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Joye AA, Bogowicz M, Gote-Schniering J, Frauenfelder T, Guckenberger M, Maurer B, Tanadini-Lang S, Gabryś HS. Radiomics on slice-reduced versus full-chest computed tomography for diagnosis and staging of interstitial lung disease in systemic sclerosis: A comparative analysis. Eur J Radiol Open 2024; 13:100596. [PMID: 39280121 PMCID: PMC11402420 DOI: 10.1016/j.ejro.2024.100596] [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: 06/05/2024] [Revised: 07/26/2024] [Accepted: 08/13/2024] [Indexed: 09/18/2024] Open
Abstract
Purpose The purpose of this study was to evaluate the efficacy of radiomics derived from slice-reduced CT (srCT) scans versus full-chest CT (fcCT) for diagnosing and staging of interstitial lung disease (ILD) in systemic sclerosis (SSc), considering the potential to reduce radiation exposure. Material and methods The fcCT corresponded to a standard high-resolution full-chest CT whereas the srCT consisted of nine axial slices. 1451 radiomic features in two dimensions from srCT and 1375 features in three dimensions from fcCT scans were extracted from 166 SSc patients. The study included first- and second-order features from original and wavelet-transformed images. We assessed the predictive performance of quantitative CT (qCT)-based logistic regression (LR) models relying on preselected features and machine learning workflows involving LR and extra-trees classifiers with data-driven feature selection. The area under the receiver operating characteristic curve (AUC) was used to estimate model performance. Results The best models for diagnosis and staging ILD achieved AUC=0.85±0.08 and AUC=0.82±0.08 with srCT, and AUC=0.83±0.06 and AUC=0.76±0.08 with fcCT, respectively. srCT-based models showed slightly superior performance over fcCT-based models, particularly in 2D-radiomic analyses when interpolation resolution closely matched the original in-plane resolution. For diagnosis, the LR outperformed qCT-models, whereas for staging, the best results were obtained with a qCT-based model. Conclusions Radiomics from srCT is an effective and preferable alternative to fcCT for diagnosing and staging SSc-ILD. This approach not only enhances predictive accuracy but also minimizes radiation exposure risks, offering a promising avenue for improved treatment decision support in SSc-ILD management.
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Affiliation(s)
- Anja A Joye
- University Hospital of Zurich, Department of Radiation Oncology, Rämistrasse 100, Zürich 8091, Switzerland
| | - Marta Bogowicz
- University Hospital of Zurich, Department of Radiation Oncology, Rämistrasse 100, Zürich 8091, Switzerland
| | - Janine Gote-Schniering
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- University Hospital of Zurich, University Zurich, Institute for Diagnostic and Interventional Radiology, Switzerland
| | - Matthias Guckenberger
- University Hospital of Zurich, Department of Radiation Oncology, Rämistrasse 100, Zürich 8091, Switzerland
| | - Britta Maurer
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- University Hospital of Zurich, Department of Radiation Oncology, Rämistrasse 100, Zürich 8091, Switzerland
| | - Hubert S Gabryś
- University Hospital of Zurich, Department of Radiation Oncology, Rämistrasse 100, Zürich 8091, Switzerland
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Robertshaw MJ, Gorman A, Glazer CS, Adams TN. Effect of antigen removal in hypersensitivity pneumonitis. BMC Pulm Med 2024; 24:398. [PMID: 39164720 PMCID: PMC11337626 DOI: 10.1186/s12890-024-03098-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/12/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Antigen removal is a cornerstone of treatment of hypersensitivity pneumonitis (HP), but its association with transplant-free survival remains unclear. Further, HP guidelines conflict as to whether antigen removal is a recommended diagnostic test in patients with suspected HP. OBJECTIVE The purpose of this study is to (1) evaluate the impact of antigen removal on transplant-free survival and (2) to describe the impact of antigen removal on pulmonary function testing and imaging in a retrospective cohort of patients with HP. METHODS We retrospectively identified HP patients evaluated between 2011 and 2020. Demographic, physiologic, radiographic, and pathologic data were recorded. RESULTS 212 patients were included in the cohort. Patients who identified and removed antigen had a better transplant-free survival than patients who did not identify antigen and patients who identified but did not remove antigen. Antigen removal was associated with improvement in FVC by 10% predicted in 16.9% of patients with fibrotic HP and 56.7% of patients with nonfibrotic HP. DISCUSSION Our results suggest that over 50% of nonfibrotic HP patients and 16.9% of fibrotic HP patients improve with exposure removal. In addition, antigen removal, rather than antigen identification, is associated with transplant-free survival in HP.
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Affiliation(s)
- Mark J Robertshaw
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - April Gorman
- Department of Statistics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig S Glazer
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Traci N Adams
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA.
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Agarwal P, Dinkel J, Herold CJ. [Interstitial lung diseases-an update]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:609-611. [PMID: 39073565 DOI: 10.1007/s00117-024-01350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Prerana Agarwal
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland.
| | - Julien Dinkel
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, München, Deutschland
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), München, Deutschland
| | - Christian J Herold
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich
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Choe J, Hwang HJ, Lee SM, Yoon J, Kim N, Seo JB. CT Quantification of Interstitial Lung Abnormality and Interstitial Lung Disease: From Technical Challenges to Future Directions. Invest Radiol 2024:00004424-990000000-00233. [PMID: 39008898 DOI: 10.1097/rli.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
ABSTRACT Interstitial lung disease (ILD) encompasses a variety of lung disorders with varying degrees of inflammation or fibrosis, requiring a combination of clinical, imaging, and pathologic data for evaluation. Imaging is essential for the noninvasive diagnosis of the disease, as well as for assessing disease severity, monitoring its progression, and evaluating treatment response. However, traditional visual assessments of ILD with computed tomography (CT) suffer from reader variability. Automated quantitative CT offers a more objective approach by using computer-based analysis to consistently evaluate and measure ILD. Advancements in technology have significantly improved the accuracy and reliability of these measurements. Recently, interstitial lung abnormalities (ILAs), which represent potential preclinical ILD incidentally found on CT scans and are characterized by abnormalities in over 5% of any lung zone, have gained attention and clinical importance. The challenge lies in the accurate and consistent identification of ILA, given that its definition relies on a subjective threshold, making quantitative tools crucial for precise ILA evaluation. This review highlights the state of CT quantification of ILD and ILA, addressing clinical and research disparities while emphasizing how machine learning or deep learning in quantitative imaging can improve diagnosis and management by providing more accurate assessments, and finally, suggests the future directions of quantitative CT in this area.
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Affiliation(s)
- Jooae Choe
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.C., H.J.H., S.M.L., J.Y., N.K., J.B.S.); and Department of Convergence Medicine, Biomedical Engineering Research Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.Y. and N.K.)
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Ji H, Song X, Lv X, Shao F, Long Y, Song Y, Song W, Qiao P, Gai Y, Jiang D, Lan X. [ 68Ga]FAPI PET for Imaging and Treatment Monitoring in a Preclinical Model of Pulmonary Fibrosis: Comparison to [ 18F]FDG PET and CT. Pharmaceuticals (Basel) 2024; 17:726. [PMID: 38931393 PMCID: PMC11206307 DOI: 10.3390/ph17060726] [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: 04/14/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE This study aimed to evaluate the feasibility of using [68Ga]-fibroblast-activating protein inhibitor (FAPI) positron emission tomography (PET) imaging for diagnosing pulmonary fibrosis in a mouse model. We also examined its value in monitoring treatment response and compared it with traditional [18F]-fluorodeoxyglucose (FDG) PET and computed tomography (CT) imaging. METHODS A model of idiopathic pulmonary fibrosis was established using intratracheal injection of bleomycin (BLM, 2 mg/kg) into C57BL/6 male mice. For the treatment of IPF, a daily oral dose of 400 mg/kg/day of pirfenidone was administered from 9 to 28 days after the establishment of the model. Disease progression and treatment efficacy were assessed at different stages of the disease every week for four weeks using CT, [18F]FDG PET, and [68Ga]FAPI PET (baseline imaging performed at week 0). Mice were sacrificed and lung tissues were harvested for hematoxylin-eosin staining, picrosirius red staining, and immunohistochemical staining for glucose transporter 1 (GLUT1) and FAP. Expression levels of GLUT1 and FAP in pathological sections were quantified. Correlations between imaging parameters and pathological quantitative values were analyzed. RESULTS CT, [18F]FDG PET and [68Ga]FAPI PET revealed anatomical and functional changes in the lung that reflected progression of pulmonary fibrosis. In untreated mice with pulmonary fibrosis, lung uptake of [18F]FDG peaked on day 14, while [68Ga]FAPI uptake and mean lung density peaked on day 21. In mice treated with pirfenidone, mean lung density and lung uptake of both PET tracers decreased. Mean lung density, [18F]FDG uptake, and [68Ga]FAPI uptake correlated well with quantitative values of picrosirius red staining, GLUT1 expression, and FAP expression, respectively. Conclusions: Although traditional CT and [18F]FDG PET reflect anatomical and metabolic status in fibrotic lung, [68Ga]FAPI PET provides a means of evaluating fibrosis progression and monitoring treatment response.
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Affiliation(s)
- Hao Ji
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiangming Song
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiaoying Lv
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Fuqiang Shao
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yu Long
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yangmeihui Song
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenyu Song
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Pengxin Qiao
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yongkang Gai
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of the Ministry of Education, Wuhan 430022, China
| | - Dawei Jiang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of the Ministry of Education, Wuhan 430022, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (H.J.); (X.S.); (X.L.); (F.S.); (Y.L.); (Y.S.); (W.S.); (P.Q.); (Y.G.)
- Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of the Ministry of Education, Wuhan 430022, China
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Millan-Billi P, Castellví I, Martinez-Martinez L, Mariscal A, Barril S, D'Alessandro M, Franquet T, Castillo D. Diagnostic Value of Krebs von den Lungen (KL-6) for Interstitial Lung Disease: A European Prospective Cohort. Arch Bronconeumol 2024; 60:350-355. [PMID: 38644152 DOI: 10.1016/j.arbres.2024.03.028] [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: 01/24/2024] [Revised: 03/15/2024] [Accepted: 03/31/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Krebs von den Lungen 6 (KL-6) is a mucin-1 glycoprotein produced by type II pneumocytes. High levels of KL-6 in blood may be found in patients with lung fibrosis. In Asia this biomarker is used for diagnosis and prognosis in interstitial lung diseases (ILD). There is a lack of information regarding KL-6 cut-off point for diagnosis and prognosis in European population. The aim of this study was to establish the cut-off point for serum KL-6 associated with the presence of ILD in the Spanish population. METHODS Prospective study including subjects who underwent chest HRCT, PFTs and autoimmune blood analysis. Two groups were created: non-ILD subjects and ILD patients. Serum KL-6 concentrations were measured using a Lumipulse KL-6 reagent assay and the optimal cut-off value was evaluated by a ROC analysis. Data on demographics and smoking history was also collected. RESULTS One hundred seventy-nine patients were included, 102 with ILD. Median serum KL-6 values overall were 762U/mL, 1080 (±787)U/mL for the ILD group vs 340 (±152)U/mL for the non-ILD group (p<0.0001). The main radiological pattern was NSIP (43%). ROC analysis showed greater specificity (86%) and sensitivity (82%) for KL-6 465U/mL for detecting ILD patients. The multivariate logistic regression model pointed to the male sex, higher KL-6 values, lower FVC and low DLCO values as independent factors associated with ILD. CONCLUSION Serum KL-6 values greater than 465U/mL have excellent sensitivity and specificity for detecting ILD in our Spanish cohort. Multicentre studies are needed to validate our results.
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Affiliation(s)
- Paloma Millan-Billi
- Respiratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Iván Castellví
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Spain; Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Martinez-Martinez
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cellular Biology, Physiology, and Immunology Department, Universitat Autònoma de Barcelona, Spain
| | - Anais Mariscal
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cellular Biology, Physiology, and Immunology Department, Universitat Autònoma de Barcelona, Spain
| | - Silvia Barril
- Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cellular Biology, Physiology, and Immunology Department, Universitat Autònoma de Barcelona, Spain; Respiratory Medicine Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Miriana D'Alessandro
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - Tomás Franquet
- Radiology Department, Thoracic Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Diego Castillo
- Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Spain.
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Nan Y, Ser JD, Tang Z, Tang P, Xing X, Fang Y, Herrera F, Pedrycz W, Walsh S, Yang G. Fuzzy Attention Neural Network to Tackle Discontinuity in Airway Segmentation. IEEE TRANSACTIONS ON NEURAL NETWORKS AND LEARNING SYSTEMS 2024; 35:7391-7404. [PMID: 37204954 DOI: 10.1109/tnnls.2023.3269223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Airway segmentation is crucial for the examination, diagnosis, and prognosis of lung diseases, while its manual delineation is unduly burdensome. To alleviate this time-consuming and potentially subjective manual procedure, researchers have proposed methods to automatically segment airways from computerized tomography (CT) images. However, some small-sized airway branches (e.g., bronchus and terminal bronchioles) significantly aggravate the difficulty of automatic segmentation by machine learning models. In particular, the variance of voxel values and the severe data imbalance in airway branches make the computational module prone to discontinuous and false-negative predictions, especially for cohorts with different lung diseases. The attention mechanism has shown the capacity to segment complex structures, while fuzzy logic can reduce the uncertainty in feature representations. Therefore, the integration of deep attention networks and fuzzy theory, given by the fuzzy attention layer, should be an escalated solution for better generalization and robustness. This article presents an efficient method for airway segmentation, comprising a novel fuzzy attention neural network (FANN) and a comprehensive loss function to enhance the spatial continuity of airway segmentation. The deep fuzzy set is formulated by a set of voxels in the feature map and a learnable Gaussian membership function. Different from the existing attention mechanism, the proposed channel-specific fuzzy attention addresses the issue of heterogeneous features in different channels. Furthermore, a novel evaluation metric is proposed to assess both the continuity and completeness of airway structures. The efficiency, generalization, and robustness of the proposed method have been proved by training on normal lung disease while testing on datasets of lung cancer, COVID-19, and pulmonary fibrosis.
