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Selvan KC, Reicher J, Muelly M, Kalra A, Adegunsoye A. Machine learning classifier is associated with mortality in interstitial lung disease: a retrospective validation study leveraging registry data. BMC Pulm Med 2024; 24:254. [PMID: 38783245 PMCID: PMC11112769 DOI: 10.1186/s12890-024-03021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Mortality prediction in interstitial lung disease (ILD) poses a significant challenge to clinicians due to heterogeneity across disease subtypes. Currently, forced vital capacity (FVC) and Gender, Age, and Physiology (GAP) score are the two most utilized metrics in prognostication. Recently, a machine learning classifier system, Fibresolve, designed to identify a variety of computed tomography (CT) patterns associated with idiopathic pulmonary fibrosis (IPF), was demonstrated to have a significant association with mortality across multiple subtypes of ILD. The purpose of this follow-up study was to retrospectively validate these findings in a large, external cohort of patients with ILD. METHODS In this multi-center validation study, Fibresolve was applied to chest CT scans of patients with confirmed ILD that had available follow-up data. Fibresolve scores categorized by tertile were analyzed using Cox regression analysis adjusted for tobacco use and modified GAP (mGAP) score. RESULTS Of 643 patients included, 446 (69.3%) died over a median follow-up time of 144 [1-821] weeks. The median [range] mGAP score was 5 [3-7]. In multivariable analysis, Fibresolve score categorized by tertile was significantly associated with mortality (Tertile 2 HR 1.47, 95% CI 0.82-2.37, p = 0.11; Tertile 3 HR 3.12, 95% CI 1.98-4.90, p < 0.001). Subgroup analyses revealed significant associations amongst those with non-IPF ILDs (Tertile 2 HR 1.95, 95% CI 1.28-2.97, Tertile 3 HR 4.66, 95% CI 2.94-7.38) and severe disease, defined by a FVC ≤ 75% (Tertile 2 HR 2.29, 95% CI 1.43-3.67, Tertile 3 HR 4.80, 95% CI 2.93-7.86). CONCLUSIONS Fibresolve is independently associated with mortality in ILD, particularly amongst patients with non-IPF ILDs and in those with severe disease.
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Affiliation(s)
- Kavitha C Selvan
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Chicago Medicine, 5841 S Maryland Avenue, Chicago, IL, 60637, USA.
| | - Joshua Reicher
- Department of Radiology, Stanford University, Stanford, CA, USA
- IMVARIA Inc, 2390 Domingo Ave. #1496, Berkley, CA, 94705, USA
| | - Michael Muelly
- Department of Radiology, Stanford University, Stanford, CA, USA
- IMVARIA Inc, 2390 Domingo Ave. #1496, Berkley, CA, 94705, USA
| | - Angad Kalra
- IMVARIA Inc, 2390 Domingo Ave. #1496, Berkley, CA, 94705, USA
| | - Ayodeji Adegunsoye
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Chicago Medicine, 5841 S Maryland Avenue, Chicago, IL, 60637, USA
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Choi B, Liu GY, Sheng Q, Amancherla K, Perry A, Huang X, San José Estépar R, Ash SY, Guan W, Jacobs DR, Martinez FJ, Rosas IO, Bowler RP, Kropski JA, Banovich NE, Khan SS, San José Estépar R, Shah R, Thyagarajan B, Kalhan R, Washko GR. Proteomic Biomarkers of Quantitative Interstitial Abnormalities in COPDGene and CARDIA Lung Study. Am J Respir Crit Care Med 2024; 209:1091-1100. [PMID: 38285918 PMCID: PMC11092953 DOI: 10.1164/rccm.202307-1129oc] [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: 07/03/2023] [Accepted: 01/29/2024] [Indexed: 01/31/2024] Open
Abstract
Rationale: Quantitative interstitial abnormalities (QIAs) are early measures of lung injury automatically detected on chest computed tomography scans. QIAs are associated with impaired respiratory health and share features with advanced lung diseases, but their biological underpinnings are not well understood. Objectives: To identify novel protein biomarkers of QIAs using high-throughput plasma proteomic panels within two multicenter cohorts. Methods: We measured the plasma proteomics of 4,383 participants in an older, ever-smoker cohort (COPDGene [Genetic Epidemiology of Chronic Obstructive Pulmonary Disease]) and 2,925 participants in a younger population cohort (CARDIA [Coronary Artery Disease Risk in Young Adults]) using the SomaLogic SomaScan assays. We measured QIAs using a local density histogram method. We assessed the associations between proteomic biomarker concentrations and QIAs using multivariable linear regression models adjusted for age, sex, body mass index, smoking status, and study center (Benjamini-Hochberg false discovery rate-corrected P ⩽ 0.05). Measurements and Main Results: In total, 852 proteins were significantly associated with QIAs in COPDGene and 185 in CARDIA. Of the 144 proteins that overlapped between COPDGene and CARDIA, all but one shared directionalities and magnitudes. These proteins were enriched for 49 Gene Ontology pathways, including biological processes in inflammatory response, cell adhesion, immune response, ERK1/2 regulation, and signaling; cellular components in extracellular regions; and molecular functions including calcium ion and heparin binding. Conclusions: We identified the proteomic biomarkers of QIAs in an older, smoking population with a higher prevalence of pulmonary disease and in a younger, healthier community cohort. These proteomics features may be markers of early precursors of advanced lung diseases.
