eprintid: 10174442 rev_number: 6 eprint_status: archive userid: 699 dir: disk0/10/17/44/42 datestamp: 2023-08-02 13:32:52 lastmod: 2023-08-02 13:32:52 status_changed: 2023-08-02 13:32:52 type: article metadata_visibility: show sword_depositor: 699 creators_name: Cheung, Wing Keung creators_name: Pakzad, Ashkan creators_name: Mogulkoc, Nesrin creators_name: Needleman, Sarah creators_name: Rangelov, Bojidar creators_name: Gudmundsson, Eyjolfur creators_name: Zhao, An creators_name: Abbas, Mariam creators_name: McLaverty, Davina creators_name: Asimakopoulos, Dimitrios creators_name: Chapman, Robert creators_name: Savas, Recep creators_name: Janes, Sam M creators_name: Hu, Yipeng creators_name: Alexander, Daniel C creators_name: Hurst, John R creators_name: Jacob, Joseph title: Automated airway quantification associates with mortality in idiopathic pulmonary fibrosis ispublished: inpress divisions: UCL divisions: B02 divisions: C10 divisions: D17 divisions: K71 keywords: Idiopathic pulmonary fibrosis, Lung, Mortality note: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ abstract: OBJECTIVES: The study examined whether quantified airway metrics associate with mortality in idiopathic pulmonary fibrosis (IPF). METHODS: In an observational cohort study (n = 90) of IPF patients from Ege University Hospital, an airway analysis tool AirQuant calculated median airway intersegmental tapering and segmental tortuosity across the 2nd to 6th airway generations. Intersegmental tapering measures the difference in median diameter between adjacent airway segments. Tortuosity evaluates the ratio of measured segmental length against direct end-to-end segmental length. Univariable linear regression analyses examined relationships between AirQuant variables, clinical variables, and lung function tests. Univariable and multivariable Cox proportional hazards models estimated mortality risk with the latter adjusted for patient age, gender, smoking status, antifibrotic use, CT usual interstitial pneumonia (UIP) pattern, and either forced vital capacity (FVC) or diffusion capacity of carbon monoxide (DLco) if obtained within 3 months of the CT. RESULTS: No significant collinearity existed between AirQuant variables and clinical or functional variables. On univariable Cox analyses, male gender, smoking history, no antifibrotic use, reduced DLco, reduced intersegmental tapering, and increased segmental tortuosity associated with increased risk of death. On multivariable Cox analyses (adjusted using FVC), intersegmental tapering (hazard ratio (HR) = 0.75, 95% CI = 0.66-0.85, p < 0.001) and segmental tortuosity (HR = 1.74, 95% CI = 1.22-2.47, p = 0.002) independently associated with mortality. Results were maintained with adjustment using DLco. CONCLUSIONS: AirQuant generated measures of intersegmental tapering and segmental tortuosity independently associate with mortality in IPF patients. Abnormalities in proximal airway generations, which are not typically considered to be abnormal in IPF, have prognostic value. CLINICAL RELEVANCE STATEMENT: Quantitative measurements of intersegmental tapering and segmental tortuosity, in proximal (second to sixth) generation airway segments, independently associate with mortality in IPF. Automated airway analysis can estimate disease severity, which in IPF is not restricted to the distal airway tree. KEY POINTS: • AirQuant generates measures of intersegmental tapering and segmental tortuosity. • Automated airway quantification associates with mortality in IPF independent of established measures of disease severity. • Automated airway analysis could be used to refine patient selection for therapeutic trials in IPF. date: 2023-07-28 date_type: published publisher: Springer Science and Business Media LLC official_url: https://doi.org/10.1007/s00330-023-09914-4 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2040718 doi: 10.1007/s00330-023-09914-4 medium: Print-Electronic pii: 10.1007/s00330-023-09914-4 lyricists_name: Hurst, John lyricists_name: Jacob, Joseph lyricists_id: JHURS15 lyricists_id: JJACO76 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner funding_acknowledgements: 209553/Z/17/Z [Wellcome Trust] full_text_status: public publication: European Radiology event_location: Germany citation: Cheung, Wing Keung; Pakzad, Ashkan; Mogulkoc, Nesrin; Needleman, Sarah; Rangelov, Bojidar; Gudmundsson, Eyjolfur; Zhao, An; ... Jacob, Joseph; + view all <#> Cheung, Wing Keung; Pakzad, Ashkan; Mogulkoc, Nesrin; Needleman, Sarah; Rangelov, Bojidar; Gudmundsson, Eyjolfur; Zhao, An; Abbas, Mariam; McLaverty, Davina; Asimakopoulos, Dimitrios; Chapman, Robert; Savas, Recep; Janes, Sam M; Hu, Yipeng; Alexander, Daniel C; Hurst, John R; Jacob, Joseph; - view fewer <#> (2023) Automated airway quantification associates with mortality in idiopathic pulmonary fibrosis. European Radiology 10.1007/s00330-023-09914-4 <https://doi.org/10.1007/s00330-023-09914-4>. (In press). Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10174442/1/s00330-023-09914-4.pdf