Publications by authors named "John H M Austin"

66 Publications

Hypersensitivity pneumonitis: Airway-centered pulmonary fibrosis on chest CT.

Respir Investig 2021 Aug 6. Epub 2021 Aug 6.

Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA. Electronic address:

Background: To evaluate the chest CT appearance of patients with a clinicopathologic diagnosis of hypersensitivity pneumonia.

Methods: IRB approval was obtained for a retrospective review of patients with a preoperative CT scan, a surgical pathology report from a transbronchial biopsy or wedge resection consistent with hypersensitivity pneumonitis, and a pulmonary consultation, which also supported the diagnosis. The pathology report was evaluated for granulomas, airway-centered fibrosis, microscopic honeycombing, and fibroblast foci. The medical records were reviewed for any known antigen exposure. Patients were separated into two groups; those with and without a known antigen exposure. The CT scans were assessed for distribution of fibrosis: upper lobe or lower lobe predominance, airway-centered versus peripheral distribution, three-density pattern, and honeycombing.

Results: 264 pathology reports included the term chronic hypersensitivity pneumonitis (CHP). Thirty-eight of the patients had a pulmonologist who gave the patient a working diagnosis of CHP. The average age of these patients was 64 years, and 21/38 were women. Seventeen of the 38 patients had at least one antigen exposure described in the medical records. All the patients had fibrosis along the airways on chest CT. Both known antigen exposure and no known antigen patients had upper and lower lung-predominant fibrosis. There were more patients with hiatal hernias in the unknown antigen group. Honeycombing was an uncommon finding.

Conclusion: Airway-centered fibrosis was present on chest CT in all 38 patients with CHP (100%), with or without known antigen exposure.
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http://dx.doi.org/10.1016/j.resinv.2021.06.011DOI Listing
August 2021

Novel Subtypes of Pulmonary Emphysema Based on Spatially-Informed Lung Texture Learning: the Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study.

IEEE Trans Med Imaging 2021 Jul 5;PP. Epub 2021 Jul 5.

Pulmonary emphysema overlaps considerably with chronic obstructive pulmonary disease (COPD), and is traditionally subcategorized into three subtypes previously identified on autopsy. Unsupervised learning of emphysema subtypes on computed tomography (CT) opens the way to new definitions of emphysema subtypes and eliminates the need of thorough manual labeling. However, CT-based emphysema subtypes have been limited to texture-based patterns without considering spatial location. In this work, we introduce a standardized spatial mapping of the lung for quantitative study of lung texture location and propose a novel framework for combining spatial and texture information to discover spatially-informed lung texture patterns (sLTPs) that represent novel emphysema subtype candidates. Exploiting two cohorts of full-lung CT scans from the MESA COPD (n=317) and EMCAP (n=22) studies, we first show that our spatial mapping enables population-wide study of emphysema spatial location. We then evaluate the characteristics of the sLTPs discovered on MESA COPD, and show that they are reproducible, able to encode standard emphysema subtypes, and associated with physiological symptoms.
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http://dx.doi.org/10.1109/TMI.2021.3094660DOI Listing
July 2021

Quantifying normal lung in pulmonary fibrosis: CT analysis and correlation with %DLCO.

Clin Imaging 2021 Sep 18;77:287-290. Epub 2021 Jun 18.

Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America. Electronic address:

Background: Chest CT scans are routinely obtained to monitor disease progression in pulmonary fibrosis. However, radiologists do not employ a standardized system for quantitative description of the severity of the disease. Development and validation of a grading system offers potential for enhancing the information that radiologists provide clinicians.

Study Design And Methods: Our retrospective review analyzed 100 sequential patients with usual interstitial pneumonitis (UIP) on HRCT scans from 2018 and 2019. A radiologic scoring system evaluated the percent of normal lung on the basis of a 0-5 point scale per lobe (findings for the right middle lobe were included in the right upper lobe score), yielding an overall additive numerical score on a scale of 20 (completely normal lung) to 0 (no normal lung). Two radiologists quantified the percentage of normal lung by consensus agreement. Percent DLCO as well as demographic data were obtained from the medical record. Statistical analysis was performed using Spearman correlation to assess correlation between grade and percent DLCO.

Results: 96 patients met the inclusion criteria; average age was 71, 68% were male. Score on CT scan ranged from 18 to 4; average 10.9, SD 3.58. The single-breath diffusing capacity (percent DLCO) ranged from 88% to 17%; mean 44.5%, SD 14.3%. Spearman's correlation for CT score and percent DLCO was 0.622, P < 0.001.

Conclusion: This scoring system quantifying the amount of normal lung on chest CT of patients with UIP correlated significantly with percent DLCO (P < 0.001) and appears to offer a promising quantitative measure to assess severity of disease.
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http://dx.doi.org/10.1016/j.clinimag.2021.06.021DOI Listing
September 2021

Associations of D-dimer with CT Lung Abnormalities, Serum Biomarkers of Lung Injury, and Forced Vital Capacity: MESA Lung Study.

Ann Am Thorac Soc 2021 Apr 16. Epub 2021 Apr 16.

Weill Cornell Medical College, 12295, Department of Medicine, New York, New York, United States.

Rationale: The coagulation cascade may play a role in the pathogenesis of interstitial lung disease through increased production of thrombin and fibrin deposition. Whether circulating coagulation cascade factors are linked to lung inflammation and scarring among community-dwelling adults is unknown.

Objective: To test the hypothesis that higher baseline D-dimer levels are associated with markers of early lung injury and scarring.

Methods: Using the Multi-Ethnic Study of Atherosclerosis cohort (n=6,814), we examined associations of baseline D-dimer levels with high attenuation areas (HAA) from Exam 1 (2000-2002, n=6,184) and interstitial lung abnormalities (ILA) from Exam 5 computed tomography (CT) scans (2010-2012, n=2,227), and serum matrix metalloproteinase-7 (MMP-7) and surfactant protein-A (SP-A) from Exam 1 (n=1,098). We examined longitudinal change in forced vital capacity (FVC) from Exams 3-6 (2004-2018, n=3,562). We used linear, logistic regression, and linear mixed models to examine associations and adjust for potential confounders.

