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Mattos WLLD, Khalil N, Spencer LG, Bonella F, Folz RJ, Rolf JD, Mogulkoc N, Lancaster LH, Jenkins RG, Lynch DA, Noble PW, Maher TM, Cottin V, Senger S, Horan GS, Greenberg S, Popmihajlov Z. Phase 2, Double-Blind, Placebo-controlled Trial of a c-Jun N-Terminal Kinase Inhibitor in Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2024; 210:435-443. [PMID: 38484130 DOI: 10.1164/rccm.202310-1907oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/13/2024] [Indexed: 08/16/2024] Open
Abstract
Rationale: Idiopathic pulmonary fibrosis is a fatal and progressive disease with limited treatment options. Objectives: We sought to assess the efficacy and safety of CC-90001, an oral inhibitor of c-Jun N-terminal kinase 1, in patients with idiopathic pulmonary fibrosis. Methods: In a Phase 2, randomized (1:1:1), double-blind, placebo-controlled study (ClinicalTrials.gov ID: NCT03142191), patients received CC-90001 (200 or 400 mg) or placebo once daily for 24 weeks. Background antifibrotic treatment (pirfenidone) was allowed. The primary endpoint was change in the percentage of predicted FVC (ppFVC) from baseline to Week 24; secondary endpoints included safety. Measurements and Main Results: In total, 112 patients received at least one dose of study drug. The study was terminated early because of a strategic decision made by the sponsor. Ninety-one patients (81%) completed the study. The least-squares mean changes from baseline in ppFVC at Week 24 were -3.1% (placebo), -2.1% (200 mg), and -1.0% (400 mg); the differences compared with placebo were 1.1% (200 mg; 95% confidence interval: -2.1, 4.3; P = 0.50) and 2.2% (400 mg; 95% confidence interval: -1.1, 5.4; P = 0.19). Adverse event frequency was similar in patients in the combined CC-90001 arms versus placebo. The most common adverse events were nausea, diarrhea, and vomiting, which were more frequent in patients in CC-90001 arms versus placebo. Fewer patients in the CC-90001 arms than in the placebo arm experienced cough and dyspnea. Conclusions: Treatment with CC-90001 over 24 weeks led to numerical improvements in ppFVC in patients with idiopathic pulmonary fibrosis compared with placebo. CC-90001 was generally well tolerated, which was consistent with previous studies. Clinical trial registered with www.clinicaltrials.gov (NCT03142191).
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Affiliation(s)
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa G Spencer
- Aintree Chest Centre, Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Rodney J Folz
- Division of Pulmonary, Critical Care and Sleep Medicine, Houston Methodist Research Institute, Houston, Texas
| | - J Douglass Rolf
- Kelowna Respiratory Clinic, Kelowna, British Columbia, Canada
| | - Nesrin Mogulkoc
- Department of Pulmonary Medicine, Ege University Hospital, Izmir, Turkey
| | - Lisa H Lancaster
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - R Gisli Jenkins
- Imperial Biomedical Research Center and
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Paul W Noble
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Toby M Maher
- Interstitial Lung Disease Unit, National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Vincent Cottin
- Department of Respiratory Medicine, Louis Pradel Hospital, Lyon, France
- University Claude Bernard Lyon 1, UMR 754, INRAE, Lyon, France
| | - Stefanie Senger
- Bristol Myers Squibb, Princeton, New Jersey; and
- Cytel Inc., Waltham, Massachusetts
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Berigei SR, Nandy S, Yamamoto S, Raphaely RA, DeCoursey A, Lee J, Sharma A, Auchincloss HG, Gaissert H, Lanuti M, Ott HC, Sachdeva UM, Wright CD, Zhao SH, Hallowell RW, Shea BS, Muniappan A, Keyes CM, Hariri LP. Microscopic Small Airway Abnormalities Identified in Early Idiopathic Pulmonary Fibrosis In Vivo Using Endobronchial Optical Coherence Tomography. Am J Respir Crit Care Med 2024; 210:473-483. [PMID: 38747674 DOI: 10.1164/rccm.202401-0249oc] [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: 01/30/2024] [Accepted: 05/15/2024] [Indexed: 08/16/2024] Open
Abstract
Rationale: Idiopathic pulmonary fibrosis (IPF) affects the subpleural lung but is considered to spare small airways. Micro-computed tomography (micro-CT) studies demonstrated small airway reduction in end-stage IPF explanted lungs, raising questions about small airway involvement in early-stage disease. Endobronchial optical coherence tomography (EB-OCT) is a volumetric imaging modality that detects microscopic features from subpleural to proximal airways. Objectives: In this study, EB-OCT was used to evaluate small airways in early IPF and control subjects in vivo. Methods: EB-OCT was performed in 12 subjects with IPF and 5 control subjects (matched by age, sex, smoking history, height, and body mass index). Subjects with IPF had early disease with mild restriction (FVC: 83.5% predicted), which was diagnosed per current guidelines and confirmed by surgical biopsy. EB-OCT volumetric imaging was acquired bronchoscopically in multiple, distinct, bilateral lung locations (total: 97 sites). IPF imaging sites were classified by severity into affected (all criteria for usual interstitial pneumonia present) and less affected (some but not all criteria for usual interstitial pneumonia present). Bronchiole count and small airway stereology metrics were measured for each EB-OCT imaging site. Measurements and Main Results: Compared with the number of bronchioles in control subjects (mean = 11.2/cm3; SD = 6.2), there was significant bronchiole reduction in subjects with IPF (42% loss; mean = 6.5/cm3; SD = 3.4; P = 0.0039), including in IPF affected (48% loss; mean: 5.8/cm3; SD: 2.8; P < 0.00001) and IPF less affected (33% loss; mean: 7.5/cm3; SD: 4.1; P = 0.024) sites. Stereology metrics showed that IPF-affected small airways were significantly larger, more distorted, and more irregular than in IPF-less affected sites and control subjects. IPF less affected and control airways were statistically indistinguishable for all stereology parameters (P = 0.36-1.0). Conclusions: EB-OCT demonstrated marked bronchiolar loss in early IPF (between 30% and 50%), even in areas minimally affected by disease, compared with matched control subjects. These findings support small airway disease as a feature of early IPF, providing novel insight into pathogenesis and potential therapeutic targets.
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Affiliation(s)
| | - Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Satomi Yamamoto
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Rebecca A Raphaely
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | | | - Jaeyul Lee
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Amita Sharma
- Department of Radiology
- Harvard Medical School, Boston, Massachusetts
| | - Hugh G Auchincloss
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Henning Gaissert
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Michael Lanuti
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Harald C Ott
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Uma M Sachdeva
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Cameron D Wright
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | | | - Robert W Hallowell
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Barry S Shea
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Ashok Muniappan
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Colleen M Keyes
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Lida P Hariri
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts; and
- Harvard Medical School, Boston, Massachusetts
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3
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Jungblut L. [Smoking-related interstitial lung disease : Radiological findings, histopathological correlations, and clinical observations]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:628-635. [PMID: 38992215 PMCID: PMC11286665 DOI: 10.1007/s00117-024-01333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/13/2024]
Abstract
CLINICAL/METHODOLOGICAL ISSUE Identifying smoking-related interstitial lung diseases (SRILD) in smokers is challenging, as clinical manifestations can be nonspecific, and there is a variety of SRILD entities that not only interconnect but can also overlap. RADIOLOGICAL STANDARD PROCEDURES In diagnosing SRILD, imaging techniques such as high-resolution computed tomography (HRCT) allow the identification of characteristic features, serving as crucial pieces of the puzzle for definitive differentiation. PERFORMANCE Studies have demonstrated that HRCT exhibits a sensitivity of approximately 80-90% in identifying SRILD, with a specificity around 70-80%. The conclusive diagnosis often requires a correlation between histopathological findings and clinical observations. PRACTICAL RECOMMENDATIONS Regular monitoring of smokers, especially when experiencing symptoms like shortness of breath and cough, coupled with a comprehensive diagnosis of SRILD, is crucial for accurate identification and individualized therapy.
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Affiliation(s)
- Lisa Jungblut
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Schweiz.
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Dinkel J, Kneidinger N, Tarantino P. The radiologist's role in detecting systemic anticancer therapy-related interstitial lung disease: an educational review. Insights Imaging 2024; 15:191. [PMID: 39090512 PMCID: PMC11294314 DOI: 10.1186/s13244-024-01771-z] [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: 03/04/2024] [Accepted: 07/07/2024] [Indexed: 08/04/2024] Open
Abstract
Systemic anticancer therapies (SACTs) are the leading cause of drug-induced interstitial lung disease (ILD). As more novel SACTs become approved, the incidence of this potentially life-threatening adverse event (AE) may increase. Early detection of SACT-related ILD allows for prompt implementation of drug-specific management recommendations, improving the likelihood of AE resolution and, in some instances, widening the patient's eligibility for future cancer treatment options. ILD requires a diagnosis of exclusion through collaboration with the patient's multidisciplinary team to rule out other possible etiologies of new or worsening respiratory signs and symptoms. At Grade 1, ILD is asymptomatic, and thus the radiologist is key to detecting the AE prior to the disease severity worsening. Planned computed tomography scans should be reviewed for the presence of ILD in addition to being assessed for tumor response to treatment, and when ILD is suspected, a high-resolution computed tomography (HRCT) scan should be requested immediately. An HRCT scan, with < 2-mm slice thickness, is the most appropriate method for detecting ILD. Multiple patterns of ILD exist, which can impact patient prognosis. The four main patterns include acute interstitial pneumonia / acute respiratory distress syndrome, organizing pneumonia, hypersensitivity pneumonitis, and non-specific interstitial pneumonia; their distinct radiological features, along with rarer patterns, are discussed here. Furthermore, HRCT is essential for following the course of ILD and might help to determine the intensity of AE management and the appropriateness of re-challenging with SACT, where indicated by drug-specific prescribing information. ILD events should be monitored closely until complete resolution. CRITICAL RELEVANCE STATEMENT: The incidence of potentially treatment-limiting and life-threatening systemic anticancer therapy-related interstitial lung disease (SACT-related ILD) events is likely increasing as more novel regimens become approved. This review provides best-practice recommendations for the early detection of SACT-related ILD by radiologists. KEY POINTS: Radiologists are crucial in detecting asymptomatic (Grade 1) ILD before severity/prognosis worsens. High-resolution computed tomography is the most appropriate method for detecting ILD. Drug-induced ILD is a diagnosis of exclusion, involving a multidisciplinary team. Familiarity with common HRCT patterns, described here, is key for prompt detection. Physicians should highlight systemic anticancer therapies (SACTs) with a known risk for interstitial lung diseases (ILD) on scan requisitions.
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Affiliation(s)
- Julien Dinkel
- Department of Radiology, University Hospital LMU Munich, Munich, Germany.
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - Nikolaus Kneidinger
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Paolo Tarantino
- Breast Oncology Center, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
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Yasuda N, Iwasawa T, Baba T, Misumi T, Cheng S, Kato S, Utsunomiya D, Ogura T. Evaluation of Progressive Architectural Distortion in Idiopathic Pulmonary Fibrosis Using Deformable Registration of Sequential CT Images. Diagnostics (Basel) 2024; 14:1650. [PMID: 39125526 PMCID: PMC11311668 DOI: 10.3390/diagnostics14151650] [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: 06/10/2024] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Monitoring the progression of idiopathic pulmonary fibrosis (IPF) using CT primarily focuses on assessing the extent of fibrotic lesions, without considering the distortion of lung architecture. OBJECTIVES To evaluate three-dimensional average displacement (3D-AD) quantification of lung structures using deformable registration of serial CT images as a parameter of local lung architectural distortion and predictor of IPF prognosis. MATERIALS AND METHODS Patients with IPF evaluated between January 2016 and March 2017 who had undergone CT at least twice were retrospectively included (n = 114). The 3D-AD was obtained by deformable registration of baseline and follow-up CT images. A computer-aided quantification software measured the fibrotic lesion volume. Cox regression analysis evaluated these variables to predict mortality. RESULTS The 3D-AD and the fibrotic lesion volume change were significantly larger in the subpleural lung region (5.2 mm (interquartile range (IQR): 3.6-7.1 mm) and 0.70% (IQR: 0.22-1.60%), respectively) than those in the inner region (4.7 mm (IQR: 3.0-6.4 mm) and 0.21% (IQR: 0.004-1.12%), respectively). Multivariable logistic analysis revealed that subpleural region 3D-AD and fibrotic lesion volume change were independent predictors of mortality (hazard ratio: 1.12 and 1.23; 95% confidence interval: 1.02-1.22 and 1.10-1.38; p = 0.01 and p < 0.001, respectively). CONCLUSIONS The 3D-AD quantification derived from deformable registration of serial CT images serves as a marker of lung architectural distortion and a prognostic predictor in patients with IPF.
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Affiliation(s)
- Naofumi Yasuda
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama 236-0051, Kanagawa, Japan;
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan; (S.C.); (S.K.); (D.U.)
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama 236-0051, Kanagawa, Japan;
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan; (S.C.); (S.K.); (D.U.)
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama 236-0051, Kanagawa, Japan; (T.B.); (T.O.)
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan;
| | - Shihyao Cheng
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan; (S.C.); (S.K.); (D.U.)
| | - Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan; (S.C.); (S.K.); (D.U.)
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan; (S.C.); (S.K.); (D.U.)
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama 236-0051, Kanagawa, Japan; (T.B.); (T.O.)
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6
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Lee JU, Park JS, Seo E, Kim JS, Lee HU, Chang Y, Park JS, Park CS. Clustering analysis of HRCT parameters measured using a texture-based automated system: relationship with clinical outcomes of IPF. BMC Pulm Med 2024; 24:367. [PMID: 39080584 PMCID: PMC11290077 DOI: 10.1186/s12890-024-03092-9] [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: 02/01/2024] [Accepted: 06/09/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE The extent of honeycombing and reticulation predict the clinical prognosis of IPF. Emphysema, consolidation, and ground glass opacity are visible in HRCT scans. To date, there have been few comprehensive studies that have used these parameters. We conducted automated quantitative analysis to identify predictive parameters for clinical outcomes and then grouped the subjects accordingly. METHODS CT images were obtained while patients held their breath at full inspiration. Parameters were analyzed using an automated lung texture quantification system. Cluster analysis was conducted on 159 IPF patients and clinical profiles were compared between clusters in terms of survival. RESULTS Kaplan-Meier analysis revealed that survival rates declined as fibrosis, reticulation, honeycombing, consolidation, and emphysema scores increased. Cox regression analysis revealed that reticulation had the most significant impact on survival rate, followed by honeycombing, consolidation, and emphysema scores. Hierarchical and K-means cluster analyses revealed 3 clusters. Cluster 1 (n = 126) with the lowest values for all parameters had the longest survival duration, and relatively-well preserved FVC and DLCO. Cluster 2 (n = 15) with high reticulation and consolidation scores had the lowest FVC and DLCO values with a predominance of female, while cluster 3 (n = 18) with high honeycombing and emphysema scores predominantly consisted of male smokers. Kaplan-Meier analysis revealed that cluster 2 had the lowest survival rate, followed by cluster 3 and cluster 1. CONCLUSION Automated quantitative CT analysis provides valuable information for predicting clinical outcomes, and clustering based on these parameters may help identify the high-risk group for management.
