1
|
Kwee AKAL, Andrinopoulou ER, van der Veer T, Gallardo-Estrella L, Charbonnier JP, Humphries SM, Lynch DA, Tiddens HAWM, de Jong PA, Pompe E. Higher small pulmonary artery and vein volume on computed tomography is associated with mortality in current and former smokers. EBioMedicine 2024; 108:105366. [PMID: 39353280 PMCID: PMC11464249 DOI: 10.1016/j.ebiom.2024.105366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 09/12/2024] [Accepted: 09/13/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND In chronic obstructive pulmonary disease (COPD), vascular alterations have been shown to contribute to hypoxia and pulmonary hypertension, but the independent contribution of small vessel abnormalities to mortality remains unclear. METHODS We quantified artery and vein dimensions on computed tomography (CT) down to 0.2 mm. Small vessel volumes (<1 mmᴓ) were normalized by body surface area. In 7903 current and former smokers of the COPDGene study (53.2% male) the independent contribution of small artery and small vein volume to all-cause mortality was tested in multivariable Cox models. Additionally, we calculated the 95th percentile of small arteries and veins in 374 never smokers to create two groups: normal and high small artery or vein volume. We describe clinical, physiological and imaging characteristics of subjects with a high small artery and high small vein volume. FINDINGS Both high small artery and high small vein volumes were independently associated with mortality with an adjusted hazard ratio of 1.07 [1.01, 1.14] and 1.34 [1.21, 1.49] per mL/m2 increase, respectively. In COPDGene, 447 (5.7%) had high small artery volume and 519 (9.1%) subjects had high small vein volume and both had more emphysema, more air trapping and more severe coronary calcium. INTERPRETATION In smokers, abnormally high volumes in small arteries and veins are both relevant for mortality, which urges investigations into the aetiology of small pulmonary vessels and cardiac function in smokers. FUNDING Award Number U01-HL089897 and U01-HL089856 from the NHLBI. COPD Foundation with contributions from AstraZeneca, Boehringer Ingelheim, Genentech, GlaxoSmithKline, Novartis, Pfizer, Siemens, and Sunovion.
Collapse
Affiliation(s)
- Anastasia K A L Kwee
- University Medical Centre Utrecht and Utrecht University, Dept. Radiology, Utrecht, Netherlands.
| | - Eleni-Rosalina Andrinopoulou
- Erasmus Medical Centre, Dept. Biostatistics, Rotterdam, Netherlands; Erasmus Medical Centre, Dept. Epidemiology, Rotterdam, Netherlands
| | - Tjeerd van der Veer
- Leiden University Medical Centre, Dept. Pulmonology, Leiden, Netherlands; Erasmus Medical Centre, Dept. Pulmonology, Rotterdam, Netherlands
| | | | | | | | - David A Lynch
- National Jewish Health, Dept. Radiology, Denver, USA
| | - Harm A W M Tiddens
- Erasmus Medical Centre, Dept. Pulmonology, Rotterdam, Netherlands; Thirona B.V., Nijmegen, Netherlands; Erasmus MC-Sophia Children's Hospital, Dept. Paediatric Pulmonology and Allergology, Rotterdam, Netherlands
| | - Pim A de Jong
- University Medical Centre Utrecht and Utrecht University, Dept. Radiology, Utrecht, Netherlands
| | - Esther Pompe
- University Medical Centre Utrecht and Utrecht University, Dept. Radiology, Utrecht, Netherlands; Meander Medical Centre, Dept. Radiology, Amersfoort, Netherlands
| |
Collapse
|
2
|
Chen Y, Charbonnier JP, Andrinopoulou ER, Sly PD, Stick SM, Tiddens HAWM. Azithromycin reduces bronchial wall thickening in infants with cystic fibrosis. J Cyst Fibros 2024; 23:870-873. [PMID: 38584038 DOI: 10.1016/j.jcf.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND COMBAT-CF showed that children aged 0-3 years treated with azithromycin did clinically better than placebo but there was no effect on CT-scores. We reanalysed CTs using an automatic bronchus-artery (BA) analysis. METHOD Inspiratory and expiratory CTs at 12 and 36 months were analysed. BA-analysis measures BA-diameters: bronchial outer wall (Bout), bronchial inner wall (Bin), artery (A), and bronchial wall thickness (Bwt) and computes BA-ratios: Bout/A and Bin/A for bronchial widening, Bwt/A and Bwa/Boa (bronchial wall area/bronchial outer area) for bronchial wall thickening. Low attenuation regions (LAR) were analysed using an automatic method. Mixed-effect model was used to compare BA-outcomes at 36 months between treatment groups. RESULTS 228 CTs (59 placebo; 66 azithromycin) were analysed. The azithromycin group had lower Bwa/Boa (p = 0.0034) and higher Bin/A (p = 0.001) relative to placebo. Bout/A (p = 0.0088) was higher because of a reduction in artery diameters which correlated to a reduction in LAR. CONCLUSION Azithromycin-treated infants with CF show a reduction in bronchial wall thickness and possibly a positive effect on lung perfusion.