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Affiliation(s)
- Bina Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Applied Chest Imaging Laboratory, and
| | - Gabrielle Y. Liu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California Davis, Sacramento, California
| | | | | | | | - Xiaoning Huang
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ruben San José Estépar
- Applied Chest Imaging Laboratory, and
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Samuel Y. Ash
- Department of Critical Care, South Shore Hospital, South Weymouth, Massachusetts
| | | | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, and
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ivan O. Rosas
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Russell P. Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Jonathan A. Kropski
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, and
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine and
| | - George R. Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Applied Chest Imaging Laboratory, and
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3
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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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Montesi SB, Gomez CR, Beers M, Brown R, Chattopadhyay I, Flaherty KR, Garcia CK, Gomperts B, Hariri LP, Hogaboam CM, Jenkins RG, Kaminski N, Kim GHJ, Königshoff M, Kolb M, Kotton DN, Kropski JA, Lasky J, Magin CM, Maher TM, McCormick M, Moore BB, Nickerson-Nutter C, Oldham J, Podolanczuk AJ, Raghu G, Rosas I, Rowe SM, Schmidt WT, Schwartz D, Shore JE, Spino C, Craig JM, Martinez FJ. Pulmonary Fibrosis Stakeholder Summit: A Joint NHLBI, Three Lakes Foundation, and Pulmonary Fibrosis Foundation Workshop Report. Am J Respir Crit Care Med 2024; 209:362-373. [PMID: 38113442 PMCID: PMC10878386 DOI: 10.1164/rccm.202307-1154ws] [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: 07/06/2023] [Accepted: 12/19/2023] [Indexed: 12/21/2023] Open
Abstract
Despite progress in elucidation of disease mechanisms, identification of risk factors, biomarker discovery, and the approval of two medications to slow lung function decline in idiopathic pulmonary fibrosis and one medication to slow lung function decline in progressive pulmonary fibrosis, pulmonary fibrosis remains a disease with a high morbidity and mortality. In recognition of the need to catalyze ongoing advances and collaboration in the field of pulmonary fibrosis, the NHLBI, the Three Lakes Foundation, and the Pulmonary Fibrosis Foundation hosted the Pulmonary Fibrosis Stakeholder Summit on November 8-9, 2022. This workshop was held virtually and was organized into three topic areas: 1) novel models and research tools to better study pulmonary fibrosis and uncover new therapies, 2) early disease risk factors and methods to improve diagnosis, and 3) innovative approaches toward clinical trial design for pulmonary fibrosis. In this workshop report, we summarize the content of the presentations and discussions, enumerating research opportunities for advancing our understanding of the pathogenesis, treatment, and outcomes of pulmonary fibrosis.
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Affiliation(s)
| | - Christian R. Gomez
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael Beers
- Pulmonary and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Brown
- Program in Neurotherapeutics, University of Massachusetts Chan Medical School, Worchester, Massachusetts
| | | | | | - Christine Kim Garcia
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | | | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine and
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Cory M. Hogaboam
- Women’s Guild Lung Institute, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - R. Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Naftali Kaminski
- Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Grace Hyun J. Kim
- Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, and
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Melanie Königshoff
- Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Martin Kolb
- Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Darrell N. Kotton
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, Massachusetts
| | - Jonathan A. Kropski
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph Lasky
- Pulmonary Fibrosis Foundation, Chicago, Illinois
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Chelsea M. Magin
- Department of Bioengineering
- Department of Pediatrics
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, and
| | - Toby M. Maher
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | | | | | - Anna J. Podolanczuk
- Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, New York
| | - Ganesh Raghu
- Division of Pulmonary, Sleep and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Ivan Rosas
- Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas; and
| | - Steven M. Rowe
- Department of Medicine and
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - David Schwartz
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Cathie Spino
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - J. Matthew Craig
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, New York
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5
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Oh JH, Kim GHJ, Song JW. Interstitial lung abnormality evaluated by an automated quantification system: prevalence and progression rate. Respir Res 2024; 25:78. [PMID: 38321467 PMCID: PMC10848490 DOI: 10.1186/s12931-024-02715-3] [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: 09/25/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Despite the importance of recognizing interstitial lung abnormalities, screening methods using computer-based quantitative analysis are not well developed, and studies on the subject with an Asian population are rare. We aimed to identify the prevalence and progression rate of interstitial lung abnormality evaluated by an automated quantification system in the Korean population. METHODS A total of 2,890 healthy participants in a health screening program (mean age: 49 years, men: 79.5%) with serial chest computed tomography images obtained at least 5 years apart were included. Quantitative lung fibrosis scores were measured on the chest images by an automated quantification system. Interstitial lung abnormalities were defined as a score ≥ 3, and progression as any score increased above baseline. RESULTS Interstitial lung abnormalities were identified in 251 participants (8.6%), who were older and had a higher body mass index. The prevalence increased with age. Quantification of the follow-up images (median interval: 6.5 years) showed that 23.5% (59/251) of participants initially diagnosed with interstitial lung abnormality exhibited progression, and 11% had developed abnormalities (290/2639). Older age, higher body mass index, and higher erythrocyte sedimentation rate were independent risk factors for progression or development. The interstitial lung abnormality group had worse survival on follow-up (5-year mortality: 3.4% vs. 1.5%; P = 0.010). CONCLUSIONS Interstitial lung abnormality could be identified in one-tenth of the participants, and a quarter of them showed progression. Older age, higher body mass index and higher erythrocyte sedimentation rate increased the risk of development or progression of interstitial lung abnormality.