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Affiliation(s)
- Jong-Uk Lee
- Department of Medical Bioscience, Graduate School, Soonchunhyang University, 22, Soonchunhyang-ro, Asan, 31538, Korea.
| | - Jong-Sook Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 14584, Republic of Korea
| | - Eunjeong Seo
- Department of Medical Bioscience, Graduate School, Soonchunhyang University, 22, Soonchunhyang-ro, Asan, 31538, Korea
| | - Jin Seol Kim
- Clinical Specialist Coreline Soft, 49 World-Cup Bukro 6-gil, Mapogu, Seoul, 03991, Korea
| | - Hae Ung Lee
- Clinical Specialist Coreline Soft, 49 World-Cup Bukro 6-gil, Mapogu, Seoul, 03991, Korea
| | - Yongjin Chang
- Clinical Specialist Coreline Soft, 49 World-Cup Bukro 6-gil, Mapogu, Seoul, 03991, Korea
| | - Jai Seong Park
- Department of Radiology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Korea
| | - Choon-Sik Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 14584, Republic of Korea.
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Peng S, Liang Y, Zhu H, Wang Y, Li Y, Zhao Z, Li Y, Zhuang R, Huang L, Zhang X, Guo Z. A nitroreductase responsive probe for early diagnosis of pulmonary fibrosis disease. Redox Biol 2024; 75:103294. [PMID: 39096854 DOI: 10.1016/j.redox.2024.103294] [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: 06/20/2024] [Revised: 07/17/2024] [Accepted: 07/28/2024] [Indexed: 08/05/2024] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a serious interstitial lung disease. However, the definitive diagnosis of IPF is impeded by the limited capabilities of current diagnostic methods, which may fail to capture the optimal timing for treatment. The main goal of this study is to determine the feasibility of a nitroreductase (NTR) responsive probe, 18F-NCRP, for early detection and deterioration monitoring of IPF. 18F-NCRP was obtained with high radiochemical purity (>95 %). BLM-injured mice were established by intratracheal instillation with bleomycin (BLM) and characterized through histological analysis. Longitudinal PET/CT imaging, biodistribution study and in vitro autoradiography were performed. The correlations between the uptake of 18F-NCRP and mean lung density (tested by CT), as well as histopathological characteristics were analyzed. In PET imaging study, 18F-NCRP exhibited promising efficacy in monitoring the progression of IPF, which was earlier than CT. The ratio of uptake in BLM-injured lung to control lung increased from 1.4-fold on D15 to 2.2-fold on D22. Biodistribution data showed a significant lung uptake of 18F-NCRP in BLM-injured mice. There was a strong positive correlation between the 18F-NCRP uptake in the BLM-injured lungs and the histopathological characteristics. Given that, 18F-NCRP PET imaging of NTR, a promising biomarker for investigating the underlying pathogenic mechanism of IPF, is attainable as well as desirable, which might lay the foundation for establishing an NTR-targeted imaging evaluation system of IPF.
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Affiliation(s)
- Shilan Peng
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Yuanyuan Liang
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Haotian Zhu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Yike Wang
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Yun Li
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Zuoquan Zhao
- Theranostics and Translational Research Center, Institute of Clinical Medicine, Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yesen Li
- Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Rongqiang Zhuang
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China
| | - Lumei Huang
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China.
| | - Xianzhong Zhang
- Theranostics and Translational Research Center, Institute of Clinical Medicine, Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Zhide Guo
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang an Biomedicine Laboratory, School of Public Health, Xiamen University, 4221-116 Xiang'An South Rd, Xiamen, 361102, China.
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Hoffmann T, Teichgräber U, Förster M, Oelzner P, Kroegel C, Renz D, Weise T, Böttcher J, Schulze PC, Wolf G, Franz M, Pfeil A. Correlation of high-resolution computed tomography and immunological bronchoalveolar lavage in interstitial lung disease at the onset of inflammatory rheumatic diseases: implications for diagnosis and therapeutic strategies. Arthritis Res Ther 2024; 26:142. [PMID: 39075618 PMCID: PMC11285604 DOI: 10.1186/s13075-024-03371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/05/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVES Inflammatory rheumatic diseases (IRD) are often associated with interstitial lung disease (ILD). The aim of the present study was to establish a correlation between the findings on HRCT and the immunological bronchoalveolar lavage (BAL). METHODS The study included 74 patients with newly diagnosed IRD and evidence of ILD on HRCT with the following pattern: ground-glass opacities (GGO), non-specific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP). Patients with other HRCT pattern were excluded. No patient received any immunosuppressive therapy. In addition to HRCT, immunological BAL was performed and the American Thoracic Society clinical practice guideline were used to define BAL patterns (lymphocytic cellular pattern, neutrophilic cellular pattern, eosinophilic cellular pattern and unspecified pattern). RESULTS The main HRCT patterns were NSIP (47.3%), GGO (33.8%), and UIP (18.9%). BAL patterns showed the following distribution: 41.9% lymphocytic cellular pattern, 23.0% neutrophilic cellular pattern, 18.9% eosinophilic cellular pattern, and 16.2% unspecific cellular pattern. Placing these data in the context of the HRCT findings, the lymphocytic cellular BAL pattern (48%) was most commonly BAL pattern associated with GGO pattern in HRCT, whereas neutrophilic and lymphocytic cellular BAL patterns were the dominant feature in NSIP and UIP. CONCLUSION In patients with new-onset IRD and ILD, inflammatory pulmonary changes are predominate, reflected by GGO on HRCT and a mainly lymphocytic cell profile in the immunological BAL. In NSIP or UIP on HRCT, the percentages of lymphocytes and neutrophils were higher in BAL fluid, representing a fibrotic component in addition to the inflammation. Consequently, patients with evidence of GGO on HRCT should primarily be treated with anti-inflammatory/immunosuppressive therapy, whereas in patients with NSIP and UIP a combination of anti-inflammatory and anti-fibrotic agents would be the appropriate treatment.
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Affiliation(s)
- Tobias Hoffmann
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ulf Teichgräber
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Martin Förster
- Department of Internal Medicine I, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Peter Oelzner
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Claus Kroegel
- Department of Internal Medicine I, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Diane Renz
- Institute of Diagnostic and Interventional Radiology, Department of Pediatric Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Joachim Böttcher
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Izhakian S, Igawa M, Chen Zion L, Mekiten O, Freidkin L, Rosengarten D, Heching M, Kramer MR. High antinuclear antibody titer is associated with increased mortality risk in patients with idiopathic pulmonary fibrosis. Clin Exp Med 2024; 24:172. [PMID: 39068615 DOI: 10.1007/s10238-024-01447-4] [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: 05/24/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a diagnosis of exclusion, requiring that potential etiologies of interstitial lung disease be ruled out. Antinuclear antibody (ANA) testing is commonly performed in individuals with IPF, but the clinical significance of ANA positivity remains uncertain. A retrospective search identified 161 patients diagnosed with IPF between May 2010 and January 2021. Data on ANA titers at the time of diagnosis were available in all cases. Mean age of the patients was 66.4 ± 9.6 years; 70.8% were male. ANA titers were high (≥ 1:160) in 25.4% of the cohort. Baseline characteristics were comparable between those with high and low ANA titers. During follow-up (median 28 months), 93 patients (57%) died. On Cox proportional-hazards analysis with lung transplantation entered as a competing risk and adjusting for potential confounders (age, sex, and baseline forced vital capacity and diffusing lung capacity for carbon monoxide), ANA ≥ 1:160, as a dichotomized variable, was significantly associated with case-specific mortality (HR 2.25, 95% CI 1.14-4.42, P = 0.02) and older age (for each 10-year increment, HR 1.55, 95% CI 1.07-2.25, P = 0.02). High ANA titers appear to be associated with increased mortality in IPF. This finding emphasizes the potential prognostic value of ANA testing. Further studies are needed to validate these findings and explore their implications for patient management.
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Affiliation(s)
- Shimon Izhakian
- Pulmonary Institute, Rabin Medical Center-Beilinson Hospital, 39 Jabotinski St., 4941492, Petach Tikva, Israel.
- Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
| | - May Igawa
- Pulmonary Institute, Rabin Medical Center-Beilinson Hospital, 39 Jabotinski St., 4941492, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Liora Chen Zion
- Pulmonary Institute, Rabin Medical Center-Beilinson Hospital, 39 Jabotinski St., 4941492, Petach Tikva, Israel
- The Adelson School of Medicine, Ariel University, 4076414, Ariel, Israel
| | - Ori Mekiten
- Pulmonary Institute, Rabin Medical Center-Beilinson Hospital, 39 Jabotinski St., 4941492, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Lev Freidkin
- Pulmonary Institute, Rabin Medical Center-Beilinson Hospital, 39 Jabotinski St., 4941492, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Rabin Medical Center-Beilinson Hospital, 39 Jabotinski St., 4941492, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Moshe Heching
- Pulmonary Institute, Rabin Medical Center-Beilinson Hospital, 39 Jabotinski St., 4941492, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Mordechai Reuven Kramer
- Pulmonary Institute, Rabin Medical Center-Beilinson Hospital, 39 Jabotinski St., 4941492, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
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10
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Lin Y, Khurelsukh K, Li IG, Wu CT, Wu YM, Lin G, Toh CH, Wan YL. Incidental Findings in Lung Cancer Screening. Cancers (Basel) 2024; 16:2600. [PMID: 39061238 PMCID: PMC11274500 DOI: 10.3390/cancers16142600] [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: 06/27/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
While low-dose computed tomography (LDCT) for lung cancer screening (LCS) has been recognized for its effectiveness in reducing lung cancer mortality, it often simultaneously leads to the detection of incidental findings (IFs) unrelated to the primary screening indication. These IFs present diagnostic and management challenges, potentially causing unnecessary anxiety and further invasive diagnostic procedures for patients. This review article provides an overview of IFs encountered in LDCT, emphasizing their clinical significance and recommended management strategies. We categorize IFs based on their anatomical locations (intrathoracic-intrapulmonary, intrathoracic-extrapulmonary, and extrathoracic) and discuss the most common findings. We highlight the importance of utilizing guidelines and standardized reporting systems by the American College of Radiology (ACR) to guide appropriate follow-ups. For each category, we present specific IF examples, their radiologic features, and the suggested management approach. This review aims to provide radiologists and clinicians with a comprehensive understanding of IFs in LCS for accurate assessment and management, ultimately enhancing patient care. Finally, we outline a few key aspects for future research and development in managing IFs.
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Affiliation(s)
- Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
| | - Khulan Khurelsukh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
| | - I-Gung Li
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan;
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Yi-Ming Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Cheng-Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
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11
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Li C, Abdurehim A, Zhao S, Sun Q, Xu J, Xie J, Zhang Y. Research on the potential mechanism of Deapioplatycodin D against pulmonary fibrosis based on bioinformatics and experimental verification. Eur J Pharmacol 2024; 974:176603. [PMID: 38679121 DOI: 10.1016/j.ejphar.2024.176603] [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: 09/27/2023] [Revised: 03/27/2024] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Pulmonary fibrosis (PF) is a group of respiratory diseases that are extremely complex and challenging to treat. Due to its high mortality rate and short survival, it's often referred to as a "tumor-like disease" that poses a serious threat to human health. OBJECTIVE We aimed validate the potential of Deapioplatycodin D (DPD) to against PF and clarify the underlying mechanism of action of DPD for the treatment of PF based on bioinformatics and experimental verification. This finding provides a basis for the development of safe and effective therapeutic PF drugs based on DPD. METHODS We used LPS-induced early PF rats as a PF model to test the overall efficacy of DPD in vivo. Then, A variety of bioinformatics methods, such as WGCNA, LASSO algorithm and immune cell infiltration (ICI), were applied to analyze the gene microarray related to PF obtained from Gene Expression Omnibus (GEO) to obtained key targets of PF. Finally, an in vitro PF model was constructed based on BEAS-2B cells while incorporating rat lung tissues to validate the regulatory effects of DPD on critical genes. RESULTS DPD can effectively alleviate inflammatory and fibrotic markers in rat lungs. WGCNA analysis resulted in a total of six expression modules, with the brown module having the highest correlation with PF. Subsequently, seven genes were acquired by intersecting the genes in the brown module with DEGs. Five key genes were identified as potential biomarkers of PF by LASSO algorithm and validation dataset verification analysis. In the ICI analysis, infiltration of activated B cell, immature B cell and natural killer cells were found to be more crucial in PF. Ultimately, it was observed that DPD could modulate key genes to achieve anti-PF effects. CONCLUSION In short, these comprehensive analysis methods were employed to identify critical biomarkers closely related to PF, which helps to elucidate the pathogenesis and potential immunotherapy targets of PF. It also provides essential support for the potential of DPD against PF.
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Affiliation(s)
- Chao Li
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin, China.
| | - Aliya Abdurehim
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin, China.
| | - Shuang Zhao
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.
| | - Qing Sun
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin, China.
| | - Jiawen Xu
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin, China.
| | - Junbo Xie
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin, China.
| | - Yanqing Zhang
- Biotechnology & Food Science College, Tianjin University of Commerce, Tianjin, 300134, China.
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Tarchi SM, Salvatore M, Lichtenstein P, Sekar T, Capaccione K, Luk L, Shaish H, Makkar J, Desperito E, Leb J, Navot B, Goldstein J, Laifer S, Beylergil V, Ma H, Jambawalikar S, Aberle D, D'Souza B, Bentley-Hibbert S, Marin MP. Radiology of fibrosis. Part I: Thoracic organs. J Transl Med 2024; 22:609. [PMID: 38956586 PMCID: PMC11218337 DOI: 10.1186/s12967-024-05244-1] [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: 02/12/2024] [Accepted: 04/27/2024] [Indexed: 07/04/2024] Open
Abstract
Sustained injury from factors such as hypoxia, infection, or physical damage may provoke improper tissue repair and the anomalous deposition of connective tissue that causes fibrosis. This phenomenon may take place in any organ, ultimately leading to their dysfunction and eventual failure. Tissue fibrosis has also been found to be central in both the process of carcinogenesis and cancer progression. Thus, its prompt diagnosis and regular monitoring is necessary for implementing effective disease-modifying interventions aiming to reduce mortality and improve overall quality of life. While significant research has been conducted on these subjects, a comprehensive understanding of how their relationship manifests through modern imaging techniques remains to be established. This work intends to provide a comprehensive overview of imaging technologies relevant to the detection of fibrosis affecting thoracic organs as well as to explore potential future advancements in this field.
