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Tanabe N, Nakagawa H, Sakao S, Ohno Y, Shimizu K, Nakamura H, Hanaoka M, Nakano Y, Hirai T. Lung imaging in COPD and asthma. Respir Investig 2024; 62:995-1005. [PMID: 39213987 DOI: 10.1016/j.resinv.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 08/04/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) and asthma are common lung diseases with heterogeneous clinical presentations. Lung imaging allows evaluations of underlying pathophysiological changes and provides additional personalized approaches for disease management. This narrative review provides an overview of recent advances in chest imaging analysis using various modalities, such as computed tomography (CT), dynamic chest radiography, and magnetic resonance imaging (MRI). Visual CT assessment localizes emphysema subtypes and mucus plugging in the airways. Dedicated software quantifies the severity and spatial distribution of emphysema and the airway tree structure, including the central airway wall thickness, branch count and fractal dimension of the tree, and airway-to-lung size ratio. Nonrigid registration of inspiratory and expiratory CT scans quantifies small airway dysfunction, local volume changes and shape deformations in specific regions. Lung ventilation and diaphragm movement are also evaluated on dynamic chest radiography. Functional MRI detects regional oxygen transfer across the alveolus using inhaled oxygen and ventilation defects and gas diffusion into the alveolar-capillary barrier tissue and red blood cells using inhaled hyperpolarized 129Xe gas. These methods have the potential to determine local functional properties in the lungs that cannot be detected by lung function tests in patients with COPD and asthma. Further studies are needed to apply these technologies in clinical practice, particularly for early disease detection and tailor-made interventions, such as the efficient selection of patients likely to respond to biologics. Moreover, research should focus on the extension of healthy life expectancy in patients at higher risk and with established diseases.
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Affiliation(s)
- Naoya Tanabe
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogo-in Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
| | - Hiroaki Nakagawa
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Seiichiro Sakao
- Department of Pulmonary Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686 Japan
| | - Yoshiharu Ohno
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Kaoruko Shimizu
- Division of Emergent Respiratory and Cardiovascular medicine, Hokkaido University Hospital, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogo-in Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
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Hwang J, Kim H, Kim SM, Yang DS. Preliminary Results of Developing Imaging Complexity Biomarkers for the Incidence of Severe Radiation Pneumonitis Following Radiotherapy in Non-Small Cell Lung Cancer Patients with Underlying Idiopathic Pulmonary Fibrosis. Life (Basel) 2024; 14:897. [PMID: 39063650 PMCID: PMC11277958 DOI: 10.3390/life14070897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) has the potential to cause fatal pulmonary toxicity after radiotherapy and can increase the morbidity and mortality of non-small-cell lung cancer (NSCLC) patients. In this context, we aimed to develop imaging complexity biomarkers to predict the incidence of severe pulmonary toxicity in patients with NSCLC who have underlying IPF and are treated with radiotherapy. Methods: We retrospectively reviewed the medical records of 19 patients with NSCLC who had underlying IPF and were treated with radiotherapy at the Korea University Guro Hospital between March 2018 and December 2022. To quantify the morphometric complexity of the lung parenchyma, box-counting fractal dimensions and lacunarity analyses were performed on pre-radiotherapy simulation chest computed tomography scans. Results: Of the 19 patients, the incidence of grade 3 or higher radiation pneumonitis was observed in 8 (42.1%). After adjusting for age, sex, smoking status, histology, and diffusing capacity of the lung for carbon monoxide, eight patients with a lower fractal dimension showed a significantly higher hazard ratio of 7.755 (1.168-51.51) for grade 3 or higher pneumonitis than those with a higher fractal dimension. Patients with lower lacunarity exhibited significantly lower hazards in all models, both with and without adjustments. The lower-than-median lacunarity group also showed significantly lower incidence curves for all models built in this study. Conclusions: We devised a technique for quantifying morphometric complexity in NSCLC patients with IPF on radiotherapy and discovered lacunarity as a potential imaging biomarker for grade 3 or higher pneumonitis.
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Affiliation(s)
- Jeongeun Hwang
- Department of Medical IT Engineering, Soonchunhyang University, Asan 31538, Chungcheongnam-do, Republic of Korea;
| | - Hakyoung Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea;
| | - Sun Myung Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea;
| | - Dae Sik Yang
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea;
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Vestal BE, Ghosh D, Estépar RSJ, Kechris K, Fingerlin T, Carlson NE. Quantifying the spatial clustering characteristics of radiographic emphysema explains variability in pulmonary function. Sci Rep 2023; 13:13862. [PMID: 37620507 PMCID: PMC10449810 DOI: 10.1038/s41598-023-40950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023] Open
Abstract
Quantitative assessment of emphysema in CT scans has mostly focused on calculating the percentage of lung tissue that is deemed abnormal based on a density thresholding strategy. However, this overall measure of disease burden discards virtually all the spatial information encoded in the scan that is implicitly utilized in a visual assessment. This simplification is likely grouping heterogenous disease patterns and is potentially obscuring clinical phenotypes and variable disease outcomes. To overcome this, several methods that attempt to quantify heterogeneity in emphysema distribution have been proposed. Here, we compare three of those: one based on estimating a power law for the size distribution of contiguous emphysema clusters, a second that looks at the number of emphysema-to-emphysema voxel adjacencies, and a third that applies a parametric spatial point process model to the emphysema voxel locations. This was done using data from 587 individuals from Phase 1 of COPDGene that had an inspiratory CT scan and plasma protein abundance measurements. The associations between these imaging metrics and visual assessment with clinical measures (FEV[Formula: see text], FEV[Formula: see text]-FVC ratio, etc.) and plasma protein biomarker levels were evaluated using a variety of regression models. Our results showed that a selection of spatial measures had the ability to discern heterogeneous patterns among CTs that had similar emphysema burdens. The most informative quantitative measure, average cluster size from the point process model, showed much stronger associations with nearly every clinical outcome examined than existing CT-derived emphysema metrics and visual assessment. Moreover, approximately 75% more plasma biomarkers were found to be associated with an emphysema heterogeneity phenotype when accounting for spatial clustering measures than when they were excluded.