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Guerra X, Rennotte S, Fetita C, Boubaya M, Debray MP, Israël-Biet D, Bernaudin JF, Valeyre D, Cadranel J, Naccache JM, Nunes H, Brillet PY. U-net convolutional neural network applied to progressive fibrotic interstitial lung disease: Is progression at CT scan associated with a clinical outcome? Respir Med Res 2024; 85:101058. [PMID: 38141579 DOI: 10.1016/j.resmer.2023.101058] [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: 05/31/2023] [Revised: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Computational advances in artificial intelligence have led to the recent emergence of U-Net convolutional neural networks (CNNs) applied to medical imaging. Our objectives were to assess the progression of fibrotic interstitial lung disease (ILD) using routine CT scans processed by a U-Net CNN developed by our research team, and to identify a progression threshold indicative of poor prognosis. METHODS CT scans and clinical history of 32 patients with idiopathic fibrotic ILDs were retrospectively reviewed. Successive CT scans were processed by the U-Net CNN and ILD quantification was obtained. Correlation between ILD and FVC changes was assessed. ROC curve was used to define a threshold of ILD progression rate (PR) to predict poor prognostic (mortality or lung transplantation). The PR threshold was used to compare the cohort survival with Kaplan Mayer curves and log-rank test. RESULTS The follow-up was 3.8 ± 1.5 years encompassing 105 CT scans, with 3.3 ± 1.1 CT scans per patient. A significant correlation between ILD and FVC changes was obtained (p = 0.004, ρ = -0.30 [95% CI: -0.16 to -0.45]). Sixteen patients (50%) experienced unfavorable outcome including 13 deaths and 3 lung transplantations. ROC curve analysis showed an aera under curve of 0.83 (p < 0.001), with an optimal cut-off PR value of 4%/year. Patients exhibiting a PR ≥ 4%/year during the first two years had a poorer prognosis (p = 0.001). CONCLUSIONS Applying a U-Net CNN to routine CT scan allowed identifying patients with a rapid progression and unfavorable outcome.
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Affiliation(s)
- Xavier Guerra
- Department of Radiology, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France.
| | - Simon Rennotte
- Samovar Laboratory, Télécom SudParis, Institut Polytechnique de Paris, Evry, France
| | - Catalin Fetita
- Samovar Laboratory, Télécom SudParis, Institut Polytechnique de Paris, Evry, France
| | - Marouane Boubaya
- Clinical Research Unit, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne Paris-Nord, Bobigny, France
| | - Marie-Pierre Debray
- Department of Radiology, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dominique Israël-Biet
- Department of Pulmonology, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris - Cité, Paris, France
| | - Jean-François Bernaudin
- INSERM UMR 1272 Hypoxie & Poumon SMBH, Université Sorbonne Paris - Nord, Bobigny, France; Medicine Sorbonne Université, Paris, France
| | - Dominique Valeyre
- INSERM UMR 1272 Hypoxie & Poumon SMBH, Université Sorbonne Paris - Nord, Bobigny, France; Department of Pulmonology, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Jacques Cadranel
- Medicine Sorbonne Université, Paris, France; Department of Pulmonology, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jean-Marc Naccache
- Department of Pulmonology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Hilario Nunes
- INSERM UMR 1272 Hypoxie & Poumon SMBH, Université Sorbonne Paris - Nord, Bobigny, France; Department of Pulmonology, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Pierre-Yves Brillet
- Department of Radiology, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France; INSERM UMR 1272 Hypoxie & Poumon SMBH, Université Sorbonne Paris - Nord, Bobigny, France
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Provan SA, Ahlfors F, Bakland G, Hu Y, Kristianslund EK, Ikdahl E, Kvien TK, Aaløkken TM, Hoffmann-Vold AM. A validation of register-derived diagnoses of interstitial lung disease in patients with inflammatory arthritis: data from the NOR-DMARD study. Scand J Rheumatol 2024; 53:173-179. [PMID: 38314728 DOI: 10.1080/03009742.2024.2306716] [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: 09/13/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE There is a lack of knowledge concerning the validity of the interstitial lung disease (ILD) diagnoses used in epidemiological studies on rheumatic diseases. This paper seeks to verify register-derived ILD diagnoses using chest computed tomography (CT) and medical records as a gold standard. METHOD The Norwegian Anti-Rheumatic Drug Register (NOR-DMARD) is a multicentre prospective observational study of patients with inflammatory arthritis who start treatment with disease-modifying anti-rheumatic drugs. NOR-DMARD is linked to the Norwegian Patient Registry (NPR) and Cause of Death Registry. We searched registers for ILD coded by ICD-10 J84 or J99 among patients with rheumatoid arthritis, psoriatic arthritis, or spondyloarthritis. We extracted chest CT reports and medical records from participating hospitals. Two expert thoracic radiologists scored examinations to confirm the ILD diagnosis. We also searched medical records to find justifications for the diagnosis following multidisciplinary evaluations. We calculated the positive predictive values (PPVs) for ILD across subsets. RESULTS We identified 71 cases with an ILD diagnosis. CT examinations were available in 65/71 patients (91.5%), of whom ILD was confirmed on CT in 29/65 (44.6%). In a further 10 patients, medical records confirmed the diagnosis, giving a total of 39/71 verified cases. The PPV of a register-derived ILD diagnosis was thus 54.9%. In a subset of patients who had received an ILD code at two or more time-points and had a CT scan taken within a relevant period, the PPV was 72.2%. CONCLUSION The validity of register-based diagnoses of ILD must be carefully considered in epidemiological studies.
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Affiliation(s)
- S A Provan
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Section for Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - F Ahlfors
- Department of Radiology, Sahlgrenska universitetssykehus, Göteborg, Sweden
| | - G Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway
| | - Y Hu
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - E K Kristianslund
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - E Ikdahl
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - T K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T M Aaløkken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - A M Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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10
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Lee JH, Chae KJ, Park J, Choi SM, Jang MJ, Hwang EJ, Jin GY, Goo JM. Measurement Variability of Same-Day CT Quantification of Interstitial Lung Disease: A Multicenter Prospective Study. Radiol Cardiothorac Imaging 2024; 6:e230287. [PMID: 38483245 PMCID: PMC11056748 DOI: 10.1148/ryct.230287] [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: 07/11/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 03/26/2024]
Abstract
Purpose To investigate quantitative CT (QCT) measurement variability in interstitial lung disease (ILD) on the basis of two same-day CT scans. Materials and Methods Participants with ILD were enrolled in this multicenter prospective study between March and October 2022. Participants underwent two same-day CT scans at an interval of a few minutes. Deep learning-based texture analysis software was used to segment ILD features. Fibrosis extent was defined as the sum of reticular opacity and honeycombing cysts. Measurement variability between scans was assessed with Bland-Altman analyses for absolute and relative differences with 95% limits of agreement (LOA). The contribution of fibrosis extent to variability was analyzed using a multivariable linear mixed-effects model while adjusting for lung volume. Eight readers assessed ILD fibrosis stability with and without QCT information for 30 randomly selected samples. Results Sixty-five participants were enrolled in this study (mean age, 68.7 years ± 10 [SD]; 47 [72%] men, 18 [28%] women). Between two same-day CT scans, the 95% LOA for the mean absolute and relative differences of quantitative fibrosis extent were -0.9% to 1.0% and -14.8% to 16.1%, respectively. However, these variabilities increased to 95% LOA of -11.3% to 3.9% and -123.1% to 18.4% between CT scans with different reconstruction parameters. Multivariable analysis showed that absolute differences were not associated with the baseline extent of fibrosis (P = .09), but the relative differences were negatively associated (β = -0.252, P < .001). The QCT results increased readers' specificity in interpreting ILD fibrosis stability (91.7% vs 94.6%, P = .02). Conclusion The absolute QCT measurement variability of fibrosis extent in ILD was 1% in same-day CT scans. Keywords: CT, CT-Quantitative, Thorax, Lung, Lung Diseases, Interstitial, Pulmonary Fibrosis, Diagnosis, Computer Assisted, Diagnostic Imaging Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
| | | | - Jimyung Park
- From the Department of Radiology and Institute of Radiation Medicine
(J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine (J.P., S.M.C.), and Medical Research
Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul
National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080,
Korea; Department of Radiology, Research Institute of Clinical Medicine of
Jeonbuk National University Biomedical Research Institute of Jeonbuk National
University Hospital, Jeonbuk National University and Medical School, Jeonju,
Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver,
Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University
Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute,
Seoul National University, Seoul, Korea (J.M.G.)
| | - Sun Mi Choi
- From the Department of Radiology and Institute of Radiation Medicine
(J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine (J.P., S.M.C.), and Medical Research
Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul
National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080,
Korea; Department of Radiology, Research Institute of Clinical Medicine of
Jeonbuk National University Biomedical Research Institute of Jeonbuk National
University Hospital, Jeonbuk National University and Medical School, Jeonju,
Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver,
Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University
Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute,
Seoul National University, Seoul, Korea (J.M.G.)
| | - Myoung-jin Jang
- From the Department of Radiology and Institute of Radiation Medicine
(J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine (J.P., S.M.C.), and Medical Research
Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul
National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080,
Korea; Department of Radiology, Research Institute of Clinical Medicine of
Jeonbuk National University Biomedical Research Institute of Jeonbuk National
University Hospital, Jeonbuk National University and Medical School, Jeonju,
Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver,
Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University
Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute,
Seoul National University, Seoul, Korea (J.M.G.)
| | - Eui Jin Hwang
- From the Department of Radiology and Institute of Radiation Medicine
(J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine (J.P., S.M.C.), and Medical Research
Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul
National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080,
Korea; Department of Radiology, Research Institute of Clinical Medicine of
Jeonbuk National University Biomedical Research Institute of Jeonbuk National
University Hospital, Jeonbuk National University and Medical School, Jeonju,
Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver,
Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University
Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute,
Seoul National University, Seoul, Korea (J.M.G.)
| | - Gong Yong Jin
- From the Department of Radiology and Institute of Radiation Medicine
(J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine (J.P., S.M.C.), and Medical Research
Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul
National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080,
Korea; Department of Radiology, Research Institute of Clinical Medicine of
Jeonbuk National University Biomedical Research Institute of Jeonbuk National
University Hospital, Jeonbuk National University and Medical School, Jeonju,
Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver,
Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University
Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute,
Seoul National University, Seoul, Korea (J.M.G.)
| | - Jin Mo Goo
- From the Department of Radiology and Institute of Radiation Medicine
(J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine (J.P., S.M.C.), and Medical Research
Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul
National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080,
Korea; Department of Radiology, Research Institute of Clinical Medicine of
Jeonbuk National University Biomedical Research Institute of Jeonbuk National
University Hospital, Jeonbuk National University and Medical School, Jeonju,
Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver,
Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University
Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute,
Seoul National University, Seoul, Korea (J.M.G.)
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11
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Alqurashi H, Marillier M, Neder-Serafini I, Bernard AC, Moran-Mendoza O, Neder JA. Impact of obesity progression or regression on the longitudinal assessment of fibrosing interstitial lung disease. Eur Respir J 2024; 63:2301864. [PMID: 38514096 DOI: 10.1183/13993003.01864-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Hadeel Alqurashi
- Division of Respirology and Sleep Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada
| | - Mathieu Marillier
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Igor Neder-Serafini
- Division of Respirology and Sleep Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada
| | | | - Onofre Moran-Mendoza
- Division of Respirology and Sleep Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada
| | - J Alberto Neder
- Division of Respirology and Sleep Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada
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12
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Ahn Y, Lee SM, Nam Y, Lee H, Choe J, Do KH, Seo JB. Deep Learning-Based CT Reconstruction Kernel Conversion in the Quantification of Interstitial Lung Disease: Effect on Reproducibility. Acad Radiol 2024; 31:693-705. [PMID: 37516583 DOI: 10.1016/j.acra.2023.06.008] [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: 04/21/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 07/31/2023]
Abstract
RATIONALE AND OBJECTIVES The effect of different computed tomography (CT) reconstruction kernels on the quantification of interstitial lung disease (ILD) has not been clearly demonstrated. The study aimed to investigate the effect of reconstruction kernels on the quantification of ILD on CT and determine whether deep learning-based kernel conversion can reduce the variability of automated quantification results between different CT kernels. MATERIALS AND METHODS Patients with ILD or interstitial lung abnormality who underwent noncontrast high-resolution CT between June 2022 and September 2022 were retrospectively included. Images were reconstructed with three different kernels: B30f, B50f, and B60f. B60f was regarded as the reference standard for quantification, and B30f and B50f images were converted to B60f images using a deep learning-based algorithm. Each disease pattern of ILD and the fibrotic score were quantified using commercial software. The effect of kernel conversion on measurement variability was estimated using intraclass correlation coefficient (ICC) and Bland-Altman method. RESULTS A total of 194 patients were included in the study. Application of different kernels induced differences in the quantified extent of each pattern. Reticular opacity and honeycombing were underestimated on B30f images and overestimated on B50f images. After kernel conversion, measurement variability was reduced (mean difference, from -2.0 to 3.9 to -0.3 to 0.4%, and 95% limits of agreement [LOA], from [-5.0, 12.7] to [-2.7, 2.1]). The fibrotic score for converted B60f from B50f images was almost equivalent to the original B60f (ICC, 1.000; mean difference, 0.0; and 95% LOA [-0.4, 0.4]). CONCLUSION Quantitative CT analysis of ILD was affected by the application of different kernels, but deep learning-based kernel conversion effectively reduced measurement variability, improving the reproducibility of quantification.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea (Y.A., S.M.L., J.C., K.-H.D., J.B.S.)