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Affiliation(s)
- Sofia Maria Tarchi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA.
| | - Mary Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Philip Lichtenstein
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Thillai Sekar
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Kathleen Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Lyndon Luk
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Hiram Shaish
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Jasnit Makkar
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Benjamin Navot
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Jonathan Goldstein
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Sherelle Laifer
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Volkan Beylergil
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Hong Ma
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Dwight Aberle
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Belinda D'Souza
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Stuart Bentley-Hibbert
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Monica Pernia Marin
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
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13
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Paik SH, Jin GY. [Using Artificial Intelligence Software for Diagnosing Emphysema and Interstitial Lung Disease]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:714-726. [PMID: 39130780 PMCID: PMC11310433 DOI: 10.3348/jksr.2024.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/23/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024]
Abstract
Researchers have developed various algorithms utilizing artificial intelligence (AI) to automatically and objectively diagnose patterns and extent of pulmonary emphysema or interstitial lung diseases on chest CT scans. Studies show that AI-based quantification of emphysema on chest CT scans reveals a connection between an increase in the relative percentage of emphysema and a decline in lung function. Notably, quantifying centrilobular emphysema has proven helpful in predicting clinical symptoms or mortality rates of chronic obstructive pulmonary disease. In the context of interstitial lung diseases, AI can classify the usual interstitial pneumonia pattern on CT scans into categories like normal, ground-glass opacity, reticular opacity, honeycombing, emphysema, and consolidation. This classification accuracy is comparable to chest radiologists (70%-80%). However, the results generated by AI are influenced by factors such as scan parameters, reconstruction algorithms, radiation doses, and the training data used to develop the AI. These limitations currently restrict the widespread adoption of AI for quantifying pulmonary emphysema and interstitial lung diseases in daily clinical practice. This paper will showcase the authors' experience using AI for diagnosing and quantifying emphysema and interstitial lung diseases through case studies. We will primarily focus on the advantages and limitations of AI for these two diseases.
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14
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Manfredi A, Sambataro G, Rai A, Cerri S, Sambataro D, Vacchi C, Cassone G, Vancheri C, Sebastiani M. Prevalence of Progressive Fibrosing Interstitial Lung Disease in Patients with Primary Sjogren Syndrome. J Pers Med 2024; 14:708. [PMID: 39063962 PMCID: PMC11278319 DOI: 10.3390/jpm14070708] [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: 05/12/2024] [Revised: 06/07/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) represents a frequent cause of morbidity and mortality in primary Sjogren syndrome (pSS). However, the prevalence and behavior of pSS-ILD remains incomplete, largely based on retrospective heterogeneous studies. AIM OF THE STUDY To investigate the prevalence of progressive pulmonary fibrosis (PPF) in a multicentric cohort of patients with pSS-ILD. Additionally, this study explored possible correlations between PPF and clinical, demographic, and serological features of pSS. METHODS All consecutive patients with pSS-ILD were enrolled in a 6-month period. Clinical, demographic, and serological features of pSS, other than functional and radiological lung features, were collected. Clinical behaviors of ILD other than PPF were also investigated. RESULTS Seventy-two patients were enrolled. A fibrosing ILD pattern was observed in 65.3% of patients with pSS-ILD; among them, 55.3% showed a PPF. The radiologic pattern (NSIP, UIP, or others) was not associated with PPF; in particular, patients with PFF had UIP in 42.3% of cases and NSIP in 57.7%, without a significant difference with respect to the non-PPF group (p = 0.29). Shorter pSS disease duration, higher age at pSS diagnosis, and lower frequency of antinuclear antibodies were correlated with the PPF subgroup. However, multivariate analysis did not confirm these associations. DISCUSSION This study provides valuable insights into the prevalence and characteristics of PPF in pSS-ILD. In particular, UIP and NSIP showed a similar evolution towards PPF in patients with pSS; for NSIP, this behavior was more frequent than for other rheumatic diseases. Our results emphasize the importance of early recognition of PPF for timely intervention and careful follow-up. CONCLUSIONS This study provides valuable insights into the prevalence and characteristics of PPF in pSS-ILD. In particular, UIP and NSIP showed a similar evolution towards PPF in patients with pSS; for NSIP, this behavior was more frequent than for other rheumatic diseases. Our results emphasize the importance of early recognition of PPF for timely intervention and careful follow-up.
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Affiliation(s)
- Andreina Manfredi
- Rheumatology Unit, Azienda Ospedaliera Policlinico di Modena, 41100 Modena, Italy
| | - Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95100 Catania, Italy (C.V.)
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95100 Catania, Italy
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, Mascalucia, 95030 Catania, Italy
| | - Alessandra Rai
- Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42124 Medena, Italy
- Rheumatology Unit, University of Modena and Reggio Emilia, 42121 Reggio Emilia, Italy
| | - Stefania Cerri
- Respiratory Disease Unit, University of Modena and Reggio Emilia, 42121 Modena, Italy
| | - Domenico Sambataro
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, Mascalucia, 95030 Catania, Italy
| | - Caterina Vacchi
- Rheumatology Unit, Azienda Ospedaliera Policlinico di Modena, 41100 Modena, Italy
| | - Giulia Cassone
- Rheumatology Unit, Azienda Ospedaliera Policlinico di Modena, 41100 Modena, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95100 Catania, Italy (C.V.)
| | - Marco Sebastiani
- Rheumatology Unit, AUSL Piacenza, 42124 Piacenza, Italy
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
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15
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Fuster-Martínez I, Calatayud S. The current landscape of antifibrotic therapy across different organs: A systematic approach. Pharmacol Res 2024; 205:107245. [PMID: 38821150 DOI: 10.1016/j.phrs.2024.107245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
Fibrosis is a common pathological process that can affect virtually all the organs, but there are hardly any effective therapeutic options. This has led to an intense search for antifibrotic therapies over the last decades, with a great number of clinical assays currently underway. We have systematically reviewed all current and recently finished clinical trials involved in the development of new antifibrotic drugs, and the preclinical studies analyzing the relevance of each of these pharmacological strategies in fibrotic processes affecting tissues beyond those being clinically studied. We analyze and discuss this information with the aim of determining the most promising options and the feasibility of extending their therapeutic value as antifibrotic agents to other fibrotic conditions.
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Affiliation(s)
- Isabel Fuster-Martínez
- Departamento de Farmacología, Universitat de València, Valencia 46010, Spain; FISABIO (Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana), Valencia 46020, Spain.
| | - Sara Calatayud
- Departamento de Farmacología, Universitat de València, Valencia 46010, Spain; CIBERehd (Centro de Investigación Biomédica en Red - Enfermedades Hepáticas y Digestivas), Spain.
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16
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Peng J, Bie Z, Li Y, Guo R, Li X. Safety and efficacy of CT-guided percutaneous microwave ablation for stage I non-small cell lung cancer in patients with comorbid idiopathic pulmonary fibrosis. Eur Radiol 2024; 34:4708-4715. [PMID: 38114848 DOI: 10.1007/s00330-023-10510-9] [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: 07/13/2023] [Revised: 09/24/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of microwave ablation (MWA) for stage I non-small cell lung cancer (NSCLC) in patients with idiopathic pulmonary fibrosis (IPF). MATERIALS AND METHODS A retrospective single-center cohort study was conducted in patients with clinical stage I NSCLC who underwent CT-guided MWA from Nov 2016 to Oct 2021. The patients were divided into the IPF group and the non-IPF group. The primary endpoints were 90-day adverse events and hospital length of stay (HLOS). The secondary endpoints included overall survival (OS) and progression-free survival (PFS). RESULTS A total of 107 patients (27 with IPF and 80 without IPF) were finally included for analysis. No procedure-related acute exacerbation of IPF or death occurred post-MWA. The rates of adverse events were similar between the groups (48.6% vs. 47.7%; p = 0.998). The incidence of grade 3 adverse events in the IPF group was higher than that in the non-IPF group without a significant difference (13.5% vs. 4.6%; p = 0.123). Median HLOS was 5 days in both groups without a significant difference (p = 0.078). The 1-year and 3-year OS were 85.2%/51.6% in the IPF group, and 97.5%/86.4% in the non-IPF group. The survival of patients with IPF was significantly poorer than the survival of patients without IPF (p < 0.001). There was no significant difference for PFS (p = 0.271). CONCLUSION MWA was feasible in the treatment of stage I NSCLC in patients with IPF. IPF had an adverse effect on the survival of stage I NSCLC treated with MWA. CLINICAL RELEVANCE STATEMENT CT-guided microwave ablation is a well-tolerated and effective potential alternative treatment for stage I non-small cell lung cancer in patients with idiopathic pulmonary fibrosis. KEY POINTS • Microwave ablation for stage I non-small cell lung cancer was well-tolerated without procedure-related acute exacerbation of idiopathic pulmonary fibrosis and death in patients with idiopathic pulmonary fibrosis. • No differences were observed in the incidence of adverse events between patients with idiopathic pulmonary fibrosis and those without idiopathic pulmonary fibrosis after microwave ablation (48.6% vs. 47.7%; p = 0.998). • The 1-year and 3-year overall survival rates (85.2%/51.6%) in the idiopathic pulmonary fibrosis group were worse than those in the non- idiopathic pulmonary fibrosis group (97.5%/86.4%) (p < 0.001).
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Affiliation(s)
- JinZhao Peng
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Street, Beijing, 100730, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100370, China
| | - ZhiXin Bie
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Street, Beijing, 100730, China
| | - YuanMing Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Street, Beijing, 100730, China
| | - RunQi Guo
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Street, Beijing, 100730, China
| | - XiaoGuang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Street, Beijing, 100730, China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100370, China.
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17
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Koh SY, Lee JH, Park H, Goo JM. Value of CT quantification in progressive fibrosing interstitial lung disease: a deep learning approach. Eur Radiol 2024; 34:4195-4205. [PMID: 38085286 DOI: 10.1007/s00330-023-10483-9] [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: 07/11/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 06/29/2024]
Abstract
OBJECTIVES To evaluate the relationship of changes in the deep learning-based CT quantification of interstitial lung disease (ILD) with changes in forced vital capacity (FVC) and visual assessments of ILD progression, and to investigate their prognostic implications. METHODS This study included ILD patients with CT scans at intervals of over 2 years between January 2015 and June 2021. Deep learning-based texture analysis software was used to segment ILD findings on CT images (fibrosis: reticular opacity + honeycombing cysts; total ILD extent: ground-glass opacity + fibrosis). Patients were grouped according to the absolute decline of predicted FVC (< 5%, 5-10%, and ≥ 10%) and ILD progression assessed by thoracic radiologists, and their quantification results were compared among these groups. The associations between quantification results and survival were evaluated using multivariable Cox regression analysis. RESULTS In total, 468 patients (239 men; 64 ± 9.5 years) were included. Fibrosis and total ILD extents more increased in patients with larger FVC decline (p < .001 in both). Patients with ILD progression had higher fibrosis and total ILD extent increases than those without ILD progression (p < .001 in both). Increases in fibrosis and total ILD extent were significant prognostic factors when adjusted for absolute FVC declines of ≥ 5% (hazard ratio [HR] 1.844, p = .01 for fibrosis; HR 2.484, p < .001 for total ILD extent) and ≥ 10% (HR 2.918, p < .001 for fibrosis; HR 3.125, p < .001 for total ILD extent). CONCLUSION Changes in ILD CT quantification correlated with changes in FVC and visual assessment of ILD progression, and they were independent prognostic factors in ILD patients. CLINICAL RELEVANCE STATEMENT Quantifying the CT features of interstitial lung disease using deep learning techniques could play a key role in defining and predicting the prognosis of progressive fibrosing interstitial lung disease. KEY POINTS • Radiologic findings on high-resolution CT are important in diagnosing progressive fibrosing interstitial lung disease. • Deep learning-based quantification results for fibrosis and total interstitial lung disease extents correlated with the decline in forced vital capacity and visual assessments of interstitial lung disease progression, and emerged as independent prognostic factors. • Deep learning-based interstitial lung disease CT quantification can play a key role in diagnosing and prognosticating progressive fibrosing interstitial lung disease.
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Affiliation(s)
- Seok Young Koh
- Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hyungin Park
- Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
- Cancer Research Institute, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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18
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Kim WY, Jung SY, Kim JY, Chae G, Kim J, Joh JS, Park TY, Baek AR, Jegal Y, Chung CR, Lee J, Cho YJ, Park JH, Hwang JH, Song JW. ECMO is associated with decreased hospital mortality in COVID-19 ARDS. Sci Rep 2024; 14:14835. [PMID: 38937516 PMCID: PMC11211457 DOI: 10.1038/s41598-024-64949-x] [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: 01/08/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
This study determined whether compared to conventional mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO) is associated with decreased hospital mortality or fibrotic changes in patients with COVID-19 acute respiratory distress syndrome. A cohort of 72 patients treated with ECMO and 390 with conventional MV were analyzed (February 2020-December 2021). A target trial was emulated comparing the treatment strategies of initiating ECMO vs no ECMO within 7 days of MV in patients with a PaO2/FiO2 < 80 or a PaCO2 ≥ 60 mmHg. A total of 222 patients met the eligibility criteria for the emulated trial, among whom 42 initiated ECMO. ECMO was associated with a lower risk of hospital mortality (hazard ratio [HR], 0.56; 95% confidence interval [CI] 0.36-0.96). The risk was lower in patients who were younger (age < 70 years), had less comorbidities (Charlson comorbidity index < 2), underwent prone positioning before ECMO, and had driving pressures ≥ 15 cmH2O at inclusion. Furthermore, ECMO was associated with a lower risk of fibrotic changes (HR, 0.30; 95% CI 0.11-0.70). However, the finding was limited due to relatively small number of patients and differences in observability between the ECMO and conventional MV groups.