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Affiliation(s)
- Ju Hyun Oh
- Department of Pulmonology and Critical Care Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Grace Hyun J Kim
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Jin Woo Song
- Department of Pulmonology and Critical Care Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-Ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Jamal F, Shashi K, Vaz N, Doyle T, Dellaripa P, Hammer M. Quantitative Chest Computed Tomography for Progression of Interstitial Lung Disease in Antisynthetase Patients. J Thorac Imaging 2023:00005382-990000000-00118. [PMID: 38126408 DOI: 10.1097/rti.0000000000000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
| | | | - Nuno Vaz
- Radiology, Brigham and Women's Hospital
| | - Tracy Doyle
- Pulmonary division, Brigham and Women's Hospital
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Kim JS, Montesi SB, Adegunsoye A, Humphries SM, Salisbury ML, Hariri LP, Kropski JA, Richeldi L, Wells AU, Walsh S, Jenkins RG, Rosas I, Noth I, Hunninghake GM, Martinez FJ, Podolanczuk AJ. Approach to Clinical Trials for the Prevention of Pulmonary Fibrosis. Ann Am Thorac Soc 2023; 20:1683-1693. [PMID: 37703509 PMCID: PMC10704236 DOI: 10.1513/annalsats.202303-188ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/13/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- John S. Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | | | - Ayodeji Adegunsoye
- Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | | | - Margaret L. Salisbury
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine, and
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan A. Kropski
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Luca Richeldi
- Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Athol U. Wells
- Department of Radiology, and
- Interstitial Lung Disease Service, Royal Brompton Hospital, London, United Kingdom
| | - Simon Walsh
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - R. Gisli Jenkins
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ivan Rosas
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Gary M. Hunninghake
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Anna J. Podolanczuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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Escalon JG, Podolanczuk AJ, Aronson KI, Legasto AC, Gruden JF, Lynch DA, Rachid L, Rabkova Y, Steinberger S. Practice patterns in reporting interstitial lung abnormality at a tertiary academic medical center. Clin Imaging 2023; 104:109996. [PMID: 37862912 DOI: 10.1016/j.clinimag.2023.109996] [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: 06/11/2023] [Revised: 09/07/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Interstitial lung abnormality (ILA) is a common finding on chest CTs and is associated with higher all-cause mortality. The 2020 Fleischner Society position paper standardized the terminology and definition of ILA. Despite these published guidelines, the extent to which radiologists use this term is unknown. We evaluated practice patterns for identification of ILAs among radiologists at a tertiary academic medical center. METHODS In this retrospective review, we identified 157 radiology reports between January 1, 2010 through December 31, 2021 containing the phrase "interstitial lung abnormality" or "interstitial abnormality". After exclusions, 125 CT scans were reviewed by thoracic-trained radiologists using the sequential reading method. RESULTS Seventy-seven (62%) patients were found to have ILA (69% subpleural fibrotic, 19% subpleural non-fibrotic, and 6% non-subpleural), nine (7%) were equivocal for ILA and 39 (31%) had no ILA. The term ILA was used exclusively by thoracic-trained radiologists except for two cases. Use of the term ILA has rapidly increased since the position paper publication (none from 2010-2017, one case in 2018, 20 cases in 2019, 41 cases in 2020, and 73 cases in 2021), and cases were typically very mild (1-25% of the lung). CONCLUSION While there has been increased use of the term ILA among thoracic-trained radiologists, non-thoracic radiologists have essentially not begun to use the term. Almost one-third of cases labeled ILA on clinical reads were re-classified as not having ILA on research reads.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - Anna J Podolanczuk
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Kerri I Aronson
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - James F Gruden
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA.
| | - Leena Rachid
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Yana Rabkova
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Sharon Steinberger
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
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Caminati A, Zompatori M, Fuccillo N, Sonaglioni A, Elia D, Cassandro R, Trevisan R, Rispoli A, Pelosi G, Harari S. Coronary artery calcium score is a prognostic factor for mortality in idiopathic pulmonary fibrosis. Minerva Med 2023; 114:815-824. [PMID: 35671002 DOI: 10.23736/s0026-4806.22.08018-1] [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: 11/08/2022]
Abstract
BACKGROUND Cardiovascular diseases are frequent in idiopathic pulmonary fibrosis (IPF) and impact on survival. We investigated the association of coronary artery calcium (CAC) score at IPF diagnosis and during mid-term follow-up, with adverse cardiovascular events and all-cause mortality. METHODS Consecutive patients with IPF were retrospectively analyzed. Demographic data, smoking history, comorbidities and pulmonary function tests (PFTs) were recorded. All patients had at least two chest high resolution computed tomography (HRCT) performed 2 years apart. The total CAC score and visual fibrotic score were calculated, and all clinically significant cardiovascular events and deaths were reported. RESULTS The population consisted of 79 patients (57 males, mean age: 74.4±7.6 years); 67% of patients had a history of smoking, 48% of hypertension, 37% of dyslipidemia and 22.8% of diabetes. The visual score was 21.28±7.99% at T0 and 26.54±9.34% at T1, respectively (T1-T0 5.26±6.13%, P<0.001). CAC score at T0 and at T1 was 537.93±839.94 and 759.98±1027.6, respectively (T1-T0 224.66±406.87, P<0.001). Mean follow-up time was 2.47±1.1 years. On multivariate analysis, male sex (HR=3.58, 95% CI: 1.14-11.2) and CAC score at T0 (HR=1.04, 95% CI: 1.01-1.07) correlated with mortality and cardiovascular events. CAC score at T0≥405 showed 82% sensitivity and 100% specificity for predicting mortality and adverse cardiovascular events. CONCLUSIONS IPF patients with a CAC score at diagnosis ≥405 have a poor prognosis over a mid-term follow-up. A higher CAC score is associated with mortality and cardiovascular events.