Results: The mean (SD) age of the cohort was 62 (10) years and D-dimer level was 0.35 (0.69) ug/mL. For every 10% increase in D-dimer level, there was an increase in HAA percent of 0.27 (95% CI 0.08 to 0.47) after adjustment for covariates. Associations were stronger among those older than 65 years (p-values for interaction<0.001). A 10% increase in D-dimer level was associated with an odds ratio of 1.05 for ILA (95% CI 0.99 to 1.11). Higher D-dimer levels were associated with higher serum MMP-7 and a faster decline in FVC. D-dimer was not associated with SP-A.

Conclusions: Higher D-dimer levels were associated with a greater burden of lung parenchymal abnormalities detected on CT scan, MMP-7, and FVC decline among community-dwelling adults.
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http://dx.doi.org/10.1513/AnnalsATS.202012-1557OCDOI Listing
April 2021

Interstitial lung abnormalities detected incidentally on CT: a Position Paper from the Fleischner Society.

Lancet Respir Med 2020 07;8(7):726-737

Department of Radiology, Denver, CO, USA.

The term interstitial lung abnormalities refers to specific CT findings that are potentially compatible with interstitial lung disease in patients without clinical suspicion of the disease. Interstitial lung abnormalities are increasingly recognised as a common feature on CT of the lung in older individuals, occurring in 4-9% of smokers and 2-7% of non-smokers. Identification of interstitial lung abnormalities will increase with implementation of lung cancer screening, along with increased use of CT for other diagnostic purposes. These abnormalities are associated with radiological progression, increased mortality, and the risk of complications from medical interventions, such as chemotherapy and surgery. Management requires distinguishing interstitial lung abnormalities that represent clinically significant interstitial lung disease from those that are subclinical. In particular, it is important to identify the subpleural fibrotic subtype, which is more likely to progress and to be associated with mortality. This multidisciplinary Position Paper by the Fleischner Society addresses important issues regarding interstitial lung abnormalities, including standardisation of the definition and terminology; predisposing risk factors; clinical outcomes; options for initial evaluation, monitoring, and management; the role of quantitative evaluation; and future research needs.
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http://dx.doi.org/10.1016/S2213-2600(20)30168-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970441PMC
July 2020

The role of initial chest X-ray in triaging patients with suspected COVID-19 during the pandemic.

Emerg Radiol 2020 Dec 22;27(6):617-621. Epub 2020 Jun 22.

Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 10032, USA.

Purpose: The purpose of our research is to evaluate the usefulness of chest X-ray for triaging patients with suspected COVID-19 infection.

Methods: IRB approval was obtained to allow a retrospective review of adult patients who presented to the Emergency Department with a complaint of fever, cough, dyspnea or hypoxia and had a chest X-ray between 12 March 2020 and 26 March 2020. The initial chest X-ray was graded on a scale of 0-3 with grade 0 representing no alveolar opacities, grade 1: < 1/3 alveolar opacities of the lung, Grade 2: 1/3 to 2/3 lung with alveolar opacities and grade 3: > 2/3 alveolar opacities of the lung. Past medical history of diabetes and hypertension, initial oxygen saturation, COVID-19 testing results, intubation, and outcome were also collected.

Results: Four hundred ten patient chest X-rays were reviewed. Oxygen saturation and X-ray grade were both significantly associated with the length of stay in hospital, the hazard ratio (HR) of discharge was 1.05 (95% CI [1.01, 1.09], p = 0.017) and 0.61 (95% CI [0.51, 0.73], p < 0.001), respectively. In addition, oxygen saturation and X-ray grade were significant predictors of intubation (odds ratio (OR) of intubation is 0.88 (95% CI [0.81, 0.96], p = 0.004) and 3.69 (95% CI [2.25, 6.07], p < 0.001).

Conclusions: Initial chest X-ray is a useful tool for triaging those subjects who might have poor outcomes with suspected COVID-19 infection and benefit most from hospitalization.
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http://dx.doi.org/10.1007/s10140-020-01808-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306559PMC
December 2020

COPDGene 2019: Redefining the Diagnosis of Chronic Obstructive Pulmonary Disease.

Chronic Obstr Pulm Dis 2019 Nov;6(5):384-399

Northeastern University, Boston, Massachusetts.

Background: Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality. Present-day diagnostic criteria are largely based solely on spirometric criteria. Accumulating evidence has identified a substantial number of individuals without spirometric evidence of COPD who suffer from respiratory symptoms and/or increased morbidity and mortality. There is a clear need for an expanded definition of COPD that is linked to physiologic, structural (computed tomography [CT]) and clinical evidence of disease. Using data from the COPD Genetic Epidemiology study (COPDGene), we hypothesized that an integrated approach that includes environmental exposure, clinical symptoms, chest CT imaging and spirometry better defines disease and captures the likelihood of progression of respiratory obstruction and mortality.

Methods: Four key disease characteristics - environmental exposure (cigarette smoking), clinical symptoms (dyspnea and/or chronic bronchitis), chest CT imaging abnormalities (emphysema, gas trapping and/or airway wall thickening), and abnormal spirometry - were evaluated in a group of 8784 current and former smokers who were participants in COPDGene Phase 1. Using these 4 disease characteristics, 8 categories of participants were identified and evaluated for odds of spirometric disease progression (FEV > 350 ml loss over 5 years), and the hazard ratio for all-cause mortality was examined.

