{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T07:04:56Z","timestamp":1784617496844,"version":"3.55.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"crossref","award":["22K17664"],"award-info":[{"award-number":["22K17664"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Lung"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Diaphragmatic dysfunction contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). Although diaphragmatic excursion during deep breathing (DE\n                      <jats:sub>max<\/jats:sub>\n                      ) is associated with exercise capacity, the relationship between computed tomography (CT)-derived diaphragm morphology and diaphragmatic function remains unclear. We investigated the association of CT-derived diaphragmatic crus thickness with diaphragmatic excursion and exercise capacity in COPD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective single-centre study included 100 patients with stable COPD who underwent chest CT, spirometry, ultrasonographic assessment of DE\n                      <jats:sub>max<\/jats:sub>\n                      , and 6-minute walk distance (6MWD) testing. Diaphragmatic crus thickness was measured on axial CT images, and the diaphragmatic thickness index (DTI) was calculated after adjustment for body mass index. Multivariable linear regression analyses were performed to identify factors independently associated with DE\n                      <jats:sub>max<\/jats:sub>\n                      and 6MWD. Patients were stratified according to DTI and DE\n                      <jats:sub>max<\/jats:sub>\n                      to evaluate combined structural and functional diaphragm phenotypes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In multivariable analyses, DTI was independently associated with DE\n                      <jats:sub>max<\/jats:sub>\n                      (\u03b2\u2009=\u20090.57,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and 6MWD (\u03b2\u2009=\u20090.25,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) after adjustment for age, pulmonary function, and skeletal muscle indices. The combined low-DTI\/low- DE\n                      <jats:sub>max<\/jats:sub>\n                      phenotype was independently associated with reduced exercise capacity (6MWD\u2009&lt;\u2009350\u00a0m; odds ratio 14.89, 95% confidence interval 3.51\u201387.89,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CT-derived diaphragmatic thickness was independently associated with diaphragmatic excursion and exercise capacity in COPD. Combined structural and functional diaphragm assessment identified patients with markedly reduced exercise capacity, suggesting a role for integrated diaphragm evaluation in functional risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00408-026-00915-w","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:53:15Z","timestamp":1784616795000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Diaphragmatic Crus Thickness Assessed by Computed Tomography with Diaphragmatic Excursion and Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease"],"prefix":"10.1007","volume":"204","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5410-1331","authenticated-orcid":false,"given":"Masashi","family":"Shiraishi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Higashimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Mizusawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Takeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaya","family":"Noguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kengo","family":"Kanki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honoka","family":"Natsume","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Nishiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Yamazaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamotsu","family":"Kimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisako","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"915_CR1","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1002\/j.2040-4603.2012.tb00444.x","volume":"2","author":"I Vogiatzis","year":"2012","unstructured":"Vogiatzis I, Zakynthinos S (2012) Factors limiting exercise tolerance in chronic lung diseases. Compr Physiol 2:1779\u20131817","journal-title":"Compr Physiol"},{"key":"915_CR2","doi-asserted-by":"publisher","first-page":"S647","DOI":"10.1097\/00005768-200107001-00002","volume":"33","author":"DE O\u2019Donnell","year":"2001","unstructured":"O\u2019Donnell DE (2001) Ventilatory limitations in chronic obstructive pulmonary disease. Med Sci Sports Exerc 33:S647\u2013S655","journal-title":"Med Sci Sports Exerc"},{"key":"915_CR3","doi-asserted-by":"publisher","first-page":"2476","DOI":"10.1113\/EP091459","volume":"111","author":"RF D\u2019Cruz","year":"2026","unstructured":"D\u2019Cruz RF, Wilkins D, Jolley CJ (2026) Exercise-induced dynamic hyperinflation in chronic obstructive pulmonary disease. Exp Physiol 111:2476\u20132484","journal-title":"Exp Physiol"},{"key":"915_CR4","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.3390\/cells14211731","volume":"14","author":"J Gea","year":"2025","unstructured":"Gea J, Orozco-Levi M, Pascual-Guardia S et al (2025) Biological mechanisms involved in muscle dysfunction in COPD: an integrative damage-regeneration-remodeling framework. Cells 