Korean J Radiol.  2019 Feb;20(2):304-312. 10.3348/kjr.2018.0204.

Prediction of Treatment Response in Patients with Chronic Obstructive Pulmonary Disease by Determination of Airway Dimensions with Baseline Computed Tomography

• Park HJ
• Lee SM
• Choe J
• Lee SM
• Kim N
• Lee JS
• Oh YM
• Seo JB

• KMID: 2438261
• DOI: http://doi.org/10.3348/kjr.2018.0204

Abstract

OBJECTIVE
To determine the predictive factors for treatment responsiveness in patients with chronic obstructive pulmonary disease (COPD) at 1-year follow-up by performing quantitative analyses of baseline CT scans.
MATERIALS AND METHODS
COPD patients (n = 226; 212 men, 14 women) were recruited from the Korean Obstructive Lung Disease cohort. Patients received a combination of inhaled long-acting beta-agonists and corticosteroids twice daily for 3 months and subsequently received medications according to the practicing clinician's decision. The emphysema index, air-trapping indices, and airway parameter (Pi10), calculated using both full-width-half-maximum and integral-based half-band (IBHB) methods, were obtained with baseline CT scans. Clinically meaningful treatment response was defined as an absolute increase of ≥ 0.225 L in the forced expiratory volume in 1 second (FEV1) at the one-year follow-up. Multivariate logistic regression analysis was performed to investigate the predictors of an increase in FEV1, and receiver operating characteristic (ROC) analysis was performed to evaluate the performance of the suggested models.
RESULTS
Treatment response was noted in 47 patients (20.8%). The mean FEV1 increase in responders was 0.36 ± 0.10 L. On univariate analysis, the air-trapping index (ATI) obtained by the subtraction method, ATI of the emphysematous area, and IBHB-measured Pi10 parameter differed significantly between treatment responders and non-responders (p = 0.048, 0.042, and 0.002, respectively). Multivariate analysis revealed that the IBHB-measured Pi10 was the only independent variable predictive of an FEV1 increase (p = 0.003). The adjusted odds ratio was 1.787 (95% confidence interval: 1.220-2.619). The area under the ROC curve was 0.641.
CONCLUSION
Measurement of standardized airway dimensions on baseline CT by using a recently validated quantification method can predict treatment responsiveness in COPD patients.

Keyword

Chronic obstructive pulmonary disease; Computed tomography; Quantification; Forced expiratory volume in 1 s; Treatment response; Airway

MeSH Terms

Adrenal Cortex Hormones
Cohort Studies
Emphysema
Follow-Up Studies
Forced Expiratory Volume
Humans
Logistic Models
Lung Diseases, Obstructive
Male
Methods
Multivariate Analysis
Odds Ratio
Pulmonary Disease, Chronic Obstructive*
ROC Curve
Tomography, X-Ray Computed
Adrenal Cortex Hormones

Figure

• 

  Fig. 1 Flowchart of study population.COPD = chronic obstructive pulmonary disease, KOLD = Korean Obstructive Lung Disease, PFT = pulmonary function test

• 

  Fig. 2 Measurement of standardized small-airway dimensions.Commercial software (Aview, Coreline Soft) automatically segments airways and detects airway level, lumens, and inner and outer boundaries of airway walls. After selecting most properly measured airways, software shows Pi10 with two different measurement algorithms (full-width-half-maximum and IBHB algorithms). IBHB = integral-based half-band, Pi10 = square root of airway wall area of theoretical airway with internal perimeter of 10 mm

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  Fig. 3 Calculation of Pi10.Square root of wall area of each measured airway (WA) was plotted against Pi of that airway. From regression line, standardized measure of airway wall thickness was predicted with Pi of 10 mm. Pi = internal perimeter

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  Fig. 4 Representative case of response to treatment in 58-year-old male patient.(A) Axial and (B) sagittal reconstructed images on baseline CT show diffuse bronchial wall thickening in both lungs (arrows). Pi10 by IBHB method was 4.82 mm and baseline FEV1 was 2.82 L. After receiving treatment, FEV1 at 1-year follow-up was 3.44 L, indicating increase of 0.62 L.FEV1 = forced expiratory volume in 1 second

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  Fig. 5 ROC curve of advanced baseline quantitation of standardized airway dimensions versus treatment response.Graph shows results of ROC analysis for differentiating between patients with and without treatment response by determining Pi10 obtained by IBHB. Area under curve for Pi10-IBHB was 0.641 (95% confidence interval: 0.558–0.724). Optimal cutoff value of Pi10-IBHB was 4.05 mm. Pi10-IBHB = Pi10 obtained by IBHB, ROC = receiver operating characteristic

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