Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Relationship between Incidental Abnormalities on Screening Thoracic Computed Tomography and Mortality: A Long-Term Follow-Up Analysis

  • Jong Eun Lee (Department of Radiology, Chonnam National University Hospital) ;
  • Won Gi Jeong (Department of Radiology, Chonnam National University Hwasun Hospital) ;
  • Hyo-Jae Lee (Department of Radiology, Chonnam National University Hospital) ;
  • Yun-Hyeon Kim (Department of Radiology, Chonnam National University Hospital) ;
  • Kum Ju Chae (Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital) ;
  • Yeon Joo Jeong (Department of Radiology and Biomedical Research Institute, Pusan National University Hospital)
  • Received : 2022.02.28
  • Accepted : 2022.07.18
  • Published : 2022.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: The present study aimed to assess the relationship between incidental abnormalities on thoracic computed tomography (CT) and mortality in a general screening population using a long-term follow-up analysis. Materials and Methods: We retrospectively collected the medical records and CT images of 840 participants (mean age ± standard deviation [SD], 58.5 ± 6.7 years; 564 male) who underwent thoracic CT at a single health promotion center between 2007 and 2010. Two thoracic radiologists independently reviewed all CT images and evaluated any incidental abnormalities (interstitial lung abnormality [ILA], emphysema, coronary artery calcification [CAC], aortic valve [AV] calcification, and pulmonary nodules). Kaplan-Meier analysis with log-rank and z-tests was performed to assess the relationship between incidental CT abnormalities and all-cause mortality in the subsequent follow-up. Cox proportional hazards regression was performed to further identify risk factors of all-cause mortality among the incidental CT abnormalities and clinical factors. Results: Among the 840 participants, 55 (6%), 171 (20%), 288 (34%), 396 (47%), and 97 (11%) had findings of ILA, emphysema, CAC, pulmonary nodule, and AV calcification, respectively, on initial CT. The participants were followed up for a mean period ± SD of 10.9 ± 1.4 years. All incidental CT abnormalities were associated with all-cause mortality in univariable analysis (p < 0.05). However, multivariable analysis further revealed fibrotic ILA as an independent risk factor for all-cause mortality (hazard ratio, 2.52 [95% confidence interval, 1.02-6.22], p = 0.046). ILA were also identified as an independent risk factor for lung cancer or respiratory disease-related deaths. Conclusion: Incidental abnormalities on screening thoracic CT were associated with increased mortality during the long-term follow-up. Among incidental CT abnormalities, fibrotic ILA were independently associated with increased mortality. Appropriate management and surveillance may be required for patients with fibrotic ILA on thoracic CT obtained for general screening purposes.

Keywords

Acknowledgement

We would like to thank Editage (www.editage.com) for their writing support.

