title: Distinct quantitative computed tomography emphysema patterns are associated with physiology and function in smokers.
abstract: BACKGROUND
  Emphysema occurs in distinct pathologic patterns, but little is known about the epidemiologic associations of these patterns. Standard quantitative measures of emphysema from computed tomography (CT) do not distinguish between distinct patterns of parenchymal destruction.
  
  
  OBJECTIVE
  To study the epidemiologic associations of distinct emphysema patterns with measures of lung-related physiology, function, and health care use in smokers.
  
  
  METHODS
  Using a local histogram-based assessment of lung density, we quantified distinct patterns of low attenuation in 9,313 smokers in the COPDGene Study. To determine if such patterns provide novel insights into chronic obstructive pulmonary disease epidemiology, we tested for their association with measures of physiology, function, and health care use.
  
  
  RESULTS
  Compared with percentage of low-attenuation area less than -950 Hounsfield units (%LAA-950), local histogram-based measures of distinct CT low-attenuation patterns are more predictive of measures of lung function, dyspnea, quality of life, and health care use. These patterns are strongly associated with a wide array of measures of respiratory physiology and function, and most of these associations remain highly significant (P < 0.005) after adjusting for %LAA-950. In smokers without evidence of chronic obstructive pulmonary disease, the mild centrilobular disease pattern is associated with lower FEV1 and worse functional status (P < 0.005).
  
  
  CONCLUSIONS
  Measures of distinct CT emphysema patterns provide novel information about the relationship between emphysema and key measures of physiology, physical function, and health care use. Measures of mild emphysema in smokers with preserved lung function can be extracted from CT scans and are significantly associated with functional measures.
authors: 1 Channing Division of Network Medicine.
authors: Peter J
authors: PJ
authors: Castaldi
authors: Raúl
authors: R
authors: San José Estépar
authors: Carlos S
authors: CS
authors: Mendoza
authors: Craig P
authors: CP
authors: Hersh
authors: Nan
authors: N
authors: Laird
authors: James D
authors: JD
authors: Crapo
authors: David A
authors: DA
authors: Lynch
authors: Edwin K
authors: EK
authors: Silverman
authors: George R
authors: GR
authors: Washko
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004417:Dyspnea / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011656:Pulmonary Emphysema / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011788:Quality of Life; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology / Q000503:physiopathology*; D013147:Spirometry; D036542:Tomography, Spiral Computed
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