Quantitative computed tomography and visual emphysema scores: association with lung function decline

Background Computed tomography (CT) visual emphysema score is a better predictor of mortality than single quantitative CT emphysema measurements in COPD, but there are numerous CT measurements that reflect COPD-related disease features. The purpose of this study was to determine if linear combinations of quantitative CT measurements by principal component analysis (PCA) have a greater association with forced expiratory volume in 1 s (FEV1) lower limit of normal (LLN) annualised change (.FEV1) than visual emphysema score in COPD. Methods In this retrospective, longitudinal study, demographic, spirometry and CT images were acquired. CT visual emphysema score and quantitative analysis were performed; low attenuation area < 950 HU (LAA950) and 12 other quantitative CT measurements were investigated. PCA was used for CT feature extraction. Multiple linear regression models for baseline FEV1 LLN and 6-year.FEV1 were used to determine associations with visual emphysema score and CT measurements. A total of 725 participants were analysed (n=299 never-smokers, n=242 at-risk and n=184 COPD). Results Quantitative CT measures (LAA950 and PCA components) were independently statistically significant ( p < 0.05) in predicting baseline FEV1 LLN, whereas visual emphysema score was not statistically significant in any baseline model. When predicting 6-year.FEV1, only visual emphysema score was significant ( p < 0.05) in models with LAA950 and PCA combination of emphysema measurements. In the model with PCA using all CT measurements predicting 6-year.FEV1, visual emphysema score ( p=0.021) along with one PCA component ( p=0.004) were statistically significant. Conclusions PCA with a combination of CT measurements reflecting several different COPD-related disease features independently predicted baseline lung function and increased the relative importance of quantitative CT compared with visual emphysema score for predicting lung function decline.