Publications by Year: 2021

BACKGROUND: Occupational exposures at the WTC site after 11 September 2001 have been associated with presumably inflammatory chronic lower airway diseases. AIMS: In this study, we describe the trajectories of expiratory air flow decline, identify subgroups with adverse progression, and investigate the association of those trajectories with quantitative computed tomography (QCT) imaging measurement of increased and decreased lung density. METHODS: We examined the trajectories of expiratory air flow decline in a group of 1,321 former WTC workers and volunteers with at least three periodic spirometries, and using QCT-measured low (LAV%, -950 HU) and high (HAV%, from -600 to -250 HU) attenuation volume percent. We calculated the individual regression line slopes for first-second forced expiratory volume (FEV slope), identified subjects with rapidly declining ("accelerated decliners") and increasing ("improved"), and compared them to subjects with "intermediate" (0 to -66.5 mL/year) FEV slope. We then used multinomial logistic regression to model those three trajectories, and the two lung attenuation metrics. RESULTS: The mean longitudinal FEV slopes for the entire study population, and its intermediate, decliner, and improved subgroups were, respectively, -40.4, -34.3, -106.5, and 37.6 mL/year. In unadjusted and adjusted analyses, LAV% and HAV% were both associated with "accelerated decliner" status (OR , 95% CI 2.37, 1.41-3.97, and 1.77, 1.08-2.89, respectively), compared to the intermediate decline. CONCLUSIONS: Longitudinal FEV decline in this cohort, known to be associated with QCT proximal airway inflammation metric, is also associated with QCT indicators of increased and decreased lung density. The improved FEV trajectory did not seem to be associated with lung density metrics.

In this work, we propose a theoretical framework based on maximum profile likelihood for pairwise and groupwise registration. By an asymptotic analysis, we demonstrate that maximum profile likelihood registration minimizes an upper bound on the joint entropy of the distribution that generates the joint image data. Further, we derive the congealing method for groupwise registration by optimizing the profile likelihood in closed form, and using coordinate ascent, or iterative model refinement. We also describe a method for feature based registration in the same framework and demonstrate it on groupwise tractographic registration. In the second part of the article, we propose an approach to deep metric registration that implements maximum likelihood registration using deep discriminative classifiers. We show further that this approach can be used for maximum profile likelihood registration to discharge the need for well-registered training data, using iterative model refinement. We demonstrate that the method succeeds on a challenging registration problem where the standard mutual information approach does not perform well.

OBJECTIVES: Muscle wasting is a recognised extra-pulmonary complication in chronic obstructive pulmonary disease and has been associated with increased risk of death. Acute respiratory exacerbations are associated with reduction of muscle function, but there is a paucity of data on their long-term effect. This study explores the relationship between acute respiratory exacerbations and long-term muscle loss using serial measurements of CT derived pectoralis muscle area (PMA). DESIGN AND SETTING: Participants were included from two prospective, longitudinal, observational, multicentre cohorts of ever-smokers with at least 10 pack-year history. PARTICIPANTS: The primary analysis included 1332 (of 2501) participants from Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and 4384 (of 10 198) participants from Genetic Epidemiology of COPD (COPDGene) who had complete data from their baseline and follow-up visits. INTERVENTIONS: PMA was measured on chest CT scans at two timepoints. Self-reported exacerbation data were collected from participants in both studies through the use of periodic longitudinal surveys. MAIN OUTCOME MEASURES: Age-related and excess muscle loss over time. RESULTS: Age, sex, race and body mass index were associated with baseline PMA. Participants experienced age-related decline at the upper end of reported normal ranges. In ECLIPSE, the exacerbation rate over time was associated with an excess muscle area loss of 1.3% (95% CI 0.6 to 1.9, p<0.001) over 3 years and in COPDGene with an excess muscle area loss of 2.1% (95% CI 1.2 to 2.8, p<0.001) over 5 years. Excess muscle area decline was absent in 273 individuals who participated in pulmonary rehabilitation. CONCLUSIONS: Exacerbations are associated with accelerated skeletal muscle loss. Each annual exacerbation was associated with the equivalent of 6 months of age-expected decline in muscle mass. Ameliorating exacerbation-associated muscle loss represents an important therapeutic target.

