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Phenotyping preserved ratio impaired spirometry (PRISm) using quantitative high-resolution computed tomography
Jun Hu1, Zhujin Shen2, Tong Su3
1Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Background:
Preserved ratio impaired spirometry (PRISm) is characterized by decreased forced expiratory volume in 1 second (FEV1) with a preserved FEV1/forced vital capacity (FVC) ratio. It is a highly prevalent and heterogeneous condition which is associated with increased risk of respiratory symptoms, developing airway limitation, and mortality. However, there are few radiological studies related to phenotyping of PRISm. We aimed to investigate the airway changes dependent on emphysema, and to evaluate the correlation between quantitative high-resolution computed tomography (HRCT) parameters and pulmonary function parameters, with the purpose of exploring the possible phenotypes of PRISm based on quantitative HRCT.
Methods:
This retrospective study enrolled 102 cases with PRISm from December 2020 to July 2023. All patients underwent inspiration computed tomography (CT) scanning and pulmonary function testing (PFT) within 3 months. The parenchyma and airway parameters were measured by automatic segmentation software (IntelliSpace Portal) with quantitative and semi-quantitative analysis, respectively. One-way analysis of variance (ANOVA) was used to compare the differences in demographic data, PFT characteristics, and CT parameters among groups. Pearson's or Spearman's correlation analysis was used to investigate the correlation between quantitative CT parameters and lung function indices.
Results:
The parenchyma and airway parameters, including total lung capacity on CT (TLCCT) and wall area percentage (WA%), displayed significant differences along with the severity of emphysema (P=0.008; P=0.004). Most of the parenchyma parameters had mild to moderate correlations with the airway parameters, among which the correlation between TLCCT and WA% was the strongest (r=-0.64, P<0.001). The TLCCT and WA% also showed statistical correlation with percentage predicted FVC (FVC% pred) that reflected restrictive ventilatory impairment (RVI) (r=0.27, P=0.006; r=-0.34, P<0.001). Based on the degree of emphysema and bronchial wall thickness, four possible radiological phenotypes were issued. There were significant differences in TLCCT, FVC/TLCCT, lumen area (LA), and WA%, and parts of lung function parameters among the four phenotypes (all P<0.05).
Conclusions:
There were differences in quantitative parenchyma and airway parameters and parts of PFT results in different morphological phenotypes based on HRCT, which may contribute to the stratification of PRISm patients by a novel radiological method.
