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Korean J Radiol. 2019 Feb;20(2):304-312. doi: 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.

Author information

1
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
2
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. sangmin.lee.md@gmail.com.
3
Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

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.

KEYWORDS:

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

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