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Affiliation(s)
- Antonella Caminati
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy -
| | - Maurizio Zompatori
- Department of Diagnostic Imaging, IRCCS MultiMedica, Milan, Italy
- DIMES Department, University of Bologna, Bologna, Italy
| | - Nicoletta Fuccillo
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
| | | | - Davide Elia
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
| | - Roberto Cassandro
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
| | - Roberta Trevisan
- Department of Diagnostic Imaging, IRCCS MultiMedica, Milan, Italy
| | - Anna Rispoli
- Department of Diagnostic Imaging, IRCCS MultiMedica, Milan, Italy
| | - Giuseppe Pelosi
- Intercompany Service of Pathological Anatomy, Scientific and Technological Pole, IRCCS MultiMedica, Milan, Italy
| | - Sergio Harari
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Putman RK, Hunninghake GM. Pinocchio, Interstitial Lung Abnormalities, and Becoming a Real Disease. Am J Respir Crit Care Med 2023; 208:830-831. [PMID: 37698944 PMCID: PMC10586245 DOI: 10.1164/rccm.202309-1556ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/14/2023] Open
Affiliation(s)
- Rachel K Putman
- Brigham and Women's Hospital Harvard Medical School Boston, Massachusetts
| | - Gary M Hunninghake
- Brigham and Women's Hospital Harvard Medical School Boston, Massachusetts
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11
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Grant-Orser A, Min B, Elmrayed S, Podolanczuk AJ, Johannson KA. Prevalence, Risk Factors, and Outcomes of Adult Interstitial Lung Abnormalities: A Systematic Review and Meta-Analysis. Am J Respir Crit Care Med 2023; 208:695-708. [PMID: 37534937 PMCID: PMC10515575 DOI: 10.1164/rccm.202302-0271oc] [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: 02/14/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023] Open
Abstract
Rationale: Incidental parenchymal abnormalities detected on chest computed tomography scans are termed interstitial lung abnormalities (ILAs). ILAs may represent early interstitial lung disease (ILD) and are associated with an increased risk of progressive fibrosis and mortality. The prevalence of ILAs is unknown, with heterogeneity across study populations. Objectives: Estimate the pooled prevalence of ILAs in lung cancer screening, general population-based, and at-risk familial cohorts using meta-analysis; identify variables associated with ILA risk; and characterize ILA-associated mortality. Methods: The study protocol was registered on PROSPERO (CRD42022373203), and Meta-analyses of Observational Studies in Epidemiology recommendations were followed. Relevant studies were searched on Embase and Medline. Study titles were screened and abstracts reviewed for full-text eligibility. Random effect models were used to pool prevalence estimates for specified subgroups and ILA-associated mortality risk. Risk of ILAs was estimated based on age, sex, and FVC. Quality assessment was conducted using an adapted Assessment Tool for Prevalence Studies. Measurements and Main Results: The search identified 9,536 studies, with 22 included, comprising 88,325 participants. The pooled ILA prevalence was 7% (95% confidence interval [CI], 0.01-0.13) in lung cancer screening, 7% (95% CI, 0.04-0.10) in general population, and 26% (95% CI, 0.20-0.32) in familial cohorts. Pooled mortality risk was increased in those with ILAs (odds ratio, 3.56; 95% CI, 2.19-5.81). Older age, male sex, and lower FVC% were associated with greater odds of ILA. Conclusions: Populations undergoing imaging for non-ILD indications demonstrate high ILA prevalence. Standardized reporting and follow-up of ILAs is needed, including defining those at greatest risk of progression to ILD.
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Affiliation(s)
| | - Bohyung Min
- Division of Respirology, Department of Medicine
| | - Seham Elmrayed
- Department of Community Health Sciences, and
- The American University in Cairo, Cairo, Egypt; and
| | - Anna J. Podolanczuk
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical Center, New York, New York
| | - Kerri A. Johannson
- Division of Respirology, Department of Medicine
- Department of Community Health Sciences, and
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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12
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Selvan KC, Kalra A, Reicher J, Muelly M, Adegunsoye A. Computer-Aided Pulmonary Fibrosis Detection Leveraging an Advanced Artificial Intelligence Triage and Notification Software. J Clin Med Res 2023; 15:423-429. [PMID: 37822853 PMCID: PMC10563821 DOI: 10.14740/jocmr5020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
Background Improvement in recognition and referral of pulmonary fibrosis (PF) is vital to improving patient outcomes within interstitial lung disease. We determined the performance metrics and processing time of an artificial intelligence triage and notification software, ScreenDx-LungFibrosis™, developed to improve detection of PF. Methods ScreenDx-LungFibrosis™ was applied to chest computed tomography (CT) scans from multisource data. Device output (+/- PF) was compared to clinical diagnosis (+/- PF), and diagnostic performance was evaluated. Primary endpoints included device sensitivity and specificity > 80% and processing time < 4.5 min. Results Of 3,018 patients included, PF was present in 22.9%. ScreenDx-LungFibrosis™ detected PF with a sensitivity and specificity of 91.3% (95% confidence interval (CI): 89.0-93.3%) and 95.1% (95% CI: 94.2-96.0%), respectively. Mean processing time was 27.6 s (95% CI: 26.0 - 29.1 s). Conclusions ScreenDx-LungFibrosis™ accurately and reliably identified PF with a rapid per-case processing time, underscoring its potential for transformative improvement in PF outcomes when routinely applied to chest CTs.
