{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:11:33Z","timestamp":1788757893176,"version":"build-2803163510"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"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>Background<\/jats:title>\n                    <jats:p>Chronic obstructive pulmonary disease (COPD) is a heterogeneous disorder involving varying contributions from airway abnormalities and emphysematous destruction. However, structural airway alterations in patients with airflow limitation but minimal emphysema remain incompletely characterized. Quantitative CT (QCT)-based airway morphology analysis may capture additional aspects of airway geometry associated with airway-predominant structural patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to evaluate lobar airway inter-tapering abnormalities on quantitative CT in patients with non-emphysematous COPD (NE-COPD) and investigate whether incorporation of inter-tapering features improves discrimination within the studied cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cross-sectional study included 173 participants who underwent inspiratory thin-section chest CT and post-bronchodilator pulmonary function testing between January 2023 and March 2025. NE-COPD was defined as airflow limitation with minimal emphysema quantified by low-attenuation area percentage below \u2212950 HU (LAA%-950\u2009&amp;lt;\u20095%). Automated airway segmentation and centerline-based analysis were used to quantify fourth-generation lobar inter-tapering indices. A clinical model incorporating age, sex, and smoking exposure was constructed. An imaging-augmented model was subsequently developed using LASSO-selected lobar inter-tapering features together with global airway branching complexity. Model performance was evaluated using receiver operating characteristic analysis, bootstrap validation, calibration assessment, decision curve analysis, and SHAP interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 173 participants, 87 had NE-COPD and 86 were Non-COPD controls. Compared with Non-COPD controls, patients with NE-COPD demonstrated altered fourth-generation lobar inter-tapering patterns in multiple lobes. The clinical model achieved an area under the curve (AUC) of 0.717. After incorporation of quantitative airway features, the imaging-augmented model demonstrated improved discrimination, with an AUC of 0.851. Bootstrap validation demonstrated stable model performance. SHAP analysis indicated that four lobar fourth-generation inter-tapering indices accounted for a substantial proportion of feature contribution within the fitted model. Decision curve analysis suggested higher theoretical net benefit of the imaging-augmented model within the evaluated threshold probability range.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Quantitative CT-derived lobar inter-tapering was associated with pulmonary function-defined non-emphysematous COPD. These findings suggest that lobar inter-tapering represents a candidate geometric CT descriptor for characterizing airway-predominant structural patterns. Further multicenter studies with external validation and integration of complementary quantitative CT descriptors are required to determine its broader clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1876551","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:23:42Z","timestamp":1788755022000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative CT-derived lobar inter-tapering as a candidate imaging feature associated with airway-predominant non-emphysematous COPD"],"prefix":"10.3389","volume":"13","author":[{"given":"Haibo","family":"Bian","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiting","family":"Xiao","sequence":"additional","affiliation":[{"name":"Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Cheng","sequence":"additional","affiliation":[{"name":"Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingru","family":"Zhang","sequence":"additional","affiliation":[{"name":"Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guopeng","family":"Shi","sequence":"additional","affiliation":[{"name":"Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongai","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruina","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanyu","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangyang","family":"Xu","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiazhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanping","family":"Wang","sequence":"additional","affiliation":[{"name":"Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University","place":["Changzhi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"B1","volume-title":"Global Strategy for the Diagnosis, Management, and Prevention of COPD","year":"2025"},{"key":"B2","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1186\/s12931-024-02913-z","article-title":"Artificial intelligence in COPD CT images: identification, staging, and quantitation","volume":"25","author":"Wu","year":"2024","journal-title":"Respir Res"},{"key":"B3","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1164\/rccm.201807-1351SO","article-title":"Imaging advances in chronic obstructive pulmonary disease. 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