Results: Using smokers without symptoms, CT imaging abnormalities or airflow obstruction as the reference population, individuals were classified as Possible COPD, Probable COPD and Definite COPD. Current Global initiative for obstructive Lung Disease (GOLD) criteria would diagnose 4062 (46%) of the 8784 study participants with COPD. The proposed COPDGene 2019 diagnostic criteria would add an additional 3144 participants. Under the new criteria, 82% of the 8784 study participants would be diagnosed with Possible, Probable or Definite COPD. These COPD groups showed increased risk of disease progression and mortality. Mortality increased in patients as the number of their COPD characteristics increased, with a maximum hazard ratio for all cause-mortality of 5.18 (95% confidence interval [CI]: 4.15-6.48) in those with all 4 disease characteristics.

Conclusions: A substantial portion of smokers with respiratory symptoms and imaging abnormalities do not manifest spirometric obstruction as defined by population normals. These individuals are at significant risk of death and spirometric disease progression. We propose to redefine the diagnosis of COPD through an integrated approach using environmental exposure, clinical symptoms, CT imaging and spirometric criteria. These expanded criteria offer the potential to stimulate both current and future interventions that could slow or halt disease progression in patients before disability or irreversible lung structural changes develop.
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http://dx.doi.org/10.15326/jcopdf.6.5.2019.0149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020846PMC
November 2019

Teleradiology: An opportunity to improve outcomes in pulmonary fibrosis.

Clin Imaging 2020 04 13;60(2):263-264. Epub 2019 Jun 13.

Department of Radiology, Columbia University Medical Center, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.clinimag.2019.05.011DOI Listing
April 2020

Ambient air pollution and pulmonary vascular volume on computed tomography: the MESA Air Pollution and Lung cohort studies.

Eur Respir J 2019 06 5;53(6). Epub 2019 Jun 5.

Dept of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.

Background: Air pollution alters small pulmonary vessels in animal models. We hypothesised that long-term ambient air pollution exposure would be associated with differences in pulmonary vascular volumes in a population-based study.

Methods: The Multi-Ethnic Study of Atherosclerosis recruited adults in six US cities. Personalised long-term exposures to ambient black carbon, nitrogen dioxide (NO), oxides of nitrogen (NO ), particulate matter with a 50% cut-off aerodynamic diameter of <2.5 μm (PM) and ozone were estimated using spatiotemporal models. In 2010-2012, total pulmonary vascular volume was measured as the volume of detectable pulmonary arteries and veins, including vessel walls and luminal blood volume, on noncontrast chest computed tomography (TPVV). Peripheral TPVV was limited to the peripheral 2 cm to isolate smaller vessels. Linear regression adjusted for demographics, anthropometrics, smoking, second-hand smoke, renal function and scanner manufacturer.

Results: The mean±sd age of the 3023 participants was 69.3±9.3 years; 46% were never-smokers. Mean exposures were 0.80 μg·m black carbon, 14.6 ppb NO and 11.0 μg·m ambient PM. Mean±sd peripheral TPVV was 79.2±18.2 cm and TPVV was 129.3±35.1 cm. Greater black carbon exposure was associated with a larger peripheral TPVV, including after adjustment for city (mean difference 0.41 (95% CI 0.03-0.79) cm per interquartile range; p=0.036). Associations for peripheral TPVV with NO were similar but nonsignificant after city adjustment, while those for PM were of similar magnitude but nonsignificant after full adjustment. There were no associations for NO or ozone, or between any pollutant and TPVV.

Conclusions: Long-term black carbon exposure was associated with a larger peripheral TPVV, suggesting diesel exhaust may contribute to remodelling of small pulmonary vessels in the general population.
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http://dx.doi.org/10.1183/13993003.02116-2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910868PMC
June 2019

CT-based Visual Classification of Emphysema: Association with Mortality in the COPDGene Study.

Radiology 2018 09 15;288(3):859-866. Epub 2018 May 15.

From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.).

Purpose To determine whether visually assessed patterns of emphysema at CT might provide a simple assessment of mortality risk among cigarette smokers. Materials and Methods Of the first 4000 cigarette smokers consecutively enrolled between 2007 and 2011 in this COPDGene study, 3171 had data available for both visual emphysema CT scores and survival. Each CT scan was retrospectively visually scored by two analysts using the Fleischner Society classification system. Severity of emphysema was also evaluated quantitatively by using percentage lung volume occupied by low-attenuation areas (voxels with attenuation of -950 HU or less) (LAA-950). Median duration of follow-up was 7.4 years. Regression analysis for the relationship between imaging patterns and survival was based on the Cox proportional hazards model, with adjustment for age, race, sex, height, weight, pack-years of cigarette smoking, current smoking status, educational level, LAA-950, and (in a second model) forced expiratory volume in 1 second (FEV). Results Observer agreement in visual scoring was good (weighted κ values, 0.71-0.80). There were 519 deaths in the study cohort. Compared with subjects who did not have visible emphysema, mortality was greater in those with any grade of emphysema beyond trace (adjusted hazard ratios, 1.7, 2.5, 5.0, and 4.1, respectively, for mild centrilobular emphysema, moderate centrilobular emphysema, confluent emphysema, and advanced destructive emphysema, P < .001). This increased mortality generally persisted after adjusting for LAA-950. Conclusion The visual presence and severity of emphysema is associated with significantly increased mortality risk, independent of the quantitative severity of emphysema. Online supplemental material is available for this article.
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http://dx.doi.org/10.1148/radiol.2018172294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122195PMC
September 2018

Unsupervised Discovery of Spatially-Informed Lung Texture Patterns for Pulmonary Emphysema: The MESA COPD Study.

Med Image Comput Comput Assist Interv 2017 Sep 4;10433:116-124. Epub 2017 Sep 4.

Department of Biomedical Engineering, Columbia University, New York, NY, USA.