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Affiliation(s)
- Kavitha C. Selvan
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Joshua Reicher
- IMVARIA Inc., Berkley, CA 94705, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Michael Muelly
- IMVARIA Inc., Berkley, CA 94705, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Ayodeji Adegunsoye
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
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13
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Kim JS, Manichaikul AW, Hoffman EA, Balte P, Anderson MR, Bernstein EJ, Madahar P, Oelsner EC, Kawut SM, Wysoczanski A, Laine AF, Adegunsoye A, Ma JZ, Taub MA, Mathias RA, Rich SS, Rotter JI, Noth I, Garcia CK, Barr RG, Podolanczuk AJ. MUC5B, telomere length and longitudinal quantitative interstitial lung changes: the MESA Lung Study. Thorax 2023; 78:566-573. [PMID: 36690926 PMCID: PMC9899287 DOI: 10.1136/thorax-2021-218139] [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: 08/26/2021] [Accepted: 07/11/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The MUC5B promoter variant (rs35705950) and telomere length are linked to pulmonary fibrosis and CT-based qualitative assessments of interstitial abnormalities, but their associations with longitudinal quantitative changes of the lung interstitium among community-dwelling adults are unknown. METHODS We used data from participants in the Multi-Ethnic Study of Atherosclerosis with high-attenuation areas (HAAs, Examinations 1-6 (2000-2018)) and MUC5B genotype (n=4552) and telomere length (n=4488) assessments. HAA was defined as the per cent of imaged lung with attenuation of -600 to -250 Hounsfield units. We used linear mixed-effects models to examine associations of MUC5B risk allele (T) and telomere length with longitudinal changes in HAAs. Joint models were used to examine associations of longitudinal changes in HAAs with death and interstitial lung disease (ILD). RESULTS The MUC5B risk allele (T) was associated with an absolute change in HAAs of 2.60% (95% CI 0.36% to 4.86%) per 10 years overall. This association was stronger among those with a telomere length below an age-adjusted percentile of 5% (p value for interaction=0.008). A 1% increase in HAAs per year was associated with 7% increase in mortality risk (rate ratio (RR)=1.07, 95% CI 1.02 to 1.12) for overall death and 34% increase in ILD (RR=1.34, 95% CI 1.20 to 1.50). Longer baseline telomere length was cross-sectionally associated with less HAAs from baseline scans, but not with longitudinal changes in HAAs. CONCLUSIONS Longitudinal increases in HAAs were associated with the MUC5B risk allele and a higher risk of death and ILD.
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Affiliation(s)
- John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ani W Manichaikul
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Pallavi Balte
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Michaela R Anderson
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elana J Bernstein
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Purnema Madahar
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics and Epidemiology, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Artur Wysoczanski
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew F Laine
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | | | - Jennie Z Ma
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Margaret A Taub
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rasika A Mathias
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen S Rich
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jerome I Rotter
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA
- The Institute for Translational Genomics and Population Sciences, The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Imre Noth
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Christine Kim Garcia
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Anna J Podolanczuk
- Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, New York, USA
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14
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Brillet PY, Tran Ba S, Nunes H. How does the MESA Lung Study sharpen blurry edges in interstitial lung abnormalities? Eur Respir J 2023; 61:2300397. [PMID: 37290811 DOI: 10.1183/13993003.00397-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Pierre-Yves Brillet
- Inserm UMR 1272 "Hypoxie et Poumon", UFR SMBH, Université Sorbonne Paris-Nord, 93000 Bobigny, France
- Service de Radiologie, Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris, 93009 Bobigny cedex, France
| | - Stéphane Tran Ba
- Service de Radiologie, Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris, 93009 Bobigny cedex, France
| | - Hilario Nunes
- Inserm UMR 1272 "Hypoxie et Poumon", UFR SMBH, Université Sorbonne Paris-Nord, 93000 Bobigny, France
- Service de Pneumologie, Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris, 93009 Bobigny cedex, France
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15
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McGroder CF, Hansen S, Hinckley Stukovsky K, Zhang D, Nath PH, Salvatore MM, Sonavane SK, Terry N, Stowell JT, D'Souza BM, Leb JS, Dumeer S, Aziz MU, Batra K, Hoffman EA, Bernstein EJ, Kim JS, Podolanczuk AJ, Rotter JI, Manichaikul AW, Rich SS, Lederer DJ, Barr RG, McClelland RL, Garcia CK. Incidence of Interstitial Lung Abnormalities: The MESA Lung Study. Eur Respir J 2023; 61:2201950. [PMID: 37202153 PMCID: PMC10773573 DOI: 10.1183/13993003.01950-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/18/2023] [Indexed: 05/20/2023]
Abstract
The incidence of newly developed interstitial lung abnormalities (ILA) and fibrotic ILA have not been previously reported.Trained thoracic radiologists evaluated 13 944 cardiac CT scans for the presence of ILA in 6197 Multi-Ethnic Study of Atherosclerosis longitudinal cohort study participants >45 years of age from 2000 to 2012. 5% of the scans were re-read by the same or a different observer in a blinded fashion. After exclusion of participants with ILA at baseline, incidence rates and incidence rate ratios for ILA and fibrotic ILA were calculated.The intra-reader agreement of ILA was 92.0% (Gwet AC1=0.912, ICC=0.982) and the inter-reader agreement of ILA was 83.5% (Gwet AC1=0.814; ICC=0.969). Incidence of ILA and fibrotic ILA was estimated to be 13.1 cases/1000 person-years and 3.5/1000 person-years, respectively. In multivariable analyses, age (HR 1.06 (1.05, 1.08), p <0.001; HR 1.08 (1.06, 1.11), p <0.001), high attenuation area (HAA) at baseline (HR 1.05 (1.03, 1.07), p <0.001; HR 1.06 (1.02, 1.10), p=0.002), and the MUC5B promoter SNP (HR 1.73 (1.17, 2.56) p=0.01; HR 4.96 (2.68, 9.15), p <0.001) were associated with incident ILA and fibrotic ILA, respectively. Ever smoking (HR 2.31 (1.34, 3.96), p= 0.002) and an IPF polygenic risk score (HR 2.09 (1.61-2.71), p<0.001) were associated only with incident fibrotic ILA.Incident ILA and fibrotic ILA were estimated by review of cardiac imaging studies. These findings may lead to wider application of a screening tool for atherosclerosis to identify preclinical lung disease.