Collapse
Affiliation(s)
- Yuxin Chen
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Sophia Children's Hospital, Erasmus MC, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Eleni-Rosalina Andrinopoulou
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Peter D Sly
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Stephen M Stick
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Harm A W M Tiddens
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Sophia Children's Hospital, Erasmus MC, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands; Thirona, Nijmegen, the Netherlands.
| |
Collapse
|
3
|
Hadj Bouzid AI, Bui S, Benlala I, Berger P, Hutt A, Liberge R, Habert P, Gaubert JY, Baque-Juston M, Morel B, Ferretti G, Denis de Senneville B, Laurent F, Macey J, Dournes G. Artificial intelligence-driven volumetric CT outcome score in cystic fibrosis: longitudinal and multicenter validation with/without modulators treatment. Eur Radiol 2024:10.1007/s00330-024-11019-5. [PMID: 39150489 DOI: 10.1007/s00330-024-11019-5] [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: 03/18/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVES Holistic segmentation of CT structural alterations with 3D deep learning has recently been described in cystic fibrosis (CF), allowing the measurement of normalized volumes of airway abnormalities (NOVAA-CT) as an automated quantitative outcome. Clinical validations are needed, including longitudinal and multicenter evaluations. MATERIALS AND METHODS The validation study was retrospective between 2010 and 2023. CF patients undergoing Elexacaftor/Tezacaftor/Ivacaftor (ETI) or corticosteroids for allergic broncho-pulmonary aspergillosis (ABPA) composed the monocenter ETI and ABPA groups, respectively. Patients from six geographically distinct institutions composed a multicenter external group. All patients had completed CT and pulmonary function test (PFT), with a second assessment at 1 year in case of ETI or ABPA treatment. NOVAA-CT quantified bronchiectasis, peribronchial thickening, bronchial mucus, bronchiolar mucus, collapse/consolidation, and their overall total abnormal volume (TAV). Two observers evaluated the visual Bhalla score. RESULTS A total of 139 CF patients (median age, 15 years [interquartile range: 13-25]) were evaluated. All correlations between NOVAA-CT to both PFT and Bhalla score were significant in the ETI (n = 60), ABPA (n = 20), and External groups (n = 59), such as the normalized TAV (ρ ≥ 0.76; p < 0.001). In both ETI and ABPA groups, there were significant longitudinal improvements in peribronchial thickening, bronchial mucus, bronchiolar mucus and collapse/consolidation (p ≤ 0.001). An additional reversibility in bronchiectasis volume was quantified with ETI (p < 0.001). Intraclass correlation coefficient of reproducibility was > 0.99. CONCLUSION NOVAA-CT automated scoring demonstrates validity, reliability and responsiveness for monitoring CF severity over an entire lung and quantifies therapeutic effects on lung structure at CT, such as the volumetric reversibility of airway abnormalities with ETI. CLINICAL RELEVANCE STATEMENT Normalized volume of airway abnormalities at CT automated 3D outcome enables objective, reproducible, and holistic monitoring of cystic fibrosis severity over an entire lung for management and endpoints during therapeutic trials. KEY POINTS Visual scoring methods lack sensitivity and reproducibility to assess longitudinal bronchial changes in cystic fibrosis (CF). AI-driven volumetric CT scoring correlates longitudinally to disease severity and reliably improves with Elexacaftor/Tezacaftor/Ivacaftor or corticosteroid treatments. AI-driven volumetric CT scoring enables reproducible monitoring of lung disease severity in CF and quantifies longitudinal structural therapeutic effects.