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea (Y.A., S.M.L., J.C., K.-H.D., J.B.S.).
| | - Yujin Nam
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea (Y.N.)
| | - Hyunna Lee
- Bigdata Research Center, Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea (H.L.)
| | - Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea (Y.A., S.M.L., J.C., K.-H.D., J.B.S.)
| | - Kyung-Hyun Do
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea (Y.A., S.M.L., J.C., K.-H.D., J.B.S.)
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea (Y.A., S.M.L., J.C., K.-H.D., J.B.S.)
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13
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Waseem Sabir M, Farhan M, Almalki NS, Alnfiai MM, Sampedro GA. FibroVit-Vision transformer-based framework for detection and classification of pulmonary fibrosis from chest CT images. Front Med (Lausanne) 2023; 10:1282200. [PMID: 38020169 PMCID: PMC10666764 DOI: 10.3389/fmed.2023.1282200] [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: 08/23/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Pulmonary Fibrosis (PF) is an immedicable respiratory condition distinguished by permanent fibrotic alterations in the pulmonary tissue for which there is no cure. Hence, it is crucial to diagnose PF swiftly and precisely. The existing research on deep learning-based pulmonary fibrosis detection methods has limitations, including dataset sample sizes and a lack of standardization in data preprocessing and evaluation metrics. This study presents a comparative analysis of four vision transformers regarding their efficacy in accurately detecting and classifying patients with Pulmonary Fibrosis and their ability to localize abnormalities within Images obtained from Computerized Tomography (CT) scans. The dataset consisted of 13,486 samples selected out of 24647 from the Pulmonary Fibrosis dataset, which included both PF-positive CT and normal images that underwent preprocessing. The preprocessed images were divided into three sets: the training set, which accounted for 80% of the total pictures; the validation set, which comprised 10%; and the test set, which also consisted of 10%. The vision transformer models, including ViT, MobileViT2, ViTMSN, and BEiT were subjected to training and validation procedures, during which hyperparameters like the learning rate and batch size were fine-tuned. The overall performance of the optimized architectures has been assessed using various performance metrics to showcase the consistent performance of the fine-tuned model. Regarding performance, ViT has shown superior performance in validation and testing accuracy and loss minimization, specifically for CT images when trained at a single epoch with a tuned learning rate of 0.0001. The results were as follows: validation accuracy of 99.85%, testing accuracy of 100%, training loss of 0.0075, and validation loss of 0.0047. The experimental evaluation of the independently collected data gives empirical evidence that the optimized Vision Transformer (ViT) architecture exhibited superior performance compared to all other optimized architectures. It achieved a flawless score of 1.0 in various standard performance metrics, including Sensitivity, Specificity, Accuracy, F1-score, Precision, Recall, Mathew Correlation Coefficient (MCC), Precision-Recall Area under the Curve (AUC PR), Receiver Operating Characteristic and Area Under the Curve (ROC-AUC). Therefore, the optimized Vision Transformer (ViT) functions as a reliable diagnostic tool for the automated categorization of individuals with pulmonary fibrosis (PF) using chest computed tomography (CT) scans.
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Affiliation(s)
| | - Muhammad Farhan
- Department of Computer Science, COMSATS University Islamabad, Sahiwal, Pakistan
| | - Nabil Sharaf Almalki
- Department of Special Education, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Mrim M. Alnfiai
- Department of Information Technology, College of Computers and Information Technology, Taif University, Taif, Saudi Arabia
| | - Gabriel Avelino Sampedro
- Faculty of Information and Communication Studies, University of the Philippines Open University, Los Baños, Philippines
- Center for Computational Imaging and Visual Innovations, De La Salle University, Manila, Philippines
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14
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Qin S, Jiao B, Kang B, Li H, Liu H, Ji C, Yang S, Yuan H, Wang X. Non-contrast computed tomography-based radiomics for staging of connective tissue disease-associated interstitial lung disease. Front Immunol 2023; 14:1213008. [PMID: 37868980 PMCID: PMC10587549 DOI: 10.3389/fimmu.2023.1213008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Rationale and introduction It is of significance to assess the severity and predict the mortality of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). In this double-center retrospective study, we developed and validated a radiomics nomogram for clinical management by using the ILD-GAP (gender, age, and pulmonary physiology) index system. Materials and methods Patients with CTD-ILD were staged using the ILD-GAP index system. A clinical factor model was built by demographics and CT features, and a radiomics signature was developed using radiomics features extracted from CT images. Combined with the radiomics signature and independent clinical factors, a radiomics nomogram was constructed and evaluated by the area under the curve (AUC) from receiver operating characteristic (ROC) analyses. The models were externally validated in dataset 2 to evaluate the model generalization ability using ROC analysis. Results A total of 245 patients from two clinical centers (dataset 1, n = 202; dataset 2, n = 43) were screened. Pack-years of smoking, traction bronchiectasis, and nine radiomics features were used to build the radiomics nomogram, which showed favorable calibration and discrimination in the training cohort {AUC, 0.887 [95% confidence interval (CI): 0.827-0.940]}, the internal validation cohort [AUC, 0.885 (95% CI: 0.816-0.922)], and the external validation cohort [AUC, 0.85 (95% CI: 0.720-0.919)]. Decision curve analysis demonstrated that the nomogram outperformed the clinical factor model and radiomics signature in terms of clinical usefulness. Conclusion The CT-based radiomics nomogram showed favorable efficacy in predicting individual ILD-GAP stages.
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Affiliation(s)
- Songnan Qin
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Bingxuan Jiao
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Bing Kang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Haiou Li
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hongwu Liu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Congshan Ji
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shifeng Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hongtao Yuan
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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15
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Capaccione KM, Salvatore MM. Radiographic grading system for usual interstitial pneumonia correlates with mortality and may serve as a surrogate endpoint in clinical trials. Clin Imaging 2023; 102:37-41. [PMID: 37541085 DOI: 10.1016/j.clinimag.2023.07.002] [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: 03/02/2023] [Revised: 06/25/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE Usual interstitial pneumonia (UIP)/ idiopathic pulmonary fibrosis (IFP) is a relentlessly progressive lung disease with outcomes similar to cancer. We have previously established a radiologic grading system for UIP and demonstrated that it correlates with pulmonary function tests; here we test the hypothesis that it correlates with mortality. Validating a correlation with mortality will demonstrate the utility of this system for monitoring progression over time clinically and in trials of anti-fibrotic agents. METHODS We searched the radiology record system "Catalyst" to identify cases and reviewed each case to confirm the diagnosis. 94 patients met the inclusion criteria for further assessment. Chest CT grade was determined by consensus of two cardiothoracic radiologists. Data was analyzed to identify the interval between chest CT and death. This interval was correlated with CT grade using Spearman correlation analysis. RESULTS For all cases, chest CT grade and mortality demonstrated a positive correlation of rs = 0.37732, 2-tailed p = 0.00018. We also employed subgroup analysis; for the subgroup with intervals less than or equal to 100 days, there was a positive correlation, rs = 0.48339, 2-tailed p = 0.03602; for the subgroup with an interval greater than 100 days between imaging and death there was a positive correlation, rs = 0.302, 2-tailed p = 0.00846. CONCLUSION These data support use of this system for monitoring clinical progression and as a surrogate endpoint for clinical trials. Future work building upon the data presented here will evaluate its utility in clinical trials and develop automated grading.
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Affiliation(s)
- Kathleen M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, United States of America.
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, United States of America
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16
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Jiao XY, Song H, Liu WW, Yang JL, Wang ZW, Yang D, Huang S. The effect of CALIPER-derived parameters for idiopathic pulmonary fibrosis in predicting prognosis, progression, and mortality: a systematic review. Eur Radiol 2023; 33:7262-7273. [PMID: 37528299 DOI: 10.1007/s00330-023-10010-w] [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: 09/03/2022] [Revised: 05/07/2023] [Accepted: 06/03/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND High-resolution computed tomography (HRCT), as the main tool for monitoring idiopathic pulmonary fibrosis (IPF), is characterized by subjective variability among radiologists and insensitivity to subtle changes. Recently, a few studies have aimed to decrease subjective bias by assessing the severity of IPF using computer software, i.e., Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER). However, these studies had diverse research directions. In this review, we systematically assess the effect of CALIPER in the management of IPF. METHODS A systematic review was conducted through a search of published studies in PubMed, Web of Science, Cochrane, Embase, Scopus, and CNKI databases from database inception through February 28, 2022. The methodological quality would be evaluated by using Methodological Index for Non-Randomized Studies (MINORS). Narrative synthesis summarized findings by participant characteristics, study design, and associations with outcomes. RESULTS Ten studies were included. They evaluated the relationship between CALIPER-derived parameters and pulmonary function test (PFT) and mortality. CALIPER-derived parameters showed a significant correlation with PFT and mortality. Two studies reported that CALIPER could be used to stratify outcomes. CONCLUSION CALIPER-derived parameters can be used to evaluate prognosis and mortality. CALIPER-derived parameters combined with composite physiologic index (CPI) or Gender-Age-Physiology (GAP) could help clinicians implement targeted management by refining prognostic stratification. However, research has been constrained by small number of retrospective investigations and sample sizes. Therefore, it is essential to design prospective controlled studies and establish the staging system by CALIPER-derived parameters and combining them with CPI, FVC, or GAP. CLINICAL RELEVANCE STATEMENT It is beneficial for clinic to provide objective, sensitive, and accurate indicators of disease progression. It also helps the clinic to develop individualized treatment plans based on the stage of disease progression and provides evaluation of efficacy in drug trials. KEY POINTS • Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER) is a quantitative CT analysis software that can be used to evaluate the progression of disease on CT. • The CALIPER-derived vessel-related structure shows great performance in the management of idiopathic pulmonary fibrosis. • CALIPER-derived parameters combined with composite physiologic index or Gender-Age-Physiology can be used to refine prognostic stratification.
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Affiliation(s)
- Xin-Yao Jiao
- Department of Radiology, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China
| | - Han Song
- Department of Radiology, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China
| | - Wei-Wu Liu
- Department of Radiology, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China
| | - Jun-Ling Yang
- Department of Respiratory, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China
| | - Zhi-Wei Wang
- Department of Radiology, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China
| | - Dan Yang
- Department of Radiology, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China
| | - Sa Huang
- Department of Radiology, The Second Hospital of Jilin University, Changchun, 130041, People's Republic of China.
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17
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Romei C. CALIPER-derived parameters for outcome prediction in idiopathic pulmonary fibrosis. Eur Radiol 2023; 33:7260-7261. [PMID: 37552262 DOI: 10.1007/s00330-023-10068-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Chiara Romei
- 2nd Radiology Unit, Radiology Department, Pisa University Hospital, Pisa, Italy.
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18
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Sigaux J, Cavalin C, Lescoat A, El Rharras S, Macchi O, Brillet PY, Sesé L, Nunes H, Boissier MC, Rosental PA, Semerano L. Are cleaning activities a source of exposure to crystalline silica in women with rheumatoid arthritis? A case-control study. RMD Open 2023; 9:e003205. [PMID: 37532470 PMCID: PMC10401212 DOI: 10.1136/rmdopen-2023-003205] [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: 04/03/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Inhalation of crystalline silica (silicon dioxide, SiO2) is associated with a wide range of acute and chronic diseases, including rheumatoid arthritis (RA). The objectives of this work were to identify the main sources of exposure to SiO2 in a series of patients with RA not selected on the basis of their professional activity, compared with a representative sample of the French general population, and to assess the association between silica exposure and disease features. METHODS The Dust Exposure Life-Course Questionnaire (DELCQ) is a tool that enables retrospective quantification of both occupational and non-occupational lifetime exposure to SiO2. DELCQ-previously validated in a large representative sample of the French general population-was administered to 97 consecutive RA patients, and exposure scores were compared between cases and age, gender and smoking status-matched controls (1:4). The main sources of SiO2 exposure were identified in cases and controls, and source-specific exposure levels were compared. The association between DELCQ scores and disease variables in cases was tested via univariable and multivariable analyses. RESULTS In women with RA, the main sources of SiO2 exposure were cleaning activities and dusty clothes laundry, with higher exposure levels from these sources versus the general population (p<0.005). Across the whole series of RA patients, high SiO2 exposure was independently associated with mediastinal lymphadenopathy (OR 6.3, 95% CI 1.4 to 27.7). CONCLUSION Cleaning activities and dusty clothes laundry may be underestimated sources of SiO2 exposure in women with RA.