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Affiliation(s)
- Claire F McGroder
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Spencer Hansen
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - David Zhang
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - P Hrudaya Nath
- Department of Radiology, University of Alabama, Birmingham, AL, USA
| | - Mary M Salvatore
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | | | - Nina Terry
- Department of Radiology, University of Alabama, Birmingham, AL, USA
| | - Justin T Stowell
- Department of Radiology, Mayo Clinic at Jacksonville, Jacksonville, FL, USA
| | - Belinda M D'Souza
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Jay S Leb
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Shifali Dumeer
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Muhammad U Aziz
- Department of Radiology, University of Alabama, Birmingham, AL, USA
| | - Kiran Batra
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Elana J Bernstein
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - John S Kim
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Anna J Podolanczuk
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ani W Manichaikul
- Department of Public Health Sciences, University of Virginia, Charlotte, VA, USA
- Center for Public Health Genomics, University of Virginia, Charlotte, VA, USA
| | - Stephen S Rich
- Department of Public Health Sciences, University of Virginia, Charlotte, VA, USA
- Center for Public Health Genomics, University of Virginia, Charlotte, VA, USA
| | - David J Lederer
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | | | - Christine Kim Garcia
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Institute for Genomic Medicine, Columbia University Medical Center, New York, NY, USA
- Center for Precision Medicine and Genomics, Columbia University Medical Center, New York, NY, USA
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16
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Kim JS, Azarbarzin A, Podolanczuk AJ, Anderson MR, Cade BE, Kawut SM, Wysoczanski A, Laine AF, Hoffman EA, Gottlieb DJ, Garcia CK, Barr RG, Redline S. Obstructive Sleep Apnea and Longitudinal Changes in Interstitial Lung Imaging and Lung Function: The MESA Study. Ann Am Thorac Soc 2023; 20:728-737. [PMID: 36790913 PMCID: PMC10174121 DOI: 10.1513/annalsats.202208-719oc] [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: 08/20/2022] [Accepted: 02/15/2023] [Indexed: 02/16/2023] Open
Abstract
Rationale: Obstructive sleep apnea (OSA) has been hypothesized to be a risk factor in interstitial lung disease (ILD) and is associated with radiological markers that may represent the earlier stages of ILD. Prior studies have been limited by their cross-sectional design and potential confounding by body habitus. Objectives: To test the hypothesis that OSA severity is associated with more high-attenuation areas (HAAs) on computed tomography and worse lung function over time among older community-dwelling adults. Methods: We used data from participants in the MESA (Multi-Ethnic Study of Atherosclerosis) who had apnea-hypopnea index (AHI) measured from polysomnography (2010-2013), high attenuation areas (HAAs, -600 to -250 Hounsfield units, n = 784), assessments from exams 5 (2010-2012) and 6 (2016-2018) full-lung computed tomography scans, and spirometry assessments (n = 677). Linear mixed-effects models with random intercept were used to examine associations of OSA severity (i.e., AHI and hypoxic burden) with changes in HAAs, total lung volumes, and forced vital capacity (FVC) between exams 5 and 6. Potential confounders were adjusted for in the model, including age, sex, smoking history, height, and weight. Results: Among those with a higher AHI there were more men and a higher body mass index. Participants with AHI ⩾ 15 events/h and in the highest hypoxic burden quartile each had increases in HAAs of 11.30% (95% confidence interval [CI], 3.74-19.35%) and 9.85% (95% CI, 1.40-19.01%) per 10 years, respectively. There was a more rapid decline in total lung volumes imaged and FVC among those with AHI ⩾ 15 events/h of 220.2 ml (95% CI, 47.8-392.5 ml) and 3.63% (95% CI, 0.43-6.83%) per 10 years, respectively. Conclusions: A greater burden of hypoxia related to obstructive events during sleep was associated with increased lung densities over time and a more rapid decline in lung volumes regardless of body habitus. Our findings suggest OSA may be a contributing factor in the early stages of ILD.
