This study analyzed six-year noncontrast CT data from the Korean KOLD cohort to investigate the dynamic patterns of emphysema holes and their clinical relevance. Using Aview (Coreline Soft), holes were automatically extracted and classified into increased, stable, or decreased diameter groups. The volume of holes with increased diameter—especially new holes—was associated with decreased FEV1, disease progression, and poorer survival. Although changes in LAA-950 were statistically insignificant, detailed morphologic hole changes provided better explanation for functional decline. Patients with lower baseline FEV1 or higher LAA-950 values exhibited more active new hole formation. A volume of increased-diameter holes exceeding 5% was associated with higher mortality, suggesting its potential role as an objective imaging biomarker. Coreline Soft authors were included in the study.
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