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Affiliation(s)
- Johanna Sigaux
- UMR Inserm U1125, Université Sorbonne Paris Nord, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Catherine Cavalin
- UMR CNRS-INRAE 7170-1427, Université Paris Dauphine, Paris, France
- Laboratoire interdisciplinaire d'évaluation des politiques publiques (LIEPP), Paris, France
| | - Alain Lescoat
- University Hospital Centre Rennes, Rennes, France
- Institut de Recherche en Santé, Environnement et Travail, INSERM, Paris, France
| | - Sarah El Rharras
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Odile Macchi
- Centre d'études des mouvements sociaux, Ecole des Hautes Etudes en Sciences Sociales (EHESS), Paris, France
| | - Pierre-Yves Brillet
- Radiology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Lucile Sesé
- Physiology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Hilario Nunes
- Respiratory Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Marie-Christophe Boissier
- UMR Inserm U1125, Université Sorbonne Paris Nord, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | | | - Luca Semerano
- UMR Inserm U1125, Université Sorbonne Paris Nord, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
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Mancini M, Bargiacchi L, De Vitis C, D'Ascanio M, De Dominicis C, Ibrahim M, Rendina EA, Ricci A, Di Napoli A, Mancini R, Vecchione A. Histologic Analysis of Idiopathic Pulmonary Fibrosis by Morphometric and Fractal Analysis. Biomedicines 2023; 11:biomedicines11051483. [PMID: 37239155 DOI: 10.3390/biomedicines11051483] [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: 04/04/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic lung disorder, ultimately leading to respiratory failure and death. Despite great research advances in understanding the mechanisms underlying the disease, its diagnosis, and its treatment, IPF still remains idiopathic without known biological or histological markers able to predict disease progression or response to treatment. The histologic hallmark of IPF is usual interstitial pneumonia (UIP), with its intricate architectural distortion and temporal inhomogeneity. We hypothesize that normal lung alveolar architecture can be compared to fractals, such as the Pythagoras tree with its fractal dimension (Df), and every pathological insult, distorting the normal lung structure, could result in Df variations. In this study, we aimed to assess the UIP histologic fractal dimension in relationship to other morphometric parameters in newly diagnosed IPF patients and its possible role in the prognostic stratification of the disease. Clinical data and lung tissue specimens were obtained from twelve patients with IPF, twelve patients with non-specific interstitial pneumonia (NSIP), and age-matched "healthy" control lung tissue from patients undergoing lung surgery for other causes. Histology and histomorphometry were performed to evaluate Df and lacunarity measures, using the box counting method on the FracLac ImageJ plugin. The results showed that Df was significantly higher in IPF patients compared to controls and fibrotic NSIP patients, indicating greater architectural distortion in IPF. Additionally, high Df values were associated with higher fibroblastic foci density and worse prognostic outcomes in IPF, suggesting that Df may serve as a potential novel prognostic marker for IPF. The scalability of Df measurements was demonstrated through repeated measurements on smaller portions from the same surgical biopsies, which were selected to mimic a cryobiopsy. Our study provides further evidence to support the use of fractal morphometry as a tool for quantifying and determining lung tissue remodeling in IPF, and we demonstrated a significant correlation between histological and radiological Df in UIP pattern, as well as a significant association between Df and FF density. Furthermore, our study demonstrates the scalability and self-similarity of Df measurements across different biopsy types, including surgical and smaller specimens.
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Affiliation(s)
- Massimiliano Mancini
- Morphologic and Molecular Pathology Unit, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Lavinia Bargiacchi
- Morphologic and Molecular Pathology Unit, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Claudia De Vitis
- Department of Clinical and Molecular Medicine Sant'Andrea University Hospital, "Sapienza" University of Rome", 00189 Rome, Italy
| | - Michela D'Ascanio
- UOC Respiratory Disease, Sant'Andrea University Hospital, 00189 Rome, Italy
| | | | - Mohsen Ibrahim
- Thoracic Surgery Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, 00189 Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, 00189 Rome, Italy
| | - Alberto Ricci
- Department of Clinical and Molecular Medicine Sant'Andrea University Hospital, "Sapienza" University of Rome", 00189 Rome, Italy
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine Sant'Andrea University Hospital, "Sapienza" University of Rome", 00189 Rome, Italy
| | - Rita Mancini
- Department of Clinical and Molecular Medicine Sant'Andrea University Hospital, "Sapienza" University of Rome", 00189 Rome, Italy
| | - Andrea Vecchione
- Department of Clinical and Molecular Medicine Sant'Andrea University Hospital, "Sapienza" University of Rome", 00189 Rome, Italy
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20
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Stainer A, Tonutti A, De Santis M, Amati F, Ceribelli A, Bongiovanni G, Torrisi C, Iacopino A, Mangiameli G, Aliberti S, Selmi C. Unmet needs and perspectives in rheumatoid arthritis-associated interstitial lung disease: A critical review. Front Med (Lausanne) 2023; 10:1129939. [PMID: 37007765 PMCID: PMC10062456 DOI: 10.3389/fmed.2023.1129939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by synovitis as the most common clinical manifestation, and interstitial lung disease (RA-ILD) represents one of the most common and potentially severe extra-articular features. Our current understanding of the mechanisms and predictors of RA-ILD is limited despite the demonstration that an early identification of progressive fibrosing forms is crucial to provide timely treatment with antifibrotic therapies. While high resolution computed tomography is the gold standard technique for the diagnosis and follow-up of RA-ILD, it has been hypothesized that serum biomarkers (including novel and rare autoantibodies), new imaging techniques such as ultrasound of the lung, or the application of innovative radiologic algorithms may help towards predicting and detecting early forms of diseases. Further, while new treatments are becoming available for idiopathic and connective tissue disease-associated forms of lung fibrosis, the treatment of RA-ILD remains anecdotal and largely unexplored. We are convinced that a better understanding of the mechanisms connecting RA with ILD in a subgroup of patients as well as the creation of adequate diagnostic pathways will be mandatory steps for a more effective management of this clinically challenging entity.
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Affiliation(s)
- Anna Stainer
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Respiratory Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Antonio Tonutti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- *Correspondence: Maria De Santis,
| | - Francesco Amati
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Respiratory Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Angela Ceribelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gabriele Bongiovanni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Chiara Torrisi
- Department of Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Antonio Iacopino
- Department of Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Mangiameli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Respiratory Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
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21
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Sviridenko A, di Santo G, Virgolini I. Imaging Fibrosis. PET Clin 2023:S1556-8598(23)00017-2. [PMID: 36990946 DOI: 10.1016/j.cpet.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Tissue injury in nonmalignant human disease can develop from either disproportionate inflammation or exaggerated fibrotic responses. The molecular and cellular fundamental of these 2 processes, their impact on disease prognosis and the treatment concept deviates fundamentally. Consequently, the synchronous assessment and quantification of these 2 processes in vivo is extremely desirable. Although noninvasive molecular techniques such as 18F-fluorodeoxyglucose PET offer insights into the degree of inflammatory activity, the assessment of the molecular dynamics of fibrosis remains challenging. The 68Ga-fibroblast activation protein inhibitor-46 may improve noninvasive clinical diagnostic performance in patients with both fibroinflammatory pathology and long-term CT-abnormalities after severe COVID-19.
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22
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Smyth RM, Neder JA, James MD, Vincent SG, Milne KM, Marillier M, de-Torres JP, Moran-Mendoza O, O'Donnell DE, Phillips DB. Physiological underpinnings of exertional dyspnoea in mild fibrosing interstitial lung disease. Respir Physiol Neurobiol 2023; 312:104041. [PMID: 36858334 DOI: 10.1016/j.resp.2023.104041] [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: 01/26/2023] [Revised: 02/20/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
The functional disturbances driving "out-of-proportion" dyspnoea in patients with fibrosing interstitial lung disease (f-ILD) showing only mild restrictive abnormalities remain poorly understood. Eighteen patients (10 with idiopathic pulmonary fibrosis) showing preserved spirometry and mildly reduced total lung capacity (≥70% predicted) and 18 controls underwent an incremental cardiopulmonary exercise test with measurements of operating lung volumes and Borg dyspnoea scores. Patients' lower exercise tolerance was associated with higher ventilation (V̇E)/carbon dioxide (V̇CO2) compared with controls (V̇E/V̇CO2 nadir=35 ± 3 versus 29 ± 2; p < 0.001). Patients showed higher tidal volume/inspiratory capacity and lower inspiratory reserve volume at a given exercise intensity, reporting higher dyspnoea scores as a function of both work rate and V̇E. Steeper dyspnoea-work rate slopes were associated with lower lung diffusing capacity, higher V̇E/V̇CO2, and lower peak O2 uptake (p < 0.05). Heightened ventilatory demands in the setting of progressively lower capacity for tidal volume expansion on exertion largely explain higher-than-expected dyspnoea in f-ILD patients with largely preserved dynamic and "static" lung volumes at rest.
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Affiliation(s)
- Reginald M Smyth
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - J Alberto Neder
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Matthew D James
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Sandra G Vincent
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Kathryn M Milne
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada; Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
| | - Mathieu Marillier
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France.
| | - Juan P de-Torres
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Onofre Moran-Mendoza
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Denis E O'Donnell
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Devin B Phillips
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
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Hsia CCW, Bates JHT, Driehuys B, Fain SB, Goldin JG, Hoffman EA, Hogg JC, Levin DL, Lynch DA, Ochs M, Parraga G, Prisk GK, Smith BM, Tawhai M, Vidal Melo MF, Woods JC, Hopkins SR. Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report. Ann Am Thorac Soc 2023; 20:161-195. [PMID: 36723475 PMCID: PMC9989862 DOI: 10.1513/annalsats.202211-915st] [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] [Indexed: 02/02/2023] Open
Abstract
Multiple thoracic imaging modalities have been developed to link structure to function in the diagnosis and monitoring of lung disease. Volumetric computed tomography (CT) renders three-dimensional maps of lung structures and may be combined with positron emission tomography (PET) to obtain dynamic physiological data. Magnetic resonance imaging (MRI) using ultrashort-echo time (UTE) sequences has improved signal detection from lung parenchyma; contrast agents are used to deduce airway function, ventilation-perfusion-diffusion, and mechanics. Proton MRI can measure regional ventilation-perfusion ratio. Quantitative imaging (QI)-derived endpoints have been developed to identify structure-function phenotypes, including air-blood-tissue volume partition, bronchovascular remodeling, emphysema, fibrosis, and textural patterns indicating architectural alteration. Coregistered landmarks on paired images obtained at different lung volumes are used to infer airway caliber, air trapping, gas and blood transport, compliance, and deformation. This document summarizes fundamental "good practice" stereological principles in QI study design and analysis; evaluates technical capabilities and limitations of common imaging modalities; and assesses major QI endpoints regarding underlying assumptions and limitations, ability to detect and stratify heterogeneous, overlapping pathophysiology, and monitor disease progression and therapeutic response, correlated with and complementary to, functional indices. The goal is to promote unbiased quantification and interpretation of in vivo imaging data, compare metrics obtained using different QI modalities to ensure accurate and reproducible metric derivation, and avoid misrepresentation of inferred physiological processes. The role of imaging-based computational modeling in advancing these goals is emphasized. Fundamental principles outlined herein are critical for all forms of QI irrespective of acquisition modality or disease entity.
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Unsupervised machine learning identifies predictive progression markers of IPF. Eur Radiol 2023; 33:925-935. [PMID: 36066734 PMCID: PMC9889455 DOI: 10.1007/s00330-022-09101-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/06/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To identify and evaluate predictive lung imaging markers and their pathways of change during progression of idiopathic pulmonary fibrosis (IPF) from sequential data of an IPF cohort. To test if these imaging markers predict outcome. METHODS We studied radiological disease progression in 76 patients with IPF, including overall 190 computed tomography (CT) examinations of the chest. An algorithm identified candidates for imaging patterns marking progression by computationally clustering visual CT features. A classification algorithm selected clusters associated with radiological disease progression by testing their value for recognizing the temporal sequence of examinations. This resulted in radiological disease progression signatures, and pathways of lung tissue change accompanying progression observed across the cohort. Finally, we tested if the dynamics of marker patterns predict outcome, and performed an external validation study on a cohort from a different center. RESULTS Progression marker patterns were identified and exhibited high stability in a repeatability experiment with 20 random sub-cohorts of the overall cohort. The 4 top-ranked progression markers were consistently selected as most informative for progression across all random sub-cohorts. After spatial image registration, local tracking of lung pattern transitions revealed a network of tissue transition pathways from healthy to a sequence of disease tissues. The progression markers were predictive for outcome, and the model achieved comparable results on a replication cohort. CONCLUSIONS Unsupervised learning can identify radiological disease progression markers that predict outcome. Local tracking of pattern transitions reveals pathways of radiological disease progression from healthy lung tissue through a sequence of diseased tissue types. KEY POINTS • Unsupervised learning can identify radiological disease progression markers that predict outcome in patients with idiopathic pulmonary fibrosis. • Local tracking of pattern transitions reveals pathways of radiological disease progression from healthy lung tissue through a sequence of diseased tissue types. • The progression markers achieved comparable results on a replication cohort.
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25
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Benegas Urteaga M, Ramírez Ruz J, Sánchez González M. Idiopathic pulmonary fibrosis. RADIOLOGIA 2022; 64 Suppl 3:227-239. [PMID: 36737162 DOI: 10.1016/j.rxeng.2022.10.009] [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: 09/30/2022] [Accepted: 10/29/2022] [Indexed: 02/05/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common fibrosing lung disease. It is associated with a very poor prognosis. Treatments can delay the progression of IPF, so early diagnosis is fundamental. Radiologists play a fundamental role in the evaluation and accurate diagnosis of IPF. Identifying the characteristic patterns of IPF on high-resolution computed tomography (HRCT) is key in the process of multidisciplinary diagnosis, often obviating the need for surgical lung biopsies. This review describes and illustrates the clinical and imaging findings in IPF in the context of the most recent international guidelines, as well as the differential diagnosis and the role of HRCT in follow-up and assessment of complications.
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Affiliation(s)
- M Benegas Urteaga
- Servicio de Radiodiagnóstico, CDI, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Ramírez Ruz
- Servicio de Anatomía Patológica, CDB, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Sánchez González
- Servicio de Radiodiagnóstico, CDI, Hospital Clínic de Barcelona, Barcelona, Spain.