References

  1. Brandsma CA, de Vries M, Costa R, Woldhuis RR, Konigshoff M, Timens W. Lung ageing and COPD: is there a role for ageing in abnormal tissue repair? Eur Respir Rev 2017;26:170073
  2. Thannickal VJ, Murthy M, Balch WE, Chandel NS, Meiners S, Eickelberg O, et al. Blue journal conference. Aging and susceptibility to lung disease. Am J Respir Crit Care Med 2015;191:261-269
  3. Leopold JA. Vascular calcification: an age-old problem of old age. Circulation 2013;127:2380-2382
  4. Ahmad FB, Anderson RN. The leading causes of death in the US for 2020. JAMA 2021;325:1829-1830
  5. Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, et al. Screening for lung cancer: US preventive services task force recommendation statement. JAMA 2021;325:962-970
  6. Hatabu H, Hunninghake GM, Richeldi L, Brown KK, Wells AU, Remy-Jardin M, et al. Interstitial lung abnormalities detected incidentally on CT: a position paper from the Fleischner Society. Lancet Respir Med 2020;8:726-737
  7. Lynch DA, Moore CM, Wilson C, Nevrekar D, Jennermann T, Humphries SM, et al. CT-based visual classification of emphysema: association with mortality in the COPDGene study. Radiology 2018;288:859-866
  8. Chiles C, Duan F, Gladish GW, Ravenel JG, Baginski SG, Snyder BS, et al. Association of coronary artery calcification and mortality in the national lung screening trial: a comparison of three scoring methods. Radiology 2015;276:82-90
  9. Munden RF, Carter BW, Chiles C, MacMahon H, Black WC, Ko JP, et al. Managing incidental findings on thoracic CT: mediastinal and cardiovascular findings. A white paper of the ACR incidental findings committee. J Am Coll Radiol 2018;15:1087-1096
  10. Gould MK, Tang T, Liu IL, Lee J, Zheng C, Danforth KN, et al. Recent trends in the identification of incidental pulmonary nodules. Am J Respir Crit Care Med 2015;192:1208-1214
  11. de Koning HJ, van der Aalst CM, de Jong PA, Scholten ET, Nackaerts K, Heuvelmans MA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med 2020;382:503-513
  12. Williams MC, Abbas A, Tirr E, Alam S, Nicol E, Shambrook J, et al. Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI/BSCCT and BSTI. Br J Radiol 2021;94:20200894
  13. Hunninghake GM, Hatabu H, Okajima Y, Gao W, Dupuis J, Latourelle JC, et al. MUC5B promoter polymorphism and interstitial lung abnormalities. N Engl J Med 2013;368:2192-2200
  14. Hecht HS, Blaha MJ, Kazerooni EA, Cury RC, Budoff M, Leipsic J, et al. CAC-DRS: coronary artery calcium data and reporting system. An expert consensus document of the society of cardiovascular computed tomography (SCCT). J Cardiovasc Comput Tomogr 2018;12:185-191
  15. American College of Radiology. Lung-RADS® version 1.1. Assessment categories release date: 2019. ACR.org Web site. www.acr.org/-/media/ACR/Files/RADS/Lung-RADS/LungRADSAssessmentCategoriesv1-1.pdf. Accessed April 20, 2022
  16. Chae KJ, Jin GY, Goo JM, Chung MJ. Interstitial lung abnormalities: what radiologists should know. Korean J Radiol 2021;22:454-463
  17. Hino T, Lee KS, Han J, Hata A, Ishigami K, Hatabu H. Spectrum of pulmonary fibrosis from interstitial lung abnormality to usual interstitial pneumonia: importance of identification and quantification of traction bronchiectasis in patient management. Korean J Radiol 2021;22:811-828
  18. Chae KJ, Chung MJ, Jin GY, Song YJ, An AR, Choi H, et al. Radiologic-pathologic correlation of interstitial lung abnormalities and predictors for progression and survival. Eur Radiol 2022;32:2713-2723
  19. Hutchinson JP, McKeever TM, Fogarty AW, Navaratnam V, Hubbard RB. Increasing global mortality from idiopathic pulmonary fibrosis in the twenty-first century. Ann Am Thorac Soc 2014;11:1176-1185
  20. Axelsson GT, Putman RK, Aspelund T, Gudmundsson EF, Hida T, Araki T, et al. The associations of interstitial lung abnormalities with cancer diagnoses and mortality. Eur Respir J 2020;56:1902154
  21. OECD. OECD health statistics 2022. OECD.org Web site. https://www.oecd.org/health/health-data.htm. Accessed February 6, 2022
  22. Ko SJ, Choi SM, Han KD, Lee CH, Lee J. All-cause mortality of patients with idiopathic pulmonary fibrosis: a nationwide population-based cohort study in Korea. Sci Rep 2021;11:15145
  23. Friedlander AL, Lynch D, Dyar LA, Bowler RP. Phenotypes of chronic obstructive pulmonary disease. COPD 2007;4:355-384
  24. Mattila T, Vasankari T, Kanervisto M, Laitinen T, Impivaara O, Rissanen H, et al. Association between all-cause and cause-specific mortality and the GOLD stages 1-4: a 30-year followup among Finnish adults. Respir Med 2015;109:1012-1018
  25. Kim RB, Kim HS, Kang DR, Choi JY, Choi NC, Hwang S, et al. The trend in incidence and case-fatality of hospitalized acute myocardial infarction patients in Korea, 2007 to 2016. J Korean Med Sci 2019;34:e322
  26. Hong S, Won YJ, Lee JJ, Jung KW, Kong HJ, Im JS, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2018. Cancer Res Treat 2021;53:301-315
  27. Munden RF, Black WC, Hartman TE, MacMahon H, Ko JP, Dyer DS, et al. Managing incidental findings on thoracic CT: lung findings. A white paper of the ACR incidental findings committee. J Am Coll Radiol 2021;18:1267-1279