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Purpose <p>To investigate the predictive value of pulmonary artery quantitative CT (qCT) parameters for acute exacerbations of COPD (AECOPD) and explore their longitudinal changes in relation to pulmonary function decline.</p> Materials and methods <p>This retrospective study included 507 COPD patients from XXX Hospital (2012–2024). Non-contrast CT images were analyzed using the FACT-Digital system to derive qCT parameters: arterial blood volume for vessels ≤ 5 mm<sup>2</sup> (BV5), total airway count (TAC), low attenuation area at -950 HU (LAA-950%), and total lung volume (TLV). ROC curves assessed predictive performance for AECOPD. Multivariable Cox regression evaluated associations between longitudinal qCT changes and outcomes (GOLD progression, FEV1 decline &gt; 30/50&#xa0;mL/year).</p> Results <p>Four qCT parameters (TLV, LAA-950%, TAC, and arterial BV5) were used to build predictive models for AE within 1&#xa0;year and frequent AE. For AE within 1&#xa0;year prediction, CT model achieved an AUC of 0.817 (95% CI 0.762–0.872), integration with clinical parameters model improved AUC to 0.839 (95% CI 0.803–0.875). Arterial BV5 &lt; 23.715&#xa0;ml and TAC &lt; 131 emerged as independent predictors. For frequent AE prediction, CT model showed an AUC of 0.767 (95% CI 0.704–0.830), integration with clinical parameters model improved AUC to 0.867 (95% CI 0.825–0.909). Arterial BV5 &lt; 18&#xa0;ml and TAC &lt; 135 were identified as independent predictors. Arterial BV5 decline&#xa0;was identified as a marginal independent risk factor for GOLD stage progression (<i>P</i> = 0.051, HR = 2.286, 95% CI 0.995–5.252), FEV1 decline &gt; 30&#xa0;mL/year (<i>P</i> = 0.008, HR = 2.256, 95% CI 1.237–4.115) and FEV1 decline &gt; 50&#xa0;mL/year&#xa0;(<i>P</i> = 0.001, HR = 2.943, 95% CI 1.525–5.680).</p> Conclusions <p>The study demonstrated that reduced small pulmonary arterial volume (BV5) is an independent risk factor for AECOPD and disease progression. Furthermore, during follow-up, decline in small pulmonary arterial volume independently predicted progression of GOLD stages and accelerated decline in lung function.</p>

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Pulmonary arterial morphological markers on non-contrast CT predicted acute exacerbations and disease progression in chronic obstructive pulmonary disease: a longitudinal cohort study

  • 期刊论文

  • 发表日期：

    2025年8月4日

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  • Xiaohe Yu,
  • Ziqi Xiong,
  • Jingxue Cao,
  • Fang Wang,
  • Xiao Bao,
  • Jingyun Shi

摘要

Purpose

To investigate the predictive value of pulmonary artery quantitative CT (qCT) parameters for acute exacerbations of COPD (AECOPD) and explore their longitudinal changes in relation to pulmonary function decline.

Materials and methods

This retrospective study included 507 COPD patients from XXX Hospital (2012–2024). Non-contrast CT images were analyzed using the FACT-Digital system to derive qCT parameters: arterial blood volume for vessels ≤ 5 mm2 (BV5), total airway count (TAC), low attenuation area at -950 HU (LAA-950%), and total lung volume (TLV). ROC curves assessed predictive performance for AECOPD. Multivariable Cox regression evaluated associations between longitudinal qCT changes and outcomes (GOLD progression, FEV1 decline > 30/50 mL/year).

Results

Four qCT parameters (TLV, LAA-950%, TAC, and arterial BV5) were used to build predictive models for AE within 1 year and frequent AE. For AE within 1 year prediction, CT model achieved an AUC of 0.817 (95% CI 0.762–0.872), integration with clinical parameters model improved AUC to 0.839 (95% CI 0.803–0.875). Arterial BV5 < 23.715 ml and TAC < 131 emerged as independent predictors. For frequent AE prediction, CT model showed an AUC of 0.767 (95% CI 0.704–0.830), integration with clinical parameters model improved AUC to 0.867 (95% CI 0.825–0.909). Arterial BV5 < 18 ml and TAC < 135 were identified as independent predictors. Arterial BV5 decline was identified as a marginal independent risk factor for GOLD stage progression (P = 0.051, HR = 2.286, 95% CI 0.995–5.252), FEV1 decline > 30 mL/year (P = 0.008, HR = 2.256, 95% CI 1.237–4.115) and FEV1 decline > 50 mL/year (P = 0.001, HR = 2.943, 95% CI 1.525–5.680).

Conclusions

The study demonstrated that reduced small pulmonary arterial volume (BV5) is an independent risk factor for AECOPD and disease progression. Furthermore, during follow-up, decline in small pulmonary arterial volume independently predicted progression of GOLD stages and accelerated decline in lung function.