Collapse
Affiliation(s)
- Amel Imene Hadj Bouzid
- Univ. Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, F-33600, Pessac, France
| | - Stephanie Bui
- Univ. Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, F-33600, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Paediatric Cystic Fibrosis Reference Center (CRCM), CIC 1401, F-33600, Pessac, France
- INSERM, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, CIC 1401, F-33600, Pessac, France
| | - Ilyes Benlala
- Univ. Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, F-33600, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Paediatric Cystic Fibrosis Reference Center (CRCM), CIC 1401, F-33600, Pessac, France
- INSERM, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, CIC 1401, F-33600, Pessac, France
| | - Patrick Berger
- Univ. Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, F-33600, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Paediatric Cystic Fibrosis Reference Center (CRCM), CIC 1401, F-33600, Pessac, France
- INSERM, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, CIC 1401, F-33600, Pessac, France
| | - Antoine Hutt
- Department of Thoracic Imaging, Heart & Lung Institute, Lille, Cedex, France
| | - Renan Liberge
- Department of Radiology, CHU Nantes, F-44000, Nantes, France
| | - Paul Habert
- Imaging Department, Hopital La Timone, APHM, Aix Marseille University, Marseille, France
| | - Jean-Yves Gaubert
- Imaging Department, Hopital La Timone, APHM, Aix Marseille University, Marseille, France
| | - Marie Baque-Juston
- Paediatric Radiology Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
| | - Baptiste Morel
- Pediatric Radiology Department, Clocheville Hospital, CHRU de Tours, Tours, France
| | - Gilbert Ferretti
- Department of Radiology, Grenoble-Alpes University Hospital, 38000, Grenoble, France
| | | | - François Laurent
- Univ. Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, F-33600, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Paediatric Cystic Fibrosis Reference Center (CRCM), CIC 1401, F-33600, Pessac, France
- INSERM, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, CIC 1401, F-33600, Pessac, France
| | - Julie Macey
- Univ. Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, F-33600, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Paediatric Cystic Fibrosis Reference Center (CRCM), CIC 1401, F-33600, Pessac, France
- INSERM, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, CIC 1401, F-33600, Pessac, France
| | - Gaël Dournes
- Univ. Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, F-33600, Pessac, France.
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Paediatric Cystic Fibrosis Reference Center (CRCM), CIC 1401, F-33600, Pessac, France.
- INSERM, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, CIC 1401, F-33600, Pessac, France.
| |
Collapse
|
4
|
Pieters ALP, van der Veer T, Meerburg JJ, Andrinopoulou ER, van der Eerden MM, Ciet P, Aliberti S, Burgel PR, Crichton ML, Shoemark A, Goeminne PC, Shteinberg M, Loebinger MR, Haworth CS, Blasi F, Tiddens HAWM, Caudri D, Chalmers JD. Structural Lung Disease and Clinical Phenotype in Bronchiectasis Patients: The EMBARC CT Study. Am J Respir Crit Care Med 2024; 210:87-96. [PMID: 38635862 DOI: 10.1164/rccm.202311-2109oc] [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: 11/17/2023] [Accepted: 04/18/2024] [Indexed: 04/20/2024] Open
Abstract
Rationale: Chest computed tomography (CT) scans are essential to diagnose and monitor bronchiectasis (BE). To date, few quantitative data are available about the nature and extent of structural lung abnormalities (SLAs) on CT scans of patients with BE. Objectives: To investigate SLAs on CT scans of patients with BE and the relationship of SLAs to clinical features using the EMBARC (European Multicenter Bronchiectasis Audit and Research Collaboration) registry. Methods: CT scans from patients with BE included in the EMBARC registry were analyzed using the validated Bronchiectasis Scoring Technique for CT (BEST-CT). The subscores of this instrument are expressed as percentages of total lung volume. The items scored are atelectasis/consolidation, BE with and without mucus plugging (MP), airway wall thickening, MP, ground-glass opacities, bullae, airways, and parenchyma. Four composite scores were calculated: total BE (i.e., BE with and without MP), total MP (i.e., BE with MP plus MP alone), total inflammatory changes (i.e., atelectasis/consolidation plus total MP plus ground-glass opacities), and total disease (i.e., all items but airways and parenchyma). Measurements and Main Results: CT scans of 524 patients with BE were analyzed. Mean subscores were 4.6 (range, 2.3-7.7) for total BE, 4.2 (1.2-8.1) for total MP, 8.3 (3.5-16.7) for total inflammatory changes, and 14.9 (9.1-25.9) for total disease. BE associated with primary ciliary dyskinesia was associated with more SLAs, whereas chronic obstructive pulmonary disease was associated with fewer SLAs. Lower FEV1, longer disease duration, Pseudomonas aeruginosa and nontuberculous mycobacterial infections, and severe exacerbations were all independently associated with worse SLAs. Conclusions: The type and extent of SLAs in patients with BE are highly heterogeneous. Strong relationships between radiological disease and clinical features suggest that CT analysis may be a useful tool for clinical phenotyping.
