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CT Emphysema and Deep Learning-derived Vertebral Bone Loss in Individuals without COPD: Findings from MESA
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DOI：10.1148/radiol.252251.png)
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Abstract
En 中文
Background: It is unknown whether subclinical emphysema-like changes, quantified at chest CT, are associated with loss of bone mineral density (BMD) in individuals without clinical chronic obstructive pulmonary disease (COPD). Purpose: To identify early imaging markers of lung and bone health using deep learning-based imaging analysis in a large multiethnic cohort. Materials and Methods: Chest CT scans obtained using the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) protocol during examination 5 and 6 of the prospective Multi-Ethnic Study of Atherosclerosis (MESA) were secondarily analyzed (April 2010-March 2018). Percentage emphysema was quantified at examination, and thoracic vertebral BMD was assessed at both examinations using a validated deep learning-based segmentation model. Participants with clinical COPD as determined on the basis of spirometry or self-reports were excluded. Linear mixed-effects models were constructed and adjusted for demographic characteristics and covariates, including smoking status, physical activity, and scanner type, and the interaction effect of sex was analyzed. Results: The cross-sectional analysis included 2312 participants (median age, 67 years [IQR, 61-75 years]; 1285 female participants), and the longitudinal study included 1109 participants (median age, 65 years [IQR, 60-72 years]; 614 female participants) with available follow-up CT data. A greater percentage of emphysema-like changes was associated with lower BMD (beta = -1.14 mg/cm(3) [95% CI: -1.76, -0.53]) cross-sectionally and with greater annual BMD loss (beta = -0.07 mg/cm(3) per year [95% CI: -0.13, -0.01]) longitudinally. Interaction effects were identified for sex (P < .001) and race or ethnicity (P = .049). In stratified models, the associations were significant for men (beta = -0.38 mg/cm(3) per year [95% CI: -0.48, -0.28]) and Black/African American participants (beta = -0.24 mg/cm(3) per year [95% CI: -0.39, -0.09]). The Johnson-Neyman method revealed more than 2.7% emphysema as a threshold for a decrease in BMD among men, which corresponded to 39% of the male participants. The results remained robust after adjustment for pulmonary function and chronic respiratory symptoms. Conclusion: In individuals without COPD, a greater percentage of emphysema-like changes was independently associated with faster vertebral bone loss, particularly in men, suggesting that subclinical emphysema may be a novel imaging marker of systemic skeletal decline.
Keywords:
COMPUTED-TOMOGRAPHY
MINERAL DENSITY
ASSOCIATION
LUNG
PHENOTYPES
AMERICAN
SMOKERS
ALPHA
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