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Choe J, Hwang HJ, Lee SM, Yoon J, Kim N, Seo JB. CT Quantification of Interstitial Lung Abnormality and Interstitial Lung Disease: From Technical Challenges to Future Directions. Invest Radiol 2024:00004424-990000000-00233. [PMID: 39008898 DOI: 10.1097/rli.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
ABSTRACT Interstitial lung disease (ILD) encompasses a variety of lung disorders with varying degrees of inflammation or fibrosis, requiring a combination of clinical, imaging, and pathologic data for evaluation. Imaging is essential for the noninvasive diagnosis of the disease, as well as for assessing disease severity, monitoring its progression, and evaluating treatment response. However, traditional visual assessments of ILD with computed tomography (CT) suffer from reader variability. Automated quantitative CT offers a more objective approach by using computer-based analysis to consistently evaluate and measure ILD. Advancements in technology have significantly improved the accuracy and reliability of these measurements. Recently, interstitial lung abnormalities (ILAs), which represent potential preclinical ILD incidentally found on CT scans and are characterized by abnormalities in over 5% of any lung zone, have gained attention and clinical importance. The challenge lies in the accurate and consistent identification of ILA, given that its definition relies on a subjective threshold, making quantitative tools crucial for precise ILA evaluation. This review highlights the state of CT quantification of ILD and ILA, addressing clinical and research disparities while emphasizing how machine learning or deep learning in quantitative imaging can improve diagnosis and management by providing more accurate assessments, and finally, suggests the future directions of quantitative CT in this area.
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Affiliation(s)
- Jooae Choe
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.C., H.J.H., S.M.L., J.Y., N.K., J.B.S.); and Department of Convergence Medicine, Biomedical Engineering Research Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.Y. and N.K.)
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Ash S, Doyle TJ, Choi B, San Jose Estepar R, Castro V, Enzer N, Kalhan R, Liu G, Bowler R, Wilson DO, San Jose Estepar R, Rosas IO, Washko GR. Utility of peripheral protein biomarkers for the prediction of incident interstitial features: a multicentre retrospective cohort study. BMJ Open Respir Res 2024; 11:e002219. [PMID: 38485250 PMCID: PMC10941119 DOI: 10.1136/bmjresp-2023-002219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION/RATIONALE Protein biomarkers may help enable the prediction of incident interstitial features on chest CT. METHODS We identified which protein biomarkers in a cohort of smokers (COPDGene) differed between those with and without objectively measured interstitial features at baseline using a univariate screen (t-test false discovery rate, FDR p<0.001), and which of those were associated with interstitial features longitudinally (multivariable mixed effects model FDR p<0.05). To predict incident interstitial features, we trained four random forest classifiers in a two-thirds random subset of COPDGene: (1) imaging and demographic information, (2) univariate screen biomarkers, (3) multivariable confirmation biomarkers and (4) multivariable confirmation biomarkers available in a separate testing cohort (Pittsburgh Lung Screening Study (PLuSS)). We evaluated classifier performance in the remaining one-third of COPDGene, and, for the final model, also in PLuSS. RESULTS In COPDGene, 1305 biomarkers were available and 20 differed between those with and without interstitial features at baseline. Of these, 11 were associated with feature progression over a mean of 5.5 years of follow-up, and of these 4 were available in PLuSS, (angiopoietin-2, matrix metalloproteinase 7, macrophage inflammatory protein 1 alpha) over a mean of 8.8 years of follow-up. The area under the curve (AUC) of classifiers using demographics and imaging features in COPDGene and PLuSS were 0.69 and 0.59, respectively. In COPDGene, the AUC of the univariate screen classifier was 0.78 and of the multivariable confirmation classifier was 0.76. The AUC of the final classifier in COPDGene was 0.75 and in PLuSS was 0.76. The outcome for all of the models was the development of incident interstitial features. CONCLUSIONS Multiple novel and previously identified proteomic biomarkers are associated with interstitial features on chest CT and may enable the prediction of incident interstitial diseases such as idiopathic pulmonary fibrosis.