14:1731","journal-title":"Cells"},{"key":"915_CR5","doi-asserted-by":"publisher","first-page":"816586","DOI":"10.3389\/fphys.2022.816586","volume":"13","author":"J Gelinas","year":"2022","unstructured":"Gelinas J, Harper M, Sasso J et al (2022) Phenotyping Cardiopulmonary Exercise Limitations in Chronic Obstructive Pulmonary Disease. Front Physiol 13:816586","journal-title":"Front Physiol"},{"key":"915_CR6","doi-asserted-by":"publisher","first-page":"469","DOI":"10.33549\/physiolres.933064","volume":"65","author":"L Hellebrandova","year":"2016","unstructured":"Hellebrandova L, Chlumsky J, Vostatek P et al (2016) Airflow limitation is accompanied by diaphragm dysfunction. Physiol Res 65:469\u2013479","journal-title":"Physiol Res"},{"key":"915_CR7","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1080\/15412555.2020.1779680","volume":"17","author":"S Marino","year":"2020","unstructured":"Marino S, Bettini P, Pini L et al (2020) Effects of chronic and acute pulmonary hyperinflation on phrenic nerve conduction in patients with COPD. COPD 17:378\u2013383","journal-title":"COPD"},{"key":"915_CR8","doi-asserted-by":"publisher","first-page":"e39795","DOI":"10.1097\/MD.0000000000039795","volume":"103","author":"BC Figueira Silva","year":"2024","unstructured":"Figueira Silva BC, Abreu DC, Souza YR et al (2024) Ultrasonography as a way of evaluating the diaphragm muscle in patients with chronic obstructive pulmonary disease. Med (Baltim) 103:e39795","journal-title":"Med (Baltim)"},{"key":"915_CR9","doi-asserted-by":"publisher","first-page":"2629","DOI":"10.2147\/COPD.S527119","volume":"20","author":"T Zhang","year":"2025","unstructured":"Zhang T, Liu Y, Wang M et al (2025) Diaphragm assessment by multimodal ultrasound imaging in patients with chronic obstructive pulmonary disease: a prospective observational study. Int J Chron Obstruct Pulmon Dis 20:2629\u20132638","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"915_CR10","doi-asserted-by":"publisher","first-page":"00589","DOI":"10.1183\/23120541.00589-2020","volume":"6","author":"M Shiraishi","year":"2020","unstructured":"Shiraishi M, Higashimoto Y, Sugiya R et al (2020) Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients. ERJ Open Res 6:00589\u20132020","journal-title":"ERJ Open Res"},{"key":"915_CR11","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1186\/s12931-021-01870-1","volume":"22","author":"M Shiraishi","year":"2021","unstructured":"Shiraishi M, Higashimoto Y, Sugiya R et al (2021) Diaphragmatic excursion is correlated with the improvement in exercise tolerance after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Respir Res 22:271","journal-title":"Respir Res"},{"key":"915_CR12","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1007\/s11604-022-01314-w","volume":"40","author":"S Wada","year":"2022","unstructured":"Wada S, Matsuoka S, Mimura H (2022) Inspiratory and expiratory CT analyses of the diaphragmatic crus in chronic obstructive pulmonary disease. Jpn J Radiol 40:1257\u20131262","journal-title":"Jpn J Radiol"},{"key":"915_CR13","doi-asserted-by":"publisher","first-page":"1220463","DOI":"10.3389\/fphys.2023.1220463","volume":"14","author":"F Touchon","year":"2023","unstructured":"Touchon F, Bermudez J, Habert P et al (2023) Change in diaphragmatic morphology in single-lung transplant recipients: a computed tomographic study. Front Physiol 14:1220463","journal-title":"Front Physiol"},{"key":"915_CR14","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1097\/RTI.0000000000000276","volume":"32","author":"W Sukkasem","year":"2017","unstructured":"Sukkasem W, Moftah SG, Kicska G et al (2017) Crus atrophy: accuracy of computed tomography in diagnosis of diaphragmatic paralysis. J Thorac Imaging 32:383\u2013390","journal-title":"J Thorac Imaging"},{"key":"915_CR15","first-page":"00129","volume":"26","author":"K Shimizu","year":"2026","unstructured":"Shimizu K, Matsuzawa R, Nakamura S et al (2026) Prognostic significance of preoperative respiratory sarcopenia for functional recovery after cardiovascular surgery. Can J Cardiol 26:00129\u201300127","journal-title":"Can J Cardiol"},{"key":"915_CR16","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1513\/AnnalsATS.201507-446OC","volume":"13","author":"K Tanimura","year":"2016","unstructured":"Tanimura K, Sato S, Fuseya Y et al (2016) Quantitative assessment of erector spinae muscles in patients with chronic obstructive pulmonary disease. Novel chest computed tomography-derived index for prognosis. Ann Am Thorac Soc 13:334\u2013341","journal-title":"Ann Am Thorac Soc"},{"key":"915_CR17","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.4187\/respcare.08678","volume":"66","author":"Y Higashimoto","year":"2021","unstructured":"Higashimoto Y, Shiraishi M, Sugiya R et al (2021) Effect of Pulmonary rehabilitation on erector spinae muscles in individuals with COPD. Respir Care 66:1458\u20131468","journal-title":"Respir Care"},{"key":"915_CR18","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/s41747-024-00491-9","volume":"8","author":"JT Bakker","year":"2024","unstructured":"Bakker JT, Hartman JE, Klooster K et al (2024) Automated evaluation of diaphragm configuration based on chest CT in COPD patients. Eur Radiol Exp 8:87","journal-title":"Eur Radiol Exp"},{"key":"915_CR19","doi-asserted-by":"publisher","first-page":"1653","DOI":"10.1164\/rccm.201009-1535OC","volume":"183","author":"N