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Affiliation(s)
- John S. Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ali Azarbarzin
- Division of Sleep and Circadian Sleep Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anna J. Podolanczuk
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, New York, New York
| | | | - Brian E. Cade
- Division of Sleep and Circadian Sleep Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Steven M. Kawut
- Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Artur Wysoczanski
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Andrew F. Laine
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Eric A. Hoffman
- Department of Radiology
- Department of Medicine, and
- Department of Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Daniel J. Gottlieb
- Veterans Affairs Boston Healthcare System, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christine Kim Garcia
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - R. Graham Barr
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, New York, New York; and
| | - Susan Redline
- Division of Sleep and Circadian Sleep Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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17
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Lee JE, Chae KJ, Suh YJ, Jeong WG, Lee T, Kim YH, Jin GY, Jeong YJ. Prevalence and Long-term Outcomes of CT Interstitial Lung Abnormalities in a Health Screening Cohort. Radiology 2023; 306:e221172. [PMID: 36219115 DOI: 10.1148/radiol.221172] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background The association between interstitial lung abnormalities (ILAs) and long-term outcomes has not been reported in Asian health screening populations. Purpose To investigate ILA prevalence in an Asian health screening cohort and determine rates and risks for ILA progression, lung cancer development, and mortality within the 10-year follow-up. Materials and Methods This observational, retrospective multicenter study included patients aged 50 years or older who underwent chest CT at three health screening centers over a 4-year period (2007-2010). ILA status was classified as none, equivocal ILA, and ILA (nonfibrotic or fibrotic). Progression was evaluated from baseline to the last follow-up CT examination, when available. The log-rank test was performed to compare mortality rates over time between ILA statuses. Multivariable Cox proportional hazards models were used to assess factors associated with hazards of ILA progression, lung cancer development, and mortality. Results Of the 2765 included patients (mean age, 59 years ± 7 [SD]; 2068 men), 94 (3%) had a finding of ILA (35 nonfibrotic and 59 fibrotic ILA) and 119 (4%) had equivocal ILA. The median time for CT follow-up and the entire observation was 8 and 12 years, respectively. ILA progression was observed in 80% (48 of 60) of patients with ILA over 8 years. Those with fibrotic and nonfibrotic ILA had a higher mortality rate than those without ILA (P < .001 and P = .01, respectively) over 12 years. Fibrotic ILA was independently associated with ILA progression (hazard ratio [HR], 10.3; 95% CI: 6.4, 16.4; P < .001), lung cancer development (HR, 4.4; 95% CI: 2.1, 9.1; P < .001), disease-specific mortality (HR, 6.7; 95% CI: 3.7, 12.2; P < .001), and all-cause mortality (HR, 2.5; 95% CI: 1.6, 3.8; P < .001) compared with no ILA. Conclusion The prevalence of interstitial lung abnormalities (ILAs) in an Asian health screening cohort was approximately 3%, and fibrotic ILA was an independent risk factor for ILA progression, lung cancer development, and mortality. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Hatabu and Hata in this issue.
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Affiliation(s)
- Jong Eun Lee
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Kum Ju Chae
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Young Ju Suh
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Won Gi Jeong
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Taebum Lee
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Yun-Hyeon Kim
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Gong Yong Jin
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Yeon Joo Jeong
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
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18
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Kim JS, Kim J, Yin X, Hiura GT, Anderson MR, Hoffman EA, Raghu G, Noth I, Manichaikul A, Rich SS, Smith BM, Podolanczuk AJ, Garcia CK, Barr RG, Prince MR, Oelsner EC. Associations of hiatus hernia with CT-based interstitial lung changes: the MESA Lung Study. Eur Respir J 2023; 61:2103173. [PMID: 35777776 PMCID: PMC10203882 DOI: 10.1183/13993003.03173-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/02/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hiatus hernia (HH) is prevalent in adults with pulmonary fibrosis. We hypothesised that HH would be associated with markers of lung inflammation and fibrosis among community-dwelling adults and stronger among MUC5B (rs35705950) risk allele carriers. METHODS In the Multi-Ethnic Study of Atherosclerosis, HH was assessed from cardiac and full-lung computed tomography (CT) scans performed at Exam 1 (2000-2002, n=3342) and Exam 5 (2010-2012, n=3091), respectively. Percentage of high attenuation areas (HAAs; percentage of voxels with attenuation between -600 and -250 HU) was measured from cardiac and lung scans. Interstitial lung abnormalities (ILAs) were examined from Exam 5 scans (n=2380). Regression models were used to examine the associations of HH with HAAs, ILAs and serum matrix metalloproteinase-7 (MMP-7), and adjusted for age, sex, race/ethnicity, educational attainment, smoking, height, weight and scanner parameters for HAA analysis. RESULTS HH detected from Exam 5 scans was associated with a mean percentage difference in HAAs of 2.23% (95% CI 0.57-3.93%) and an increase of 0.48% (95% CI 0.07-0.89%) per year, particularly in MUC5B risk allele carriers (p-value for interaction=0.02). HH was associated with ILAs among those <80 years of age (OR for ILAs 1.78, 95% CI 1.14-2.80) and higher serum MMP-7 level among smokers (p-value for smoking interaction=0.04). CONCLUSIONS HH was associated with more HAAs over time, particularly among MUC5B risk allele carriers, and ILAs in younger adults, and may be a risk factor in the early stages of interstitial lung disease.