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26
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Gabryś HS, Gote-Schniering J, Brunner M, Bogowicz M, Blüthgen C, Frauenfelder T, Guckenberger M, Maurer B, Tanadini-Lang S. Transferability of radiomic signatures from experimental to human interstitial lung disease. Front Med (Lausanne) 2022; 9:988927. [DOI: 10.3389/fmed.2022.988927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
BackgroundInterstitial lung disease (ILD) defines a group of parenchymal lung disorders, characterized by fibrosis as their common final pathophysiological stage. To improve diagnosis and treatment of ILD, there is a need for repetitive non-invasive characterization of lung tissue by quantitative parameters. In this study, we investigated whether CT image patterns found in mice with bleomycin induced lung fibrosis can be translated as prognostic factors to human patients diagnosed with ILD.MethodsBleomycin was used to induce lung fibrosis in mice (n_control = 36, n_experimental = 55). The patient cohort consisted of 98 systemic sclerosis (SSc) patients (n_ILD = 65). Radiomic features (n_histogram = 17, n_texture = 137) were extracted from microCT (mice) and HRCT (patients) images. Predictive performance of the models was evaluated with the area under the receiver-operating characteristic curve (AUC). First, predictive performance of individual features was examined and compared between murine and patient data sets. Second, multivariate models predicting ILD were trained on murine data and tested on patient data. Additionally, the models were reoptimized on patient data to reduce the influence of the domain shift on the performance scores.ResultsPredictive power of individual features in terms of AUC was highly correlated between mice and patients (r = 0.86). A model based only on mean image intensity in the lung scored AUC = 0.921 ± 0.048 in mice and AUC = 0.774 (CI95% 0.677-0.859) in patients. The best radiomic model based on three radiomic features scored AUC = 0.994 ± 0.013 in mice and validated with AUC = 0.832 (CI95% 0.745-0.907) in patients. However, reoptimization of the model weights in the patient cohort allowed to increase the model’s performance to AUC = 0.912 ± 0.058.ConclusionRadiomic signatures of experimental ILD derived from microCT scans translated to HRCT of humans with SSc-ILD. We showed that the experimental model of BLM-induced ILD is a promising system to test radiomic models for later application and validation in human cohorts.
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Juge P, Granger B, Debray M, Ebstein E, Louis‐Sidney F, Kedra J, Doyle TJ, Borie R, Constantin A, Combe B, Flipo R, Mariette X, Vittecoq O, Saraux A, Carvajal‐Alegria G, Sibilia J, Berenbaum F, Kannengiesser C, Boileau C, Sparks JA, Crestani B, Fautrel B, Dieudé P. A Risk Score to Detect Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease. Arthritis Rheumatol 2022; 74:1755-1765. [PMID: 35583934 PMCID: PMC9828082 DOI: 10.1002/art.42162] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Patients at high risk of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) would benefit from being identified before the onset of respiratory symptoms; this can be done by screening patients with the use of chest high-resolution computed tomography (HRCT). Our objective was to develop and validate a risk score for patients who have subclinical RA-ILD. METHODS Our study included a discovery population and a replication population from 2 prospective RA cohorts (ESPOIR and TRANSLATE2, respectively) without pulmonary symptoms who had received chest HRCT scans. All patients were genotyped for MUC5B rs35705950. After multiple logistic regression, a risk score based on independent risk factors for subclinical RA-ILD was developed in the discovery population and tested for validation in the replication population. RESULTS The discovery population included 163 patients with RA, and the replication population included 89 patients with RA. The prevalence of subclinical RA-ILD was 19.0% and 16.9%, respectively. In the discovery population, independent risk factors for subclinical RA-ILD were presence of the MUC5B rs35705950 T allele (odds ratio [OR] 3.74 [95% confidence interval (95% CI) 1.37, 10.39]), male sex (OR 3.93 [95% CI 1.40, 11.39]), older age at RA onset (for each year, OR 1.10 [95% CI 1.04, 1.16]), and increased mean Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (for each unit, OR 2.03 [95% CI 1.24, 3.42]). We developed and validated a derived risk score with receiver operating characteristic areas under the curve of 0.82 (95% CI 0.70-0.94) for the discovery population and 0.78 (95% CI 0.65-0.92) for the replication population. Excluding MUC5B rs35705950 from the model provided a lower goodness of fit (likelihood ratio test, P = 0.01). CONCLUSION We developed and validated a risk score that could help identify patients at high risk of subclinical RA-ILD. Our findings support an important contribution of MUC5B rs35705950 to subclinical RA-ILD risk.
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Affiliation(s)
- Pierre‐Antoine Juge
- Université de Paris, INSERM UMR 1152, F‐75018, and Service de Rhumatologie, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
| | - Benjamin Granger
- Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique Département de Biostatistiques, INSERM UMR 1136, F‐75013, and Santé Publique et Information Médicale, Groupe Hospitalier Pitié‐SalpêtrièreAP‐HP, F‐5013ParisFrance
| | - Marie‐Pierre Debray
- Université de Paris, INSERM UMR 1152, F‐75018, and Service de Radiologie, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
| | - Esther Ebstein
- Service de Rhumatologie, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
| | | | - Joanna Kedra
- Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique Département de Biostatistiques, INSERM UMR 1136, F‐75013, and Service de Rhumatologie, Groupe Hospitalier Pitié‐SalpêtrièreAP‐HP, F‐75013ParisFrance
| | - Tracy J. Doyle
- Division of Pulmonary and Critical Care Medicine, Department of MedicineBrigham and Women's HospitalBostonMassachusetts
| | - Raphaël Borie
- Université de Paris, INSERM UMR 1152, F‐75018, Service de Pneumologie A, Centre de compétences maladies pulmonaires rares, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
| | - Arnaud Constantin
- Université Toulouse III–Paul Sabatier, INSERM UMR 1043, F‐31024, and Service de Rhumatologie, Hôpital Purpan, F‐31024ToulouseFrance
| | - Bernard Combe
- Université de Montpellier and Departement de Rhumatologie, Hôpital Lapeyronie, F‐34000MontpellierFrance
| | - René‐Marc Flipo
- Université de Lille, and Service de Rhumatologie, Hôpital Salengro, F‐59000LilleFrance
| | - Xavier Mariette
- Université Paris‐Saclay, INSERM UMR 1184, CEA, F‐94270, and Service de Rhumatologie, Hôpital BicêtreAP‐HP, F‐94270Le Kremlin BicêtreFrance
| | - Olivier Vittecoq
- Rouen University Hospital, Service de Rhumatologie, CIC‐CRB 1404, F‐76000, and Normandy University, UNIROUEN, INSERM, U1234, FR‐76000RouenFrance
| | - Alain Saraux
- Université de Bretagne Occidentale, INSERM UMR 1227, F‐29200, and Service de Rhumatologie, Hôpital de la Cavale Blanche, F‐2900BrestFrance
| | - Guillermo Carvajal‐Alegria
- Université de Bretagne Occidentale, INSERM UMR 1227, F‐29200, and Service de Rhumatologie, Hôpital de la Cavale Blanche, F‐2900BrestFrance
| | - Jean Sibilia
- Université de Strasbourg, INSERM UMR S1109, F‐67000, and Service de Rhumatologie, RESO: Centre de Reference des Maladies Autoimmunes Systémiques Rares Est Sud‐Ouest, Hôpital De Hautepierre, F‐67000StrasbourgFrance
| | - Francis Berenbaum
- Sorbonne Université, CRSA, INSERM UMR 938, F‐75012, Service de Rhumatologie, Hôpital Saint‐AntoineAP‐HP, F‐75012ParisFrance
| | - Caroline Kannengiesser
- Université de Paris, INSERM UMR 1152, F‐75018, Département de Génétique Moléculaire, Hôpital Bichat‐Claude BernardAP‐HP, FR‐75018ParisFrance
| | - Catherine Boileau
- Département de Génétique Moléculaire, Hôpital Bichat‐Claude Bernard, AP‐HP, FR‐75018, Université de Paris, INSERM UMR 1148, F‐75018ParisFrance
| | - Jeffrey A. Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical SchoolBostonMassachusetts
| | - Bruno Crestani
- Université de Paris, INSERM UMR 1152, F‐75018, Service de Pneumologie A, Centre de compétences maladies pulmonaires rares, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
| | - Bruno Fautrel
- Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique Département de Biostatistiques, INSERM UMR 1136, F‐75013, and Service de Rhumatologie, Groupe Hospitalier Pitié‐SalpêtrièreAP‐HP, F‐75013ParisFrance
| | - Philippe Dieudé
- Université de Paris, INSERM UMR 1152, F‐75018, and Service de Rhumatologie, Hôpital Bichat‐Claude BernardAP‐HP, F‐75018ParisFrance
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Benegas Urteaga M, Ramírez Ruz J, Sánchez González M. Fibrosis pulmonar idiopática. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Axelsson GT, Halldorsson AB, Jonsson HM, Eythorsson E, Sigurdardottir SE, Hardardottir H, Gudmundsson G, Hansdottir S. Respiratory function and CT abnormalities among survivors of COVID-19 pneumonia: a nationwide follow-up study. BMJ Open Respir Res 2022; 9:9/1/e001347. [PMID: 36216402 PMCID: PMC9556742 DOI: 10.1136/bmjresp-2022-001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Considering the pulmonary burden caused by acute COVID-19, questions remain of respiratory consequences after recovery. The aim of the study was to describe respiratory function of COVID-19 pneumonia survivors at mid-term follow-up (median 68 days) and assess whether impairments were predicted by acute illness severity or residual CT abnormalities. METHODS Residents of Iceland that had COVID-19 and oxygen saturation ≤94% from 28 February 2020 to 30 April 2021 were offered a clinical follow-up visit with an interview, a 6 min walk test (6MWT), spirometry with gas exchange measurement and chest CT. The results of these examinations were described, grouped by the level of care during acute illness. The associations of disease severity and CT abnormalities at follow-up with subjective dyspnoea, 6MWT results and lung function test results were estimated with regression analyses. RESULTS Of 190 eligible patients, 164 (86%) participated in the study. Of those, 32 had never been admitted to hospital, 103 were admitted to hospital without intensive care and 29 had required intensive care. At a follow-up, need for intensive care during acute illness was associated with shorter walking distance on 6MWT, lower oxygen saturation and lower DLCO. Imaging abnormalities at follow-up were observed for most participants (74%) and the magnitude of these changes was associated with decrements in 6MWT distance, oxygen saturation, forced vital capacity and DLCO. CONCLUSIONS The findings show that impaired exercise capacity and lung physiology at follow-up were primarily observed for patients with COVID-19 pneumonia that required intensive care treatment and/or had persistent imaging abnormalities.
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Affiliation(s)
- Gisli Thor Axelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland,Department of Internal Medicine, Landspitali, Reykjavik, Iceland
| | | | | | - Elias Eythorsson
- Department of Internal Medicine, Landspitali, Reykjavik, Iceland
| | | | - Hronn Hardardottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland,Department of Respiratory Medicine and Sleep, Landspitali, Reykjavik, Iceland
| | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland,Department of Respiratory Medicine and Sleep, Landspitali, Reykjavik, Iceland
| | - Sif Hansdottir
- Department of Respiratory Medicine and Sleep, Landspitali, Reykjavik, Iceland
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Computed Tomography Imaging in ILD: New Trends for the Clinician. J Clin Med 2022; 11:jcm11195952. [PMID: 36233818 PMCID: PMC9573254 DOI: 10.3390/jcm11195952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
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Lee I, Kim J, Yeo Y, Lee JY, Jeong I, Joh JS, Kim G, Chin BS, Kim Y, Kim MK, Jeon J, Yoon Y, Jin SC, Kim J. Prognostic Factors for Pulmonary Fibrosis Following Pneumonia in Patients with COVID-19: A Prospective Study. J Clin Med 2022; 11:jcm11195913. [PMID: 36233779 PMCID: PMC9573655 DOI: 10.3390/jcm11195913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
The frequency and clinical manifestation of lung fibrosis accompanied by coronavirus disease (COVID-19) are not well-established. We aimed to identify the factors attributed to post-COVID-19 fibrosis. This single-center prospective study included patients diagnosed with COVID-19 pneumonia from 12 April to 22 October 2021 in the Republic of Korea. The primary outcome was the presence of pulmonary fibrosis on a CT scan 3 months after discharge; the fibrosis risk was estimated by a multiple logistic regression. The mean patient age was 55.03 ± 12.32 (range 27–85) years; 65 (66.3%) were men and 33 (33.7%) were women. The age, Charlson Comorbidity Index, lactate dehydrogenase level, aspartate aminotransferase level, and Krebs von den Lungen-6 level were significantly higher and the albumin level and the saturation of the peripheral oxygen/fraction of inspired oxygen (SpO2/FiO2) ratio were significantly lower in the fibrosis group than in the non-fibrosis group; the need for initial oxygen support was also greater in the fibrosis group. An older age (adjusted odds ratio (AOR) 1.12; 95% confidence interval (CI) 1.03–1.21) and a lower initial SpO2/FiO2 ratio (AOR 7.17; 95% CI 1.72–29.91) were significant independent risk factors for pulmonary fibrosis after COVID-19 pneumonia. An older age and a low initial SpO2/FiO2 ratio were crucial in predicting pulmonary fibrosis after COVID-19 pneumonia.
