Abstract
Diffusing capacity for carbon monoxide (DLCO) reflects pulmonary gas exchange efficiency, but its measurement and interpretation remain challenging due to physiological and technical variability. Quantitative computed tomography (CT) provides structural insights that may help address these limitations. This study investigated associations among demographic factors, spirometric values, DLCO, and CT-derived metrics in patients with various lung conditions. Additionally, we developed predictive models for DLCO. We analyzed mean lung density (MLD), percentile index 15 (PI15), percentages of low and high attenuation areas (LAA% and HAA%), emphysema size heterogeneity (D-slope), airway wall thickness (AWTPi10), and pulmonary vascular indices. Network analysis and random forest regression were employed to identify determinants and predictors of DLCO. DLCO correlated positively with weight and whole lung volume, and negatively with age, MLD variation, HAA%, and D-slope. DLCO/alveolar volume was positively associated with weight, body mass index, and lung density metrics (PI15), and negatively with LAA% and D-slope. CT-derived metrics exhibited distinct correlation patterns compared to spirometric measurements. The random forest model predicted DLCO with correlation coefficient of 0.82, an RMSE of 3.04 mL/min/mmHg, and an R2 of 0.58, indicating considerable predictive performance. Integrating quantitative CT metrics improves the understanding of DLCO. Imaging-based models may enhance diagnostic precision and support personalized management strategies for pulmonary diseases.
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Abbreviations
- AWTPi10:
-
Airway wall thickness at an internal perimeter of 10 mm
- BMI:
-
Body mass index
- BV5:
-
Blood volume in vessels with a cross-sectional area of ≤ 5 mm2
- BV5/TBV:
-
Ratio of small blood vessel volume (≤ 5 mm) to total blood volume
- CT:
-
Computed tomography
- DLCO:
-
Diffusing capacity for carbon monoxide
- DLCO/VA:
-
Diffusing capacity for carbon monoxide corrected for alveolar volume
- FEV1 :
-
Forced expiratory volume in one second
- FEV1/FVC:
-
Ratio of forced expiratory volume in one second to forced vital capacity
- FVC:
-
Forced vital capacity
- HAA:
-
High-attenuation area
- LAA:
-
Low-attenuation area
- MLD:
-
Mean lung density
- TBV:
-
Total blood volume
- V/Q:
-
Ventilation-perfusion ratio
Acknowledgments
The authors gratefully acknowledge the contributions of the laboratory staff—Mikyung Lee, Juhyeon Park, and Dayoung Han—for their assistance in conducting the measurements.
Funding
This work was supported by the National Research Foundation of Korea (NIRF) grant funded by the Korean government (MSIT: No. RS-2024-00359875). The funding bodies played no role in the study design, data collection, analysis, interpretation, and writing of the manuscript.
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This study was conducted in accordance with the principles of the Declaration of Helsinki. The ethics committee of Ilsan Paik Hospital approved the study (IRB No. 2025-02-008).
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Chung, S.J., Kang, J., Kim, D.H. et al. Structural determinants of pulmonary diffusing capacity identified by network analysis and machine learning on quantitative CT. Sci Rep (2026). https://doi.org/10.1038/s41598-026-51056-2
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DOI: https://doi.org/10.1038/s41598-026-51056-2