The reaction of [Re(CO)3(THF)(μ-Br)]2 or [Re(CO)5X] (X = Cl, Br, I) with the diaryl-2-azabutadienes [(RS)2C[double bond, length as m-dash]C(H)-N[double bond, length as m-dash]CAr2] containing two thioether arms at the 4,4-position forms the luminescent S,N-chelate complexes fac-[(OC)3ReX(RS)2C[double bond, length as m-dash]C(H)-N[double bond, length as m-dash]CAr2] (1a-h). The halide abstraction by silver triflate converts [(OC)3ReCl(PhS)2C[double bond, length as m-dash]C(H)-N[double bond, length as m-dash]CPh2] (1c) to [(OC)3Re(OS([double bond, length as m-dash]O)2CF3)(PhS)2C[double bond, length as m-dash]C(H)-N[double bond, length as m-dash]CPh2] (1j) bearing a covalently bound triflate ligand. The cyclic voltammograms reveal reversible S^N ligand-centred reduction and irreversible oxidation waves for all complexes. The crystal structures of nine octahedral complexes have been determined along with that of (NaphtylS)2C[double bond, length as m-dash]C(H)-N[double bond, length as m-dash]CPh2 (L6). A rich system of weak non-covalent intermolecular secondary interactions through CHX(Cl, Br)Re, CHO, COπ(Ph), CHπCO, CHO and CHS contacts has been evidenced. The photophysical properties have been investigated by steady-state and time-resolved absorption (fs transient absorption, fs-TAS) and emission (ns-TCSPC and ps-Streak camera) spectroscopy in 2-MeTHF solution at 298 and 77 K. The emission bands are composed of either singlet (450 < λmax < 535 nm) and/or triplet emissions (at 77 K only, λmax < 640 nm, or appearing as a tail at λ > 600 nm), which decay in a multiexponential manner for the fluorescence (short ps (i.e.

Amyotrophic Lateral Sclerosis-Frontotemporal Dementia (ALS-FTD) may present typical behavioral variant FTD symptoms. This study aims to determine whether profile and severity of cognitive-behavioral symptoms in ALS/ALS-FTD are predicted by regional cortical atrophy. The hypothesis is that executive dysfunction can be predicted by dorsolateral prefrontal cortical (dlPFC) atrophy, apathy by dorsomedial PFC (dmPFC) and anterior cingulate cortical (ACC) atrophy, disinhibition by orbitofrontal cortical (OFC) atrophy. 3.0 Tesla MRI scans were acquired from 22 people with ALS or ALS-FTD. Quantitative cortical thickness analysis was performed with FreeSurfer. A priori-defined regions of interest (ROI) were used to measure cortical thickness in each participant and calculate magnitude of atrophy in comparison to 115 healthy controls. Spearman correlations were used to evaluate associations between frontal ROI cortical thickness and cognitive-behavioral symptoms, measured by Neuropsychiatric Inventory Questionnaire (NPI-Q) and Clinical Dementia Rating (CDR) scale. ALS-FTD participants exhibited variable degrees of apathy (NPI-Q/apathy: 1.6 ± 1.2), disinhibition (NPI-Q/disinhibition: 1.2 ± 1.2), executive dysfunction (CDR/judgment-problem solving: 1.7 ± 0.8). Within the ALS-FTD group, executive dysfunction correlated with dlPFC atrophy (ρ:-0.65;p < 0.05); similar trends were seen for apathy with ACC (ρ:-0.53;p < 0.10) and dmPFC (ρ:-0.47;p < 0.10) atrophy, for disinhibition with OFC atrophy (ρ:-0.51;p < 0.10). Compared to people with ALS, those with ALS-FTD showed more diffuse atrophy involving precentral gyrus, prefrontal, temporal regions. Profile and severity of cognitive-behavioral symptoms in ALS-FTD are predicted by regional prefrontal atrophy. These findings are consistent with established brain-behavior models and support the role of quantitative MRI in diagnosis, management, counseling, monitoring and prognostication for a neurodegenerative disorder with diverse phenotypes.

Background The relationship between emphysema progression and long-term outcomes is unclear. Purpose To determine the relationship between emphysema progression at CT and mortality among participants with emphysema. Materials and Methods In a secondary analysis of two prospective observational studies, COPDGene (, NCT00608764) and Evaluation of Chronic Obstructive Pulmonary Disease Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE; , NCT00292552), emphysema was measured at CT at two points by using the volume-adjusted lung density at the 15th percentile of the lung density histogram (hereafter, lung density perc15) method. The association between emphysema progression rate and all-cause mortality was analyzed by using Cox regression adjusted for ethnicity, sex, baseline age, pack-years, and lung density, baseline and change in smoking status, forced expiratory volume in 1 second, and 6-minute walk distance. In COPDGene, respiratory mortality was analyzed by using the Fine and Gray method. Results A total of 5143 participants (2613 men [51%]; mean age, 60 years ± 9 [standard deviation]) in COPDGene and 1549 participants (973 men [63%]; mean age, 62 years ± 8) in ECLIPSE were evaluated, of which 2097 (40.8%) and 1179 (76.1%) had emphysema, respectively. Baseline imaging was performed between January 2008 and December 2010 for COPDGene and January 2006 and August 2007 for ECLIPSE. Follow-up imaging was performed after 5.5 years ± 0.6 in COPDGene and 3.0 years ± 0.2 in ECLIPSE, and mortality was assessed over the ensuing 5 years in both. For every 1 g/L per year faster rate of decline in lung density perc15, all-cause mortality increased by 8% in COPDGene (hazard ratio [HR], 1.08; 95% CI: 1.01, 1.16; = .03) and 6% in ECLIPSE (HR, 1.06; 95% CI: 1.00, 1.13; = .045). In COPDGene, respiratory mortality increased by 22% (HR, 1.22; 95% CI: 1.13, 1.31; < .001) for the same increase in the rate of change in lung density perc15. Conclusion In ever-smokers with emphysema, emphysema progression at CT was associated with increased all-cause and respiratory mortality. © RSNA, 2021 See also the editorial by Lee and Park in this issue.

