OBJECTIVE: To identify image biomarkers associated with overall life expectancy from low-dose CT and integrate them as an index for assessing an individual's health. METHODS: Two categories of CT image features, body composition tissues and cardiopulmonary vasculature characteristics, were quantified from LDCT scans in the Pittsburgh Lung Screening Study cohort (n = 3635). Cox proportional-hazards models identified significant image features which were integrated with subject demographics to predict the subject's overall hazard. Subjects were stratified using composite model predictions and feature-specific risk stratification thresholds. The model's performance was validated extensively, including 5-fold cross-validation on PLuSS baseline, PLuSS follow-up examinations, and the National Lung Screening Trial (NLST). RESULTS: The composite model had significantly improved prognostic ability compared to the baseline model (P <
.01) with AUCs of 0.774 (95% CI: 0.757-0.792) on PLuSS, 0.723 (95% CI: 0.703-0.744) on PLuSS follow-up, and 0.681 (95% CI: 0.651-0.710) on the NLST cohort. The identified high-risk stratum were several times more likely to die, with mortality rates of 79.34% on PLuSS, 76.47% on PLuSS follow-up, and 46.74% on NLST. Two cardiopulmonary structures (intrapulmonary artery-vein ratio, intrapulmonary vein density) and two body composition tissues (SM density, bone density) identified high-risk patients. CONCLUSIONS: Body composition and pulmonary vasculatures are predictive of an individual's health risk
their integrations with subject demographics facilitate the assessment of an individual's overall health status or susceptibility to disease. ADVANCES IN KNOWLEDGE: CT-computed body composition and vasculature biomarkers provide improved prognostic value. The integration of CT biomarkers and patient demographic information improves subject risk stratification.