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      Calculating air volume fractions from computed tomography images for chronic obstructive pulmonary disease diagnosis

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          Abstract

          Quantitative evaluation using image biomarkers calculated from threshold-segmented low-attenuation areas on chest computed tomography (CT) images for diagnosing chronic obstructive pulmonary diseases (COPD) has been widely investigated. However, the segmentation results depend on the applied threshold and slice thickness of the CT images because of the partial volume effect (PVE). In this study, the air volume fraction (AV/TV) of lungs was calculated from CT images using a two-compartment model (TCM) for COPD diagnosis. A relative air volume histogram (RAVH) was constructed using the AV/TV values to describe the air content characteristics of lungs. In phantom studies, the TCM accurately calculated total cavity volumes and foam masses with percent errors of less than 8% and ±4%, respectively. In patient studies, the relative volumes of normal and damaged lung tissues and the damaged-to-normal RV ratio were defined and calculated from the RAVHs as image biomarkers, which correctly differentiated COPD patients from controls in 2.5- and 5-mm-thick images with areas under receiver operating characteristic curves of >0.94. The AV/TV calculated using the TCM can prevent the effect of slice thickness, and the image biomarkers calculated from the RAVH are reliable for diagnosing COPD

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          Most cited references23

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          The meaning and use of the area under a receiver operating characteristic (ROC) curve.

          A representation and interpretation of the area under a receiver operating characteristic (ROC) curve obtained by the "rating" method, or by mathematical predictions based on patient characteristics, is presented. It is shown that in such a setting the area represents the probability that a randomly chosen diseased subject is (correctly) rated or ranked with greater suspicion than a randomly chosen non-diseased subject. Moreover, this probability of a correct ranking is the same quantity that is estimated by the already well-studied nonparametric Wilcoxon statistic. These two relationships are exploited to (a) provide rapid closed-form expressions for the approximate magnitude of the sampling variability, i.e., standard error that one uses to accompany the area under a smoothed ROC curve, (b) guide in determining the size of the sample required to provide a sufficiently reliable estimate of this area, and (c) determine how large sample sizes should be to ensure that one can statistically detect differences in the accuracy of diagnostic techniques.
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            Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.

            This guideline is an official statement of the American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS). It represents an update of the 2007 ACP clinical practice guideline on diagnosis and management of stable chronic obstructive pulmonary disease (COPD) and is intended for clinicians who manage patients with COPD. This guideline addresses the value of history and physical examination for predicting airflow obstruction; the value of spirometry for screening or diagnosis of COPD; and COPD management strategies, specifically evaluation of various inhaled therapies (anticholinergics, long-acting β-agonists, and corticosteroids), pulmonary rehabilitation programs, and supplemental oxygen therapy. This guideline is based on a targeted literature update from March 2007 to December 2009 to evaluate the evidence and update the 2007 ACP clinical practice guideline on diagnosis and management of stable COPD. RECOMMENDATION 1: ACP, ACCP, ATS, and ERS recommend that spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms (Grade: strong recommendation, moderate-quality evidence). Spirometry should not be used to screen for airflow obstruction in individuals without respiratory symptoms (Grade: strong recommendation, moderate-quality evidence). RECOMMENDATION 2: For stable COPD patients with respiratory symptoms and FEV(1) between 60% and 80% predicted, ACP, ACCP, ATS, and ERS suggest that treatment with inhaled bronchodilators may be used (Grade: weak recommendation, low-quality evidence). RECOMMENDATION 3: For stable COPD patients with respiratory symptoms and FEV(1) 50% predicted. (Grade: weak recommendation, moderate-quality evidence). RECOMMENDATION 7: ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia (Pao(2) ≤55 mm Hg or Spo(2) ≤88%) (Grade: strong recommendation, moderate-quality evidence).
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              CT-based Biomarker Provides Unique Signature for Diagnosis of COPD Phenotypes and Disease Progression