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Affiliation(s)
- Won-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jeong-Yeon Kim
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Ganghee Chae
- Department of Pulmonary and Critical Care Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Junghyun Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Joon-Sung Joh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Borame Medical Center, Seoul, Republic of Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Yangjin Jegal
- Department of Pulmonary and Critical Care Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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19
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Nan Y, Xing X, ShiyiWang, Tang Z, Felder FN, Zhang S, Ledda RE, Ding X, Yu R, Liu W, Shi F, Sun T, Cao Z, Zhang M, Gu Y, Zhang H, Gao J, Wang P, Tang W, Yu P, Kang H, Chen J, Lu X, Zhang B, Mamalakis M, Prinzi F, Carlini G, Cuneo L, Banerjee A, Xing Z, Zhu L, Mesbah Z, Jain D, Mayet T, Yuan H, Lyu Q, Qayyum A, Mazher M, Wells A, Walsh SL, Yang G. Hunting imaging biomarkers in pulmonary fibrosis: Benchmarks of the AIIB23 challenge. Med Image Anal 2024; 97:103253. [PMID: 38968907 DOI: 10.1016/j.media.2024.103253] [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: 12/20/2023] [Revised: 04/16/2024] [Accepted: 06/22/2024] [Indexed: 07/07/2024]
Abstract
Airway-related quantitative imaging biomarkers are crucial for examination, diagnosis, and prognosis in pulmonary diseases. However, the manual delineation of airway structures remains prohibitively time-consuming. While significant efforts have been made towards enhancing automatic airway modelling, current public-available datasets predominantly concentrate on lung diseases with moderate morphological variations. The intricate honeycombing patterns present in the lung tissues of fibrotic lung disease patients exacerbate the challenges, often leading to various prediction errors. To address this issue, the 'Airway-Informed Quantitative CT Imaging Biomarker for Fibrotic Lung Disease 2023' (AIIB23) competition was organized in conjunction with the official 2023 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). The airway structures were meticulously annotated by three experienced radiologists. Competitors were encouraged to develop automatic airway segmentation models with high robustness and generalization abilities, followed by exploring the most correlated QIB of mortality prediction. A training set of 120 high-resolution computerised tomography (HRCT) scans were publicly released with expert annotations and mortality status. The online validation set incorporated 52 HRCT scans from patients with fibrotic lung disease and the offline test set included 140 cases from fibrosis and COVID-19 patients. The results have shown that the capacity of extracting airway trees from patients with fibrotic lung disease could be enhanced by introducing voxel-wise weighted general union loss and continuity loss. In addition to the competitive image biomarkers for mortality prediction, a strong airway-derived biomarker (Hazard ratio>1.5, p < 0.0001) was revealed for survival prognostication compared with existing clinical measurements, clinician assessment and AI-based biomarkers.
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Affiliation(s)
- Yang Nan
- Bioengineering Department and Imperial-X, Imperial College London, London, UK; Royal Brompton Hospital, London, UK.
| | - Xiaodan Xing
- Bioengineering Department and Imperial-X, Imperial College London, London, UK.
| | - ShiyiWang
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Zeyu Tang
- Bioengineering Department and Imperial-X, Imperial College London, London, UK
| | - Federico N Felder
- Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Sheng Zhang
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Xiaoliu Ding
- Shanghai MicroPort MedBot (Group) Co., Ltd., China
| | - Ruiqi Yu
- Shanghai MicroPort MedBot (Group) Co., Ltd., China
| | - Weiping Liu
- Shanghai MicroPort MedBot (Group) Co., Ltd., China
| | - Feng Shi
- Shanghai United Imaging Intelligence Co., Ltd., China
| | - Tianyang Sun
- Shanghai United Imaging Intelligence Co., Ltd., China
| | - Zehong Cao
- Shanghai United Imaging Intelligence Co., Ltd., China
| | - Minghui Zhang
- Institute of Medical Robotics, Shanghai Jiao Tong University, China
| | - Yun Gu
- Institute of Medical Robotics, Shanghai Jiao Tong University, China
| | - Hanxiao Zhang
- Institute of Medical Robotics, Shanghai Jiao Tong University, China
| | - Jian Gao
- Department Computational Biology, School of Life Sciences, Fudan University, Shanghai, China
| | - Pingyu Wang
- Cambridge International Exam Centre in Shanghai Experimental School, China
| | - Wen Tang
- InferVision Medical Technology Co., Ltd., China
| | - Pengxin Yu
- InferVision Medical Technology Co., Ltd., China
| | - Han Kang
- InferVision Medical Technology Co., Ltd., China
| | - Junqiang Chen
- Shanghai MediWorks Precision Instruments Co., Ltd, China
| | - Xing Lu
- Sanmed Biotech Ltd., Zhuhai, China
| | | | | | - Francesco Prinzi
- Department of Biomedicine, University of Palermo, Palermo, Italy
| | - Gianluca Carlini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lisa Cuneo
- Istituto Italiano di Tecnologia, Nanoscopy, Genova, Italy
| | - Abhirup Banerjee
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK
| | - Zhaohu Xing
- Hong Kong University of Science and Technology (Guangzhou), Guangzhou, China
| | - Lei Zhu
- Hong Kong University of Science and Technology (Guangzhou), Guangzhou, China
| | - Zacharia Mesbah
- INSA Rouen Normandie, Univ Rouen Normandie, Université Le Havre Normandie, France; Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France
| | - Dhruv Jain
- INSA Rouen Normandie, Univ Rouen Normandie, Université Le Havre Normandie, France
| | - Tsiry Mayet
- INSA Rouen Normandie, Univ Rouen Normandie, Université Le Havre Normandie, France
| | - Hongyu Yuan
- Department of Radiology, Wake Forest University School of Medicine, USA
| | - Qing Lyu
- Department of Radiology, Wake Forest University School of Medicine, USA
| | - Abdul Qayyum
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Moona Mazher
- Department of Computer Science, University College London, United Kingdom
| | - Athol Wells
- Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Simon Lf Walsh
- Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Guang Yang
- Bioengineering Department and Imperial-X, Imperial College London, London, UK; Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, UK.
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20
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Gao Y, Liu MF, Li Y, Liu X, Cao YJ, Long QF, Yu J, Li JY. Mesenchymal stem cells-extracellular vesicles alleviate pulmonary fibrosis by regulating immunomodulators. World J Stem Cells 2024; 16:670-689. [PMID: 38948098 PMCID: PMC11212550 DOI: 10.4252/wjsc.v16.i6.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/22/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Pulmonary fibrosis (PF) is a chronic interstitial lung disease characterized by fibroblast proliferation and extracellular matrix formation, causing structural damage and lung failure. Stem cell therapy and mesenchymal stem cells-extracellular vesicles (MSC-EVs) offer new hope for PF treatment. AIM To investigate the therapeutic potential of MSC-EVs in alleviating fibrosis, oxidative stress, and immune inflammation in A549 cells and bleomycin (BLM)-induced mouse model. METHODS The effect of MSC-EVs on A549 cells was assessed by fibrosis markers [collagen I and α-smooth muscle actin (α-SMA), oxidative stress regulators [nuclear factor E2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1), and inflammatory regulators [nuclear factor-kappaB (NF-κB) p65, interleukin (IL)-1β, and IL-2]. Similarly, they were assessed in the lungs of mice where PF was induced by BLM after MSC-EV transfection. MSC-EVs ion PF mice were detected by pathological staining and western blot. Single-cell RNA sequencing was performed to investigate the effects of the MSC-EVs on gene expression profiles of macrophages after modeling in mice. RESULTS Transforming growth factor (TGF)-β1 enhanced fibrosis in A549 cells, significantly increasing collagen I and α-SMA levels. Notably, treatment with MSC-EVs demonstrated a remarkable alleviation of these effects. Similarly, the expression of oxidative stress regulators, such as Nrf2 and HO-1, along with inflammatory regulators, including NF-κB p65 and IL-1β, were mitigated by MSC-EV treatment. Furthermore, in a parallel manner, MSC-EVs exhibited a downregulatory impact on collagen deposition, oxidative stress injuries, and inflammatory-related cytokines in the lungs of mice with PF. Additionally, the mRNA sequencing results suggested that BLM may induce PF in mice by upregulating pulmonary collagen fiber deposition and triggering an immune inflammatory response. The findings collectively highlight the potential therapeutic efficacy of MSC-EVs in ameliorating fibrotic processes, oxidative stress, and inflammatory responses associated with PF. CONCLUSION MSC-EVs could ameliorate fibrosis in vitro and in vivo by downregulating collagen deposition, oxidative stress, and immune-inflammatory responses.
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Affiliation(s)
- Ying Gao
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial Rehabilitation Hospital, Xi'an 710000, Shaanxi Province, China
| | - Mei-Fang Liu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Ningxia Medical University (The First People's Hospital of Yinchuan), Yinchuan 750001, Ningxia Hui Autonomous Region, China
| | - Yang Li
- School of Clinical Medicine, Xi'an Medical University, Xi'an 710021, Shaanxi Province, China
| | - Xi Liu
- Department of Respiratory and Critical Care Medicine, Xi'an Central Hospital, Xi'an 710000, Shaanxi Province, China
| | - Yu-Jie Cao
- Department of Respiratory and Critical Care Medicine, Xi'an Central Hospital, Xi'an 710000, Shaanxi Province, China
| | - Qian-Fa Long
- Department of Neurosurgery, Xi'an Central Hospital, Xi'an 710000, Shaanxi Province, China
| | - Jun Yu
- Department of Emergency, Xi'an Central Hospital, Xi'an 710000, Shaanxi Province, China
| | - Jian-Ying Li
- Department of Respiratory and Critical Care Medicine, Xi'an Central Hospital, Xi'an 710000, Shaanxi Province, China.
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21
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Gao Y, Liu MF, Li Y, Liu X, Cao YJ, Long QF, Yu J, Li JY. Mesenchymal stem cells-extracellular vesicles alleviate pulmonary fibrosis by regulating immunomodulators. World J Stem Cells 2024; 16:669-688. [DOI: 10.4252/wjsc.v16.i6.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/22/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Pulmonary fibrosis (PF) is a chronic interstitial lung disease characterized by fibroblast proliferation and extracellular matrix formation, causing structural damage and lung failure. Stem cell therapy and mesenchymal stem cells-extracellular vesicles (MSC-EVs) offer new hope for PF treatment.
AIM To investigate the therapeutic potential of MSC-EVs in alleviating fibrosis, oxidative stress, and immune inflammation in A549 cells and bleomycin (BLM)-induced mouse model.
METHODS The effect of MSC-EVs on A549 cells was assessed by fibrosis markers [collagen I and α-smooth muscle actin (α-SMA), oxidative stress regulators [nuclear factor E2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1), and inflammatory regulators [nuclear factor-kappaB (NF-κB) p65, interleukin (IL)-1β, and IL-2]. Similarly, they were assessed in the lungs of mice where PF was induced by BLM after MSC-EV transfection. MSC-EVs ion PF mice were detected by pathological staining and western blot. Single-cell RNA sequencing was performed to investigate the effects of the MSC-EVs on gene expression profiles of macrophages after modeling in mice.
RESULTS Transforming growth factor (TGF)-β1 enhanced fibrosis in A549 cells, significantly increasing collagen I and α-SMA levels. Notably, treatment with MSC-EVs demonstrated a remarkable alleviation of these effects. Similarly, the expression of oxidative stress regulators, such as Nrf2 and HO-1, along with inflammatory regulators, including NF-κB p65 and IL-1β, were mitigated by MSC-EV treatment. Furthermore, in a parallel manner, MSC-EVs exhibited a downregulatory impact on collagen deposition, oxidative stress injuries, and inflammatory-related cytokines in the lungs of mice with PF. Additionally, the mRNA sequencing results suggested that BLM may induce PF in mice by upregulating pulmonary collagen fiber deposition and triggering an immune inflammatory response. The findings collectively highlight the potential therapeutic efficacy of MSC-EVs in ameliorating fibrotic processes, oxidative stress, and inflammatory responses associated with PF.
CONCLUSION MSC-EVs could ameliorate fibrosis in vitro and in vivo by downregulating collagen deposition, oxidative stress, and immune-inflammatory responses.
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Affiliation(s)
- Ying Gao
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial Rehabilitation Hospital, Xi’an 710000, Shaanxi Province, China
| | - Mei-Fang Liu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Ningxia Medical University (The First People’s Hospital of Yinchuan), Yinchuan 750001, Ningxia Hui Autonomous Region, China
| | - Yang Li
- School of Clinical Medicine, Xi’an Medical University, Xi’an 710021, Shaanxi Province, China
| | - Xi Liu
- Department of Respiratory and Critical Care Medicine, Xi’an Central Hospital, Xi’an 710000, Shaanxi Province, China
| | - Yu-Jie Cao
- Department of Respiratory and Critical Care Medicine, Xi’an Central Hospital, Xi’an 710000, Shaanxi Province, China
| | - Qian-Fa Long
- Department of Neurosurgery, Xi’an Central Hospital, Xi’an 710000, Shaanxi Province, China
| | - Jun Yu
- Department of Emergency, Xi’an Central Hospital, Xi’an 710000, Shaanxi Province, China
| | - Jian-Ying Li
- Department of Respiratory and Critical Care Medicine, Xi’an Central Hospital, Xi’an 710000, Shaanxi Province, China
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22
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Le L, Narula N, Zhou F, Smereka P, Ordner J, Theise N, Moore WH, Girvin F, Azour L, Moreira AL, Naidich DP, Ko JP. Diseases Involving the Lung Peribronchovascular Region: A CT Imaging Pathologic Classification. Chest 2024:S0012-3692(24)00776-1. [PMID: 38909953 DOI: 10.1016/j.chest.2024.05.033] [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: 11/29/2023] [Revised: 04/12/2024] [Accepted: 05/13/2024] [Indexed: 06/25/2024] Open
Abstract
TOPIC IMPORTANCE Chest CT imaging holds a major role in the diagnosis of lung diseases, many of which affect the peribronchovascular region. Identification and categorization of peribronchovascular abnormalities on CT imaging can assist in formulating a differential diagnosis and directing further diagnostic evaluation. REVIEW FINDINGS The peribronchovascular region of the lung encompasses the pulmonary arteries, airways, and lung interstitium. Understanding disease processes associated with structures of the peribronchovascular region and their appearances on CT imaging aids in prompt diagnosis. This article reviews current knowledge in anatomic and pathologic features of the lung interstitium composed of intercommunicating prelymphatic spaces, lymphatics, collagen bundles, lymph nodes, and bronchial arteries; diffuse lung diseases that present in a peribronchovascular distribution; and an approach to classifying diseases according to patterns of imaging presentations. Lung peribronchovascular diseases can appear on CT imaging as diffuse thickening, fibrosis, masses or masslike consolidation, ground-glass or air space consolidation, and cysts, acknowledging some disease may have multiple presentations. SUMMARY A category approach to peribronchovascular diseases on CT imaging can be integrated with clinical features as part of a multidisciplinary approach for disease diagnosis.
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Affiliation(s)
- Linda Le
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Navneet Narula
- Department of Pathology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Fang Zhou
- Department of Pathology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Paul Smereka
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Jeffrey Ordner
- Department of Pathology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Neil Theise
- Department of Pathology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - William H Moore
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Francis Girvin
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, NY
| | - Lea Azour
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY; Department of Radiological Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Andre L Moreira
- Department of Pathology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - David P Naidich
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY
| | - Jane P Ko
- Department of Radiology, NYU Langone Health; NYU Grossman School of Medicine, New York, NY.
