Emphysema detection by qualitative and quantitative analysis and relationship to spirometric obstruction in an urban comprehensive lung cancer screening programme: the Temple Healthy Chest Initiative (THCI) – a retrospective cohort study

This study analyzed the relationship between emphysema detection and spirometric obstruction in an urban minority population undergoing lung cancer screening through the Temple Healthy Chest Initiative (THCI) program. 2111 individuals underwent low-dose CT (LDCT), of whom 629 underwent spirometry. AI-assisted quantitative CT (QCT) analysis was performed in a subcohort of 181 patients using Aview software (Coreline, Seoul, South Korea) to analyze low-attenuation area (%LAA) at −950 HU and −910 HU. Radiologist qualitative interpretation showed sensitivity 81.3% and specificity 53.4%, while %LAA-910 HU≥6% threshold demonstrated sensitivity 63%, specificity 49%, and positive predictive value 73%. Median %LAA significantly increased with increasing COPD GOLD stages (p<0.001). This study recommends spirometry when %LAA≥6%.