Automated Coronary Artery Calcium and Quantitative Emphysema in Lung Cancer Screening
Open Access
- 20 January 2023
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Thoracic Imaging
- Vol. 38 (4), W52-W63
- https://doi.org/10.1097/rti.0000000000000698
Abstract
Purpose: To assess automated coronary artery calcium (CAC) and quantitative emphysema (percentage of low attenuation areas [%LAA]) for predicting mortality and lung cancer (LC) incidence in LC screening. To explore correlations between %LAA, CAC, and forced expiratory value in 1 second (FEV1) and the discriminative ability of %LAA for airflow obstruction. Materials and Methods: Baseline low-dose computed tomography scans of the BioMILD trial were analyzed using an artificial intelligence software. Univariate and multivariate analyses were performed to estimate the predictive value of %LAA and CAC. Harrell C-statistic and time-dependent area under the curve (AUC) were reported for 3 nested models (Modelsurvey: age, sex, pack-years; Modelsurvey-LDCT: Modelsurvey plus %LAA plus CAC; Modelfinal: Modelsurvey-LDCT plus selected confounders). The correlations between %LAA, CAC, and FEV1 and the discriminative ability of %LAA for airflow obstruction were tested using the Pearson correlation coefficient and AUC-receiver operating characteristic curve, respectively. Results: A total of 4098 volunteers were enrolled. %LAA and CAC independently predicted 6-year all-cause (Modelfinal hazard ratio [HR], 1.14 per %LAA interquartile range [IQR] increase [95% CI, 1.05-1.23], 2.13 for CAC ≥400 [95% CI, 1.36-3.28]), noncancer (Modelfinal HR, 1.25 per %LAA IQR increase [95% CI, 1.11-1.37], 3.22 for CAC ≥400 [95%CI, 1.62-6.39]), and cardiovascular (Modelfinal HR, 1.25 per %LAA IQR increase [95% CI, 1.00-1.46], 4.66 for CAC ≥400, [95% CI, 1.80-12.58]) mortality, with an increase in concordance probability in Modelsurvey-LDCT compared with Modelsurvey (P1 (P1, with %LAA enabling the identification of airflow obstruction with moderate discriminative ability.Keywords
This publication has 46 references indexed in Scilit:
- Screening for Lung Cancer With Low-Dose Computed Tomography: A Systematic Review to Update the U.S. Preventive Services Task Force RecommendationAnnals of Internal Medicine, 2013
- Mortality by Level of Emphysema and Airway Wall ThicknessAmerican Journal of Respiratory and Critical Care Medicine, 2013
- Emphysema detected on computed tomography and risk of lung cancer: A systematic review and meta-analysisLung Cancer, 2012
- Coronary Artery Calcium Can Predict All-Cause Mortality and Cardiovascular Events on Low-Dose CT Screening for Lung CancerAmerican Journal of Roentgenology, 2012
- Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic ScreeningThe New England Journal of Medicine, 2011
- Clinical and Radiographic Predictors of GOLD–Unclassified Smokers in the COPDGene StudyAmerican Journal of Respiratory and Critical Care Medicine, 2011
- Quantitative Computed Tomography Analysis, Airflow Obstruction, and Lung Cancer in the Pittsburgh Lung Screening StudyJournal of Thoracic Oncology, 2011
- On the C‐statistics for evaluating overall adequacy of risk prediction procedures with censored survival dataStatistics in Medicine, 2011
- Effect of Emphysema on Lung Cancer Risk in Smokers: A Computed Tomography–Based AssessmentCancer Prevention Research, 2011
- Assessing the Relationship Between Lung Cancer Risk and Emphysema Detected on Low-Dose CT of the ChestSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2007