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23
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Carroll MB, Kanne JP, Martin Rother MD. Update on Interstitial Pneumonias. Clin Chest Med 2024; 45:419-431. [PMID: 38816097 DOI: 10.1016/j.ccm.2023.08.015] [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] [Indexed: 06/01/2024]
Abstract
The American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Asociación Latinoamericana de Tórax 2018 clinical practice guideline and 2022 update provide recommendations to define and diagnose idiopathic pulmonary fibrosis (IPF) in patients with newly diagnosed interstitial lung disease. The guideline emphasizes recognition of usual interstitial pneumonia (UIP) and probable UIP patterns of fibrosis on high-resolution CT, which can obviate the need for surgical lung biopsy and allow timely initiation of antifibrotic pharmacotherapy citing a high correlation with UIP on histopathology. This article reviews the recent 2022 IPF clinical practice guideline with a focus on the imaging updates.
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Affiliation(s)
- Melissa B Carroll
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Maria Daniela Martin Rother
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
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24
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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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25
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Byrne L, McCarthy C, Fabre A, Gupta N. Pulmonary Manifestations of Sjögren's Disease. Semin Respir Crit Care Med 2024; 45:397-410. [PMID: 38621712 DOI: 10.1055/s-0044-1785675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Sjögren's disease (SjD) is a chronic, progressive autoimmune condition of exocrine and extraglandular tissues. It can present with isolated disease characterized by lymphocytic infiltration of salivary or lacrimal glands, but in approximately one-third of the patients, lymphocytic infiltration extends beyond exocrine glands to involve extraglandular organs such as the lungs. Pulmonary complications have been reported to occur between 9 and 27% of patients with SjD across studies. Respiratory manifestations occur on a spectrum of severity and include airways disease, interstitial lung disease, cystic lung disease, and lymphoma. Lung involvement can greatly affect patients' quality of life, has a major impact on the overall prognosis, and frequently leads to alteration in the treatment plans, highlighting the importance of maintaining a high index of clinical suspicion and taking appropriate steps to facilitate early recognition and intervention.
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Affiliation(s)
- Louise Byrne
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Aurelie Fabre
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Nishant Gupta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, Ohio
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26
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Walsh SLF, van Beek EJR. Glossary of Terms for Thoracic Imaging: Implications for Machine Learning and Future Practice. Radiology 2024; 311:e240907. [PMID: 38832883 DOI: 10.1148/radiol.240907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Affiliation(s)
- Simon L F Walsh
- From the National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK (S.L.F.W.); and the University of Edinburgh Centre for Cardiovascular Science-Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom (E.J.R.v.B.)
| | - Edwin J R van Beek
- From the National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK (S.L.F.W.); and the University of Edinburgh Centre for Cardiovascular Science-Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom (E.J.R.v.B.)
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27
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Galvin JR, Franks TJ. Diffuse Parenchymal Lung Disease and the Inherent Limitations of a Glossary. Radiology 2024; 311:e240948. [PMID: 38832884 DOI: 10.1148/radiol.240948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Affiliation(s)
- Jeffrey R Galvin
- From the Departments of Diagnostic Radiology and Medicine (Pulmonary Division), University of Maryland School of Medicine, 22 Greene St, Baltimore, MD 21201 (J.R.G.); and Department of Defense, Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.)
| | - Teri J Franks
- From the Departments of Diagnostic Radiology and Medicine (Pulmonary Division), University of Maryland School of Medicine, 22 Greene St, Baltimore, MD 21201 (J.R.G.); and Department of Defense, Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.)
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28
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Kastrati K, Nakuz TS, Kulterer OC, Geßl I, Simader E, Mrak D, Bonelli M, Kiener HP, Prayer F, Prosch H, Aletaha D, Langsteger W, Traub-Weidinger T, Blüml S, Lechner-Radner H, Hacker M, Mandl P. FAPi PET/CT for assessment and visualisation of active myositis-related interstitial lung disease: a prospective observational pilot study. EClinicalMedicine 2024; 72:102598. [PMID: 38633577 PMCID: PMC11019096 DOI: 10.1016/j.eclinm.2024.102598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
Background Interstitial lung disease (ILD) is a common manifestation of idiopathic inflammatory myopathies (IIM) and a substantial contributor to hospitalisation, increased morbidity, and mortality. In-vivo evidence of ongoing tissue remodelling in IIM-ILD is scarce. We aimed to evaluate fibroblast activation in lungs of IIM-patients and control individuals using ⁶⁸Ga-labelled inhibitor of Fibroblast-Activation-Protein (FAPi) based positronic emission tomography and computed tomography imaging (PET/CT). Methods In this prospective observational pilot study, consecutive patients with IIM and participants without rheumatic conditions or ILD serving as a control group were recruited at the Medical University of Vienna, Austria, and underwent FAPi PET/CT imaging. Standard-of-care procedures including clinical examination, assessment of severity of dyspnoea, high-resolution computed tomography (HR-CT), and pulmonary function testing (PFT) were performed on all patients with IIM at baseline and for patients with IIM-ILD at follow-up of 12 months. Baseline pulmonary FAPi-uptake was assessed by the maximum (SUVmax) and mean (SUVmean) standardized uptake values (SUV) over the whole lung (wl). SUV was corrected for blood pool background activity and target-to-background ratios (TBR) were calculated. We compared pulmonary FAPi-uptake between patients with IIM-ILD and those without ILD, as well as controls, and correlated baseline FAP-uptake with standard diagnostic tools such as HR-CT and PFT. For predictive implications, we investigated whether patients with IIM and progressive ILD exhibited higher baseline FAPi-uptake compared to those with stable ILD. Metrics are reported as mean with standard deviation (±SD). Findings Between November 16, 2021 and October 10, 2022, a total of 32 patients were enrolled in the study. Three participants from the control group were excluded due to cardiopulmonary disease. In individuals with IIM-ILD (n = 14), wlTBRmax and wlTBRmean were significantly increased as compared with both non-ILD-IIM patients (n = 5) and the control group (n = 16): wlTBRmax: 2.06 ± 1.04 vs. 1.04 ± 0.22 (p = 0.019) and 1.08 ± 0.19 (p = 0.0012) and wlTBRmean: 0.45 ± 0.19 vs. 0.26 ± 0.06 (p = 0.025) and 0.27 ± 0.07 (p = 0.0024). Similar values were observed in wlTBRmax or wlTBRmean between non-ILD IIM patients and the control group. Patients with progressive ILD displayed significantly enhanced wlTBRmax and wlTBRmean values at baseline compared to patients with stable ILD: wlTBRmax: 1.30 ± 0.31 vs. 2.63 ± 1.04 (p = 0.0084) and wlTBRmean: 0.32 ± 0.08 vs. 0.55 ± 0.19 (p = 0.021). Strong correlations were found between FAPi-uptake and disease extent on HR-CT (wlTBRmax: R = 0.42, p = 0.07; wlTBRmean: R = 0.56, p = 0.013) and severity of respiratory symptoms determined by the New York Heart Association (NYHA) classification tool (wlTBRmax: R = 0.52, p = 0.022; wlTBRmean: R = 0.59, p = 0.0073). Further, pulmonary FAPi-uptake showed inverse correlation with forced vital capacity (FVC) (wlTBRmax: R = -0.56, p = 0.012; wlTBRmean: R = -0.64, p = 0.0033) and diffusing capacity of the lungs for carbon monoxide (DLCO) (wlTBRmax: R = -0.52, p = 0.028; wlTBRmean: R = -0.68, p = 0.0017). Interpretation Our study demonstrates higher fibroblast activation in patients with IIM-ILD compared to non-ILD patients and controls. Intensity of pulmonary FAPi accumulation was associated with progression of ILD. Considering that this study was carried out on a small population, FAPi PET/CT may serve as a useful non-invasive tool for risk stratification of lung disease in IIM. Funding The Austrian Research Fund.
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Affiliation(s)
- Kastriot Kastrati
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas S. Nakuz
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oana C. Kulterer
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Irina Geßl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Simader
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Daniel Mrak
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Bonelli
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Hans Peter Kiener
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Florian Prayer
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Helmut Prosch
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Werner Langsteger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Blüml
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Helga Lechner-Radner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Sparks JA, Dieudé P, Hoffmann-Vold AM, Burmester GR, Walsh SL, Kreuter M, Stock C, Sambevski S, Alves M, Emery P. Design of ANCHOR-RA: a multi-national cross-sectional study on screening for interstitial lung disease in patients with rheumatoid arthritis. BMC Rheumatol 2024; 8:19. [PMID: 38773593 PMCID: PMC11107068 DOI: 10.1186/s41927-024-00389-4] [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: 09/07/2023] [Accepted: 05/10/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) are at risk of developing interstitial lung disease (ILD), which is associated with high mortality. Screening tools based on risk factors are needed to decide which patients with RA should be screened for ILD using high-resolution computed tomography (HRCT). The ANCHOR-RA study is a multi-national cross-sectional study that will develop a multivariable model for prediction of RA-ILD, which can be used to inform screening for RA-ILD in clinical practice. METHODS Investigators will enrol consecutive patients with RA who have ≥ 2 of the following risk factors for RA-ILD: male; current or previous smoker; age ≥ 60 years at RA diagnosis; high-positive rheumatoid factor and/or anti-cyclic citrullinated peptide (titre > 3 x upper limit of normal); presence or history of certain extra-articular manifestations of RA (vasculitis, Felty's syndrome, secondary Sjögren's syndrome, cutaneous rheumatoid nodules, serositis, and/or scleritis/uveitis); high RA disease activity in the prior 12 months. Patients previously identified as having ILD, or who have had a CT scan in the prior 2 years, will not be eligible. Participants will undergo an HRCT scan at their local site, which will be assessed centrally by two expert radiologists. Data will be collected prospectively on demographic and RA-related characteristics, patient-reported outcomes, comorbidities and pulmonary function. The primary outcomes will be the development of a probability score for RA-ILD, based on a multivariable model incorporating potential risk factors commonly assessed in clinical practice, and an estimate of the prevalence of RA-ILD in the study population. It is planned that 1200 participants will be enrolled at approximately 30 sites in the USA, UK, Germany, France, Italy, Spain. DISCUSSION Data from the ANCHOR-RA study will add to the body of evidence to support recommendations for screening for RA-ILD to improve detection of this important complication of RA and enable early intervention. TRIAL REGISTRATION clinicaltrials.gov NCT05855109 (submission date: 3 May 2023).
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Affiliation(s)
- Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA.
| | - Philippe Dieudé
- Department of Rheumatology, Bichat-Claude Bernard University Hospital, Assistance Publique-Hôpitaux de Paris, INSERM UMR1152, University of Paris, Paris, France
| | - Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, University of Zurich, Oslo, Norway
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Lf Walsh
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael Kreuter
- Center for Pulmonary Medicine, Departments of Pneumology, Critical Care & Sleep Medicine, Mainz University Medical Center and of Pulmonary, Marienhaus Clinic Mainz, Mainz, Germany
| | - Christian Stock
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Steven Sambevski
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Margarida Alves
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Paul Emery
- NIHR Leeds Biomedical Research Centre, Institute of Rheumatic and Musculoskeletal Medicine, Leeds Teaching Hospitals NHS Trust and Leeds, University of Leeds, Leeds, UK
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30
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Zhang Q, Song R, Hang J, Wei S, Zhu Y, Zhang G, Ding B, Ye X, Guo X, Zhang D, Wu P, Lin H, Tu J. A lung disease diagnosis algorithm based on 2D spectral features of ultrasound RF signals. ULTRASONICS 2024; 140:107315. [PMID: 38603903 DOI: 10.1016/j.ultras.2024.107315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024]
Abstract
Lung diseases are commonly diagnosed based on clinical pathological indications criteria and radiological imaging tools (e.g., X-rays and CT). During a pandemic like COVID-19, the use of ultrasound imaging devices has broadened for emergency examinations by taking their unique advantages such as portability, real-time detection, easy operation and no radiation. This provides a rapid, safe, and cost-effective imaging modality for screening lung diseases. However, the current pulmonary ultrasound diagnosis mainly relies on the subjective assessments of sonographers, which has high requirements for the operator's professional ability and clinical experience. In this study, we proposed an objective and quantifiable algorithm for the diagnosis of lung diseases that utilizes two-dimensional (2D) spectral features of ultrasound radiofrequency (RF) signals. The ultrasound data samples consisted of a set of RF signal frames, which were collected by professional sonographers. In each case, a region of interest of uniform size was delineated along the pleural line. The standard deviation curve of the 2D spatial spectrum was calculated and smoothed. A linear fit was applied to the high-frequency segment of the processed data curve, and the slope of the fitted line was defined as the frequency spectrum standard deviation slope (FSSDS). Based on the current data, the method exhibited a superior diagnostic sensitivity of 98% and an accuracy of 91% for the identification of lung diseases. The area under the curve obtained by the current method exceeded the results obtained that interpreted by professional sonographers, which indicated that the current method could provide strong support for the clinical ultrasound diagnosis of lung diseases.
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Affiliation(s)
- Qi Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Renjie Song
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Jing Hang
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Siqi Wei
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yifei Zhu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Guofeng Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Bo Ding
- Zhuhai Ecare Electronics Science & Technology Co., Ltd., Zhuhai 519041, China
| | - Xinhua Ye
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiasheng Guo
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Dong Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Pingping Wu
- Jiangsu Key Laboratory of Public Project Audit, Nanjing Audit University, Nanjing 211815, China
| | - Han Lin
- Jiangsu Key Laboratory of Public Project Audit, Nanjing Audit University, Nanjing 211815, China.
| | - Juan Tu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China.
