CLE 组的总死亡率最高。具有定量但无视觉肺气肿的受试者和具有视觉但不定量肺气肿的受试者代表患有轻度COPD的独特群体，具有进展风险，并且可能具有不同的潜在机制。与没有 CT 异常的个体相比，间隔旁和中重度 CLE 受试者在五年内表现出肺气肿的显着进展（P<0.05）。 结论 视觉和定量 CT 特征的结合反映了异质性 COPD 综合征的不同潜在病理过程，并为 COPD 患者的重新分类提供了有用的方法。