{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T22:21:57Z","timestamp":1777760517044,"version":"3.51.4"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To propose a refined CT-based phenotypic classification of pulmonary bullae and investigate the differences in demographic characteristics, morphological features, and pulmonary function among different subtypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study enrolled 467 patients diagnosed with pulmonary bullae who underwent chest CT at Tangdu Hospital from January 2023 to December 2024. Patients were classified into three phenotypes: bullous emphysema, intrapulmonary bullae, and subpleural bullae. Demographic data, smoking history, BMI, bulla morphology (size, number, internal septations, wall thickness, margin regularity), and pulmonary function parameters (FVC, FEV\n                      <jats:sub>1<\/jats:sub>\n                      , FEV\n                      <jats:sub>1<\/jats:sub>\n                      \/FVC, DLCO) were collected and compared among groups. Subgroup analyses were performed based on smoking status, BMI level, and COPD status.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant intergroup differences were observed in age, BMI, and smoking history (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Patients with bullous emphysema were older, had lower BMI, and higher smoking rates. Morphologically, the bullous emphysema group exhibited significantly greater maximum bulla length, width, and surface area compared to the other two groups (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Smoking was associated with larger bullae, higher proportions of internal septations and thick walls, and fewer regular margins (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Low BMI patients (BMI &amp;lt; 23.03 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) demonstrated larger bullae with more complex morphology compared to high BMI patients (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Functionally, the bullous emphysema group had significantly lower FEV\n                      <jats:sub>1<\/jats:sub>\n                      , FEV\n                      <jats:sub>1<\/jats:sub>\n                      % predicted, FEV\n                      <jats:sub>1<\/jats:sub>\n                      \/FVC, and DLCO% predicted (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Patients with COPD (\n                      <jats:italic>n<\/jats:italic>\n                      = 83) showed larger bullae and lower proportions of regular margins and internal septations compared to non-COPD patients (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CT-based phenotyping of pulmonary bullae reveals distinct demographic, morphological, and functional profiles. Bullous emphysema is associated with more severe morphological abnormalities and pulmonary function impairment. Smoking and low BMI are modifiable factors promoting bulla progression. This classification provides a foundation for personalized clinical surveillance and intervention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1752828","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T13:57:41Z","timestamp":1777471061000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A retrospective analysis of the anatomic characteristics of pulmonary bullae based on chest CT classification and their association with pulmonary function"],"prefix":"10.3389","volume":"13","author":[{"given":"Xin","family":"Zou","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi\u2019an","place":["Shaanxi, China"]},{"name":"Department of Tuberculosis, The 987th Hospital of Joint Logistic Support Force, Baoji","place":["Shaanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoqing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Disease Control and Prevention, Xi\u2019an Eighth Hospital, Xi\u2019an","place":["Shaanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weixin","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Graduate Studies, Xi\u2019an Medical University, Xi\u2019an","place":["Shaanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi\u2019an","place":["Shaanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi\u2019an","place":["Shaanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wangping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi\u2019an","place":["Shaanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1148\/radiol.2462070712","article-title":"Fleischner Society: glossary of terms for thoracic imaging.","volume":"246","author":"Hansell","year":"2008","journal-title":"Radiology."},{"key":"B2","doi-asserted-by":"publisher","first-page":"5956","DOI":"10.3390\/jcm14175956","article-title":"Visual and predictive assessment of pneumothorax recurrence in adolescents using machine learning on chest CT.","volume":"14","author":"Hyun","year":"2025","journal-title":"J Clin 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