Unsupervised discovery of pulmonary emphysema subtypes offers the potential for new definitions of emphysema on lung computed tomography (CT) that go beyond the standard subtypes identified on autopsy. Emphysema subtypes can be defined on CT as a variety of textures with certain spatial prevalence. However, most existing approaches for learning emphysema subtypes on CT are limited to texture features, which are sub-optimal due to the lack of spatial information. In this work, we exploit a standardized spatial mapping of the lung and propose a novel framework for combining spatial and texture information to discover spatially-informed lung texture patterns (sLTPs). Our spatial mapping is demonstrated to be a powerful tool to study emphysema spatial locations over different populations. The discovered sLTPs are shown to have high reproducibility, ability to encode standard emphysema subtypes, and significant associations with clinical characteristics.
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http://dx.doi.org/10.1007/978-3-319-66182-7_14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5773120PMC
September 2017

Human airway branch variation and chronic obstructive pulmonary disease.

Proc Natl Acad Sci U S A 2018 01 16;115(5):E974-E981. Epub 2018 Jan 16.

Department of Medicine, University of California, San Francisco, CA 94110.

Susceptibility to chronic obstructive pulmonary disease (COPD) beyond cigarette smoking is incompletely understood, although several genetic variants associated with COPD are known to regulate airway branch development. We demonstrate that in vivo central airway branch variants are present in 26.5% of the general population, are unchanged over 10 y, and exhibit strong familial aggregation. The most common airway branch variant is associated with COPD in two cohorts ( = 5,054), with greater central airway bifurcation density, and with emphysema throughout the lung. The second most common airway branch variant is associated with COPD among smokers, with narrower airway lumens in all lobes, and with genetic polymorphisms within the gene. We conclude that central airway branch variation, readily detected by computed tomography, is a biomarker of widely altered lung structure with a genetic basis and represents a COPD susceptibility factor.
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http://dx.doi.org/10.1073/pnas.1715564115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798356PMC
January 2018

A Longitudinal Cohort Study of Aspirin Use and Progression of Emphysema-like Lung Characteristics on CT Imaging: The MESA Lung Study.

Chest 2018 07 12;154(1):41-50. Epub 2017 Dec 12.

Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.

Background: Platelet activation reduces pulmonary microvascular blood flow and contributes to inflammation; these factors have been implicated in the pathogenesis of COPD and emphysema. We hypothesized that regular use of aspirin, a platelet inhibitor, would be associated with a slower progression of emphysema-like lung characteristics on CT imaging and a slower decline in lung function.

Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants 45 to 84 years of age without clinical cardiovascular disease from 2000 to 2002. The MESA Lung Study assessed the percentage of emphysema-like lung below -950 Hounsfield units ("percent emphysema") on cardiac (2000-2007) and full-lung CT scans (2010-2012). Regular aspirin use was defined as 3 or more days per week. Mixed-effect models adjusted for demographics, anthropometric features, smoking, hypertension, angiotensin-converting enzyme inhibitor or angiotensin II-receptor blocker use, C-reactive protein levels, sphingomyelin levels, and scanner factors.

Results: At baseline, the 4,257 participants' mean (± SD) age was 61 ± 10 years, 54% were ever smokers, and 22% used aspirin regularly. On average, percent emphysema increased 0.60 percentage points over 10 years (95% CI, 0.35-0.94). Progression of percent emphysema was slower among regular aspirin users compared with patients who did not use aspirin (fully adjusted model: -0.34% /10 years, 95% CI, -0.60 to -0.08; P = .01). Results were similar in ever smokers and with doses of 81 and 300 to 325 mg and were of greater magnitude among those with airflow limitation. No association was found between aspirin use and change in lung function.

Conclusions: Regular aspirin use was associated with a more than 50% reduction in the rate of emphysema progression over 10 years. Further study of aspirin and platelets in emphysema may be warranted.
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http://dx.doi.org/10.1016/j.chest.2017.11.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045779PMC
July 2018

Explaining Radiological Emphysema Subtypes with Unsupervised Texture Prototypes: MESA COPD Study.

Med Comput Vis Bayesian Graph Models Biomed Imaging (2016) 2017;2017:69-80. Epub 2017 Jul 1.

Dept. of Biomedical Engineering, Columbia University, New York, NY, USA.

Pulmonary emphysema is traditionally subcategorized into three subtypes, which have distinct radiological appearances on computed tomography (CT) and can help with the diagnosis of chronic obstructive pulmonary disease (COPD). Automated texture-based quantification of emphysema subtypes has been successfully implemented via supervised learning of these three emphysema subtypes. In this work, we demonstrate that unsupervised learning on a large heterogeneous database of CT scans can generate texture prototypes that are visually homogeneous and distinct, reproducible across subjects, and capable of predicting accurately the three standard radiological subtypes. These texture prototypes enable automated labeling of lung volumes, and open the way to new interpretations of lung CT scans with finer subtyping of emphysema.
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http://dx.doi.org/10.1007/978-3-319-61188-4_7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708576PMC
July 2017

Associations between emphysema-like lung on CT and incident airflow limitation: a general population-based cohort study.

Thorax 2018 05 26;73(5):486-488. Epub 2017 Oct 26.

Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, New York, USA.

Emphysema on CT is associated with accelerated lung function decline in heavy smokers and patients with COPD; however, in the general population, it is not known whether greater emphysema-like lung on CT is associated with incident COPD. We used data from 2045 adult participants without initial prebronchodilator airflow limitation, classified by FEV/FVC<0.70, in the Multi-Ethnic Study of Atherosclerosis. Emphysema-like lung on baseline cardiac CT, defined as per cent low attenuation areas>upper limit of normal, was associated with increased odds of incident airflow limitation at 5-year follow-up on both prebronchodilator (adjusted OR 2.62, 95% CI 1.47 to 4.67) and postbronchodilator (adjusted OR 4.38, 95% CI 1.63 to 11.74) spirometry, independent of smoking history. These results support investigation into whether emphysema-like lung could be informative for COPD risk stratification.
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http://dx.doi.org/10.1136/thoraxjnl-2017-210842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903958PMC
May 2018

Endothelial progenitor cells in chronic obstructive pulmonary disease and emphysema.

