Artificial Intelligence-based CT Assessment of Bronchiectasis: The COPDGene Study.

Journal: Radiology
PMID: 36511808

Abstract

Background CT is the standard method used to assess bronchiectasis. A higher airway-to-artery diameter ratio (AAR) is typically used to identify enlarged bronchi and bronchiectasis; however, current imaging methods are limited in assessing the extent of this metric in CT scans. Purpose To determine the extent of AARs using an artificial intelligence-based chest CT and assess the association of AARs with exacerbations over time. Materials and Methods In a secondary analysis of ever-smokers from the prospective, observational, multicenter COPDGene study, AARs were quantified using an artificial intelligence tool. The percentage of airways with AAR greater than 1 (a measure of airway dilatation) in each participant on chest CT scans was determined. Pulmonary exacerbations were prospectively determined through biannual follow-up (from July 2009 to September 2021). Multivariable zero-inflated regression models were used to assess the association between the percentage of airways with AAR greater than 1 and the total number of pulmonary exacerbations over follow-up. Covariates included demographics, lung function, and conventional CT parameters. Results Among 4192 participants (median age, 59 years; IQR, 52-67 years; 1878 men [45%]), 1834 had chronic obstructive pulmonary disease (COPD). During a 10-year follow-up and in adjusted models, the percentage of airways with AARs greater than 1 (quartile 4 vs 1) was associated with a higher total number of exacerbations (risk ratio [RR], 1.08; 95% CI: 1.02, 1.15; = .01). In participants meeting clinical and imaging criteria of bronchiectasis (ie, clinical manifestations with ≥3% of AARs >1) versus those who did not, the RR was 1.37 (95% CI: 1.31, 1.43; < .001). Among participants with COPD, the corresponding RRs were 1.10 (95% CI: 1.02, 1.18; = .02) and 1.32 (95% CI: 1.26, 1.39; < .001), respectively. Conclusion In ever-smokers with chronic obstructive pulmonary disease, artificial intelligence-based CT measures of bronchiectasis were associated with more exacerbations over time. Clinical trial registration no. NCT00608764 © RSNA, 2022 See also the editorial by Schiebler and Seo in this issue.

Authors

  • Alejandro A Díaz
    From the Division of Pulmonary and Critical Care Medicine (A.A.D., W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San José Estépar, Raúl San José Estépar), Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division of Network Medicine (E.K.S.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology, University of California-San Diego, San Diego, Calif (A.Y., S.K.); Division of Pulmonary Diseases and Critical Care, University of Texas-San Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.).
  • Pietro Nardelli
  • Wei Wang
    State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau 999078, China.
  • Rubén San José Estépar
    From the Division of Pulmonary and Critical Care Medicine (A.A.D., W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San José Estépar, Raúl San José Estépar), Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division of Network Medicine (E.K.S.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology, University of California-San Diego, San Diego, Calif (A.Y., S.K.); Division of Pulmonary Diseases and Critical Care, University of Texas-San Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.).
  • Andrew Yen
  • Seth Kligerman
  • Diego J Maselli
    From the Division of Pulmonary and Critical Care Medicine (A.A.D., W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San José Estépar, Raúl San José Estépar), Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division of Network Medicine (E.K.S.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology, University of California-San Diego, San Diego, Calif (A.Y., S.K.); Division of Pulmonary Diseases and Critical Care, University of Texas-San Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.).
  • Wojciech R Dolliver
    From the Division of Pulmonary and Critical Care Medicine (A.A.D., W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San José Estépar, Raúl San José Estépar), Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division of Network Medicine (E.K.S.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology, University of California-San Diego, San Diego, Calif (A.Y., S.K.); Division of Pulmonary Diseases and Critical Care, University of Texas-San Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.).
  • Andrew Tsao
    Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, YAW 6048, Boston, MA, 02114, USA.
  • José L Orejas
    From the Division of Pulmonary and Critical Care Medicine (A.A.D., W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San José Estépar, Raúl San José Estépar), Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division of Network Medicine (E.K.S.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology, University of California-San Diego, San Diego, Calif (A.Y., S.K.); Division of Pulmonary Diseases and Critical Care, University of Texas-San Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.).
  • Stefano Aliberti
    Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Respiratory Unit, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
  • Timothy R Aksamit
    From the Division of Pulmonary and Critical Care Medicine (A.A.D., W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San José Estépar, Raúl San José Estépar), Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division of Network Medicine (E.K.S.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology, University of California-San Diego, San Diego, Calif (A.Y., S.K.); Division of Pulmonary Diseases and Critical Care, University of Texas-San Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.).
  • Kendra A Young
    Department of Epidemiology, University of Colorado, Denver, Aurora, CO.
  • Gregory L Kinney
    Department of Epidemiology, University of Colorado, Denver, Aurora, CO.
  • George R Washko
    3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston Massachusetts.
  • Edwin K Silverman
    Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
  • Raúl San José Estépar
    2 Applied Chest Imaging Laboratory, Department of Radiology, and.

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