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Affiliation(s)
- Inhan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
| | - Joohae Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
| | - Yohwan Yeo
- Department of Family Medicine, College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea
| | - Ji Yeon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
| | - Ina Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
| | - Joon-Sung Joh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
| | - Gayeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
| | - Bum Sik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
| | - Yeonjae Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
| | - Min-Kyung Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
| | - Jaehyun Jeon
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
| | - Yup Yoon
- Department of Radiology, National Medical Center, Seoul 04564, Korea
| | - Sung Chan Jin
- Department of Radiology, National Medical Center, Seoul 04564, Korea
| | - Junghyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Korea
- Correspondence: ; Tel.: +82-31-8086-2470
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Khanna D, Distler O, Cottin V, Brown KK, Chung L, Goldin JG, Matteson EL, Kazerooni EA, Walsh SL, McNitt-Gray M, Maher TM. Diagnosis and monitoring of systemic sclerosis-associated interstitial lung disease using high-resolution computed tomography. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:168-178. [PMID: 36211204 PMCID: PMC9537704 DOI: 10.1177/23971983211064463] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 01/09/2023]
Abstract
Patients with systemic sclerosis are at high risk of developing systemic sclerosis-associated interstitial lung disease. Symptoms and outcomes of systemic sclerosis-associated interstitial lung disease range from subclinical lung involvement to respiratory failure and death. Early and accurate diagnosis of systemic sclerosis-associated interstitial lung disease is therefore important to enable appropriate intervention. The most sensitive and specific way to diagnose systemic sclerosis-associated interstitial lung disease is by high-resolution computed tomography, and experts recommend that high-resolution computed tomography should be performed in all patients with systemic sclerosis at the time of initial diagnosis. In addition to being an important screening and diagnostic tool, high-resolution computed tomography can be used to evaluate disease extent in systemic sclerosis-associated interstitial lung disease and may be helpful in assessing prognosis in some patients. Currently, there is no consensus with regards to frequency and scanning intervals in patients at risk of interstitial lung disease development and/or progression. However, expert guidance does suggest that frequency of screening using high-resolution computed tomography should be guided by risk of developing interstitial lung disease. Most experienced clinicians would not repeat high-resolution computed tomography more than once a year or every other year for the first few years unless symptoms arose. Several computed tomography techniques have been developed in recent years that are suitable for regular monitoring, including low-radiation protocols, which, together with other technologies, such as lung ultrasound and magnetic resonance imaging, may further assist in the evaluation and monitoring of patients with systemic sclerosis-associated interstitial lung disease. A video abstract to accompany this article is available at: https://www.globalmedcomms.com/respiratory/Khanna/HRCTinSScILD.
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Affiliation(s)
- Dinesh Khanna
- Scleroderma Program, Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Vincent Cottin
- Hospices Civils de Lyon, Department of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, INRAE, UMR754, University Claude Bernard Lyon 1, Lyon, France
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Lorinda Chung
- Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Jonathan G Goldin
- David Geffen School of Medicine and UCLA Medical Center, Los Angeles, CA, USA
| | | | - Ella A Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA
- Division of Pulmonary Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Simon Lf Walsh
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Michael McNitt-Gray
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Physics and Biology in Medicine Graduate Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
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Hoang-Thi TN, Chassagnon G, Tran HD, Le-Dong NN, Dinh-Xuan AT, Revel MP. How Artificial Intelligence in Imaging Can Better Serve Patients with Bronchial and Parenchymal Lung Diseases? J Pers Med 2022; 12:jpm12091429. [PMID: 36143214 PMCID: PMC9505778 DOI: 10.3390/jpm12091429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
With the rapid development of computing today, artificial intelligence has become an essential part of everyday life, with medicine and lung health being no exception. Big data-based scientific research does not mean simply gathering a large amount of data and letting the machines do the work by themselves. Instead, scientists need to identify problems whose solution will have a positive impact on patients’ care. In this review, we will discuss the role of artificial intelligence from both physiological and anatomical standpoints, starting with automatic quantitative assessment of anatomical structures using lung imaging and considering disease detection and prognosis estimation based on machine learning. The evaluation of current strengths and limitations will allow us to have a broader view for future developments.
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Affiliation(s)
- Trieu-Nghi Hoang-Thi
- Department of Diagnostic Imaging, Vinmec Healthcare System, Ho Chi Minh City 70000, Vietnam
| | - Guillaume Chassagnon
- AP-HP. Centre, Cochin Hospital, Department of Radiology, Université de Paris, 75005 Paris, France
| | - Hai-Dang Tran
- Department of Diagnostic Imaging, Vinmec Healthcare System, Ho Chi Minh City 70000, Vietnam
| | - Nhat-Nam Le-Dong
- AP-HP. Centre, Cochin Hospital, Department of Respiratory Physiology, Université de Paris, 75005 Paris, France
| | - Anh Tuan Dinh-Xuan
- AP-HP. Centre, Cochin Hospital, Department of Respiratory Physiology, Université de Paris, 75005 Paris, France
| | - Marie-Pierre Revel
- AP-HP. Centre, Cochin Hospital, Department of Radiology, Université de Paris, 75005 Paris, France
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34
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Current Imaging of Idiopathic Pulmonary Fibrosis. Radiol Clin North Am 2022; 60:873-888. [DOI: 10.1016/j.rcl.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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35
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Wu X, Yin C, Chen X, Zhang Y, Su Y, Shi J, Weng D, Jiang X, Zhang A, Zhang W, Li H. Idiopathic Pulmonary Fibrosis Mortality Risk Prediction Based on Artificial Intelligence: The CTPF Model. Front Pharmacol 2022; 13:878764. [PMID: 35559265 PMCID: PMC9086624 DOI: 10.3389/fphar.2022.878764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) needs a precise prediction method for its prognosis. This study took advantage of artificial intelligence (AI) deep learning to develop a new mortality risk prediction model for IPF patients. Methods: We established an artificial intelligence honeycomb segmentation system that segmented the honeycomb tissue area automatically from 102 manually labeled (by radiologists) cases of IPF patients’ CT images. The percentage of honeycomb in the lung was calculated as the CT fibrosis score (CTS). The severity of the patients was evaluated by pulmonary function and physiological feature (PF) parameters (including FVC%pred, DLco%pred, SpO2%, age, and gender). Another 206 IPF cases were randomly divided into a training set (n = 165) and a verification set (n = 41) to calculate the fibrosis percentage in each case by the AI system mentioned previously. Then, using a competing risk (Fine–Gray) proportional hazards model, a risk score model was created according to the training set’s patient data and used the validation data set to validate this model. Result: The final risk prediction model (CTPF) was established, and it included the CT stages and the PF (pulmonary function and physiological features) grades. The CT stages were defined into three stages: stage I (CTS≤5), stage II (5 < CTS<25), and stage III (≥25). The PF grades were classified into mild (a, 0–3 points), moderate (b, 4–6 points), and severe (c, 7–10 points). The AUC index and Briers scores at 1, 2, and 3 years in the training set were as follows: 74.3 [63.2,85.4], 8.6 [2.4,14.8]; 78 [70.2,85.9], 16.0 [10.1,22.0]; and 72.8 [58.3,87.3], 18.2 [11.9,24.6]. The results of the validation sets were similar and suggested that high-risk patients had significantly higher mortality rates. Conclusion: This CTPF model with AI technology can predict mortality risk in IPF precisely.
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Affiliation(s)
- Xuening Wu
- The Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Chengsheng Yin
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.,Department of Pulmonary and Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Xianqiu Chen
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yiliang Su
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dong Weng
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Xing Jiang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Aihong Zhang
- Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China
| | - Wenqiang Zhang
- The Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Huiping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
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Raghu G, Remy-Jardin M, Richeldi L, Thomson CC, Inoue Y, Johkoh T, Kreuter M, Lynch DA, Maher TM, Martinez FJ, Molina-Molina M, Myers JL, Nicholson AG, Ryerson CJ, Strek ME, Troy LK, Wijsenbeek M, Mammen MJ, Hossain T, Bissell BD, Herman DD, Hon SM, Kheir F, Khor YH, Macrea M, Antoniou KM, Bouros D, Buendia-Roldan I, Caro F, Crestani B, Ho L, Morisset J, Olson AL, Podolanczuk A, Poletti V, Selman M, Ewing T, Jones S, Knight SL, Ghazipura M, Wilson KC. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2022; 205:e18-e47. [PMID: 35486072 PMCID: PMC9851481 DOI: 10.1164/rccm.202202-0399st] [Citation(s) in RCA: 894] [Impact Index Per Article: 447.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: This American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax guideline updates prior idiopathic pulmonary fibrosis (IPF) guidelines and addresses the progression of pulmonary fibrosis in patients with interstitial lung diseases (ILDs) other than IPF. Methods: A committee was composed of multidisciplinary experts in ILD, methodologists, and patient representatives. 1) Update of IPF: Radiological and histopathological criteria for IPF were updated by consensus. Questions about transbronchial lung cryobiopsy, genomic classifier testing, antacid medication, and antireflux surgery were informed by systematic reviews and answered with evidence-based recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 2) Progressive pulmonary fibrosis (PPF): PPF was defined, and then radiological and physiological criteria for PPF were determined by consensus. Questions about pirfenidone and nintedanib were informed by systematic reviews and answered with evidence-based recommendations using the GRADE approach. Results:1) Update of IPF: A conditional recommendation was made to regard transbronchial lung cryobiopsy as an acceptable alternative to surgical lung biopsy in centers with appropriate expertise. No recommendation was made for or against genomic classifier testing. Conditional recommendations were made against antacid medication and antireflux surgery for the treatment of IPF. 2) PPF: PPF was defined as at least two of three criteria (worsening symptoms, radiological progression, and physiological progression) occurring within the past year with no alternative explanation in a patient with an ILD other than IPF. A conditional recommendation was made for nintedanib, and additional research into pirfenidone was recommended. Conclusions: The conditional recommendations in this guideline are intended to provide the basis for rational, informed decisions by clinicians.
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Su Y, Qiu ZS, Chen J, Ju MJ, Ma GG, He JW, Yu SJ, Liu K, Lure FYM, Tu GW, Zhang YY, Luo Z. Usage of compromised lung volume in monitoring steroid therapy on severe COVID-19. Respir Res 2022; 23:105. [PMID: 35488261 PMCID: PMC9051749 DOI: 10.1186/s12931-022-02025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/14/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Quantitative computed tomography (QCT) analysis may serve as a tool for assessing the severity of coronavirus disease 2019 (COVID-19) and for monitoring its progress. The present study aimed to assess the association between steroid therapy and quantitative CT parameters in a longitudinal cohort with COVID-19. METHODS Between February 7 and February 17, 2020, 72 patients with severe COVID-19 were retrospectively enrolled. All 300 chest CT scans from these patients were collected and classified into five stages according to the interval between hospital admission and follow-up CT scans: Stage 1 (at admission); Stage 2 (3-7 days); Stage 3 (8-14 days); Stage 4 (15-21 days); and Stage 5 (22-31 days). QCT was performed using a threshold-based quantitative analysis to segment the lung according to different Hounsfield unit (HU) intervals. The primary outcomes were changes in percentage of compromised lung volume (%CL, - 500 to 100 HU) at different stages. Multivariate Generalized Estimating Equations were performed after adjusting for potential confounders. RESULTS Of 72 patients, 31 patients (43.1%) received steroid therapy. Steroid therapy was associated with a decrease in %CL (- 3.27% [95% CI, - 5.86 to - 0.68, P = 0.01]) after adjusting for duration and baseline %CL. Associations between steroid therapy and changes in %CL varied between different stages or baseline %CL (all interactions, P < 0.01). Steroid therapy was associated with decrease in %CL after stage 3 (all P < 0.05), but not at stage 2. Similarly, steroid therapy was associated with a more significant decrease in %CL in the high CL group (P < 0.05), but not in the low CL group. CONCLUSIONS Steroid administration was independently associated with a decrease in %CL, with interaction by duration or disease severity in a longitudinal cohort. The quantitative CT parameters, particularly compromised lung volume, may provide a useful tool to monitor COVID-19 progression during the treatment process. Trial registration Clinicaltrials.gov, NCT04953247. Registered July 7, 2021, https://clinicaltrials.gov/ct2/show/NCT04953247.
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Affiliation(s)
- Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ze-Song Qiu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Jun Chen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min-Jie Ju
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Guang Ma
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jin-Wei He
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Shen-Ji Yu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Yu-Yao Zhang
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China.
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
- Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
- Shanghai Key Lab of Lung Inflammation and Injury, Shanghai, China.
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Su Y, Qiu ZS, Chen J, Ju MJ, Ma GG, He JW, Yu SJ, Liu K, Lure FYM, Tu GW, Zhang YY, Luo Z. Usage of compromised lung volume in monitoring steroid therapy on severe COVID-19. Respir Res 2022. [PMID: 35488261 DOI: 10.21203/rs.3.rs-698051/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Quantitative computed tomography (QCT) analysis may serve as a tool for assessing the severity of coronavirus disease 2019 (COVID-19) and for monitoring its progress. The present study aimed to assess the association between steroid therapy and quantitative CT parameters in a longitudinal cohort with COVID-19. METHODS Between February 7 and February 17, 2020, 72 patients with severe COVID-19 were retrospectively enrolled. All 300 chest CT scans from these patients were collected and classified into five stages according to the interval between hospital admission and follow-up CT scans: Stage 1 (at admission); Stage 2 (3-7 days); Stage 3 (8-14 days); Stage 4 (15-21 days); and Stage 5 (22-31 days). QCT was performed using a threshold-based quantitative analysis to segment the lung according to different Hounsfield unit (HU) intervals. The primary outcomes were changes in percentage of compromised lung volume (%CL, - 500 to 100 HU) at different stages. Multivariate Generalized Estimating Equations were performed after adjusting for potential confounders. RESULTS Of 72 patients, 31 patients (43.1%) received steroid therapy. Steroid therapy was associated with a decrease in %CL (- 3.27% [95% CI, - 5.86 to - 0.68, P = 0.01]) after adjusting for duration and baseline %CL. Associations between steroid therapy and changes in %CL varied between different stages or baseline %CL (all interactions, P < 0.01). Steroid therapy was associated with decrease in %CL after stage 3 (all P < 0.05), but not at stage 2. Similarly, steroid therapy was associated with a more significant decrease in %CL in the high CL group (P < 0.05), but not in the low CL group. CONCLUSIONS Steroid administration was independently associated with a decrease in %CL, with interaction by duration or disease severity in a longitudinal cohort. The quantitative CT parameters, particularly compromised lung volume, may provide a useful tool to monitor COVID-19 progression during the treatment process. Trial registration Clinicaltrials.gov, NCT04953247. Registered July 7, 2021, https://clinicaltrials.gov/ct2/show/NCT04953247.