PLoS One 2017 14;12(3):e0173446. Epub 2017 Mar 14.

Department of Medicine, Columbia University, New York, New York, United States of America.

Endothelial injury is implicated in the pathogenesis of COPD and emphysema; however the role of endothelial progenitor cells (EPCs), a marker of endothelial cell repair, and circulating endothelial cells (CECs), a marker of endothelial cell injury, in COPD and its subphenotypes is unresolved. We hypothesized that endothelial progenitor cell populations would be decreased in COPD and emphysema and that circulating endothelial cells would be increased. Associations with other subphenotypes were examined. The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with COPD and controls age 50-79 years without clinical cardiovascular disease. Endothelial progenitor cell populations (CD34+KDR+ and CD34+KDR+CD133+ cells) and circulating endothelial cells (CD45dimCD31+CD146+CD133-) were measured by flow cytometry. COPD was defined by standard spirometric criteria. Emphysema was assessed qualitatively and quantitatively on CT. Full pulmonary function testing and expiratory CTs were measured in a subset. Among 257 participants, both endothelial progenitor cell populations, and particularly CD34+KDR+ endothelial progenitor cells, were reduced in COPD. The CD34+KDR+CD133+ endothelial progenitor cells were associated inversely with emphysema extent. Both endothelial progenitor cell populations were associated inversely with extent of panlobular emphysema and positively with diffusing capacity. Circulating endothelial cells were not significantly altered in COPD but were inversely associated with pulmonary microvascular blood flow on MRI. There was no consistent association of endothelial progenitor cells or circulating endothelial cells with measures of gas trapping. These data provide evidence that endothelial repair is impaired in COPD and suggest that this pathological process is specific to emphysema.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173446PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349667PMC
September 2017

Angiotensin-Converting Inhibitors and Angiotensin II Receptor Blockers and Longitudinal Change in Percent Emphysema on Computed Tomography. The Multi-Ethnic Study of Atherosclerosis Lung Study.

Ann Am Thorac Soc 2017 May;14(5):649-658

1 Department of Medicine, College of Physicians and Surgeons.

Rationale: Although emphysema on computed tomography (CT) is associated with increased morbidity and mortality in patients with and without spirometrically defined chronic obstructive pulmonary disease, no available medications target emphysema outside of alpha-1 antitrypsin deficiency. Transforming growth factor-β and endothelial dysfunction are implicated in emphysema pathogenesis, and angiotensin II receptor blockers (ARBs) inhibit transforming growth factor-β, improve endothelial function, and restore airspace architecture in murine models. Evidence in humans is, however, lacking.

Objectives: To determine whether angiotensin-converting enzyme (ACE) inhibitor and ARB dose is associated with slowed progression of percent emphysema by CT.

Methods: The Multi-Ethnic Study of Atherosclerosis researchers recruited participants ages 45-84 years from the general population from 2000 to 2002. Medication use was assessed by medication inventory. Percent emphysema was defined as the percentage of lung regions less than -950 Hounsfield units on CTs. Mixed-effects regression models were used to adjust for confounders.

Results: Among 4,472 participants, 12% used an ACE inhibitor and 6% used an ARB at baseline. The median percent emphysema was 3.0% at baseline, and the rate of progression was 0.64 percentage points over a median of 9.3 years. Higher doses of ACE or ARB were independently associated with a slower change in percent emphysema (P = 0.03). Over 10 years, in contrast to a predicted mean increase in percent emphysema of 0.66 percentage points in those who did not take ARBs or ACE inhibitors, the predicted mean increase in participants who used maximum doses of ARBs or ACE inhibitors was 0.06 percentage points (P = 0.01). The findings were of greatest magnitude among former smokers (P < 0.001). Indications for ACE inhibitor or ARB drugs (hypertension and diabetes) and other medications for hypertension and diabetes were not associated independently with change in percent emphysema. There was no evidence that ACE inhibitor or ARB dose was associated with decline in lung function.

Conclusions: In a large population-based study, ACE inhibitors and ARBs were associated with slowed progression of percent emphysema by chest CT, particularly among former smokers. Randomized clinical trials of ACE and ARB agents are warranted for the prevention and treatment of emphysema.
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http://dx.doi.org/10.1513/AnnalsATS.201604-317OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427735PMC
May 2017

Lung function, percent emphysema, and QT duration: The Multi-Ethnic Study of Atherosclerosis (MESA) lung study.

Respir Med 2017 02 8;123:1-7. Epub 2016 Dec 8.

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States.

Background: The QT interval on electrocardiogram (ECG) reflects ventricular repolarization; a prolonged QT interval is associated with increased mortality risk. Prior studies suggest an association between chronic obstructive pulmonary disease (COPD) and prolonged QT interval. However, these studies were small and often enrolled hospital-based samples. We tested the hypotheses that lower lung function and increased percent emphysema on computed tomography (CT) are associated with a prolonged QT interval in a general population sample and additionally in those with COPD.

Methods: As part of the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study, we assessed spirometry, full-lung CT scans, and ECGs in participants aged 45-84 years. The QT on ECGs was corrected for heart rate (QTc) using the Framingham formula. QTc values = 460 msec in women and ≥450 msec in men were considered abnormal (prolonged QT). Multivariate regression models were used to examine the cross-sectional association between pulmonary measures and QT RESULTS: The mean age of the sample of 2585 participants was 69 years, and 47% were men. There was an inverse association between FEV%, FVC%, FEV/FVC%, emphysema, QTc duration and prolonged QTc. Gender was a significant interaction term, even among never smokers. Having severe COPD was also associated with QTc prolongation.

