{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:01:04Z","timestamp":1790834464659,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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 diagnosed primarily by post-bronchodilator spirometry, but quantitative CT can characterize emphysema and visible-airway structural abnormalities that are not fully captured by airflow measurements alone. Because CT-derived emphysema and airway features have been extensively studied, this single-center study aimed to develop and describe quantitative CT-based classification models and to explore bronchial-tree morphology as a hypothesis-generating imaging phenotype, rather than to establish a clinically validated diagnostic replacement for pulmonary function testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 229 participants (138 with COPD and 91 control participants) at Fudan University Zhongshan Hospital. HRCT was used to quantify visible-airway dimensions at a prespecified eighth-generation airway, emphysema extent quantified as low attenuation area percentage (LAA%), and bronchial-tree morphology. Clinical variables including smoking history, modified Medical Research Council (mMRC) dyspnea score, and pulmonary function tests were recorded. Multivariable logistic regression was used to develop single-center models for COPD classification and for classification of severe airflow obstruction (FEV1%pred &amp;lt; 50%, corresponding to GOLD spirometric grades 3\u20134). Model performance is reported as apparent performance because internal and external validation were not performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with control participants, COPD participants had smaller airway lumen area, higher wall-to-diameter ratio (T\/D), higher wall area percentage (WA%), and higher LAA%. Mean wall thickness did not differ significantly, indicating that the group difference mainly reflected lumen narrowing rather than wall thickening. Emphysema extent was associated with lower FEV1\/FVC and FEV1%pred. Sparse-type bronchial morphology was associated with COPD in multivariable analysis (OR 28.6, 95% CI 6.7\u2013149.8), but the wide confidence interval and the need for reproducible operational validation require cautious interpretation. The combined clinical-CT development models achieved apparent AUCs of 0.906 for COPD classification and 0.859 for classification of severe airflow obstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Quantitative HRCT emphysema and visible-airway measurements were associated with COPD status and spirometric airflow obstruction. The models should be regarded as single-center development models, and the bronchial-tree morphology finding should be interpreted as hypothesis-generating until reproducibility, calibration, incremental value, and external validation are demonstrated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1900490","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:41:34Z","timestamp":1790833294000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative CT features for COPD classification and GOLD spirometric severity assessment: a single-center model-development study"],"prefix":"10.3389","volume":"13","author":[{"given":"Kaifeng","family":"Du","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Fudan University Minhang Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiameng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Rushan People's Hospital","place":["Rushan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojing","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University","place":["Qingdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhao","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Fudan University Minhang Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiwen","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Fudan University Minhang Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine Xinhua Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1016\/j.rmed.2011.01.008","article-title":"Lower limit of normal or FEV1\/FVC < 0.70 in diagnosing COPD: an evidence-based review","volume":"105","author":"Mohamed Hoesein","year":"2011","journal-title":"Respir Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/1465-9921-13-13","article-title":"GOLD or lower limit of normal definition? 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