Collapse
Affiliation(s)
- Angelina L P Pieters
- Department of Radiology and Nuclear Medicine
- Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Jennifer J Meerburg
- Department of Radiology and Nuclear Medicine
- Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eleni-Rosalina Andrinopoulou
- Department of Biostatistics, and
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine
- Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Respiratory Unit, Milan, Italy
| | - Pierre-Regis Burgel
- Institut Cochin, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Megan L Crichton
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Amelia Shoemark
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Pieter C Goeminne
- Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
| | | | - Michael R Loebinger
- Host Defence Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; and
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Harm A W M Tiddens
- Department of Radiology and Nuclear Medicine
- Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daan Caudri
- Department of Radiology and Nuclear Medicine
- Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - James D Chalmers
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| |
Collapse
|
5
|
McNally P, Davies J, Ciet P, Tiddens H. Reply to Dournes and Benlala: Hierarchical Computed Tomography Scoring Systems Cannot Discriminate Between Reversible Bronchiectasis and Mucus Plugs. Am J Respir Crit Care Med 2024; 209:1039-1040. [PMID: 38354409 DOI: 10.1164/rccm.202311-2199le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/13/2024] [Indexed: 02/16/2024] Open
Affiliation(s)
- Paul McNally
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Children's Health Ireland, Dublin, Ireland
| | - Jane Davies
- Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Harm Tiddens
- Department of Pediatric Pulmonology, Erasmus Medical Centre, Rotterdam, the Netherlands; and
- Thirona, Nijmegen, the Netherlands
| |
Collapse
|
6
|
van den Bosch WB, Lv Q, Andrinopoulou ER, Pijnenburg MW, Ciet P, Janssens HM, Tiddens HA. Children with severe asthma have substantial structural airway changes on computed tomography. ERJ Open Res 2024; 10:00121-2023. [PMID: 38226065 PMCID: PMC10789264 DOI: 10.1183/23120541.00121-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/17/2023] [Indexed: 01/17/2024] Open
Abstract
Background In adults with severe asthma (SA) bronchial wall thickening, bronchiectasis and low attenuation regions (LAR) have been described on chest computed tomography (CT) scans. The extent to which these structural abnormalities are present in children with SA is largely unknown. Our aim was to study the presence and extent of airway abnormalities on chest CT of children with SA. Methods 161 inspiratory and expiratory CT scans, either spirometer-controlled or technician-controlled, obtained in 131 children with SA (mean±SD age 11.0±3.8 years) were collected retrospectively. Inspiratory scans were analysed manually using a semi-quantitative score and automatically using LungQ (v2.1.0.1; Thirona B.V., Nijmegen, the Netherlands). LungQ segments the bronchial tree, identifies the generation for each bronchus-artery (BA) pair and measures the following BA dimensions: outer bronchial wall diameter (Bout), adjacent artery diameter (A) and bronchial wall thickness (Bwt). Bronchiectasis was defined as Bout/A ≥1.1, bronchial wall thickening as Bwt/A ≥0.14. LAR, reflecting small airways disease (SAD), was measured automatically on inspiratory and expiratory scans and manually on expiratory scans. Functional SAD was defined as FEF25-75 and/or FEF75 z-scores <-1.645. Results are shown as median and interquartile range. Results Bronchiectasis was present on 95.8% and bronchial wall thickening on all CTs using the automated method. Bronchiectasis was present on 28% and bronchial wall thickening on 88.8% of the CTs using the manual semi-quantitative analysis. The percentage of BA pairs defined as bronchiectasis was 24.62% (12.7-39.3%) and bronchial wall thickening was 41.7% (24.0-79.8%) per CT using the automated method. LAR was observed on all CTs using the automatic analysis and on 82.9% using the manual semi-quantitative analysis. Patients with LAR or functional SAD had more thickened bronchi than patients without. Conclusion Despite a large discrepancy between the automated and the manual semi-quantitative analysis, bronchiectasis and bronchial wall thickening are present on most CT scans of children with SA. SAD is related to bronchial wall thickening.