Conclusions: Our analysis revealed a significant association between lower lung function and longer QTc in men but not in women in a population-based sample. Our findings suggest the possibility of gender differences in the risk of QTc-associated arrhythmias in a population-based sample.
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http://dx.doi.org/10.1016/j.rmed.2016.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5302224PMC
February 2017

Percent Emphysema and Daily Motor Activity Levels in the General Population: Multi-Ethnic Study of Atherosclerosis.

Chest 2017 05 6;151(5):1039-1050. Epub 2016 Dec 6.

Department of Medicine, Columbia University, New York, NY. Electronic address:

Background: COPD is associated with reduced physical capacity. However, it is unclear whether pulmonary emphysema, which can occur without COPD, is associated with reduced physical activity in daily life, particularly among people without COPD and never smokers. We hypothesized that greater percentage of emphysema-like lung on CT scan is associated with reduced physical activity assessed by actigraphy and self-report.

Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants free of clinical cardiovascular disease from the general population. Percent emphysema was defined as percentage of voxels < -950 Hounsfield units on full-lung CT scans. Physical activity was measured by wrist actigraphy over 7 days and a questionnaire. Multivariable linear regression was used to adjust for age, sex, race/ethnicity, height, weight, education, smoking, pack-years, and lung function.

Results: Among 1,435 participants with actigraphy and lung measures, 47% had never smoked, and 8% had COPD. Percent emphysema was associated with lower activity levels on actigraphy (P = .001), corresponding to 1.5 hour less per week of moderately paced walking for the average participant in quintile 2 vs 4 of percent emphysema. This association was significant among participants without COPD (P = .004) and among ever (P = .01) and never smokers (P = .03). It was also independent of coronary artery calcium and left ventricular ejection fraction. There was no evidence that percent emphysema was associated with self-reported activity levels.

Conclusions: Percent emphysema was associated with decreased physical activity in daily life objectively assessed by actigraphy in the general population, among participants without COPD, and nonsmokers.
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http://dx.doi.org/10.1016/j.chest.2016.11.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472515PMC
May 2017

High attenuation areas on chest computed tomography in community-dwelling adults: the MESA study.

Eur Respir J 2016 11 28;48(5):1442-1452. Epub 2016 Jul 28.

Dept of Medicine, Columbia University Medical Center, New York, NY, USA

Evidence suggests that lung injury, inflammation and extracellular matrix remodelling precede lung fibrosis in interstitial lung disease (ILD). We examined whether a quantitative measure of increased lung attenuation on computed tomography (CT) detects lung injury, inflammation and extracellular matrix remodelling in community-dwelling adults sampled without regard to respiratory symptoms or smoking.We measured high attenuation areas (HAA; percentage of lung voxels between -600 and -250 Hounsfield Units) on cardiac CT scans of adults enrolled in the Multi-Ethnic Study of Atherosclerosis.HAA was associated with higher serum matrix metalloproteinase-7 (mean adjusted difference 6.3% per HAA doubling, 95% CI 1.3-11.5), higher interleukin-6 (mean adjusted difference 8.8%, 95% CI 4.8-13.0), lower forced vital capacity (FVC) (mean adjusted difference -82 mL, 95% CI -119--44), lower 6-min walk distance (mean adjusted difference -40 m, 95% CI -1--80), higher odds of interstitial lung abnormalities at 9.5 years (adjusted OR 1.95, 95% CI 1.43-2.65), and higher all cause-mortality rate over 12.2 years (HR 1.58, 95% CI 1.39-1.79).High attenuation areas are associated with biomarkers of inflammation and extracellular matrix remodelling, reduced lung function, interstitial lung abnormalities, and a higher risk of death among community-dwelling adults.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089905PMC
http://dx.doi.org/10.1183/13993003.00129-2016DOI Listing
November 2016

Rheumatoid arthritis-associated autoantibodies and subclinical interstitial lung disease: the Multi-Ethnic Study of Atherosclerosis.

Thorax 2016 12 8;71(12):1082-1090. Epub 2016 Sep 8.

Department of Medicine, Columbia University Medical Center, New York, New York, USA.

Background: Adults with interstitial lung disease (ILD) often have serologic evidence of autoimmunity of uncertain significance without overt autoimmune disease. We examined associations of rheumatoid arthritis (RA)-associated antibodies with subclinical ILD in community-dwelling adults.

Methods: We measured serum rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (anti-CCP) and high attenuation areas (HAAs; CT attenuation values between -600 and -250 Hounsfield units) on cardiac CT in 6736 community-dwelling US adults enrolled in the Multi-Ethnic Study of Atherosclerosis. We measured interstitial lung abnormalities (ILAs) in 2907 full-lung CTs at 9.5-year median follow-up. We used generalised linear and additive models to examine associations between autoantibodies and both HAA and ILA, and tested for effect modification by smoking.

Results: In adjusted models, HAA increased by 0.49% (95% CI 0.11% to 0.86%) per doubling of RF IgM and by 0.95% (95% CI 0.50% to 1.40%) per RF IgA doubling. ILA prevalence increased by 11% (95% CI 3% to 20%) per RF IgA doubling. Smoking modified the associations of both RF IgM and anti-CCP with both HAA and ILA (interaction p values varied from 0.01 to 0.09). Among ever smokers, HAA increased by 0.81% (95% CI 0.33% to 1.30%) and ILA prevalence increased by 14% (95% CI 5% to 24%,) per RF IgM doubling; and HAA increased by 1.31% (95% CI 0.45% to 2.18%) and ILA prevalence increased by 13% (95% CI 2% to 24%) per anti-CCP doubling. Among never smokers, no meaningful associations were detected.

Conclusions: RA-related autoimmunity is associated with both quantitative and qualitative subclinical ILD phenotypes on CT, particularly among ever smokers.
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http://dx.doi.org/10.1136/thoraxjnl-2016-208932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342945PMC
December 2016

The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification.

