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@ARTICLE{Mascalchi:274082,
      author       = {M. Mascalchi$^*$ and C. Romei and C. Marzi and S. Diciotti
                      and G. Picozzi and F. Pistelli and M. Zappa and E. Paci and
                      F. Carozzi and G. Gorini and F. Falaschi and A. L. Deliperi
                      and G. Camiciottoli and L. Carrozzi and D. Puliti},
      title        = {{P}ulmonary emphysema and coronary artery calcifications at
                      baseline {LDCT} and long-term mortality in smokers and
                      former smokers of the {ITALUNG} screening trial.},
      journal      = {European radiology},
      volume       = {33},
      number       = {5},
      issn         = {0938-7994},
      address      = {Heidelberg},
      publisher    = {Springer},
      reportid     = {DKFZ-2023-00428},
      pages        = {3115-3123},
      year         = {2023},
      note         = {#EA:C020# / 2023 May;33(5):3115-3123},
      abstract     = {Cardiovascular disease (CVD), lung cancer (LC), and
                      respiratory diseases are main causes of death in smokers and
                      former smokers undergoing low-dose computed tomography
                      (LDCT) for LC screening. We assessed whether quantification
                      of pulmonary emphysematous changes at baseline LDCT has a
                      predictive value concerning long-term mortality.In this
                      longitudinal study, we assessed pulmonary emphysematous
                      changes with densitometry (volume corrected relative area
                      below - 950 Hounsfield units) and coronary artery
                      calcifications (CAC) with a 0-3 visual scale in baseline
                      LDCT of 524 participants in the ITALUNG trial and analyzed
                      their association with mortality after 13.6 years of
                      follow-up using conventional statistics and a machine
                      learning approach.Pulmonary emphysematous changes were
                      present in $32.3\%$ of subjects and were mild $(6\%$ ≤
                      RA950 ≤ $9\%)$ in $14.9\%$ and moderate-severe (RA950 >
                      $9\%)$ in $17.4\%.$ CAC were present in $67\%$ of subjects
                      (mild in $34.7\%,$ moderate-severe in $32.2\%).$ In the
                      follow-up, 81 $(15.4\%)$ subjects died (20 of LC, 28 of
                      other cancers, 15 of CVD, 4 of respiratory disease, and 14
                      of other conditions). After adjusting for age, sex, smoking
                      history, and CAC, moderate-severe emphysema was
                      significantly associated with overall (OR 2.22; 95CI
                      1.34-3.70) and CVD (OR 3.66; 95CI 1.21-11.04) mortality.
                      Machine learning showed that RA950 was the best single
                      feature predictive of overall and CVD
                      mortality.Moderate-severe pulmonary emphysematous changes
                      are an independent predictor of long-term overall and CVD
                      mortality in subjects participating in LC screening and
                      should be incorporated in the post-test calculation of the
                      individual mortality risk profile.• Densitometry allows
                      quantification of pulmonary emphysematous changes in
                      low-dose CT examinations for lung cancer screening. •
                      Emphysematous lung density changes are an independent
                      predictor of long-term overall and cardio-vascular disease
                      mortality in smokers and former smokers undergoing
                      screening. • Emphysematous changes quantification should
                      be included in the post-test calculation of the individual
                      mortality risk profile.},
      keywords     = {Cardiovascular disease (Other) / Cause of death (Other) /
                      Lung neoplasm (Other) / Pulmonary emphysema (Other) /
                      Smokers (Other)},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36854875},
      doi          = {10.1007/s00330-023-09504-4},
      url          = {https://inrepo02.dkfz.de/record/274082},
}