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Humphries SM, Thieke D, Baraghoshi D, Strand MJ, Swigris JJ, Chae KJ, Hwang HJ, Oh AS, Flaherty KR, Adegunsoye A, Jablonski R, Lee CT, Husain AN, Chung JH, Strek ME, Lynch DA. Deep Learning Classification of Usual Interstitial Pneumonia Predicts Outcomes. Am J Respir Crit Care Med 2024; 209:1121-1131. [PMID: 38207093 DOI: 10.1164/rccm.202307-1191oc] [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: 07/12/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
Rationale: Computed tomography (CT) enables noninvasive diagnosis of usual interstitial pneumonia (UIP), but enhanced image analyses are needed to overcome the limitations of visual assessment. Objectives: Apply multiple instance learning (MIL) to develop an explainable deep learning algorithm for prediction of UIP from CT and validate its performance in independent cohorts. Methods: We trained an MIL algorithm using a pooled dataset (n = 2,143) and tested it in three independent populations: data from a prior publication (n = 127), a single-institution clinical cohort (n = 239), and a national registry of patients with pulmonary fibrosis (n = 979). We tested UIP classification performance using receiver operating characteristic analysis, with histologic UIP as ground truth. Cox proportional hazards and linear mixed-effects models were used to examine associations between MIL predictions and survival or longitudinal FVC. Measurements and Main Results: In two cohorts with biopsy data, MIL improved accuracy for histologic UIP (area under the curve, 0.77 [n = 127] and 0.79 [n = 239]) compared with visual assessment (area under the curve, 0.65 and 0.71). In cohorts with survival data, MIL-UIP classifications were significant for mortality (n = 239, mortality to April 2021: unadjusted hazard ratio, 3.1; 95% confidence interval [CI], 1.96-4.91; P < 0.001; and n = 979, mortality to July 2022: unadjusted hazard ratio, 3.64; 95% CI, 2.66-4.97; P < 0.001). Individuals classified as UIP positive by the algorithm had a significantly greater annual decline in FVC than those classified as UIP negative (-88 ml/yr vs. -45 ml/yr; n = 979; P < 0.01), adjusting for extent of lung fibrosis. Conclusions: Computerized assessment using MIL identifies clinically significant features of UIP on CT. Such a method could improve confidence in radiologic assessment of patients with interstitial lung disease, potentially enabling earlier and more precise diagnosis.
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Affiliation(s)
| | | | | | | | - Jeffrey J Swigris
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colorado
| | - Kum Ju Chae
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Hye Jeon Hwang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Andrea S Oh
- Department of Radiology, University of California Los Angeles, Los Angeles, California
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Renea Jablonski
- Section of Pulmonary and Critical Care, Department of Medicine
| | - Cathryn T Lee
- Section of Pulmonary and Critical Care, Department of Medicine
| | - Aliya N Husain
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | | | - Mary E Strek
- Section of Pulmonary and Critical Care, Department of Medicine
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Kanne JP, Walker CM, Brixey AG, Brown KK, Chelala L, Kazerooni EA, Walsh SLF, Lynch DA. Progressive Pulmonary Fibrosis and Interstitial Lung Abnormalities: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024. [PMID: 38656115 DOI: 10.2214/ajr.24.31125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Progressive pulmonary fibrosis (PPF) and interstitial lung abnormalities (ILA) are relatively new concepts in interstitial lung disease (ILD) imaging and clinical management. Recognition of signs of PPF, as well as identification and classification of ILA, are important tasks during chest high-resolution CT interpretation, to optimize management of patients with ILD and those at risk of developing ILD. However, following professional society guidance, the role of imaging surveillance remains unclear in stable patients with ILD, asymptomatic patients with ILA who are at risk of progression, and asymptomatic patients at risk of developing ILD without imaging abnormalities. In this AJR Expert Panel Narrative Review, we summarize the current knowledge regarding PPF and ILA and describe the range of clinical practice with respect to imaging patients with ILD, those with ILA, and those at risk of developing ILD. In addition, we offer suggestions to help guide surveillance imaging in areas with an absence of published guidelines, where such decisions are currently driven primarily by local pulmonologists' preference.
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Affiliation(s)
- Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Christopher M Walker
- Department of Radiology, The University of Kansas Medical Center, Kansas City, KS
| | - Anupama G Brixey
- Department of Radiology, Portland VA Healthcare System, Oregon Health & Science University, Portland, OR
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO
| | - Lydia Chelala
- Department of Radiology, University of Chicago Medicine, Chicago, IL
| | - Ella A Kazerooni
- Departments of Radiology & Internal Medicine, University of Michigan Medical School / Michigan Medicine, Ann Arbor, MI
| | - Simon L F Walsh
- Department of Radiology, Imperial College, London, United Kingdom
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
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Sofíudóttir BK, Harders S, Laursen CB, Lage-Hansen PR, Nielsen SM, Just SA, Christensen R, Davidsen JR, Ellingsen T. Detection of Interstitial Lung Disease in Rheumatoid Arthritis by Thoracic Ultrasound: A Diagnostic Test Accuracy Study. Arthritis Care Res (Hoboken) 2024. [PMID: 38622106 DOI: 10.1002/acr.25351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/29/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To determine the diagnostic accuracy of thoracic ultrasound (TUS) for detecting interstitial lung disease (ILD) in rheumatoid arthritis (RA) with respiratory symptoms. METHODS Individuals with RA visiting rheumatologic outpatient clinics in the Region of Southern Denmark were systematically screened for dyspnea, cough, recurrent pneumonia, prior severe pneumonia, or a chest x-ray indicating interstitial abnormalities. Eighty participants with a positive screening were consecutively included. Individuals were not eligible if they had a chest high-resolution computed tomography (HRCT) less than 12 months ago or were already diagnosed with ILD. A blinded TUS expert evaluated TUS, and TUS was registered as positive for ILD if at least 10 B-lines or bilateral thickened and fragmented pleura were present. The primary outcomes were TUS's sensitivity, specificity, and positive predictive value and negative predictive value. An ILD-specialized thoracic radiologist assessed HRCT, followed by a multidisciplinary team discussion, which was the reference standard. The accepted window of HRCT was less than 30 days after TUS was performed. RESULTS A total of 77 participants received HRCT less than 30 days after TUS, and 23 (30%) were diagnosed with ILD. TUS had a sensitivity of 82.6% (95% confidence interval [CI] 61.2%-95.0%) and a specificity of 51.9% (95% CI 37.8%-65.7%), corresponding to a positive predictive value of 42.2% (95% CI 27.7%-57.8%) and a negative predictive value of 87.5% (95% CI 71.0%-96.5%). CONCLUSION To our knowledge, this prospective study is the first to use respiratory symptoms in RA as inclusion criteria. Systematic screening for respiratory symptoms combined with TUS can reduce the diagnostic delay of ILD in RA.
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Affiliation(s)
- Bjørk K Sofíudóttir
- Odense University Hospital, Odense, Bispebjerg and Frederiksberg Hospital, Copenhagen, and University of Southern Denmark, Odense, Denmark
| | - Stefan Harders
- Odense University Hospital, Odense, and Aarhus University Hospital, Aarhus, Denmark
| | - Christian B Laursen
- Odense University Hospital and University of Southern Demark, Odense, Denmark
| | | | - Sabrina M Nielsen
- Odense University Hospital, Odense, and Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Søren A Just
- Odense University Hospital - Svendborg Hospital, Svendborg, Denmark
| | - Robin Christensen
- Odense University Hospital, Odense, Bispebjerg and Frederiksberg Hospital, Copenhagen, and University of Southern Denmark, Odense, Denmark
| | - Jesper R Davidsen
- Odense University Hospital and University of Southern Demark, Odense, Denmark
| | - Torkell Ellingsen
- Odense University Hospital and University of Southern Demark, Odense, Denmark
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Canderan G, Muehling LM, Kadl A, Ladd S, Bonham C, Cross CE, Lima SM, Yin X, Sturek JM, Wilson JM, Keshavarz B, Bryant N, Murphy DD, Cheon IS, McNamara CA, Sun J, Utz PJ, Dolatshahi S, Irish JM, Woodfolk JA. Distinct Type 1 Immune Networks Underlie the Severity of Restrictive Lung Disease after COVID-19. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.03.587929. [PMID: 38617217 PMCID: PMC11014603 DOI: 10.1101/2024.04.03.587929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
The variable etiology of persistent breathlessness after COVID-19 have confounded efforts to decipher the immunopathology of lung sequelae. Here, we analyzed hundreds of cellular and molecular features in the context of discrete pulmonary phenotypes to define the systemic immune landscape of post-COVID lung disease. Cluster analysis of lung physiology measures highlighted two phenotypes of restrictive lung disease that differed by their impaired diffusion and severity of fibrosis. Machine learning revealed marked CCR5+CD95+ CD8+ T-cell perturbations in mild-to-moderate lung disease, but attenuated T-cell responses hallmarked by elevated CXCL13 in more severe disease. Distinct sets of cells, mediators, and autoantibodies distinguished each restrictive phenotype, and differed from those of patients without significant lung involvement. These differences were reflected in divergent T-cell-based type 1 networks according to severity of lung disease. Our findings, which provide an immunological basis for active lung injury versus advanced disease after COVID-19, might offer new targets for treatment.
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García Mullor MM, Arenas-Jiménez JJ, Ureña Vacas A, Gayá García-Manso I, Pérez Pérez JL, Serra Serra N, García Sevila R. Prevalence and prognostic meaning of interstitial lung abnormalities in remote CT scans of patients with interstitial lung disease treated with antifibrotic therapy. RADIOLOGIA 2024; 66 Suppl 1:S10-S23. [PMID: 38642956 DOI: 10.1016/j.rxeng.2023.03.006] [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: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 04/22/2024]
Abstract
OBJECTIVES To describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. METHODS We conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. RESULTS We included 50 patients. Only 1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2 months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (p = 0.04). Obvious honeycombing in the lower zones was also significantly (p < 0.05) associated with a faster progression rate. CONCLUSIONS Fibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.
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Affiliation(s)
- M M García Mullor
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - A Ureña Vacas
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - I Gayá García-Manso
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - J L Pérez Pérez
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - N Serra Serra
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - R García Sevila
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain
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Brixey AG, Oh AS, Alsamarraie A, Chung JH. Pictorial Review of Fibrotic Interstitial Lung Disease on High-Resolution CT Scan and Updated Classification. Chest 2024; 165:908-923. [PMID: 38056824 DOI: 10.1016/j.chest.2023.11.037] [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: 05/25/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023] Open
Abstract
TOPIC IMPORTANCE Given the recently expanded approval of antifibrotics for various fibrotic interstitial lung diseases (ILDs), early and correct recognition of these diseases is imperative for physicians. Because high-resolution chest CT scan forms the backbone of diagnosis for ILD, this review will discuss evidence-based imaging findings of key fibrotic ILDs and an approach for differentiating these diseases. REVIEW FINDINGS (1) Imaging findings of nonspecific interstitial pneumonia may evolve over time and become indistinguishable from usual interstitial pneumonia. Therefore, if remote imaging can be reviewed, this would increase the likelihood of an accurate imaging diagnosis, particularly if findings appear to represent a usual interstitial pneumonia pattern on the recent examination. (2) Given the difficulty and lack of objectivity in classifying patients with hypersensitivity pneumonitis into acute, subacute, and chronic categories and that prognosis depends primarily on presence or absence of fibrosis, the new set of guidelines released in 2020 categorizes patients with hypersensitivity pneumonitis as either nonfibrotic (purely inflammatory) or fibrotic (either purely fibrotic or mixed fibrotic/inflammatory) based on imaging and/or histologic findings, and the prior temporal terms are no longer used. (3) Interstitial lung abnormalities are incidental CT scan findings that may suggest early ILD in patients without clinical suspicion for ILD. Patients with high-risk features should undergo clinical evaluation for ILD and be actively monitored for disease progression. SUMMARY Fibrotic ILD on high-resolution chest CT scan is a complex topic, but with use of an evidence-based analysis and algorithm as provided in this article, the probability of a correct imaging diagnosis increases.
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Affiliation(s)
- Anupama Gupta Brixey
- Portland VA Health Care System, Department of Diagnostic Radiology, Section of Cardiothoracic Imaging, Oregon Health & Science University, Portland, OR.
| | - Andrea S Oh
- Department of Diagnostic Radiology, University of California, Los Angeles, Los Angeles, CA
| | - Aseel Alsamarraie
- Department of Internal Medicine, Washington State University, Providence Medical Center, Everett, WA
| | - Jonathan H Chung
- Department of Diagnostic Radiology, The University of California, San Diego, San Diego, CA
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Lucà S, Pagliuca F, Perrotta F, Ronchi A, Mariniello DF, Natale G, Bianco A, Fiorelli A, Accardo M, Franco R. Multidisciplinary Approach to the Diagnosis of Idiopathic Interstitial Pneumonias: Focus on the Pathologist's Key Role. Int J Mol Sci 2024; 25:3618. [PMID: 38612431 PMCID: PMC11011777 DOI: 10.3390/ijms25073618] [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: 02/01/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Idiopathic Interstitial Pneumonias (IIPs) are a heterogeneous group of the broader category of Interstitial Lung Diseases (ILDs), pathologically characterized by the distortion of lung parenchyma by interstitial inflammation and/or fibrosis. The American Thoracic Society (ATS)/European Respiratory Society (ERS) international multidisciplinary consensus classification of the IIPs was published in 2002 and then updated in 2013, with the authors emphasizing the need for a multidisciplinary approach to the diagnosis of IIPs. The histological evaluation of IIPs is challenging, and different types of IIPs are classically associated with specific histopathological patterns. However, morphological overlaps can be observed, and the same histopathological features can be seen in totally different clinical settings. Therefore, the pathologist's aim is to recognize the pathologic-morphologic pattern of disease in this clinical setting, and only after multi-disciplinary evaluation, if there is concordance between clinical and radiological findings, a definitive diagnosis of specific IIP can be established, allowing the optimal clinical-therapeutic management of the patient.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Francesca Pagliuca
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Fabio Perrotta
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Domenica Francesca Mariniello
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Giovanni Natale
- Division of Thoracic Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia, 2, 80138 Naples, Italy; (G.N.); (A.F.)
| | - Andrea Bianco
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Alfonso Fiorelli
- Division of Thoracic Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia, 2, 80138 Naples, Italy; (G.N.); (A.F.)
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
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Gayá García-Manso I, Arenas Jiménez J, Hernández Blasco L, García Garrigós E, Nofuentes Pérez E, Sirera Matilla M, Ruiz Alcaraz S, García Sevila R. Radiological usual interstitial pneumonia pattern is associated with two-year mortality in patients with idiopathic pulmonary fibrosis. Heliyon 2024; 10:e26623. [PMID: 38434331 PMCID: PMC10906386 DOI: 10.1016/j.heliyon.2024.e26623] [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: 09/19/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction The new diagnostic guidelines for idiopathic pulmonary fibrosis (IPF) did not rule out the possibility of combining the radiological patterns of usual interstitial pneumonia (UIP) and probable UIP, given the similar management and diagnostic capacity. However, the prognostic implications of these patterns have not been fully elucidated, with different studies showing heterogeneous results. We applied the new criteria to a retrospective series of patients with IPF, assessing survival based on radiological patterns, findings, and their extension. Methods Two thoracic radiologists reviewed high-resolution computed tomography images taken at diagnosis in 146 patients with IPF, describing the radiological findings and patterns. The association of each radiological finding and radiological patterns with two-year mortality was analysed. Results The two-year mortality rate was 40.2% in IPF patients with an UIP radiological pattern versus 7.1% in those with probable UIP. Compared to the UIP pattern, probable UIP was protective against mortality, even after adjusting for age, sex, pulmonary function, and extent of fibrosis (hazard ratio (HR) 0.23, 95% confidence interval (CI) 0.06-0.99). Receiving antifibrotic treatment was also a protective factor (HR 0.51, 95%CI 0.27-0.98). Honeycombing (HR 3.62, 95%CI 1.27-10.32), an acute exacerbation pattern (HR 4.07, 95%CI 1.84-8.96), and the overall extent of fibrosis (HR 1.04, 95%CI 1.02-1.06) were predictors of mortality. Conclusions In our series, two-year mortality was higher in patients with IPF who presented a radiological pattern of UIP versus probable UIP on the initial scan. Honeycombing, an acute exacerbation pattern, and a greater overall extent of fibrosis were also predictors of increased mortality. The prognostic differences between the radiological pattern of UIP and probable UIP in our series would support maintaining them as two differentiated patterns.