J Thorac Oncol 2015 Sep;10(9):1243-1260

Department of Pathology, MD Anderson Cancer Center, Houston, Texas.

The 2015 World Health Organization (WHO) Classification of Tumors of the Lung, Pleura, Thymus and Heart has just been published with numerous important changes from the 2004 WHO classification. The most significant changes in this edition involve (1) use of immunohistochemistry throughout the classification, (2) a new emphasis on genetic studies, in particular, integration of molecular testing to help personalize treatment strategies for advanced lung cancer patients, (3) a new classification for small biopsies and cytology similar to that proposed in the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (4) a completely different approach to lung adenocarcinoma as proposed by the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (5) restricting the diagnosis of large cell carcinoma only to resected tumors that lack any clear morphologic or immunohistochemical differentiation with reclassification of the remaining former large cell carcinoma subtypes into different categories, (6) reclassifying squamous cell carcinomas into keratinizing, nonkeratinizing, and basaloid subtypes with the nonkeratinizing tumors requiring immunohistochemistry proof of squamous differentiation, (7) grouping of neuroendocrine tumors together in one category, (8) adding NUT carcinoma, (9) changing the term sclerosing hemangioma to sclerosing pneumocytoma, (10) changing the name hamartoma to "pulmonary hamartoma," (11) creating a group of PEComatous tumors that include (a) lymphangioleiomyomatosis, (b) PEComa, benign (with clear cell tumor as a variant) and
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http://dx.doi.org/10.1097/JTO.0000000000000630DOI Listing
September 2015

Clinical and Radiologic Disease in Smokers With Normal Spirometry.

JAMA Intern Med 2015 Sep;175(9):1539-49

National Jewish Health, Denver, Colorado.

Importance: Airflow obstruction on spirometry is universally used to define chronic obstructive pulmonary disease (COPD), and current or former smokers without airflow obstruction may assume that they are disease free.

Objective: To identify clinical and radiologic evidence of smoking-related disease in a cohort of current and former smokers who did not meet spirometric criteria for COPD, for whom we adopted the discarded label of Global Initiative for Obstructive Lung Disease (GOLD) 0.

Design, Setting, And Participants: Individuals from the Genetic Epidemiology of COPD (COPDGene) cross-sectional observational study completed spirometry, chest computed tomography (CT) scans, a 6-minute walk, and questionnaires. Participants were recruited from local communities at 21 sites across the United States. The GOLD 0 group (n = 4388) (ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity >0.7 and FEV1 ≥80% predicted) from the COPDGene study was compared with a GOLD 1 group (n = 794), COPD groups (n = 3690), and a group of never smokers (n = 108). Recruitment began in January 2008 and ended in July 2011.

Main Outcomes And Measures: Physical function impairments, respiratory symptoms, CT abnormalities, use of respiratory medications, and reduced respiratory-specific quality of life.

Results: One or more respiratory-related impairments were found in 54.1% (2375 of 4388) of the GOLD 0 group. The GOLD 0 group had worse quality of life (mean [SD] St George's Respiratory Questionnaire total score, 17.0 [18.0] vs 3.8 [6.8] for the never smokers; P < .001) and a lower 6-minute walk distance, and 42.3% (127 of 300) of the GOLD 0 group had CT evidence of emphysema or airway thickening. The FEV1 percent predicted distribution and mean for the GOLD 0 group were lower but still within the normal range for the population. Current smoking was associated with more respiratory symptoms, but former smokers had greater emphysema and gas trapping. Advancing age was associated with smoking cessation and with more CT findings of disease. Individuals with respiratory impairments were more likely to use respiratory medications, and the use of these medications was associated with worse disease.

Conclusions And Relevance: Lung disease and impairments were common in smokers without spirometric COPD. Based on these results, we project that there are 35 million current and former smokers older than 55 years in the United States who may have unrecognized disease or impairment. The effect of chronic smoking on the lungs and the individual is substantially underestimated when using spirometry alone.
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http://dx.doi.org/10.1001/jamainternmed.2015.2735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564354PMC
September 2015

Pulmonary Microvascular Blood Flow in Mild Chronic Obstructive Pulmonary Disease and Emphysema. The MESA COPD Study.

Am J Respir Crit Care Med 2015 Sep;192(5):570-80

3 Department of Medicine.

Rationale: Smoking-related microvascular loss causes end-organ damage in the kidneys, heart, and brain. Basic research suggests a similar process in the lungs, but no large studies have assessed pulmonary microvascular blood flow (PMBF) in early chronic lung disease.

Objectives: To investigate whether PMBF is reduced in mild as well as more severe chronic obstructive pulmonary disease (COPD) and emphysema.

Methods: PMBF was measured using gadolinium-enhanced magnetic resonance imaging (MRI) among smokers with COPD and control subjects age 50 to 79 years without clinical cardiovascular disease. COPD severity was defined by standard criteria. Emphysema on computed tomography (CT) was defined by the percentage of lung regions below -950 Hounsfield units (-950 HU) and by radiologists using a standard protocol. We adjusted for potential confounders, including smoking, oxygenation, and left ventricular cardiac output.

Measurements And Main Results: Among 144 participants, PMBF was reduced by 30% in mild COPD, by 29% in moderate COPD, and by 52% in severe COPD (all P < 0.01 vs. control subjects). PMBF was reduced with greater percentage emphysema-950HU and radiologist-defined emphysema, particularly panlobular and centrilobular emphysema (all P ≤ 0.01). Registration of MRI and CT images revealed that PMBF was reduced in mild COPD in both nonemphysematous and emphysematous lung regions. Associations for PMBF were independent of measures of small airways disease on CT and gas trapping largely because emphysema and small airways disease occurred in different smokers.

