Abstract:
Objective To explore the value of quantitative chest CT in early diagnosis of chronic obstructive pulmonary disease (COPD).
Methods The clinical data of 138 cases of COPD high-risk patients in Shanghai community and COPD high-risk respondents in outpatient clinic of Zhongshan Hospital, Fudan University from September 20, 2013 to May 20, 2014 were retrospectively analyzed. All high-risk participants underwent pulmonary function and chest CT examination at baseline and 1 year later. Chest CT images were imported into quantitative CT analysis software to collect quantitative CT data. These participants were divided into COPD group (n=40) and non-COPD group (n=98) based on their lung functions after 1 year. The differences in baseline lung function and quantitative CT measurements between the two groups were compared. Binary logistic regression was used to analyze the predictors of COPD in high-risk individuals after 1 year of follow-up, and the efficacy of the logistic regression model was evaluated by ROC curve.
Results There were no significant differences in gender, body mass index (BMI), the percentage value of forced expiratory volume in 1 second predicted (FEV1% pred), airway wall area ratio (WA%), total airway count (TAC), and airway wall thickness (WT) between the two groups at baseline. Compared to the non-COPD group, the square root of the tracheal wall area at 10 mm from the inner circumference of the airway (Pi10), (3.43 3.30, 3.54 vs 3.23 3.15, 3.36, P < 0.001), and the percentage area of low attenuation regions below -950 HU (LAA% -950), (2.06 0.32, 6.29 vs 0.57 0.25, 1.89, P=0.015) were significantly higher in the COPD group.The mean lung density (MLD) in the COPD group was lower than that in the non-COPD group (-799.89±35.62 vs -783.60±43.52, P=0.038). Binary logistic regression analysis indicated that age and Pi10 were risk factors for COPD (P < 0.05), with an area under the ROC curve of 0.791 (95% CI 0.714-0.868).
Conclusions In the COPD high-risk population with normal lung function, patients with elevated Pi10 and LAA% -950 have a higher incidence of COPD one year later, suggesting that quantitative chest CT measurements such as Pi10 and LAA% -950 can assist clinicians in identifying early-stage COPD.
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