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Article History

Received: 29 August 2025

Accepted: 9 November 2025

First Online: 11 December 2025

Declarations

:

: A.K., K.A., and M.O. are employees of Canon Medical Systems Corporation, Tochigi, Japan. M.K. is an employee of Canon Inc., Tokyo, Japan. D.W.L. received payment to institution for organization of a regional pulmonary hypertension course sponsored by Ferrer, MSD, and Johnson & Johnson, and received travel support for a perceptorship course at Aarhus University Hospital. He serves as a board member of the ILD section of the Dutch Association of pulmonary physicians (NVALT). M.W.V. receives funding from ZonMw Memorabel grant (No. 733050817), TAP-dementia ZonMw funded project (#10510032120003), Medical Delta research grant, and ABOARD public–private partnership (ZonMW #73305095007, Health ~ Holland #LSHM20106). She received honorarium paid to institution for an educational lecture to EISAI company (topic unrelated to the present manuscript). V.G. received grant payments from NIA grants N01-AG-12100 and HHSN271201200022C. D.C.C receives research grant from NIH. G.M.H. receives funding from NIH NHLBI grants R01 HL111024, R01 HL130974, and R01 HL135142, and received consulting fees from Gerson Lehrman Group and Boehringer Ingelheim, and lecture honoraria from Boehringer Ingelheim, and travel support for meetings from Boehringer Ingelheim. M.N. and H.H. received research grants to institution from Canon Medical Systems and Konica Minolta. H. H. also received consulting fees from Canon Medical Systems Inc. and Boehringer Ingelheim Inc. (less than $5,000 USD per year each). G.G. received grant payments from Landspitali Scientific Fund, University of Iceland Research Fund, and Icelandic Research Fund. K.A., M.O., M.K., and H.H. are co-inventors on US patent application number 63/610,842. M.O. holds stock options in Institute for Advanced Diagnosis for Rare Diseases & Conditions K.K.

: This study was a secondary analysis of de-identified imaging data from two previously approved cohort studies. The Rotterdam Study was approved by the Medical Ethics Committee (MEC 02.1015), and the AGES-Reykjavik Study was approved by the Institutional Review Board (VSN 00–063). As this study involved only retrospective analysis of existing anonymized imaging data, additional ethical approval was not required.

: Written informed consent was obtained from all participants in the original cohort studies. As this study used only de-identified data, additional informed consent was not required.