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- Title
Low morphometric complexity of emphysematous lesions predicts survival in chronic obstructive pulmonary disease patients.
- Authors
Hwang, Jeongeun; Oh, Yeon-Mok; Lee, Minho; Choi, Seunghyun; Seo, Joon Beom; Lee, Sang Min; Kim, Namkug
- Abstract
<bold>Objectives: </bold>To investigate whether morphometric complexity in the lung can predict survival and act as a new prognostic marker in patients with chronic obstructive pulmonary disease (COPD).<bold>Methods: </bold>COPD (n = 302) patients were retrospectively reviewed. All patients underwent volumetric computed tomography and pulmonary function tests at enrollment (2005-2015). For complexity analysis, we applied power law exponent of the emphysema size distribution (Dsize) as well as box-counting fractal dimension (Dbox3D) analysis. Patients' survival at February 2017 was ascertained. Univariate and multivariate Cox proportional hazards analyses were performed, and prediction performances of various combinatorial models were compared.<bold>Results: </bold>Patients were 66 ± 6 years old, had 41 ± 28 pack-years' smoking history and variable GOLD stages (n = 20, 153, 108 and 21 in stages I-IV). The median follow-up time was 6.1 years (range: 0.2-11.6 years). Sixty-three patients (20.9%) died, of whom 35 died of lung-related causes. In univariate Cox analysis, lower Dsize and Dbox3D were significantly associated with both all-cause and lung-related mortality (both p < 0.001). In multivariate analysis, the backward elimination method demonstrated that Dbox3D, along with age and the BODE index, was an independent predictor of survival (p = 0.014; HR, 2.08; 95% CI, 1.16-3.71). The contributions of Dsize and Dbox3D to the combinatorial survival model were comparable with those of the emphysema index and lung-diffusing capacity.<bold>Conclusions: </bold>Low morphometric complexity in the lung is a predictor of survival in patients with COPD.<bold>Key Points: </bold>• A newly suggested method for quantifying lung morphometric complexity is feasible. • Morphometric complexity measured on chest CT images predicts COPD patients' survival. • Complexity, diffusing capacity and emphysema index contribute similarly to the survival model.
- Subjects
OBSTRUCTIVE lung diseases; PULMONARY emphysema; COMPUTED tomography; PULMONARY function tests; PROPORTIONAL hazards models
- Publication
European Radiology, 2019, Vol 29, Issue 1, p176
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-018-5551-7