Deep Learning Estimation of Small Airway Disease from Inspiratory Chest Computed Tomography: Clinical Validation, Repeatability, and Associations with Adverse Clinical Outcomes in Chronic Obstructive Pulmonary Disease.

IF 19.4 1区 医学 Q1 CRITICAL CARE MEDICINE
Muhammad F A Chaudhary, Hira A Awan, Sarah E Gerard, Sandeep Bodduluri, Alejandro P Comellas, Igor Z Barjaktarevic, R Graham Barr, Christopher B Cooper, Craig J Galban, MeiLan K Han, Jeffrey L Curtis, Nadia N Hansel, Jerry A Krishnan, Martha G Menchaca, Fernando J Martinez, Jill Ohar, Luis G Vargas Buonfiglio, Robert Paine, Surya P Bhatt, Eric A Hoffman, Joseph M Reinhardt
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引用次数: 0

Abstract

Rationale: Quantifying functional small airway disease (fSAD) requires additional expiratory computed tomography (CT) scans, limiting clinical applicability. Artificial intelligence (AI) could enable fSAD quantification from chest CT scans at total lung capacity (TLC) alone (fSADTLC). Objectives: To evaluate an AI model for estimating fSADTLC, compare it with dual-volume parametric response mapping fSAD (fSADPRM), and assess its clinical associations and repeatability in chronic obstructive pulmonary disease (COPD). Methods: We analyzed 2,513 participants from SPIROMICS (the Subpopulations and Intermediate Outcome Measures in COPD Study). Using a randomly sampled subset (n = 1,055), we developed a generative model to produce virtual expiratory CT scans for estimating fSADTLC in the remaining 1,458 SPIROMICS participants. We compared fSADTLC with dual-volume fSADPRM. We investigated univariate and multivariable associations of fSADTLC with FEV1, FEV1/FVC ratio, 6-minute-walk distance, St. George's Respiratory Questionnaire score, and FEV1 decline. The results were validated in a subset of patients from the COPDGene (Genetic Epidemiology of COPD) study (n = 458). Multivariable models were adjusted for age, race, sex, body mass index, baseline FEV1, smoking pack-years, smoking status, and percent emphysema. Measurements and Main Results: Inspiratory fSADTLC showed a strong correlation with fSADPRM in SPIROMICS (Pearson's R = 0.895) and COPDGene (R = 0.897) cohorts. Higher fSADTLC levels were significantly associated with lower lung function, including lower postbronchodilator FEV1 (in liters) and FEV1/FVC ratio, and poorer quality of life reflected by higher total St. George's Respiratory Questionnaire scores independent of percent CT emphysema. In SPIROMICS, individuals with higher fSADTLC experienced an annual decline in FEV1 of 1.156 ml (relative decrease; 95% confidence interval [CI], 0.613-1.699; P < 0.001) per year for every 1% increase in fSADTLC. The rate of decline in the COPDGene cohort was slightly lower at 0.866 ml/yr (relative decrease; 95% CI, 0.345-1.386; P < 0.001) per 1% increase in fSADTLC. Inspiratory fSADTLC demonstrated greater consistency between repeated measurements, with a higher intraclass correlation coefficient of 0.99 (95% CI, 0.98-0.99) compared with fSADPRM (0.83; 95% CI, 0.76-0.88). Conclusions: Small airway disease can be reliably assessed from a single inspiratory CT scan using generative AI, eliminating the need for an additional expiratory CT scan. fSAD estimation from inspiratory CT correlates strongly with fSADPRM, demonstrates a significant association with FEV1 decline, and offers greater repeatability.

吸气式胸部CT对小气道疾病的深度学习评估:COPD患者的临床验证、可重复性以及与不良临床结果的关联
理由:量化功能性小气道疾病(fSAD)需要额外的呼气计算机断层扫描(CT),限制了临床适用性。人工智能(AI)可以通过胸部CT扫描的全肺容量(fSADTLC)来量化fSAD。目的:评价一种估算fSADTLC的AI模型,将其与双容积参数反应映射fSAD (fSADPRM)进行比较,并评估其在慢性阻塞性肺疾病(COPD)中的临床相关性和可重复性。方法:我们分析了来自COPD研究(SPIROMICS)亚群和中间结果测量的2513名参与者。使用随机抽样的子集(n = 1055),我们开发了一个生成模型来生成虚拟呼气ct,以估计剩余1458名SPIROMICS参与者的fSADTLC。我们将fSADTLC与双体积参数响应映射fSADPRM进行了比较。我们研究了fSADTLC与FEV1、FEV1/FVC、6分钟步行距离(6MWD)、圣乔治呼吸问卷(SGRQ)和FEV1下降的单变量和多变量关联。结果在COPDGene研究的一个子集(n = 458)中得到验证。多变量模型根据年龄、种族、性别、BMI、基线FEV1、吸烟年限、吸烟状况和肺气肿百分比进行调整。测量结果和主要结果:在SPIROMICS组(Pearson’s R = 0.895)和COPDGene组(R = 0.897)中,吸气fSADTLC均与fSADPRM有很强的相关性。较高的fSADTLC水平与较低的肺功能显著相关,包括支气管扩张剂后FEV1 (L)和FEV1/FVC比值较低,以及SGRQ总分较高反映的较差的生活质量,与CT肺气肿百分比无关。在SPIROMICS中,fSADTLC较高的个体FEV1每年下降1.156 mL(相对下降;95% ci: 0.613, 1.699;P < 0.001), fSADTLC每增加1%。COPDGene下降率略低,为0.866 mL /年(相对下降;95% ci: 0.345, 1.386;P < 0.001), fSADTLC增加百分比。与fSADPRM [ICC: 0.83 (95% CI: 0.76, 0.88)]相比,吸气式fSADTLC在重复测量之间表现出更高的一致性,其类内相关系数(ICC)为0.99 (95% CI: 0.98, 0.99)。结论:使用生成式人工智能可以通过单次吸气CT扫描可靠地评估小气道疾病,无需额外的呼气CT扫描。吸气CT的fSAD估计与fSADPRM密切相关,与FEV1下降有显著关联,并提供了更高的可重复性。
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来源期刊
CiteScore
27.30
自引率
4.50%
发文量
1313
审稿时长
3-6 weeks
期刊介绍: The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.
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