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Affiliation(s)
| | - Juan Arenas Jiménez
- Department of Radiology, Dr. Balmis General University Hospital, ISABIAL, Alicante, Spain
| | - Luis Hernández Blasco
- Department of Pulmonology, Dr. Balmis General University Hospital, ISABIAL, Alicante, Spain
- Department of Clinical Medicine. UMH. Alicante, Spain
| | - Elena García Garrigós
- Department of Radiology, Dr. Balmis General University Hospital, ISABIAL, Alicante, Spain
| | - Ester Nofuentes Pérez
- Department of Pulmonology, Vinalopó University Hospital, Elche, ISABIAL, Alicante, Spain
| | - Marina Sirera Matilla
- Department of Radiology, Dr. Balmis General University Hospital, ISABIAL, Alicante, Spain
| | - Sandra Ruiz Alcaraz
- Department of Pulmonology, Elche General University Hospital, Elche, ISABIAL, Alicante, Spain
| | - Raquel García Sevila
- Department of Pulmonology, Dr. Balmis General University Hospital, ISABIAL, Alicante, Spain
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Fujita R, Iwasawa T, Aoki T, Iwao Y, Ogura T, Utsunomiya D. Detection of the usual interstitial pneumonia pattern in chest CT: effect of computer-aided diagnosis on radiologist diagnostic performance. Acta Radiol 2024; 65:259-266. [PMID: 32064889 DOI: 10.1177/0284185120902393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anti-fibrotic drugs for interstitial pulmonary fibrosis (IPF) have been developed. Physicians are becoming increasingly aware of the need for better diagnosis of IPF. PURPOSE To evaluate whether a computer-aided system can improve the diagnostic performance of general radiologists in detecting the usual interstitial pneumonia (UIP) pattern on computed tomography (CT). MATERIAL AND METHODS We included 60 CT datasets from 30 patients with IPF and 30 with idiopathic fibrosing non-specific interstitial pneumonia (fNSIP), all diagnosed by a multidisciplinary diagnosis (MDD) procedure that included surgical biopsy. We analyzed the CT data using a computer-aided system (Gaussian histogram normalized correlation: GHNC). Five general radiologists with <6 years of experience each interpreted these CT scans with and without the GHNC results. We compared the likelihoods of a UIP-pattern diagnosis with the likelihood of the same diagnosis by MDD using the average area under the curve (AUC) of the receiver operating characteristics (ROC). We also evaluated the association between the radiologists' diagnosis and survival using the Kaplan-Meier method. RESULTS In the ROC analysis, the AUC increased significantly from 0.731 without GHNC to 0.829 with GHNC (P = 0.0396). The diagnosis without GHNC was not significantly associated with survival for any radiologist, but the UIP diagnosis with GHNC was significantly associated with a worse prognosis for four out of five radiologists. CONCLUSION The computer-aided system could increase the confidence level of UIP-pattern diagnosis by non-expert radiologists.
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Affiliation(s)
- Ryo Fujita
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
- Department of Radiology, School of Medicine, Yokohama City University, Yokohama City, Japan
- Ministry of Health, Labour and Welfare, Medical Professions Division, Health Policy Bureau
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
- Department of Radiology, School of Medicine, Yokohama City University, Yokohama City, Japan
| | - Takatoshi Aoki
- Ministry of Health, Labour and Welfare, Medical Professions Division, Health Policy Bureau
| | - Yuma Iwao
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takashi Ogura
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Daisuke Utsunomiya
- Department of Radiology, School of Medicine, Yokohama City University, Yokohama City, Japan
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40
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Zhu M, Zhao L, Zhang X, Zhao R. Astragaloside IV restrains pulmonary fibrosis progression via the circ_0008898/miR-211-5p/HMGB1 axis. Chem Biol Drug Des 2024; 103:e14508. [PMID: 38514749 DOI: 10.1111/cbdd.14508] [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: 10/16/2023] [Revised: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
Pulmonary Fibrosis (PF) is a fatal lung disease with complicated pathogenesis. Astragaloside IV (ASV) has been discovered to alleviate PF progression, and the potential molecular mechanism of ASV in the development of PF need to be further clarified. Bleomycin (BLM) was used to construct PF in vivo model. Expression levels of circ_0008898, miR-211-5p, high mobility group protein B1 (HMGB1), alpha smooth muscle Actin (α-SMA) and Collagen I were examined by Quantitative real time polymerase chain reaction (qRT-PCR) and western blot. Cell survival was analyzed using Cell Counting Kit-8 (CCK-8) and EdU (5-ethynyl-2'-deoxyuridine) assay. The invasion abilities were investigated by transwell assay. The levels of inflammatory factors were tested via using Enzyme-linked immunosorbent assay (ELISA). The relationship between circ_0008898 or HMGB1 and miR-211-5p was identified by dual-luciferase reporter assay. The results showed that ASV attenuated BLM-induced pulmonary fibrosis in vivo. In vitro study, ASV alleviated TGF-β1-induced fibrogenesis in HFL1 cells. Circ_0008898 was increased in TGF-β1-induced HFL1 cells. ASV-induced impacts were abrogated by circ_0008898 overexpression in TGF-β1-induced HFL1 cells. Mechanistically, circ_0008898 competitively bound to miR-211-5p to increase the expression of its target HMGB1. MiR-211-5p deficiency rescued ASV-mediated effects in TGF-β1-induced HFL1 cells. In addition, HMGB1 overexpression partially overturned circ_0008898 interference-induced impacts in HFL1 cells upon TGF-β1 treatment. In conclusion, our work manifested that ASV hindered PF process by mediating the circ_0008898/miR-211-5p/HMGB1 network.
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Affiliation(s)
- Min Zhu
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou City, China
| | - Limin Zhao
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou City, China
| | - Xueying Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou City, China
| | - Ruijuan Zhao
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou City, China
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Arshad M, Athar ZM, Hiba T. Current and Novel Treatment Modalities of Idiopathic Pulmonary Fibrosis. Cureus 2024; 16:e56140. [PMID: 38618480 PMCID: PMC11015429 DOI: 10.7759/cureus.56140] [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] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) presents a clinical challenge characterized by progressive fibrosis and destruction of lung tissue. Despite recent advancements, including antifibrotic medications like pirfenidone and nintedanib, IPF remains a chronic and often fatal condition with limited treatment options. This article provides an overview of the current treatment modalities for IPF and explores the need for new therapeutic approaches. Antifibrotic medications have shown efficacy in slowing disease progression but are not curative and may not be suitable for all patients. Ongoing research focuses on emerging therapies such as stem cell therapy, immunomodulatory agents, and novel pharmacological targets like phosphodiesterase 4B (PDE4B) inhibitors. While these treatments offer promise, there remains an unmet need for effective therapies capable of halting or reversing fibrotic lung damage.
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Affiliation(s)
| | | | - Tasneem Hiba
- Internal Medicine, BronxCare Health System, Bronx, USA
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Hariri LP, Beasley MB, Sholl LM, Wikenheiser-Brokamp KA. Speaking the Same Language: The Fleischner Society Glossary for Thoracic Imaging. Radiology 2024; 310:e240414. [PMID: 38530190 PMCID: PMC10982826 DOI: 10.1148/radiol.240414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Lida P. Hariri
- From the Department of Pathology, Division of Pulmonary and Critical
Care Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit
St, Boston, MA 02114 (L.P.H.); Department of Pathology, the Icahn School of
Medicine at Mount Sinai, New York, NY (M.B.B.); Department of Pathology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (L.M.S.);
Division of Pathology and Laboratory Medicine, Division of Pulmonary Medicine,
and Perinatal Institute Division of Pulmonary Biology, Cincinnati
Children’s Hospital Medical Center, Cincinnati, Ohio (K.A.W.B.); and
Department of Pathology and Laboratory Medicine, University of Cincinnati,
Cincinnati, Ohio (K.A.W.B.)
| | - Mary Beth Beasley
- From the Department of Pathology, Division of Pulmonary and Critical
Care Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit
St, Boston, MA 02114 (L.P.H.); Department of Pathology, the Icahn School of
Medicine at Mount Sinai, New York, NY (M.B.B.); Department of Pathology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (L.M.S.);
Division of Pathology and Laboratory Medicine, Division of Pulmonary Medicine,
and Perinatal Institute Division of Pulmonary Biology, Cincinnati
Children’s Hospital Medical Center, Cincinnati, Ohio (K.A.W.B.); and
Department of Pathology and Laboratory Medicine, University of Cincinnati,
Cincinnati, Ohio (K.A.W.B.)
| | - Lynette M. Sholl
- From the Department of Pathology, Division of Pulmonary and Critical
Care Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit
St, Boston, MA 02114 (L.P.H.); Department of Pathology, the Icahn School of
Medicine at Mount Sinai, New York, NY (M.B.B.); Department of Pathology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (L.M.S.);
Division of Pathology and Laboratory Medicine, Division of Pulmonary Medicine,
and Perinatal Institute Division of Pulmonary Biology, Cincinnati
Children’s Hospital Medical Center, Cincinnati, Ohio (K.A.W.B.); and
Department of Pathology and Laboratory Medicine, University of Cincinnati,
Cincinnati, Ohio (K.A.W.B.)
| | - Kathryn A. Wikenheiser-Brokamp
- From the Department of Pathology, Division of Pulmonary and Critical
Care Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit
St, Boston, MA 02114 (L.P.H.); Department of Pathology, the Icahn School of
Medicine at Mount Sinai, New York, NY (M.B.B.); Department of Pathology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (L.M.S.);
Division of Pathology and Laboratory Medicine, Division of Pulmonary Medicine,
and Perinatal Institute Division of Pulmonary Biology, Cincinnati
Children’s Hospital Medical Center, Cincinnati, Ohio (K.A.W.B.); and
Department of Pathology and Laboratory Medicine, University of Cincinnati,
Cincinnati, Ohio (K.A.W.B.)
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Nam JG, Kang SK, Choi H, Hong W, Park J, Goo JM, Lee JS, Park CM. Sixty-four-fold data reduction of chest radiographs using a super-resolution convolutional neural network. Br J Radiol 2024; 97:632-639. [PMID: 38265235 PMCID: PMC11027241 DOI: 10.1093/bjr/tqae006] [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: 03/15/2023] [Revised: 11/13/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To develop and validate a super-resolution (SR) algorithm generating clinically feasible chest radiographs from 64-fold reduced data. METHODS An SR convolutional neural network was trained to produce original-resolution images (output) from 64-fold reduced images (input) using 128 × 128 patches (n = 127 030). For validation, 112 radiographs-including those with pneumothorax (n = 17), nodules (n = 20), consolidations (n = 18), and ground-glass opacity (GGO; n = 16)-were collected. Three image sets were prepared: the original images and those reconstructed using SR and conventional linear interpolation (LI) using 64-fold reduced data. The mean-squared error (MSE) was calculated to measure similarity between the reconstructed and original images, and image noise was quantified. Three thoracic radiologists evaluated the quality of each image and decided whether any abnormalities were present. RESULTS The SR-images were more similar to the original images than the LI-reconstructed images (MSE: 9269 ± 1015 vs. 9429 ± 1057; P = .02). The SR-images showed lower measured noise and scored better noise level by three radiologists than both original and LI-reconstructed images (Ps < .01). The radiologists' pooled sensitivity with the SR-reconstructed images was not significantly different compared with the original images for detecting pneumothorax (SR vs. original, 90.2% [46/51] vs. 96.1% [49/51]; P = .19), nodule (90.0% [54/60] vs. 85.0% [51/60]; P = .26), consolidation (100% [54/54] vs. 96.3% [52/54]; P = .50), and GGO (91.7% [44/48] vs. 95.8% [46/48]; P = .69). CONCLUSIONS SR-reconstructed chest radiographs using 64-fold reduced data showed a lower noise level than the original images, with equivalent sensitivity for detecting major abnormalities. ADVANCES IN KNOWLEDGE This is the first study applying super-resolution in data reduction of chest radiographs.
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Affiliation(s)
- Ju Gang Nam
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul 03080, Republic of Korea
- Artificial Intelligence Collaborative Network, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | | | - Hyewon Choi
- Department of Radiology, Chung-Ang University Hospital and College of Medicine, Seoul 06973, Republic of Korea
| | - Wonju Hong
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
| | - Jongsoo Park
- Department of Radiology, Yeungnam University Medical Center, Daegu 42415, Republic of Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul 03080, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
| | - Jae Sung Lee
- Brightonix Imaging Inc, Seoul 04782, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
- Department of Nuclear Medicine, Seoul National University Hospital and College of Medicine, Seoul 03080, Republic of Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul 03080, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
- Institute of Medical and Biological Engineering, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
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44
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Kim SH, Kim SY, Yoon HY, Song JW. PM 10 increases mortality risk in rheumatoid arthritis-associated interstitial lung disease. RMD Open 2024; 10:e003680. [PMID: 38331470 PMCID: PMC10860120 DOI: 10.1136/rmdopen-2023-003680] [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: 09/02/2023] [Accepted: 01/22/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES The effect of air pollution on the prognosis of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) remains poorly understood. We aimed to evaluate the effect of long-term exposure to particulate matter with an aerodynamic diameter of ≤10 µm (PM10) and nitrogen dioxide (NO2) on mortality in patients with RA-ILD. METHODS We included 309 patients (mean age, 61.7 years; male, 44.3%) with RA-ILD. Individual-level long-term exposures to PM10 and NO2 at their residential addresses were estimated using a national-scale exposure prediction model. The effect of the two air pollutants on mortality was estimated using a Cox-proportional hazards model adjusted for individual-level and area-level characteristics. RESULTS The median follow-up period was 4.8 years, and 40.8% of patients died or underwent lung transplantation. The annual average concentrations of PM10 and NO2 were 56.3 μg/m3 and 22.4 ppb, respectively. When air pollutant levels were stratified by quartiles, no association was observed between air pollutant concentration and mortality in patients with RA-ILD. However, when stratified by two groups (high exposure (top 25th percentile) vs low exposure (bottom 75th percentile)), we observed a significant association between high PM10 exposure and mortality (HR 1.68; 95% CI 1.11 to 2.52; p=0.013) but no association between NO2 exposure and mortality. In the subgroup analyses, the effect of high PM10 exposure on mortality was significant in patients aged <65 years (HR 1.98; 95% CI 1.02 to 3.85; p=0.045). CONCLUSIONS Our results indicated that high PM10 exposure may be associated with mortality in patients with RA-ILD.
