Chest MRI and CT Predictors of 10-Year All-Cause Mortality in COPD

Pulmonary imaging measurements using magnetic resonance imaging (MRI) and computed tomography (CT) have the potential to deepen our understanding of chronic obstructive pulmonary disease (COPD) by measuring airway and parenchymal pathologic information that cannot be provided by spirometry. Currently, MRI and CT measurements are not included in mortality risk predictions, diagnosis, or COPD staging. We evaluated baseline pulmonary function, MRI and CT measurements alongside imaging texture-features to predict 10-year all-cause mortality in ex-smokers with (n = 93; 31 females; 70 ± 9years) and without (n = 69; 29 females, 69 ± 9years) COPD. CT airway and vessel measurements, helium-3 (3He) MRI ventilation defect percent (VDP) and apparent diffusion coefficients (ADC) were quantified. MRI and CT texture-features were extracted using PyRadiomics (version2.2.0). Associations between 10-year all-cause mortality and all clinical and imaging measurements were evaluated using multivariable regression model odds-ratios. Machine-learning predictive models for 10-year all-cause mortality were evaluated using area-under-receiver-operator-characteristic-curve (AUC), sensitivity and specificity analyses. DLCO (%pred) (HR = 0.955, 95%CI: 0.934-0.976, p p p = 0.001) were the strongest predictors of 10-year mortality. A machine-learning model trained on clinical, imaging, and imaging textures was the best predictive model (AUC = 0.82, sensitivity = 83%, specificity = 84%) and outperformed the solely clinical model (AUC = 0.76, sensitivity = 77%, specificity = 79%). In ex-smokers, regardless of COPD status, addition of CT and MR imaging texture measurements to clinical models provided unique prognostic information of mortality risk that can allow for better clinical management.Clinical Trial Registration: www.clinicaltrials.gov NCT02279329</p

Forest plots of the HR of the combined endpoint per one SD of annual mean CCA-IMT change (with 95% CIs).

<p>Panel I: Group A (asymptomatic individuals with three or more CVD risk factors), HR adjusted for age, sex and average mean CCA-IMT (model 1). Panel II: Group A (asymptomatic individuals with three or more CVD risk factors), HR adjusted for age, sex, average mean CCA-IMT and other CVD risk factors (model 2). Panel III: Group B (asymptomatic individuals with carotid plaques), HR adjusted for age, sex and average mean CCA-IMT (model 1). Panel IV: Group B (asymptomatic individuals with carotid plaques), HR adjusted for age, sex, average mean CCA-IMT and other CVD risk factors (model 2). Panel V: Group C (individuals with previous CVD events), HR adjusted for age, sex and average mean CCA-IMT (model 1). Panel VI: Group C (individuals with previous CVD events), HR adjusted for age, sex, average mean CCA-IMT and other CVD risk factors (model 2).</p

Forest plots of the HR of the combined endpoint per one SD of average mean CCA-IMT (with 95% CIs).

<p>Panel I: Group A (asymptomatic individuals with three or more CVD risk factors), HR adjusted for age, sex and annual mean CCA-IMT change (model 1). Panel II: Group A (asymptomatic individuals with three or more CVD risk factors), HR adjusted for age, sex, annual mean CCA-IMT change and other CVD risk factors (model 2). Panel III: Group B (asymptomatic individuals with carotid plaques), HR adjusted for age, sex and annual mean CCA-IMT change (model 1). Panel IV: Group B (asymptomatic individuals with carotid plaques), HR adjusted for age, sex, annual mean CCA-IMT change and other CVD risk factors (model 2). Panel V: Group C (individuals with previous CVD events), HR adjusted for age, sex and annual mean CCA-IMT change (model 1). Panel VI: Group C (individuals with previous CVD events), HR adjusted for age, sex, annual mean CCA-IMT change and other CVD risk factors (model 2).</p

Meta-regression plot for the HR (combined endpoint) per SD of annual mean CCA-IMT change (model 1), by the correlation of baseline and follow-up common CIMT.

<p>The size of each circle represents the precision of the log HR.</p

Cohorts and subsamples.

<p>Cohorts and subsamples.</p

Inclusion criteria.

<p>Inclusion criteria.</p