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Introduction Lung cancer screening with low‑dose CT(LDCT) has been shown to detect lung cancer early stage in high-risk subjects. Almost 50% of patients who underwent LDCT screening had lung nodules coexisting with emphysema or COPD. It is still not clear whether emphysema increased the risk for lung nodules. To explore the association between visual emphysema and lung nodules with low-dose CT. Methods The baseline low-dose CT scans of 1166 participants from a prospective lung cancer screening study were used for the detection of lung nodules and emphysema. The presence of lung nodules, emphysema and subtypes of emphysema were visually assessed. All the non-calcified nodules independent of size were included in the analysis. Multivariable logistic regression analyses were performed to estimate the association between the presence, subtypes of emphysema, and lung nodules. In this way, odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated. All analyses were adjusted for age, gender, BMI, and smoking status. Results Lung nodules were identified in 907 (78.1%) participants, 674 (58.0%) of whom were diagnosed with emphysema. The participants with lung nodules were older (mean 61.7 vs 59.3 years, p < 0.001), prone to males(47.0% vs 35.7%, p < 0.001) and current smokers(25.4% vs 16.1%, p < 0.001). Participants with emphysema had a higher risk for lung nodules (OR:2.13; 95%CI:1.58-2.87). In terms of the subtypes of emphysema, participants with the centrilobular emphysema had a 2 fold increased risk for the presence of lung nodules(OR:2.15, 95%CI:1.59-2.92) even after adjustment for the covariates, but not for the participants with paraseptal emphysema(OR:1.87, 95%CI:0.84-4.17). Conclusion Emphysema based on low-dose CT is an independent risk factor for lung nodules. The next step is to evaluate whether participants with emphysema and lung nodules are also at increased risk to develop lung cancer. |