Collapse
Affiliation(s)
- Wytse B. van den Bosch
- Erasmus MC – Sophia Children's Hospital, University Medical Center Rotterdam, Department of Paediatrics, division of Respiratory Medicine and Allergology, Rotterdam, the Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Radiology and Nuclear Medicine, Rotterdam, the Netherlands
| | - Qianting Lv
- Erasmus MC – Sophia Children's Hospital, University Medical Center Rotterdam, Department of Paediatrics, division of Respiratory Medicine and Allergology, Rotterdam, the Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Radiology and Nuclear Medicine, Rotterdam, the Netherlands
| | - Eleni-Rosalina Andrinopoulou
- Erasmus MC, University Medical Center Rotterdam, Department of Biostatistics, Rotterdam, the Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Epidemiology, Rotterdam, the Netherlands
| | - Mariëlle W.H. Pijnenburg
- Erasmus MC – Sophia Children's Hospital, University Medical Center Rotterdam, Department of Paediatrics, division of Respiratory Medicine and Allergology, Rotterdam, the Netherlands
| | - Pierluigi Ciet
- Erasmus MC – Sophia Children's Hospital, University Medical Center Rotterdam, Department of Paediatrics, division of Respiratory Medicine and Allergology, Rotterdam, the Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Radiology and Nuclear Medicine, Rotterdam, the Netherlands
- Department of Radiology, Policlinico Universitario, University of Cagliari, Cagliari, Italy
| | - Hettie M. Janssens
- Erasmus MC – Sophia Children's Hospital, University Medical Center Rotterdam, Department of Paediatrics, division of Respiratory Medicine and Allergology, Rotterdam, the Netherlands
| | - Harm A.W.M. Tiddens
- Erasmus MC – Sophia Children's Hospital, University Medical Center Rotterdam, Department of Paediatrics, division of Respiratory Medicine and Allergology, Rotterdam, the Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Radiology and Nuclear Medicine, Rotterdam, the Netherlands
- Thirona BV, Nijmegen, the Netherlands
| |
Collapse
|
7
|
Dettmer S, Weinheimer O, Sauer-Heilborn A, Lammers O, Wielpütz MO, Fuge J, Welte T, Wacker F, Ringshausen FC. Qualitative and quantitative evaluation of computed tomography changes in adults with cystic fibrosis treated with elexacaftor-tezacaftor-ivacaftor: a retrospective observational study. Front Pharmacol 2023; 14:1245885. [PMID: 37808186 PMCID: PMC10552920 DOI: 10.3389/fphar.2023.1245885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction: The availability of highly effective triple cystic fibrosis transmembrane conductance regulator (CFTR) modulator combination therapy with elexacaftor-tezacaftor-ivacaftor (ETI) has improved pulmonary outcomes and quality of life of people with cystic fibrosis (pwCF). The aim of this study was to assess computed tomography (CT) changes under ETI visually with the Brody score and quantitatively with dedicated software, and to correlate CT measures with parameters of clinical response. Methods: Twenty two adult pwCF with two consecutive CT scans before and after ETI treatment initiation were retrospectively included. CT was assessed visually employing the Brody score and quantitatively by YACTA, a well-evaluated scientific software computing airway dimensions and lung parenchyma with wall percentage (WP), wall thickness (WT), lumen area (LA), bronchiectasis index (BI), lung volume and mean lung density (MLD) as parameters. Changes in CT metrics were evaluated and the visual and quantitative parameters were correlated with each other and with clinical changes in sweat chloride concentration, spirometry [percent predicted of forced expiratory volume in one second (ppFEV1)] and body mass index (BMI). Results: The mean (SD) Brody score improved with ETI [55 (12) vs. 38 (15); p < 0.001], incl. sub-scores for mucus plugging, peribronchial thickening, and parenchymal changes (all p < 0.001), but not for bronchiectasis (p = 0.281). Quantitatve WP (p < 0.001) and WT (p = 0.004) were reduced, conversely LA increased (p = 0.003), and BI improved (p = 0.012). Lung volume increased (p < 0.001), and MLD decreased (p < 0.001) through a reduction of ground glass opacity areas (p < 0.001). Changes of the Brody score correlated with those of quantitative parameters, exemplarily WT with the sub-score for mucus plugging (r = 0.730, p < 0.001) and peribronchial thickening (r = 0.552, p = 0.008). Changes of CT parameters correlated with those of clinical response parameters, in particular ppFEV1 with the Brody score (r = -0.606, p = 0.003) and with WT (r = -0.538, p = 0.010). Discussion: Morphological treatment response to ETI can be assessed using the Brody score as well as quantitative CT parameters. Changes in CT correlated with clinical improvements. The quantitative analysis with YACTA proved to be an objective, reproducible and simple method for monitoring lung disease, particularly with regard to future interventional clinical trials.
Collapse
Affiliation(s)
- Sabine Dettmer
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Annette Sauer-Heilborn
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
| | - Oliver Lammers
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Jan Fuge
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Felix C. Ringshausen
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
| |
Collapse
|