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Objective <p>Although chest CT is the primary tool for evaluating bronchiectasis, accurately measuring its extent poses challenges. This study aimed to automatically quantify bronchiectasis using an artificial intelligence (AI)-based analysis of the bronchial tapering ratio on chest CT and assess its association with clinical outcomes in patients with chronic obstructive pulmonary disease (COPD).</p> Materials and methods <p>COPD patients from two prospective multicenter cohorts were included. AI-based airway quantification was performed on baseline CT, measuring the tapering ratio for each bronchus in the whole lung. The bronchiectasis score accounting for the extent of bronchi with abnormal tapering (inner lumen tapering ratio ≥ 1.1, indicating airway dilatation) in the whole lung was calculated. Associations between the bronchiectasis score and all-cause mortality and acute exacerbation (AE) were assessed using multivariable models.</p> Results <p>The discovery and validation cohorts included 361 (mean age, 67 years; 97.5% men) and 112 patients (mean age, 67 years; 93.7% men), respectively. In the discovery cohort, 220 (60.9%) had a history of at least one AE and 59 (16.3%) died during follow-up, and 18 (16.1%) died in the validation cohort. Bronchiectasis score was independently associated with increased mortality (discovery: adjusted HR, 1.86 [95% CI: 1.08–3.18]; validation: HR, 5.42 [95% CI: 1.97–14.92]). The score was also associated with risk of any AE, severe AE, and shorter time to first AE (for all, <i>p</i> &lt; 0.05).</p> Conclusions <p>In patients with COPD, the quantified extent of bronchiectasis using AI-based CT quantification of the bronchial tapering ratio was associated with all-cause mortality and the risk of AE over time.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Can AI-based CT quantification of bronchial tapering reliably assess bronchiectasis relevant to clinical outcomes in patients with COPD?</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Scores from this AI-based method of automatically quantifying the extent of whole lung bronchiectasis were independently associated with all-cause mortality and risk of AEs in COPD patients</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>AI-based bronchiectasis analysis on CT may shift clinical research toward more objective, quantitative assessment methods and support risk stratification and management in COPD, highlighting its potential to enhance clinically relevant imaging evaluation</i>.</p> Graphical Abstract <p></p>

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Bronchiectasis in patients with chronic obstructive pulmonary disease: AI-based CT quantification using the bronchial tapering ratio

  • 期刊论文

  • 发表日期：

    2025年8月26日

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  • Hyejin Park,
  • Jooae Choe,
  • Sang Min Lee,
  • Soyeoun Lim,
  • Jae Seung Lee,
  • Yeon-Mok Oh,
  • Jung-Bok Lee,
  • Hye Jeon Hwang,
  • Jihye Yun,
  • Seungbin Bae,
  • Donghoon Yu,
  • Li-Cher Loh,
  • Choo-Khoon Ong,
  • Joon Beom Seo

摘要

Objective

Although chest CT is the primary tool for evaluating bronchiectasis, accurately measuring its extent poses challenges. This study aimed to automatically quantify bronchiectasis using an artificial intelligence (AI)-based analysis of the bronchial tapering ratio on chest CT and assess its association with clinical outcomes in patients with chronic obstructive pulmonary disease (COPD).

Materials and methods

COPD patients from two prospective multicenter cohorts were included. AI-based airway quantification was performed on baseline CT, measuring the tapering ratio for each bronchus in the whole lung. The bronchiectasis score accounting for the extent of bronchi with abnormal tapering (inner lumen tapering ratio ≥ 1.1, indicating airway dilatation) in the whole lung was calculated. Associations between the bronchiectasis score and all-cause mortality and acute exacerbation (AE) were assessed using multivariable models.

Results

The discovery and validation cohorts included 361 (mean age, 67 years; 97.5% men) and 112 patients (mean age, 67 years; 93.7% men), respectively. In the discovery cohort, 220 (60.9%) had a history of at least one AE and 59 (16.3%) died during follow-up, and 18 (16.1%) died in the validation cohort. Bronchiectasis score was independently associated with increased mortality (discovery: adjusted HR, 1.86 [95% CI: 1.08–3.18]; validation: HR, 5.42 [95% CI: 1.97–14.92]). The score was also associated with risk of any AE, severe AE, and shorter time to first AE (for all, p < 0.05).

Conclusions

In patients with COPD, the quantified extent of bronchiectasis using AI-based CT quantification of the bronchial tapering ratio was associated with all-cause mortality and the risk of AE over time.

Key Points

Question Can AI-based CT quantification of bronchial tapering reliably assess bronchiectasis relevant to clinical outcomes in patients with COPD?

Findings Scores from this AI-based method of automatically quantifying the extent of whole lung bronchiectasis were independently associated with all-cause mortality and risk of AEs in COPD patients.

Clinical relevance AI-based bronchiectasis analysis on CT may shift clinical research toward more objective, quantitative assessment methods and support risk stratification and management in COPD, highlighting its potential to enhance clinically relevant imaging evaluation.

Graphical Abstract