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Affiliation(s)
- Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ze-Song Qiu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Jun Chen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min-Jie Ju
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Guang Ma
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jin-Wei He
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Shen-Ji Yu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Yu-Yao Zhang
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China.
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China. .,Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China. .,Shanghai Key Lab of Lung Inflammation and Injury, Shanghai, China.
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Robbie H, Wells AU, Fang C, Jacob J, Walsh SLF, Nair A, Camoras R, Desai SR, Devaraj A. Serial decline in lung volume parameters on computed tomography (CT) predicts outcome in idiopathic pulmonary fibrosis (IPF). Eur Radiol 2022; 32:2650-2660. [PMID: 34716781 PMCID: PMC7615167 DOI: 10.1007/s00330-021-08338-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In patients with IPF, this study aimed (i) to examine the relationship between serial change in CT parameters of lung volume and lung function, (ii) to identify the prognostic value of serial change in CT parameters of lung volume, and (iii) to define a threshold for serial change in CT markers of lung volume that optimally captures disease progression. METHODS Serial CTs were analysed for progressive volume loss or fibrosis progression in 81 IPF patients (66 males, median age = 67 years) with concurrent forced vital capacity (FVC) (median follow-up 12 months, range 6-23 months). Serial CT measurements of volume loss comprised oblique fissure posterior retraction distance (OFPRD), aortosternal distance (ASD), lung height corrected for body habitus (LH), and automated CT-derived total lung volumes (ALV) (measured using commercially available software). Fibrosis progression was scored visually. Serial changes in CT markers and FVC were compared using regression analysis, and evaluated against mortality using Cox proportional hazards. RESULTS There were 58 deaths (72%, median survival = 17 months). Annual % change in ALV was most significantly related to annual % change in FVC (R2 = 0.26, p < 0.0001). On multivariate analysis, annual % change in ASD predicted mortality (HR = 0.97, p < 0.001), whereas change in FVC did not. A 25% decline in annual % change in ASD best predicted mortality, superior to 10% decline in FVC and fibrosis progression. CONCLUSION In IPF, serial decline in CT markers of lung volume and, specifically, annualised 25% reduction in aortosternal distance provides evidence of disease progression, not always identified by FVC trends or changes in fibrosis extent. KEY POINTS • Serial decline in automated and surrogate markers of lung volume on CT corresponds to changes in FVC. • Annualised reductions in the distance between ascending aorta and posterior border of the sternum on CT predict mortality beyond annualised percentage change in FVC.
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Affiliation(s)
- Hasti Robbie
- King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, SE5 9RS, London , UK.
| | - Athol U Wells
- Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, SW3 6NP, London, UK
- National Heart and Lung Institute (NHLI), Dovehouse St, Chelsea, SW3 6LY, London, UK
- Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
| | - Cheng Fang
- King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, SE5 9RS, London , UK
| | - Joseph Jacob
- Centre for Medical Image Computing, 90 High Holborn, London, UK
- UCL Respiratory, Rayne building, 5 University Street, London, UK
| | - Simon L F Walsh
- National Heart and Lung Institute, Imperial College, London, UK
| | - Arjun Nair
- University College London Hospital, 235 Euston Rd, Fitzrovia, NW1 2BU, London, UK
| | - Rose Camoras
- Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, SW3 6NP, London, UK
| | - Sujal R Desai
- Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, SW3 6NP, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, SW3 6NP, London, UK
- National Heart and Lung Institute (NHLI), Dovehouse St, Chelsea, SW3 6LY, London, UK
- Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
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Kell DB, Laubscher GJ, Pretorius E. A central role for amyloid fibrin microclots in long COVID/PASC: origins and therapeutic implications. Biochem J 2022; 479:537-559. [PMID: 35195253 PMCID: PMC8883497 DOI: 10.1042/bcj20220016] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/15/2022]
Abstract
Post-acute sequelae of COVID (PASC), usually referred to as 'Long COVID' (a phenotype of COVID-19), is a relatively frequent consequence of SARS-CoV-2 infection, in which symptoms such as breathlessness, fatigue, 'brain fog', tissue damage, inflammation, and coagulopathies (dysfunctions of the blood coagulation system) persist long after the initial infection. It bears similarities to other post-viral syndromes, and to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Many regulatory health bodies still do not recognize this syndrome as a separate disease entity, and refer to it under the broad terminology of 'COVID', although its demographics are quite different from those of acute COVID-19. A few years ago, we discovered that fibrinogen in blood can clot into an anomalous 'amyloid' form of fibrin that (like other β-rich amyloids and prions) is relatively resistant to proteolysis (fibrinolysis). The result, as is strongly manifested in platelet-poor plasma (PPP) of individuals with Long COVID, is extensive fibrin amyloid microclots that can persist, can entrap other proteins, and that may lead to the production of various autoantibodies. These microclots are more-or-less easily measured in PPP with the stain thioflavin T and a simple fluorescence microscope. Although the symptoms of Long COVID are multifarious, we here argue that the ability of these fibrin amyloid microclots (fibrinaloids) to block up capillaries, and thus to limit the passage of red blood cells and hence O2 exchange, can actually underpin the majority of these symptoms. Consistent with this, in a preliminary report, it has been shown that suitable and closely monitored 'triple' anticoagulant therapy that leads to the removal of the microclots also removes the other symptoms. Fibrin amyloid microclots represent a novel and potentially important target for both the understanding and treatment of Long COVID and related disorders.
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Affiliation(s)
- Douglas B. Kell
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, U.K
- The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kemitorvet 200, 2800 Kgs Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, 7602, South Africa
| | | | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, 7602, South Africa
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Usefulness of Body Composition CT Analysis in Patients with Idiopathic Pulmonary Fibrosis: A Pilot Study. Acad Radiol 2022; 29 Suppl 2:S191-S201. [PMID: 34417107 DOI: 10.1016/j.acra.2021.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the feasibility of a chest CT-based body composition analysis in idiopathic pulmonary fibrosis (IPF), and to investigate the respective contribution of lung and muscle CT quantitative analyses to the prognosis of IPF. METHOD A total of 71 IPF patients were recruited at diagnosis. All patients underwent a standard chest CT-scan and a bioelectrical impedance analysis considered as reference standard for estimating malnutrition through the use of the fat-free mass index (FFMI). The skeletal muscle index (SMI) was measured on chest-CT at the level of the first lumbar vertebra by two radiologists. Lung fibrosis extent was quantified by three radiologists in consensus. The extent of emphysema, the pulmonary artery to aorta (PA/AO) diameter ratio and lymph node enlargement were also reported. Mortality and hospitalization over a 14-month follow-up were recorded. RESULTS A low FFMI defining malnutrition was identified in 26.8% of patients. SMI was significantly lower in these patients (p<0.001) and was correlated with FFMI (r=0.637, p<0.001). Interobserver agreement of SMI measurement was very good (ICC=0.91). For diagnosing malnutrition, SMI showed a 0.79 sensitivity, a 0.69 specificity, a 0.48 PPV and a 0.90 NPV. In univariate analysis, fibrosis extent was significantly associated with death, while SMI did not reach significance. In multivariate analysis, fibrosis extent and PA/AO ratio were independently associated with hospitalization. CONCLUSIONS SMI measured on chest CT could be a reliable tool to exclude malnutrition in IPF. A quantitative analysis of both fibrosis and skeletal muscle may allow holistic management of IPF patients.
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Röhrich M, Leitz D, Glatting FM, Wefers AK, Weinheimer O, Flechsig P, Kahn N, Mall MA, Giesel FL, Kratochwil C, Huber PE, Deimling AV, Heußel CP, Kauczor HU, Kreuter M, Haberkorn U. Fibroblast Activation Protein-Specific PET/CT Imaging in Fibrotic Interstitial Lung Diseases and Lung Cancer: A Translational Exploratory Study. J Nucl Med 2022; 63:127-133. [PMID: 34272325 PMCID: PMC8717194 DOI: 10.2967/jnumed.121.261925] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
Interstitial lung diseases (ILDs) comprise over 200 parenchymal lung disorders. Among them, fibrosing ILDs, especially idiopathic pulmonary fibrosis, are associated with a poor prognosis, whereas some other ILDs, such as sarcoidosis, have a much better prognosis. A high proportion manifests as fibrotic ILD (fILD). Lung cancer (LC) is a frequent complication of fILD. Activated fibroblasts are crucial for fibrotic processes in fILD. The aim of this exploratory study was to evaluate the imaging properties of static and dynamic fibroblast activation protein (FAP) inhibitor (FAPI) PET/CT in various types of fILD and to confirm FAP expression in fILD lesions by FAP immunohistochemistry of human fILD biopsy samples and of lung sections of genetically engineered (Nedd4-2-/- ) mice with an idiopathic pulmonary fibrosislike lung disease. Methods: PET scans of 15 patients with fILD and suspected LC were acquired 10, 60, and 180 min after the administration of 150-250 MBq of a 68Ga-labeled FAPI tracer (FAPI-46). In 3 patients, dynamic scans over 40 min were performed instead of imaging after 10 min. The SUVmax and SUVmean of fibrotic lesions and LC were measured and CT-density-corrected. Target-to-background ratios (TBRs) were calculated. PET imaging was correlated with CT-based fibrosis scores. Time-activity curves derived from dynamic imaging were analyzed. FAP immunohistochemistry of 4 human fILD biopsy samples and of fibrotic lungs of Nedd4-2-/- mice was performed. Results: fILD lesions as well as LC showed markedly elevated 68Ga-FAPI uptake (density-corrected SUVmax and SUVmean 60 min after injection: 11.12 ± 6.71 and 4.29 ± 1.61, respectively, for fILD lesions and 16.69 ± 9.35 and 6.44 ± 3.29, respectively, for LC) and high TBR (TBR of density-corrected SUVmax and SUVmean 60 min after injection: 2.30 ± 1.47 and 1.67 ± 0.79, respectively, for fILD and 3.90 ± 2.36 and 2.37 ± 1.14, respectively, for LC). SUVmax and SUVmean decreased over time, with a stable TBR for fILD and a trend toward an increasing TBR in LC. Dynamic imaging showed differing time-activity curves for fILD and LC. 68Ga-FAPI uptake showed a positive correlation with the CT-based fibrosis index. Immunohistochemistry of human biopsy samples and the lungs of Nedd4-2-/- mice showed a patchy expression of FAP in fibrotic lesions, preferentially in the transition zone to healthy lung parenchyma. Conclusion:68Ga-FAPI PET/CT imaging is a promising new imaging modality for fILD and LC. Its potential clinical value for monitoring and therapy evaluation of fILD should be investigated in future studies.
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Affiliation(s)
- Manuel Röhrich
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany;
| | - Dominik Leitz
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Frederik M Glatting
- Clinical Cooperation Unit Molecular and Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Oliver Weinheimer
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicolas Kahn
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thorax Clinic, University of Heidelberg, Heidelberg, Germany; and
| | - Marcus A Mall
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter E Huber
- Clinical Cooperation Unit Molecular and Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Claus Peter Heußel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Hans Ulrich Kauczor
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Xu W, Wu W, Zheng Y, Chen Z, Tao X, Zhang D, Zhao J, Wang K, Guo B, Luo Q, Han Q, Zhou Y, Ye S. A Computed Tomography Radiomics-Based Prediction Model on Interstitial Lung Disease in Anti-MDA5-Positive Dermatomyositis. Front Med (Lausanne) 2021; 8:768052. [PMID: 34912828 PMCID: PMC8667862 DOI: 10.3389/fmed.2021.768052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Anti-melanoma differentiation-associated gene 5-positive dermatomyositis-associated interstitial lung disease (MDA5+ DM-ILD) is a life-threatening disease. The current study aimed to quantitatively assess the pulmonary high-resolution computed tomography (HRCT) images of MDA5+ DM-ILD by applying the radiomics approach and establish a multidimensional risk prediction model for the 6-month mortality. Methods: This retrospective study was conducted in 228 patients from two centers, namely, a derivation cohort and a longitudinal internal validation cohort in Renji Hospital, as well as an external validation cohort in Guangzhou. The derivation cohort was randomly divided into training and testing sets. The primary outcome was 6-month all-cause mortality since the time of admission. Baseline pulmonary HRCT images were quantitatively analyzed by radiomics approach, and a radiomic score (Rad-score) was generated. Clinical predictors selected by univariable Cox regression were further incorporated with the Rad-score, to enhance the prediction performance of the final model (Rad-score plus model). In parallel, an idiopathic pulmonary fibrosis (IPF)-based visual CT score and ILD-GAP score were calculated as comparators. Results: The Rad-score was significantly associated with the 6-month mortality, outperformed the traditional visual score and ILD-GAP score. The Rad-score plus model was successfully developed to predict the 6-month mortality, with C-index values of 0.88 [95% confidence interval (CI), 0.79–0.96] in the training set (n = 121), 0.88 (95%CI, 0.71–1.0) in the testing set (n = 31), 0.83 (95%CI, 0.68–0.98) in the internal validation cohort (n = 44), and 0.84 (95%CI, 0.64–1.0) in the external validation cohort (n = 32). Conclusions: The radiomic feature was an independent and reliable prognostic predictor for MDA5+ DM-ILD.