Conclusions: PMBF was reduced in mild COPD, including in regions of lung without frank emphysema, and may represent a distinct pathological process from small airways disease. PMBF may provide an imaging biomarker for therapeutic strategies targeting the pulmonary microvasculature.
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http://dx.doi.org/10.1164/rccm.201411-2120OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595687PMC
September 2015

CT-Definable Subtypes of Chronic Obstructive Pulmonary Disease: A Statement of the Fleischner Society.

Radiology 2015 Oct 11;277(1):192-205. Epub 2015 May 11.

From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.).

The purpose of this statement is to describe and define the phenotypic abnormalities that can be identified on visual and quantitative evaluation of computed tomographic (CT) images in subjects with chronic obstructive pulmonary disease (COPD), with the goal of contributing to a personalized approach to the treatment of patients with COPD. Quantitative CT is useful for identifying and sequentially evaluating the extent of emphysematous lung destruction, changes in airway walls, and expiratory air trapping. However, visual assessment of CT scans remains important to describe patterns of altered lung structure in COPD. The classification system proposed and illustrated in this article provides a structured approach to visual and quantitative assessment of COPD. Emphysema is classified as centrilobular (subclassified as trace, mild, moderate, confluent, and advanced destructive emphysema), panlobular, and paraseptal (subclassified as mild or substantial). Additional important visual features include airway wall thickening, inflammatory small airways disease, tracheal abnormalities, interstitial lung abnormalities, pulmonary arterial enlargement, and bronchiectasis.
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http://dx.doi.org/10.1148/radiol.2015141579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4613878PMC
October 2015

Intercellular adhesion molecule 1 and progression of percent emphysema: the MESA Lung Study.

Respir Med 2015 Feb 22;109(2):255-64. Epub 2014 Oct 22.

Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address:

Background: Endothelial intercellular adhesion molecule (ICAM) 1 binds neutrophils and facilitates their transmigration into the lung; E-selectin facilitates leukocyte rolling. As neutrophils contribute to tissue destruction in emphysema and chronic obstructive pulmonary disease, we hypothesized that soluble ICAM-1 (sICAM-1) and E-selectin (sE-selectin) would be associated with longitudinal progression of emphysema and lung function decline.

Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants 45-84 years old without clinical cardiovascular disease in 2000-02. The MESA Lung Study assessed percent emphysema (<-950 Hounsfield units) on cardiac (2000-07) and full-lung CT scans (2010-12), and spirometry was assessed twice over five years. sICAM-1 and sE-selectin were measured at baseline. Mixed-effect models adjusted for demographics, anthropometry, smoking, C-reactive protein, sphingomyelin and scanner factors.

Results: Among 1865 MESA Lung participants with measurement of sICAM-1 and percent emphysema the mean log-sICAM-1 was 5.5 ± 0.3 ng/mL and percent emphysema increased 0.73 percentage points (95% CI: 0.34, 1.12; P < 0.001) over ten years. A one SD increase in sICAM-1 was associated with an accelerated increase in percent emphysema of 0.23 percentage points over ten years (95% CI: 0.06, 0.39; P = 0.007). No significant association was found for sE-selectin, or between any adhesion molecule and lung function.

Conclusions: Higher levels of sICAM-1 were independently associated with progression of percent emphysema in a general population sample.
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http://dx.doi.org/10.1016/j.rmed.2014.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331236PMC
February 2015

Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: the MESA COPD study.

J Am Coll Cardiol 2014 Nov 3;64(19):2000-9. Epub 2014 Nov 3.

Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. Electronic address:

Background: The classic cardiovascular complication of chronic obstructive pulmonary disease (COPD) is cor pulmonale or right ventricular (RV) enlargement. Most studies of cor pulmonale were conducted decades ago.

Objectives: This study sought to examine RV changes in contemporary COPD and emphysema using cardiac magnetic resonance (CMR) imaging.

Methods: We performed a case-control study nested predominantly in 2 general population studies of 310 participants with COPD and control subjects 50 to 79 years of age with ≥10 pack-years of smoking who were free of clinical cardiovascular disease. RV volumes and mass were assessed using magnetic resonance imaging. COPD and COPD severity were defined according to standard spirometric criteria. The percentage of emphysema was defined as the percentage of lung regions <-950 Hounsfield units on full-lung computed tomography; emphysema subtypes were scored by radiologists. Results were adjusted for age, race/ethnicity, sex, height, weight, smoking status, pack-years, systemic hypertension, and sleep apnea.

Results: Right ventricular end-diastolic volume (RVEDV) was reduced in COPD compared with control subjects (-7.8 ml; 95% confidence interval: -15.0 to -0.5 ml; p = 0.04). Increasing severity of COPD was associated with lower RVEDV (p = 0.004) and lower RV stroke volume (p < 0.001). RV mass and ejection fraction were similar between the groups. A greater percentage of emphysema also was associated with lower RVEDV (p = 0.005) and stroke volume (p < 0.001), as was the presence of centrilobular and paraseptal emphysema.

Conclusions: RV volumes are lower without significant alterations in RV mass and ejection fraction in contemporary COPD, and this reduction is related to the greater percentage of emphysema on computed tomography.
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http://dx.doi.org/10.1016/j.jacc.2014.07.991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347835PMC
November 2014

ACR-STR practice parameter for the performance and reporting of lung cancer screening thoracic computed tomography (CT): 2014 (Resolution 4).

J Thorac Imaging 2014 Sep;29(5):310-6

*University of Michigan, Ann Arbor, MI †Columbia Presbyterian Medical Center, New York, NY ‡Dartmouth-Hitchcock Medical Center, Lebanon, NH §National Jewish Health, Denver, CO ∥USF Health, Tampa, FL ¶Stanford University Medical Center, Palo Alto, CA #UCLA Department of Radiology, Los Angeles, CA **Houston Methodist Hospital, Houston, TX ††University of Washington, Lake Forest Park, WA.

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http://dx.doi.org/10.1097/RTI.0000000000000097DOI Listing
September 2014
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