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Affiliation(s)
- Brian E Vestal
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA.
| | - Debashis Ghosh
- Department of Biostatistics and Informatics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory (ACIL), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katerina Kechris
- Department of Biostatistics and Informatics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Tasha Fingerlin
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA
| | - Nichole E Carlson
- Department of Biostatistics and Informatics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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Ibaraki T, Tomoda K, Fujioka N, Sakaguchi K, Fujita Y, Yamamoto Y, Hontsu S, Yamauchi M, Yoshikawa M, Tanabe N, Tanimura K, Sato S, Saeki K, Muro S. Fractal dimension in CT low attenuation areas is predictive of long-term oxygen therapy initiation in COPD patients: Results from two observational cohort studies. Respir Investig 2021; 60:137-145. [PMID: 34583896 DOI: 10.1016/j.resinv.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/18/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Some chronic obstructive pulmonary disease (COPD) patients develop hypoxemia with disease progression, with some even requiring long-term oxygen therapy (LTOT). Lung function, especially diffusing capacity, and the annual decline in PaO2, are reported to be predictive factors of chronic respiratory failure. However, the association between lung morphometry evaluated using computed tomography (CT) images and LTOT initiation is unknown. METHODS We retrospectively evaluated the relationship between clinical indices, including pulmonary function, body mass index (BMI), and CT parameters, at baseline and LTOT initiation in two prospective COPD cohorts. In the Nara Medical University cohort (n = 76), the low attenuation area (LAA) and its fractal dimension (fractal D) were adapted as the indices for parenchymal destruction in CT images. The association between these CT measurements and LTOT initiation was replicated in the Kyoto University cohort (n = 130). RESULTS In the Nara Medical University cohort, lower BMI (hazard ratio [HR]:0.70, p = 0.006), lower % diffusing capacity (%DLCO) (HR: 0.92, p = 0.006), lower %DLCO/VA (HR, 0.90, p = 0.008), higher RV/TLC (HR, 1.26, p = 0.012), higher LAA% (HR: 1.18, p = 0.001), and lower fractal D (HR: 3.27 × 10-8, p < 0.001) were associated with LTOT initiation. Multivariate analysis in the Kyoto University cohort confirmed that lower %DLCO and lower fractal D were independently associated with LTOT initiation, whereas LAA% was not. CONCLUSION Fractal D, which is the index for morphometric complexity of LAA in CT analysis, is predictive of LTOT initiation in COPD patients.
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Affiliation(s)
- Takahiro Ibaraki
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan; Saiseikai Suita Hospital, Osaka, Japan
| | - Koich Tomoda
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Nobuhiro Fujioka
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Kazuhiro Sakaguchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Yukio Fujita
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Yoshifumi Yamamoto
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Shigeto Hontsu
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Masanori Yoshikawa
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuya Tanimura
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University, Nara, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan.
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Tanabe N, Sato S, Suki B, Hirai T. Fractal Analysis of Lung Structure in Chronic Obstructive Pulmonary Disease. Front Physiol 2021; 11:603197. [PMID: 33408642 PMCID: PMC7779609 DOI: 10.3389/fphys.2020.603197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
Chest CT is often used for localizing and quantitating pathologies associated with chronic obstructive pulmonary disease (COPD). While simple measurements of areas and volumes of emphysema and airway structure are common, these methods do not capture the structural complexity of the COPD lung. Since the concept of fractals has been successfully applied to evaluate complexity of the lung, this review is aimed at describing the fractal properties of airway disease, emphysema, and vascular abnormalities in COPD. An object forms a fractal if it exhibits the property of self-similarity at different length scales of evaluations. This fractal property is governed by power-law functions characterized by the fractal dimension (FD). Power-laws can also manifest in other statistical descriptors of structure such as the size distribution of emphysema clusters characterized by the power-law exponent D. Although D is not the same as FD of emphysematous clusters, it is a useful index to characterize the spatial pattern of disease progression and predict clinical outcomes in patients with COPD. The FD of the airway tree shape and the D of the size distribution of airway branches have been proposed indexes of structural assessment and clinical predictions. Simulations are also useful to understand the mechanism of disease progression. Therefore, the power-law and fractal analysis of the parenchyma and airways, especially when combined with computer simulations, could lead to a better understanding of the structural alterations during the progression of COPD and help identify subjects at a high risk of severe COPD.
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Affiliation(s)
- Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Béla Suki
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Metze K, Adam R, Florindo JB. The fractal dimension of chromatin - a potential molecular marker for carcinogenesis, tumor progression and prognosis. Expert Rev Mol Diagn 2019; 19:299-312. [DOI: 10.1080/14737159.2019.1597707] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Konradin Metze
- Department of Pathology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Randall Adam
- Department of Pathology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - João Batista Florindo
- Department of Applied Mathematics, Institute of Mathematics, Statistics and Scientific Computing, State University of Campinas, Campinas, Brazil
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