Benjamin M. Smith, MD, MS, John H. M. Austin, MD, John D

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Pulmonary Emphysema Subtypes on Computed Tomography: The MESA COPD Study Benjamin M. Smith, MD, MS, John H.M. Austin, MD, John D. Newell, MD, Belinda M. D'Souza, MD, Anna Rozenshtein, MD, Eric A. Hoffman, PhD, Firas Ahmed, MD, MPH, R. Graham Barr, MD, DrPH The American Journal of Medicine Volume 127, Issue 1, Pages 94.e7-94.e23 (January 2014) DOI: 10.1016/j.amjmed.2013.09.020 Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 1 Reference images for absence of emphysema and emphysema subtypes. Axial computed tomography images were selected from training set scans in which all 4 raters independently agreed on the absence or isolated presence of each emphysema subtype. (A) Absence of emphysema; (B) Centrilobular emphysema; (C) Paraseptal emphysema; (D) Panlobular emphysema. The American Journal of Medicine 2014 127, 94.e7-94.e23DOI: (10.1016/j.amjmed.2013.09.020) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 2 Proportions of MESA COPD Study participants with one or multiple subtypes of emphysema. Presence of each emphysema subtype was defined as ≥1% of the lung volume affected. Proportions are weighted to reflect distribution in the source population (see Methods for details). COPD = chronic obstructive pulmonary disease; MESA = Multi-Ethnic Study of Atherosclerosis. The American Journal of Medicine 2014 127, 94.e7-94.e23DOI: (10.1016/j.amjmed.2013.09.020) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 3 Male sex, body mass index, and pack-years of smoking among MESA COPD Study participants by emphysema subtype. *Indicates P <.05 for bivariate comparison of emphysema subtype versus control group (no emphysema) adjusted for multiple subtype comparisons using Dunnett's procedure. Pack-years, sex prevalence, and body mass are weighted to reflect distribution in the source population (see Methods for details). (A) Pack-years of smoking; (B) Sex; and (C) Body mass index. COPD = chronic obstructive pulmonary disease; MESA = Multi-Ethnic Study of Atherosclerosis. The American Journal of Medicine 2014 127, 94.e7-94.e23DOI: (10.1016/j.amjmed.2013.09.020) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 4 Prevalence of predominant emphysema subtypes among MESA COPD Study participants by COPD severity. Predominant emphysema subtype was defined as the subtype affecting the greatest percentage of lung in each participant and severity of COPD was defined by GOLD spirometric criteria. Proportions are weighted to reflect distribution in the source population (see Methods for details). COPD = chronic obstructive pulmonary disease; GOLD = global initiative for chronic obstructive lung disease; MESA = Multi-Ethnic Study of Atherosclerosis. The American Journal of Medicine 2014 127, 94.e7-94.e23DOI: (10.1016/j.amjmed.2013.09.020) Copyright © 2014 Elsevier Inc. Terms and Conditions