              Chronic obstructive pulmonary disease (COPD) is increasingly being recognized as a highly heterogeneous disorder, composed of varying pathobiology. Accurate detection of COPD subtypes by image biomarkers are urgently needed to enable individualized treatment thus improving patient outcome. We adapted the Parametric Response Map (PRM), a voxel-wise image analysis technique, for assessing COPD phenotype. We analyzed whole lung CT scans of 194 COPD individuals acquired at inspiration and expiration from the COPDGene Study. PRM identified the extent of functional small airways disease (fSAD) and emphysema as well as provided CT-based evidence that supports the concept that fSAD precedes emphysema with increasing COPD severity. PRM is a versatile imaging biomarker capable of diagnosing disease extent and phenotype, while providing detailed spatial information of disease distribution and location. PRMs ability to differentiate between specific COPD phenotypes will allow for more accurate diagnosis of individual patients complementing standard clinical techniques.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: ResourcesRole: SoftwareRole: SupervisionRole: Validation
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: Validation
                Role: Formal analysisRole: InvestigationRole: ValidationRole: Visualization
                Role: Formal analysisRole: Investigation
                Role: Data curationRole: Funding acquisitionRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                16 April 2020
                2020
                : 15
                : 4
                : e0231730
                Affiliations
                [1 ] Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
                [2 ] Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
                [3 ] Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
                [4 ] Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
                Clinic for Infectious and tropical diseases, Clinical centre of Serbia, SERBIA
                Author notes

                Competing Interests: The authors declare no competing interests.

                Author information
                http://orcid.org/0000-0002-8554-9136
                Article
                PONE-D-19-28044
                10.1371/journal.pone.0231730
                7162278
                32298358
                3e6d85d5-b0d6-4448-8a01-758325180a35
                © 2020 Chuang et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 7 October 2019
                : 30 March 2020
                Page count
                Figures: 8, Tables: 2, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100004699, Chung Shan Medical University Hospital;
                Award ID: CSH-2019-C-012
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100004663, Ministry of Science and Technology, Taiwan;
                Award ID: MOST 108-2314-B-040 -005 -
                Award Recipient :
                YST was funded by the Chung Shan Medical University Hospital, Taiwan ( http://www.csh.org.tw/index.html) under Contract CSH-2019-C-012. CTS was funded by the Ministry of Science and Technology of Taiwan ( https://www.most.gov.tw/en/) under Contract MOST 108-2314-B-040 -005 -. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Research and Analysis Methods
                Imaging Techniques
                Neuroimaging
                Computed Axial Tomography
                Biology and Life Sciences
                Neuroscience
                Neuroimaging
                Computed Axial Tomography
                Medicine and Health Sciences
                Diagnostic Medicine
                Diagnostic Radiology
                Tomography
                Computed Axial Tomography
                Research and Analysis Methods
                Imaging Techniques
                Diagnostic Radiology
                Tomography
                Computed Axial Tomography
                Medicine and Health Sciences
                Radiology and Imaging
                Diagnostic Radiology
                Tomography
                Computed Axial Tomography
                Medicine and Health Sciences
                Pulmonology
                Chronic Obstructive Pulmonary Disease
                Medicine and Health Sciences
                Diagnostic Medicine
                Diagnostic Radiology
                Pulmonary Imaging
                Research and Analysis Methods
                Imaging Techniques
                Diagnostic Radiology
                Pulmonary Imaging
                Medicine and Health Sciences
                Radiology and Imaging
                Diagnostic Radiology
                Pulmonary Imaging
                Physical Sciences
                Materials Science
                Materials
                Foams
                Biology and Life Sciences
                Biochemistry
                Biomarkers
                Research and Analysis Methods
                Imaging Techniques
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Blood
                Medicine and Health Sciences
                Anatomy
                Body Fluids
                Blood
                Biology and Life Sciences
                Physiology
                Body Fluids
                Blood
                Medicine and Health Sciences
                Physiology
                Body Fluids
                Blood
                Medicine and Health Sciences
                Pulmonology
                Chronic Obstructive Pulmonary Disease
                Emphysema
                Custom metadata
                The Institutional Review Board of the Chung Shan Medical University Hospital, which approved this study, has restricted public sharing of the CT and PFT data in any form because they contain identifying patient information. To request data access, please use the contact information as follows: Institutional Review Board of the Chung Shan Medical University Hospital. ( irb@ 123456csh.org.tw ).

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