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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 is 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 computed tomography (CT) scans acquired at inspiration and expiration of 194 individuals with COPD 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. PRM's ability to differentiate between specific COPD phenotypes will allow for more accurate diagnosis of individual patients, complementing standard clinical techniques., COPD is an increasingly prevalent disorder characterized by incompletely reversible airflow limitation (1), (2). Presently, it is the fourth leading cause of death in the United States, with over 11 [...]

Byline: Giuseppina D'Agostino (Osgoode Hall Law School of York University, 1-19 Foxchase Avenue, Vaughan, Ontario, L4L 9M9 Canada); Chris Hinds (Oxford University Computing Laboratory, Wolfson Building, Parks Rd, Oxford OX1 [...]