TY - JOUR
T1 - Artificial Intelligence–derived Measurements of Myosteatosis from Coronary Artery Calcium CT Scans to Predict COPD
T2 - The Multi-Ethnic Study of Atherosclerosis
AU - Azimi, Amir
AU - Atlas, Kyle
AU - Reeves, Anthony P.
AU - Zhang, Chenyu
AU - Wasserthal, Jakob
AU - Mirjalili, Seyed Reza
AU - Atlas, Thomas
AU - Henschke, Claudia I.
AU - Yankelevitz, David F.
AU - Zulueta, Javier J.
AU - De-Torres, Juan P.
AU - Seijo, Luis M.
AU - Mechanick, Jeffrey I.
AU - Branch, Andrea
AU - Ma, Ning
AU - Yip, Rowena
AU - Fan, Wenjun
AU - Roy, Sion K.
AU - Nasir, Khurram
AU - Molloi, Sabee
AU - Fayad, Zahi A.
AU - McConnell, Michael V.
AU - Kakadiaris, Ioannis A.
AU - Abela, George S.
AU - Vliegenthart, Rozemarijn
AU - Maron, David J.
AU - Narula, Jagat
AU - Williams, Kim A.
AU - Shah, Prediman K.
AU - Budoff, Matthew J.
AU - Levy, Daniel
AU - Benjamin, Emelia J.
AU - Mehran, Roxana
AU - Kloner, Robert A.
AU - Wong, Nathan D.
AU - Naghavi, Morteza
N1 - Publisher Copyright:
©The Author(s) 2026. Published by the Radiological Society of North America.
PY - 2026/2
Y1 - 2026/2
N2 - Purpose: To evaluate the predictive value of myosteatosis as an opportunistic finding in coronary artery calcium (CAC) CT scans for clinically diagnosed chronic obstructive pulmonary disease (COPD) and compare it with an artificial intelligence (AI)–measured biomarker of emphysema derived from the same scans. Materials and Methods: In this prospective study, baseline CAC CT scans and 20-year follow-up data were analyzed. Myosteatosis was defined as the lowest quartile of thoracic skeletal muscle mean attenuation (males < 33.5 HU, females < 27.0 HU). The emphysema-like lung biomarker was quantified as the percentage of lung voxels below −950 HU in CAC CT scans. COPD was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification, and International Classification of Diseases, 10th Revision, Clinical Modification diagnostic codes from hospital discharge records. Hazard ratios (HRs) for COPD were calculated using proportional hazard regression models, comparing the bottom versus top quartiles of myosteatosis and emphysema-like lung measurements. Results: Among 5535 participants in the Multi-Ethnic Study of Atherosclerosis (mean age ± SD, 62.2 years ± 10.3, 47.6% males), 396 (7.1%) were diagnosed with COPD over the 20-year follow-up period. Myosteatosis showed a stronger association with COPD than emphysema (unadjusted HRs, 5.98 [95% CI: 4.14, 8.63] and 2.12 [95% CI: 1.61, 2.78], respectively [P <.001]). After adjusting for covariates (age, sex, smoking status, body mass index, race, asthma, physical activity, inflammatory markers, and insulin resistance), the HRs were reduced to 2.74 (95% CI: 1.81, 4.16) and 1.50 (95% CI: 1.12, 2.00), respectively (P =.02). Conclusion: AI-measured myosteatosis in CAC CT scans strongly predicted future diagnosed COPD independently of known risk factors. ClinicalTrials.gov: NCT00005487.
AB - Purpose: To evaluate the predictive value of myosteatosis as an opportunistic finding in coronary artery calcium (CAC) CT scans for clinically diagnosed chronic obstructive pulmonary disease (COPD) and compare it with an artificial intelligence (AI)–measured biomarker of emphysema derived from the same scans. Materials and Methods: In this prospective study, baseline CAC CT scans and 20-year follow-up data were analyzed. Myosteatosis was defined as the lowest quartile of thoracic skeletal muscle mean attenuation (males < 33.5 HU, females < 27.0 HU). The emphysema-like lung biomarker was quantified as the percentage of lung voxels below −950 HU in CAC CT scans. COPD was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification, and International Classification of Diseases, 10th Revision, Clinical Modification diagnostic codes from hospital discharge records. Hazard ratios (HRs) for COPD were calculated using proportional hazard regression models, comparing the bottom versus top quartiles of myosteatosis and emphysema-like lung measurements. Results: Among 5535 participants in the Multi-Ethnic Study of Atherosclerosis (mean age ± SD, 62.2 years ± 10.3, 47.6% males), 396 (7.1%) were diagnosed with COPD over the 20-year follow-up period. Myosteatosis showed a stronger association with COPD than emphysema (unadjusted HRs, 5.98 [95% CI: 4.14, 8.63] and 2.12 [95% CI: 1.61, 2.78], respectively [P <.001]). After adjusting for covariates (age, sex, smoking status, body mass index, race, asthma, physical activity, inflammatory markers, and insulin resistance), the HRs were reduced to 2.74 (95% CI: 1.81, 4.16) and 1.50 (95% CI: 1.12, 2.00), respectively (P =.02). Conclusion: AI-measured myosteatosis in CAC CT scans strongly predicted future diagnosed COPD independently of known risk factors. ClinicalTrials.gov: NCT00005487.
KW - AI-CVD
KW - Adipose Tissue (Obesity Studies)
KW - Applications-CT
KW - Chronic Obstructive Pulmonary Disease
KW - Coronary Artery Calcium Scan
KW - Emphysema
KW - Metabolic Disorders
KW - Myosteatosis
KW - Pulmonary
KW - Thorax
UR - https://www.scopus.com/pages/publications/105032742186
U2 - 10.1148/ryct.250205
DO - 10.1148/ryct.250205
M3 - Article
AN - SCOPUS:105032742186
SN - 2638-6135
VL - 8
JO - Radiology: Cardiothoracic Imaging
JF - Radiology: Cardiothoracic Imaging
IS - 1
M1 - e250205
ER -