BACKGROUND: Pulmonary vascular disease is associated with poor outcomes in individuals affected by interstitial lung disease. The pulmonary vessels can be quantified with noninvasive imaging, but whether radiographic indicators of vasculopathy are associated with early interstitial changes is not known. RESEARCH QUESTION: Are pulmonary vascular volumes, quantified from CT scans, associated with interstitial lung abnormalities (ILA) in a community-based sample with a low burden of lung disease? STUDY DESIGN AND METHODS: In 2,386 participants of the Framingham Heart Study, we used CT imaging to calculate pulmonary vascular volumes, including the small vessel fraction (a surrogate of vascular pruning). We constructed multivariable logistic regression models to investigate associations of vascular volumes with ILA, progression of ILA, and restrictive pattern on spirometry. In secondary analyses, we additionally adjusted for diffusing capacity and emphysema, and performed a sensitivity analysis restricted to participants with normal FVC and diffusing capacity.

BACKGROUND: Pulmonary endothelial damage has been shown to preceed the development of emphysema in animals, and vascular changes in humans have been observed in COPD and emphysema. RESEARCH QUESTION: Is intraparenchymal vascular pruning associated with longitudinal progression of emphysema on CT or decline in lung function over 5 years? STUDY DESIGN AND METHODS: The COPDGene Study enrolled ever-smokers with and without COPD in 2008-2011. The percent of emphysema-like lung was assessed at baseline and after 5 years on non-contrast CT as the percentage of lung voxels <-950 Hounsfield units. An automated CT-based tool assessed and classified intrapulmonary arteries and veins. Spirometry measures are post-bronchodilator. Pulmonary arterial pruning was defined as a lower ratio of small artery volume (<5mm cross sectional area) to total lung artery volume. Mixed linear models included demographics, anthropomorphics, smoking and COPD; with emphysema models also adjusting for CT scanner and lung function models adjusting for clinical center and baseline percent emphysema. RESULTS: At baseline the 4,227 participants were 60±9 years old, 50% female, 28% black, 47% current smokers and 41% had COPD. Median percent emphysema was 2.1 (IQR: 0.6, 6.3) and progressed 0.24 percentage points/year (95% CI: 0.22, 0.26) over 5.6 years. Mean FEV/FVC was 68.5±14.2% and declined 0.26%/year (95% CI: -0.30, -0.23). Greater pulmonary arterial pruning was associated with more rapid progression of percent emphysema (0.11 percentage points/year per SD arterial pruning, 95% CI: 0.09, 0.16), including after adjusting for baseline percent emphysema and FEV. Arterial pruning was also associated with a faster decline in FEV/FVC (-0.04%/year per SD arterial pruning, 95% CI: -0.008, -0.001). INTERPRETATION: Pulmonary arterial pruning was associated with faster progression of percent emphysema and more rapid decline in FEV/FVC over 5 years in ever-smokers, suggesting pulmonary vascular differences may be relevant in disease progression.

Diffusion tensor imaging provides increased sensitivity to microstructural tissue changes compared to conventional anatomical imaging but also presents limited specificity. To tackle this problem, the DIAMOND model subdivides the voxel content into diffusion compartments and draws from diffusion-weighted data to estimate compartmental non-central matrix-variate Gamma distributions of diffusion tensors. It models each sub-voxel fascicle separately, resolving crossing white-matter pathways and allowing for a fascicle-element (fixel) based analysis of microstructural features. Alternatively, specific features of the intra-voxel diffusion tensor distribution can be selectively measured using tensor-valued diffusion-weighted acquisition schemes. However, the impact of such schemes on estimating brain microstructural features has only been studied in a handful of parametric single-fascicle models. In this work, we derive a general Laplace transform for the non-central matrix-variate Gamma distribution, which enables the extension of DIAMOND to tensor-valued encoded data. We then evaluate this "Magic DIAMOND" model in silico and in vivo on various combinations of tensor-valued encoded data. Assessing uncertainty on parameter estimation via stratified bootstrap, we investigate both voxel-based and fixel-based metrics by carrying out multi-peak tractography. We demonstrate using in silico evaluations that tensor-valued diffusion encoding significantly improves Magic DIAMOND’s accuracy. Most importantly, we show in vivo that our estimated metrics can be robustly mapped along tracks across regions of fiber crossing, which opens new perspectives for tractometry and microstructure mapping along specific white-matter tracts.