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Affiliation(s)
- Wenwen Xu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanlong Wu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zheng
- Department of Pulmonology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiwei Chen
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinwei Tao
- CT Scientific Collaboration, Siemens Healthineers, Shanghai, China
| | - Danting Zhang
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiangfeng Zhao
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaiwen Wang
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bingpeng Guo
- State Key Laboratory of Respiratory Disease, National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qun Luo
- State Key Laboratory of Respiratory Disease, National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qian Han
- State Key Laboratory of Respiratory Disease, National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang Ye
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Koo CW, Larson NB, Parris-Skeete CT, Karwoski RA, Kalra S, Bartholmai BJ, Carmona EM. Prospective machine learning CT quantitative evaluation of idiopathic pulmonary fibrosis in patients undergoing anti-fibrotic treatment using low- and ultra-low-dose CT. Clin Radiol 2021; 77:e208-e214. [PMID: 34887070 DOI: 10.1016/j.crad.2021.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/09/2021] [Indexed: 01/01/2023]
Abstract
AIM To compare the machine learning computed tomography (CT) quantification tool, Computer-Aided Lung Informatics for Pathology Evaluation and Ratings (CALIPER) to pulmonary function testing (PFT) in assessing idiopathic pulmonary fibrosis (IPF) for patients undergoing treatment and determine the effects of limited (LD) and ultra-low dose (ULD) CT on CALIPER performance. MATERIALS AND METHODS Thirty-eight IPF patients underwent PFT and standard, LD, and ULD CT. CALIPER classified each CT voxel into either vessel-related structures (VRS), normal, reticular (R), honeycomb (HC) or ground-glass (GG) features. CALIPER-derived interstitial lung disease (ILD) extent represented the sum of GG, R and HC values. Repeated-measures correlation coefficient (ρrm) and 95% confidence interval (CI) evaluated CALIPER features correlation with PFT. Lin's concordance correlation coefficient (CCC) assessed concordance of CALIPER parameters across different CT dosages. RESULTS Twenty patients completed 12 months of follow-up. CALIPER ILD correlated significantly with percent predicted (%) forced vital capacity (FVC) and forced expiratory volume in 1 second (%FEV1; p=0.004, ρrm -0.343, 95% CI [-0.547, -0.108] and 0.008, -0.321, [-0.518, -0.07], respectively). VRS significantly correlated with %FVC and %FEV1 (p=0.000, ρrm -0.491, 95% CI [-0.685, -0.251] and -0.478, 0.000, [-0.653, -0.231], respectively). There was near perfect LD and moderate ULD concordance with standard dose CT for both ILD (CCC 0.995, 95% CI 0.988-0.999 and 0.9, 0.795-0.983, respectively) and VRS (CCC 0.989, 95% CI 0.963-0.997 and 0.915, 0.806-0.956, respectively). CONCLUSIONS CALIPER parameters correlate well with PFTs for evaluation of IPF in patients undergoing anti-fibrotic treatment without being influenced by dose variation. CALIPER may serve as a robust, objective adjunct to PFTs in assessing anti-fibrotic treatment related changes.
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Affiliation(s)
- C W Koo
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | - N B Larson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | | | - R A Karwoski
- Biomedical Imaging Resources, Research Applications Solutions, Mayo Clinic, Rochester, MN, USA
| | - S Kalra
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - B J Bartholmai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - E M Carmona
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA
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Abstract
Childhood interstitial lung disease (ChILD) is an umbrella term encompassing a diverse group of diffuse lung diseases affecting infants and children. Although the timely and accurate diagnosis of ChILD is often challenging, it is optimally achieved through the multidisciplinary integration of imaging findings with clinical data, genetics, and potentially lung biopsy. This article reviews the definition and classification of ChILD; the role of imaging, pathology, and genetics in ChILD diagnosis; treatment options; and future goals. In addition, a practical approach to ChILD imaging based on the latest available research and the characteristic imaging appearance of ChILD entities are presented.
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Nardocci C, Simon J, Kiss F, Györke T, Szántó P, Tárnoki ÁD, Tárnoki DL, Müller V, Maurovich-Horvat P. The role of imaging in the diagnosis and management of idiopathic pulmonary fibrosis. IMAGING 2021. [DOI: 10.1556/1647.2021.00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease lacking a definite etiology, characterized by the nonspecific symptoms of dyspnea and dry cough. Due to its poor prognosis, imaging techniques play an essential role in diagnosing and managing IPF. High resolution computed tomography (HRCT) has been shown to be the most sensitive modality for the diagnosis of pulmonary fibrosis. It is the primary imaging modality used for the assessment and follow-up of patients with IPF. Other not commonly used imaging methods are under research, such as ultrasound, magnetic resonance imaging and positron emission tomography-computed tomography are alternative imaging techniques. This literature review aims to provide a brief overview of the imaging of IPF-related alterations.
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Affiliation(s)
- Chiara Nardocci
- 1 Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Judit Simon
- 1 Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- 2 MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Fanni Kiss
- 3 Department of Nuclear Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tamás Györke
- 3 Department of Nuclear Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Péter Szántó
- 1 Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Ádám Domonkos Tárnoki
- 1 Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- 4 National Institute of Oncology, Budapest, Hungary
| | - Dávid László Tárnoki
- 1 Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- 4 National Institute of Oncology, Budapest, Hungary
| | - Veronika Müller
- 5 Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- 1 Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- 2 MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Utility of a Deep Learning Algorithm for Detection of Reticular Opacity on Chest Radiograph in Patients with Interstitial Lung Disease. AJR Am J Roentgenol 2021; 218:642-650. [PMID: 34668769 DOI: 10.2214/ajr.21.26682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Deep learning has been heavily explored for pulmonary nodule detection on chest radiograph. Reticular opacity detection in interstitial lung disease (ILD) is challenging and may also benefit from a deep learning algorithm (DLA). Objective: To evaluate the utility of DLA for detection of reticular opacity on chest radiographs in patients with surgically confirmed ILD. Methods: This retrospective study included 197 patients (130 men, 67 women; mean age 62.6±7.6 years) with surgically proven ILD between January 2017 and December 2018 who underwent preoperative chest radiograph and chest CT within a 30-day interval. A total of 197 age- and sex-matched control patients with normal chest radiographs were randomly selected. Commercially available DLA was used to detect lower lobe or subpleural abnormalities; those matching reticular opacity location on CT were deemed true-positives. Six readers (three thoracic radiologists; three residents) independently reviewed radiographs for reticular opacity presence with and without DLA. Interobserver agreement was assessed. Diagnostic performance was compared among interpretations. Subanalysis was performed according to CT-based classification of reticular opacity severity. DLA performance was also assessed in 102 chest radiographs from a different institution (51 with ILD; 51 matched controls). Results: Interobserver agreement was moderate (κ=0.517) for readers alone versus almost perfect (κ=0.870) for readers with DLA. Sensitivity, specificity, and accuracy for reticular opacity for DLA were 98.0%, 99.0%, and 98.5%; for pooled readers alone were 77.3%, 92.3%, and 84.8%; and for readers with DLA were 93.8%, 97.3%, and 95.6%. All metrics were significantly better (all p≤.002) for DLA and for readers with DLA compared with readers alone. Sensitivity for readers without and with DLA were 66.7% and 86.8% in mild disease, 84.2% and 98.8% in moderate disease, and 87.3% and 100.0% in severe disease. DLA exhibited 100.0% accuracy in the cases from the second center. Conclusions: DLA outperformed readers in reticular opacity detection, and use of DLA improved reader performance and interobservser agreement. Benefit of DLA was more notable in terms of sensitivity than specificity and was maintained in mild disease. Clinical Impact: Use of DLA may facilitate detection of reticular opacity on chest radiograph in the early stages of ILD.
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Schniering J, Maciukiewicz M, Gabrys HS, Brunner M, Blüthgen C, Meier C, Braga-Lagache S, Uldry AC, Heller M, Guckenberger M, Fretheim H, Nakas CT, Hoffmann-Vold AM, Distler O, Frauenfelder T, Tanadini-Lang S, Maurer B. Computed tomography-based radiomics decodes prognostic and molecular differences in interstitial lung disease related to systemic sclerosis. Eur Respir J 2021; 59:13993003.04503-2020. [PMID: 34649979 PMCID: PMC9117734 DOI: 10.1183/13993003.04503-2020] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
Background Radiomic features calculated from routine medical images show great potential for personalised medicine in cancer. Patients with systemic sclerosis (SSc), a rare, multiorgan autoimmune disorder, have a similarly poor prognosis due to interstitial lung disease (ILD). Here, our objectives were to explore computed tomography (CT)-based high-dimensional image analysis (“radiomics”) for disease characterisation, risk stratification and relaying information on lung pathophysiology in SSc-ILD. Methods We investigated two independent, prospectively followed SSc-ILD cohorts (Zurich, derivation cohort, n=90; Oslo, validation cohort, n=66). For every subject, we defined 1355 robust radiomic features from standard-of-care CT images. We performed unsupervised clustering to identify and characterise imaging-based patient clusters. A clinically applicable prognostic quantitative radiomic risk score (qRISSc) for progression-free survival (PFS) was derived from radiomic profiles using supervised analysis. The biological basis of qRISSc was assessed in a cross-species approach by correlation with lung proteomic, histological and gene expression data derived from mice with bleomycin-induced lung fibrosis. Results Radiomic profiling identified two clinically and prognostically distinct SSc-ILD patient clusters. To evaluate the clinical applicability, we derived and externally validated a binary, quantitative radiomic risk score (qRISSc) composed of 26 features that accurately predicted PFS and significantly improved upon clinical risk stratification parameters in multivariable Cox regression analyses in the pooled cohorts. A high qRISSc score, which identifies patients at risk for progression, was reverse translatable from human to experimental ILD and correlated with fibrotic pathway activation. Conclusions Radiomics-based risk stratification using routine CT images provides complementary phenotypic, clinical and prognostic information significantly impacting clinical decision making in SSc-ILD. CT-based radiomics decodes phenotypic, prognostic and molecular differences in SSc-ILD, and predicts progression-free survival with a significant impact on future clinical decision making in SSc-ILDhttps://bit.ly/3zPaMOn
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Affiliation(s)
- Janine Schniering
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Lung Biology and Disease and Comprehensive Pneumology Center, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Malgorzata Maciukiewicz
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hubert S Gabrys
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Brunner
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Rheumatology and Immunology, University Hospital Bern, University Bern, Switzerland
| | - Christian Blüthgen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chantal Meier
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sophie Braga-Lagache
- Proteomics and Mass Spectrometry Core Facility, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Anne-Christine Uldry
- Proteomics and Mass Spectrometry Core Facility, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Manfred Heller
- Proteomics and Mass Spectrometry Core Facility, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Håvard Fretheim
- Department of Rheumatology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christos T Nakas
- Laboratory of Biometry, University of Thessaly, Volos, Greece.,University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Oliver Distler
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Britta Maurer
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland .,Department of Rheumatology and Immunology, University Hospital Bern, University Bern, Switzerland
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Ohno Y, Aoyagi K, Takenaka D, Yoshikawa T, Fujisawa Y, Sugihara N, Hamabuchi N, Hanamatsu S, Obama Y, Ueda T, Hattori H, Murayama K, Toyama H. Machine learning for lung texture analysis on thin-section CT: Capability for assessments of disease severity and therapeutic effect for connective tissue disease patients in comparison with expert panel evaluations. Acta Radiol 2021; 63:1363-1373. [PMID: 34636644 DOI: 10.1177/02841851211044973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The need for quantitative assessment of interstitial lung involvement on thin-section computed tomography (CT) has arisen in interstitial lung diseases including connective tissue disease (CTD). PURPOSE To evaluate the capability of machine learning (ML)-based CT texture analysis for disease severity and treatment response assessments in comparison with qualitatively assessed thin-section CT for patients with CTD. MATERIAL AND METHODS A total of 149 patients with CTD-related ILD (CTD-ILD) underwent initial and follow-up CT scans (total 364 paired serial CT examinations), pulmonary function tests, and serum KL-6 level tests. Based on all follow-up examination results, all paired serial CT examinations were assessed as "Stable" (n = 188), "Worse" (n = 98) and "Improved" (n = 78). Next, quantitative index changes were determined by software, and qualitative disease severity scores were assessed by consensus of two radiologists. To evaluate differences in each quantitative index as well as in disease severity score between paired serial CT examinations, Tukey's honestly significant difference (HSD) test was performed among the three statuses. Stepwise regression analyses were performed to determine changes in each pulmonary functional parameter and all quantitative indexes between paired serial CT scans. RESULTS Δ% normal lung, Δ% consolidation, Δ% ground glass opacity, Δ% reticulation, and Δdisease severity score showed significant differences among the three statuses (P < 0.05). All differences in pulmonary functional parameters were significantly affected by Δ% normal lung, Δ% reticulation, and Δ% honeycomb (0.16 ≤r2 ≤0.42; P < 0.05). CONCLUSION ML-based CT texture analysis has better potential than qualitatively assessed thin-section CT for disease severity assessment and treatment response evaluation for CTD-ILD.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kota Aoyagi
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Daisuke Takenaka
- Department of Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Takeshi Yoshikawa
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Department of Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | | | - Naoki Sugihara
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Satomu Hanamatsu
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yuki Obama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hidekazu Hattori
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kazuhiro Murayama
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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50
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Pulmonary function tests in systemic sclerosis-associated interstitial lung disease: new directions and future prospects. CURRENT OPINION IN PHYSIOLOGY 2021. [DOI: 10.1016/j.cophys.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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