Tanabe","year":"2011","unstructured":"Tanabe N, Muro S, Hirai T et al (2011) Impact of exacerbations on emphysema progression in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 183:1653\u20131659","journal-title":"Am J Respir Crit Care Med"},{"key":"915_CR20","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1164\/rccm.166.4.518","volume":"166","author":"American Thoracic Society\/European Respiratory S","year":"2002","unstructured":"American Thoracic Society\/European Respiratory S (2002) ATS\/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 166:518\u2013624","journal-title":"Am J Respir Crit Care Med"},{"key":"915_CR21","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1164\/rccm.201402-0337ST","volume":"189","author":"CA Redlich","year":"2014","unstructured":"Redlich CA, Tarlo SM, Hankinson JL et al (2014) Official American Thoracic Society technical standards: spirometry in the occupational setting. Am J Respir Crit Care Med 189:983\u2013993","journal-title":"Am J Respir Crit Care Med"},{"key":"915_CR22","doi-asserted-by":"publisher","first-page":"2101499","DOI":"10.1183\/13993003.01499-2021","volume":"60","author":"S Stanojevic","year":"2022","unstructured":"Stanojevic S, Kaminsky DA, Miller MR et al (2022) ERS\/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J 60:2101499","journal-title":"Eur Respir J"},{"key":"915_CR23","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1016\/j.resinv.2014.03.003","volume":"52","author":"M Kubota","year":"2014","unstructured":"Kubota M, Kobayashi H, Quanjer PH et al (2014) Reference values for spirometry, including vital capacity, in Japanese adults calculated with the LMS method and compared with previous values. Respir Investig 52:242\u2013250","journal-title":"Respir Investig"},{"key":"915_CR24","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1164\/ajrccm.166.1.at1102","volume":"166","author":"Laboratories ATSCoPSfCPF","year":"2002","unstructured":"Laboratories ATSCoPSfCPF (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111\u2013117","journal-title":"Am J Respir Crit Care Med"},{"key":"915_CR25","doi-asserted-by":"publisher","first-page":"1428","DOI":"10.1183\/09031936.00150314","volume":"44","author":"AE Holland","year":"2014","unstructured":"Holland AE, Spruit MA, Troosters T et al (2014) An official European Respiratory Society\/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 44:1428\u20131446","journal-title":"Eur Respir J"},{"key":"915_CR26","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1183\/09031936.00150414","volume":"44","author":"SJ Singh","year":"2014","unstructured":"Singh SJ, Puhan MA, Andrianopoulos V et al (2014) An official systematic review of the European Respiratory Society\/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J 44:1447\u20131478","journal-title":"Eur Respir J"},{"key":"915_CR27","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1183\/09059180.00010002","volume":"15","author":"DE O\u2019Donnell","year":"2006","unstructured":"O\u2019Donnell DE, Laveneziana P (2006) Physiology and consequences of lung hyperinflation in COPD. Eur Respiratory Rev 15:61\u201367","journal-title":"Eur Respiratory Rev"},{"key":"915_CR28","first-page":"187","volume":"9","author":"P Gagnon","year":"2014","unstructured":"Gagnon P, Guenette JA, Langer D et al (2014) Pathogenesis of hyperinflation in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 9:187\u2013201","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"915_CR29","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1111\/ggi.14519","volume":"23","author":"S Sato","year":"2023","unstructured":"Sato S, Miyazaki S, Tamaki A et al (2023) Respiratory sarcopenia: A position paper by four professional organizations. Geriatr Gerontol Int 23:5\u201315","journal-title":"Geriatr Gerontol Int"}],"container-title":["Lung"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00408-026-00915-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00408-026-00915-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00408-026-00915-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:53:16Z","timestamp":1784616796000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00408-026-00915-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["915"],"URL":"https:\/\/doi.org\/10.1007\/s00408-026-00915-w","relation":{},"ISSN":["1432-1750"],"issn-type":[{"value":"1432-1750","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"assertion":[{"value":"16 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Computed tomography\u2013derived diaphragmatic crus thickness is independently associated with diaphragmatic excursion and exercise capacity in COPD and combined structural and functional diaphragm assessment may improve functional risk stratification.","order":3,"name":"Ethics","label":"Take-home message","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethics Committee of Kindai University School of Medicine (approval number R08-016).","order":4,"name":"Ethics","label":"Ethics Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for informed consent was waived owing to the retrospective nature of the study, and an opt-out approach was used in accordance with institutional regulations.","order":5,"name":"Ethics","label":"Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"48"}}