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Affiliation(s)
- Soo Han Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Sun-Young Kim
- Department of Cancer AI & Digital Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Hee-Young Yoon
- Division of Allergy and Respiratory Diseases, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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45
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Oh AS, Lynch DA, Swigris JJ, Baraghoshi D, Dyer DS, Hale VA, Koelsch TL, Marrocchio C, Parker KN, Teague SD, Flaherty KR, Humphries SM. Deep Learning-based Fibrosis Extent on Computed Tomography Predicts Outcome of Fibrosing Interstitial Lung Disease Independent of Visually Assessed Computed Tomography Pattern. Ann Am Thorac Soc 2024; 21:218-227. [PMID: 37696027 DOI: 10.1513/annalsats.202301-084oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023] Open
Abstract
Rationale: Radiologic pattern has been shown to predict survival in patients with fibrosing interstitial lung disease. The additional prognostic value of fibrosis extent by quantitative computed tomography (CT) is unknown. Objectives: We hypothesized that fibrosis extent provides information beyond visually assessed CT pattern that is useful for outcome prediction. Methods: We performed a retrospective analysis of chest CT, demographics, longitudinal pulmonary function, and transplantation-free survival among participants in the Pulmonary Fibrosis Foundation Patient Registry. CT pattern was classified visually according to the 2018 usual interstitial pneumonia criteria. Extent of fibrosis was objectively quantified using data-driven textural analysis. We used Kaplan-Meier plots and Cox proportional hazards and linear mixed-effects models to evaluate the relationships between CT-derived metrics and outcomes. Results: Visual assessment and quantitative analysis were performed on 979 enrollment CT scans. Linear mixed-effect modeling showed that greater baseline fibrosis extent was significantly associated with the annual rate of decline in forced vital capacity. In multivariable models that included CT pattern and fibrosis extent, quantitative fibrosis extent was strongly associated with transplantation-free survival independent of CT pattern (hazard ratio, 1.04; 95% confidence interval, 1.04-1.05; P < 0.001; C statistic = 0.73). Conclusions: The extent of lung fibrosis by quantitative CT is a strong predictor of physiologic progression and survival, independent of visually assessed CT pattern.
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Affiliation(s)
- Andrea S Oh
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | | | - Jeffrey J Swigris
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
| | - David Baraghoshi
- Department of Biostatistics, National Jewish Health, Denver, Colorado
| | | | | | | | | | | | | | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
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46
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Mackintosh JA, Keir G, Troy LK, Holland AE, Grainge C, Chambers DC, Sandford D, Jo HE, Glaspole I, Wilsher M, Goh NSL, Reynolds PN, Chapman S, Mutsaers SE, de Boer S, Webster S, Moodley Y, Corte TJ. Treatment of idiopathic pulmonary fibrosis and progressive pulmonary fibrosis: A position statement from the Thoracic Society of Australia and New Zealand 2023 revision. Respirology 2024; 29:105-135. [PMID: 38211978 PMCID: PMC10952210 DOI: 10.1111/resp.14656] [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: 06/02/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive disease leading to significant morbidity and mortality. In 2017 the Thoracic Society of Australia and New Zealand (TSANZ) and Lung Foundation Australia (LFA) published a position statement on the treatment of IPF. Since that time, subsidized anti-fibrotic therapy in the form of pirfenidone and nintedanib is now available in both Australia and New Zealand. More recently, evidence has been published in support of nintedanib for non-IPF progressive pulmonary fibrosis (PPF). Additionally, there have been numerous publications relating to the non-pharmacologic management of IPF and PPF. This 2023 update to the position statement for treatment of IPF summarizes developments since 2017 and reaffirms the importance of a multi-faceted approach to the management of IPF and progressive pulmonary fibrosis.
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Affiliation(s)
- John A. Mackintosh
- Department of Respiratory MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
| | - Gregory Keir
- Department of Respiratory MedicinePrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Lauren K. Troy
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Anne E. Holland
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of PhysiotherapyThe Alfred HospitalMelbourneVictoriaAustralia
- Department of Respiratory Research@AlfredCentral Clinical School, Monash UniversityMelbourneVictoriaAustralia
| | - Christopher Grainge
- Department of Respiratory MedicineJohn Hunter HospitalNewcastleNew South WalesAustralia
| | - Daniel C. Chambers
- Department of Respiratory MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
| | - Debra Sandford
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Thoracic MedicineCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Helen E. Jo
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Ian Glaspole
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Respiratory MedicineThe Alfred HospitalMelbourneVictoriaAustralia
| | - Margaret Wilsher
- Department of Respiratory MedicineTe Toka Tumai AucklandAucklandNew Zealand
| | - Nicole S. L. Goh
- Department of Respiratory MedicineAustin HospitalMelbourneVictoriaAustralia
- Institute for Breathing and SleepMelbourneVictoriaAustralia
- University of MelbourneMelbourneVictoriaAustralia
| | - Paul N. Reynolds
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Thoracic MedicineCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Sally Chapman
- Institute for Respiratory Health, University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Steven E. Mutsaers
- Department of Respiratory MedicineFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Sally de Boer
- Department of Respiratory MedicineTe Toka Tumai AucklandAucklandNew Zealand
| | - Susanne Webster
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Yuben Moodley
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Institute for Respiratory Health, University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of Respiratory MedicineFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Tamera J. Corte
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
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Farquhar HJ, Beckert L, Edwards AL, Matteson EL, Frampton CMA, Ganly E, Yetton R, Thiessen R, Haslett J, Bucknall D, Stamp LK. Rheumatoid interstitial lung disease in Canterbury, Aotearoa New Zealand - A retrospective cohort study. Semin Arthritis Rheum 2024; 64:152359. [PMID: 38157761 DOI: 10.1016/j.semarthrit.2023.152359] [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: 09/11/2023] [Revised: 11/28/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Rheumatoid arthritis associated interstitial lung disease (RA-ILD), is an important extra-articular manifestation of rheumatoid arthritis (RA). The frequency, risk factors, and prognosis of RA-ILD are incompletely understood. AIMS To determine the prevalence and incidence, clinical characteristics and risk factors for development, and outcomes of persons with RA-ILD in the population of the Canterbury District Health Board (CDHB) catchment area. METHODS Individuals aged ≥ 18 years with RA, resident in the CDHB catchment area between 1 January 2006 and 31 December 2008 (Period One), and 1 January 2011 to 31 December 2013 (Period Two) were identified by medical record review and followed until 30 June 2019. Individuals with RA-ILD as defined by pre-specified criteria were identified. The association between demographic and clinical characteristics and RA-ILD development and mortality was examined using Cox-proportional hazards models. RESULTS The prevalence of RA-ILD per 100,000 was 10.97 (95 % CI 7.53,14.42) for Period One, and 14.74 (95 % CI 10.84,18.63) for Period Two. Among individuals evaluated for risk factors for RA-ILD development, the estimated cumulative incidence of ILD at 10 years was 4.47 % (95 % CI 3.14, 6.14). After adjusting for age, rheumatoid factor positivity (HR 3.73, 95 % CI, 1.32,10.56), extra-articular manifestations other than RA-ILD (HR 4.48, 95 % CI 2.36,8.48), and subcutaneous rheumatoid nodules (HR 4.66, 95 % CI 2.34, 9.26) were associated with increased risk of developing RA-ILD. The standardised mortality ratio for RA-ILD was 3.90 (95 % CI 2.55,5.72) compared to the general population. Extent of ILD on CT chest was associated with mortality (HR for >20% vs. < 20 % 4.47, 95 % CI 1.67,11.96). CONCLUSIONS Clinically evident RA-ILD occurred in approximately 5 % of individuals with RA. Mortality was increased almost fourfold compared to the general population. Radiologic extent was the most important prognostic factor.
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Affiliation(s)
- Hamish J Farquhar
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Adriene L Edwards
- Respiratory Department, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Eric L Matteson
- Division of Rheumatology and Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Edward Ganly
- Radiology Department, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Renee Yetton
- Radiology Department, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Rennae Thiessen
- Radiology Department, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Janine Haslett
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Danielle Bucknall
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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48
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Bankier AA, MacMahon H, Colby T, Gevenois PA, Goo JM, Leung AN, Lynch DA, Schaefer-Prokop CM, Tomiyama N, Travis WD, Verschakelen JA, White CS, Naidich DP. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2024; 310:e232558. [PMID: 38411514 PMCID: PMC10902601 DOI: 10.1148/radiol.232558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 02/28/2024]
Abstract
Members of the Fleischner Society have compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984, 1996, and 2008, respectively. The impetus to update the previous version arose from multiple considerations. These include an awareness that new terms and concepts have emerged, others have become obsolete, and the usage of some terms has either changed or become inconsistent to a degree that warranted a new definition. This latest glossary is focused on terms of clinical importance and on those whose meaning may be perceived as vague or ambiguous. As with previous versions, the aim of the present glossary is to establish standardization of terminology for thoracic radiology and, thereby, to facilitate communications between radiologists and clinicians. Moreover, the present glossary aims to contribute to a more stringent use of terminology, increasingly required for structured reporting and accurate searches in large databases. Compared with the previous version, the number of images (chest radiography and CT) in the current version has substantially increased. The authors hope that this will enhance its educational and practical value. All definitions and images are hyperlinked throughout the text. Click on each figure callout to view corresponding image. © RSNA, 2024 Supplemental material is available for this article. See also the editorials by Bhalla and Powell in this issue.
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Affiliation(s)
- Alexander A. Bankier
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Heber MacMahon
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Thomas Colby
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Pierre Alain Gevenois
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Jin Mo Goo
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Ann N.C. Leung
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - David A. Lynch
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Cornelia M. Schaefer-Prokop
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Noriyuki Tomiyama
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - William D. Travis
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Johny A. Verschakelen
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Charles S. White
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - David P. Naidich
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
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49
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Lee KS, Han J, Wada N, Hata A, Lee HY, Yi C, Hino T, Doyle TJ, Franquet T, Hatabu H. Imaging of Pulmonary Fibrosis: An Update, From the AJR Special Series on Imaging of Fibrosis. AJR Am J Roentgenol 2024; 222:e2329119. [PMID: 37095673 DOI: 10.2214/ajr.23.29119] [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] [Indexed: 04/26/2023]
Abstract
Pulmonary fibrosis is recognized as occurring in association with a wide and increasing array of conditions, and it presents with a spectrum of chest CT appearances. Idiopathic pulmonary fibrosis (IPF), which corresponds histologically with usual interstitial pneumonia and represents the most common idiopathic interstitial pneumonia, is a chronic progressive fibrotic interstitial lung disease (ILD) of unknown cause. Progressive pulmonary fibrosis (PPF) describes the radiologic development of pulmonary fibrosis in patients with ILD of a known or unknown cause other than IPF. The recognition of PPF impacts management of patients with ILD-for example, in guiding initiation of antifibrotic therapy. Interstitial lung abnormalities are an incidental CT finding in patients without suspected ILD and may represent an early intervenable form of pulmonary fibrosis. Traction bronchiectasis and/or bronchiolectasis, when detected in the setting of chronic fibrosis, is generally considered evidence of irreversible disease, and progression predicts worsening mortality risk. Awareness of the association between pulmonary fibrosis and connective tissue diseases, particularly rheumatoid arthritis, is increasing. This review provides an update on the imaging of pulmonary fibrosis, with attention given to recent advances in disease understanding with relevance to radiologic practice. The essential role of a multidisciplinary approach to clinical and radiologic data is highlighted.
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Affiliation(s)
- Kyung Soo Lee
- Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine, ChangWon, Republic of Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Noriaki Wada
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Akinori Hata
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - ChinA Yi
- Department of Radiology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Takuya Hino
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tracy J Doyle
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Tomas Franquet
- Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Hiroto Hatabu
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
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50
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Smith ML, Mino-Kenudson M, Butterfield RJ, Dacic S, Colby TV, Churg A, Beasley MB, Hariri LP. Pulmonary Pathology Society Survey on Practice Approaches in the Histologic Diagnosis of Fibrotic Interstitial Lung Disease: Consensus and Opportunities. Arch Pathol Lab Med 2024; 148:168-177. [PMID: 37226833 DOI: 10.5858/arpa.2022-0530-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 05/26/2023]
Abstract
CONTEXT.— The pathologic diagnosis of usual interstitial pneumonia (UIP) remains a challenging area, and application of histologic UIP guidelines has proved difficult. OBJECTIVE.— To understand current practice approaches by pulmonary pathologists for the histologic diagnosis of UIP and other fibrotic interstitial lung diseases (ILDs). DESIGN.— The Pulmonary Pathology Society (PPS) ILD Working Group developed and sent a 5-part survey on fibrotic ILD electronically to the PPS membership. RESULTS.— One hundred sixty-one completed surveys were analyzed. Of the respondents, 89% reported using published histologic features in clinical guidelines for idiopathic pulmonary fibrosis (IPF) in their pathologic diagnosis; however, there was variability in reporting terminology, quantity and quality of histologic features, and the use of guideline categorization. Respondents were very likely to have access to pulmonary pathology colleagues (79%), pulmonologists (98%), and radiologists (94%) to discuss cases. Half of respondents reported they may alter their pathologic diagnosis based on additional clinical and radiologic history if it is pertinent. Airway-centered fibrosis, granulomas, and types of inflammatory infiltrates were considered important, but there was poor agreement on how these features are defined. CONCLUSIONS.— There is significant consensus among the PPS membership on the importance of histologic guidelines/features of UIP. There are unmet needs for (1) consensus and standardization of diagnostic terminology and incorporation of recommended histopathologic categories from the clinical IPF guidelines into pathology reports, (2) agreement on how to incorporate into the report relevant clinical and radiographic information, and (3) defining the quantity and quality of features needed to suggest alternative diagnoses.
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Affiliation(s)
- Maxwell L Smith
- From the Departments of Laboratory Medicine and Pathology (Smith, Colby)
| | - Mari Mino-Kenudson
- the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Mino-Kenudson, Hariri)
| | | | - Sanja Dacic
- the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dacic)
| | - Thomas V Colby
- From the Departments of Laboratory Medicine and Pathology (Smith, Colby)
| | - Andrew Churg
- the Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada (Churg)
| | - Mary Beth Beasley
- the Department of Pathology, Mount Sinai Health System, Icahn School of Medicine, New York, New York (Beasley)
| | - Lida P Hariri
- the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Mino-Kenudson, Hariri)
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