title: Visual Assessment of CT Findings in Smokers With Nonobstructed Spirometric Abnormalities in The COPDGene®Study.
abstract: Within the COPD Genetic Epidemiology (COPDGene®) study population of cigarette smokers, 9% were found to be unclassifiable by the Global Initiative for chronic Obstructive Lung Disease (GOLD) criteria. This study was to identify the differences in computed tomography (CT) findings between this nonobstructed (GOLDU) group and a control group of smokers with normal lung function. This research was approved by the institutional review board of each institution. CT images of 400 participants in the COPDGene®study (200 GOLDU, 200 smokers with normal lung function) were retrospectively evaluated in a blinded fashion. Visual CT assessment included lobar analysis of emphysema (type, extent), presence of paraseptal emphysema, airway wall thickening, expiratory air trapping, centrilobular nodules, atelectasis, non-fibrotic and fibrotic interstitial lung disease (ILD), pleural thickening, diaphragmatic eventration, vertebral body changes and internal thoracic diameters (in mm). Univariate comparisons of groups for each CT parameter and multiple logistic regression were performed to determine the imaging features associated with GOLDU. When compared with the control group, GOLDU participants had a significantly higher prevalence of unilateral diaphragm eventration (30% vs. 16%), airway wall thickening, centrilobular nodules, reticular abnormality, paraseptal emphysema (33% vs. 17%), linear atelectasis (60% vs. 35.6%), kyphosis (12% vs. 4%), and a smaller internal transverse thoracic diameter (255 ± 22.5 [standard deviation] vs. 264.8 ± 22.4, mm) (all p<0.05). With multiple logistic regression, all of these CT parameters, except non-fibrotic ILD and kyphosis, remained significantly associated with GOLDU status (p<0.05). In cigarette smokers, chest wall abnormalities and parenchymal lung disease, which contribute to restrictive physiologic impairment, are associated with GOLD-nonobstructed status.
authors.affiliation: Department of Radiology, National Jewish Health, Denver, CO ; Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
authors.forename: Song Soo
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Department of Radiology, National Jewish Health, Denver, CO.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yagihashi
authors.affiliation: Department of Radiology, National Jewish Health, Denver, CO.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Stinson
authors.affiliation: Department of Radiology, National Jewish Health, Denver, CO.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Zach
authors.affiliation: Department of Radiology, National Jewish Health, Denver, CO.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: McKenzie
authors.affiliation: Division of Biostatistics and Bioinformatics, National Jewish Health, and Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, CO.
authors.forename: Douglas
authors.initials: D
authors.lastname: Curran-Everett
authors.affiliation: Channing Division of Network Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Wan
authors.affiliation: Channing Division of Network Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Silverman
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO.
authors.forename: James D
authors.initials: JD
authors.lastname: Crapo
authors.affiliation: Department of Radiology, National Jewish Health, Denver, CO.
authors.forename: David A
authors.initials: DA
authors.lastname: Lynch
keywords: classification; computed tomography; lung diseases; obstructive