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Affiliation(s)
- Samuel Ash
- Department of Critical Care Medicine, South Shore Hospital, South Weymouth, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Tracy J Doyle
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bina Choi
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Victor Castro
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nicholas Enzer
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ravi Kalhan
- Division of Pulmonary/Critical Care, Northwestern University, Chicago, Illinois, USA
| | - Gabrielle Liu
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - David O Wilson
- Medicine, Pulmonary Division, University of Pittsburgh, pittsburgh, Pennsylvania, USA
| | - Raul San Jose Estepar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ivan O Rosas
- Department of Medicine: Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - George R Washko
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Sotoudeh-Paima S, Ho FC, Nejad MG, Kavuri A, O'Sullivan-Murphy B, Lynch DA, Segars WP, Samei E, Abadi E. Development and Application of a Virtual Imaging Trial Framework for Longitudinal Quantification of Emphysema in CT. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2024; 12925:129251H. [PMID: 38741597 PMCID: PMC11090051 DOI: 10.1117/12.3006925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Pulmonary emphysema is a progressive lung disease that requires accurate evaluation for optimal management. This task, possible using quantitative CT, is particularly challenging as scanner and patient attributes change over time, negatively impacting the CT-derived quantitative measures. Efforts to minimize such variations have been limited by the absence of ground truth in clinical data, thus necessitating reliance on clinical surrogates, which may not have one-to-one correspondence to CT-based findings. This study aimed to develop the first suite of human models with emphysema at multiple time points, enabling longitudinal assessment of disease progression with access to ground truth. A total of 14 virtual subjects were modeled across three time points. Each human model was virtually imaged using a validated imaging simulator (DukeSim), modeling an energy-integrating CT scanner. The models were scanned at two dose levels and reconstructed with two reconstruction kernels, slice thicknesses, and pixel sizes. The developed longitudinal models were further utilized to demonstrate utility in algorithm testing and development. Two previously developed image processing algorithms (CT-HARMONICA, EmphysemaSeg) were evaluated. The results demonstrated the efficacy of both algorithms in improving the accuracy and precision of longitudinal quantifications, from 6.1±6.3% to 1.1±1.1% and 1.6±2.2% across years 0-5. Further investigation in EmphysemaSeg identified that baseline emphysema severity, defined as >5% emphysema at year 0, contributed to its reduced performance. This finding highlights the value of virtual imaging trials in enhancing the explainability of algorithms. Overall, the developed longitudinal human models enabled ground-truth based assessment of image processing algorithms for lung quantifications.
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Affiliation(s)
- Saman Sotoudeh-Paima
- Department of Radiology, Duke University School of Medicine, Durham, NC
- Department of Electrical and Computer Engineering, Duke University, Durham, NC
| | - Fong Chi Ho
- Department of Radiology, Duke University School of Medicine, Durham, NC
- Department of Electrical and Computer Engineering, Duke University, Durham, NC
| | | | - Amar Kavuri
- Department of Radiology, Duke University School of Medicine, Durham, NC
| | | | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - W Paul Segars
- Department of Radiology, Duke University School of Medicine, Durham, NC
- Department of Biomedical Engineering, Duke University, Durham, NC
- Department Physics, Duke University, Durham, NC
| | - Ehsan Samei
- Department of Radiology, Duke University School of Medicine, Durham, NC
- Department of Electrical and Computer Engineering, Duke University, Durham, NC
- Department of Biomedical Engineering, Duke University, Durham, NC
- Department Physics, Duke University, Durham, NC
- Medical Physics Graduate Program, Duke University, Durham, NC
| | - Ehsan Abadi
- Department of Radiology, Duke University School of Medicine, Durham, NC
- Department of Electrical and Computer Engineering, Duke University, Durham, NC
- Medical Physics Graduate Program, Duke University, Durham, NC
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Goo JM. Reduce Measurement Variability at Longitudinal Quantitative CT to Improve Assessment of Emphysema. Radiology 2024; 310:e233168. [PMID: 38165246 DOI: 10.1148/radiol.233168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Jin Mo Goo
- From the Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daekhak-ro, Jongno-gu, Seoul 110-744, Korea; and Cancer Research Institute, Seoul National University, Seoul, Korea
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