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Affiliation(s)
- John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jinhye Kim
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
- Department of Radiology, Westchester Medical Center, Valhalla, NY, USA
| | - Xiaorui Yin
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Grant T Hiura
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Eric A Hoffman
- Department of Radiology, Carver School of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ganesh Raghu
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Imre Noth
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ani Manichaikul
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Stephen S Rich
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Benjamin M Smith
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Anna J Podolanczuk
- Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, NY, USA
| | - Christine Kim Garcia
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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19
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Choi B, Adan N, Doyle TJ, San José Estépar R, Harmouche R, Humphries SM, Moll M, Cho MH, Putman RK, Hunninghake GM, Kalhan R, Liu GY, Diaz AA, Mason SE, Rahaghi FN, Pistenmaa CL, Enzer N, Poynton C, Sánchez-Ferrero GV, Ross JC, Lynch DA, Martinez FJ, Han MK, Bowler RP, Wilson DO, Rosas IO, Washko GR, San José Estépar R, Ash SY. Quantitative Interstitial Abnormality Progression and Outcomes in the Genetic Epidemiology of COPD and Pittsburgh Lung Screening Study Cohorts. Chest 2023; 163:164-175. [PMID: 35780812 PMCID: PMC9859724 DOI: 10.1016/j.chest.2022.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/25/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The risk factors and clinical outcomes of quantitative interstitial abnormality progression over time have not been characterized. RESEARCH QUESTIONS What are the associations of quantitative interstitial abnormality progression with lung function, exercise capacity, and mortality? What are the demographic and genetic risk factors for quantitative interstitial abnormality progression? STUDY DESIGN AND METHODS Quantitative interstitial abnormality progression between visits 1 and 2 was assessed from 4,635 participants in the Genetic Epidemiology of COPD (COPDGene) cohort and 1,307 participants in the Pittsburgh Lung Screening Study (PLuSS) cohort. We used multivariable linear regression to determine the risk factors for progression and the longitudinal associations between progression and FVC and 6-min walk distance, and Cox regression models for the association with mortality. RESULTS Age at enrollment, female sex, current smoking status, and the MUC5B minor allele were associated with quantitative interstitial abnormality progression. Each percent annual increase in quantitative interstitial abnormalities was associated with annual declines in FVC (COPDGene: 8.5 mL/y; 95% CI, 4.7-12.4 mL/y; P < .001; PLuSS: 9.5 mL/y; 95% CI, 3.7-15.4 mL/y; P = .001) and 6-min walk distance, and increased mortality (COPDGene: hazard ratio, 1.69; 95% CI, 1.34-2.12; P < .001; PLuSS: hazard ratio, 1.28; 95% CI, 1.10-1.49; P = .001). INTERPRETATION The objective, longitudinal measurement of quantitative interstitial abnormalities may help identify people at greatest risk for adverse events and most likely to benefit from early intervention.
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Affiliation(s)
- Bina Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
| | - Najma Adan
- Department of Biology, University of Washington, Bothell, WA
| | - Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ruben San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Rola Harmouche
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Matthew Moll
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rachel K Putman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gabrielle Y Liu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Stefanie E Mason
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Carrie L Pistenmaa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Nicholas Enzer
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Clare Poynton
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Gonzalo Vegas Sánchez-Ferrero
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Russell P Bowler
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ivan O Rosas
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
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20
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Hoang-Thi TN, Chassagnon G, Tran HD, Le-Dong NN, Dinh-Xuan AT, Revel MP. How Artificial Intelligence in Imaging Can Better Serve Patients with Bronchial and Parenchymal Lung Diseases? J Pers Med 2022; 12:jpm12091429. [PMID: 36143214 PMCID: PMC9505778 DOI: 10.3390/jpm12091429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
With the rapid development of computing today, artificial intelligence has become an essential part of everyday life, with medicine and lung health being no exception. Big data-based scientific research does not mean simply gathering a large amount of data and letting the machines do the work by themselves. Instead, scientists need to identify problems whose solution will have a positive impact on patients’ care. In this review, we will discuss the role of artificial intelligence from both physiological and anatomical standpoints, starting with automatic quantitative assessment of anatomical structures using lung imaging and considering disease detection and prognosis estimation based on machine learning. The evaluation of current strengths and limitations will allow us to have a broader view for future developments.
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Affiliation(s)
- Trieu-Nghi Hoang-Thi
- Department of Diagnostic Imaging, Vinmec Healthcare System, Ho Chi Minh City 70000, Vietnam
| | - Guillaume Chassagnon
- AP-HP. Centre, Cochin Hospital, Department of Radiology, Université de Paris, 75005 Paris, France
| | - Hai-Dang Tran
- Department of Diagnostic Imaging, Vinmec Healthcare System, Ho Chi Minh City 70000, Vietnam
| | - Nhat-Nam Le-Dong
- AP-HP. Centre, Cochin Hospital, Department of Respiratory Physiology, Université de Paris, 75005 Paris, France
| | - Anh Tuan Dinh-Xuan
- AP-HP. Centre, Cochin Hospital, Department of Respiratory Physiology, Université de Paris, 75005 Paris, France
| | - Marie-Pierre Revel
- AP-HP. Centre, Cochin Hospital, Department of Radiology, Université de Paris, 75005 Paris, France
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21
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Quantitative Computed Tomography: What Clinical Questions Can it Answer in Chronic Lung Disease? Lung 2022; 200:447-455. [PMID: 35751660 PMCID: PMC9378468 DOI: 10.1007/s00408-022-00550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/07/2022] [Indexed: 01/27/2023]
Abstract
Quantitative computed tomography (QCT) has recently gained an important role in the functional assessment of chronic lung disease. Its capacity in diagnostic, staging, and prognostic evaluation in this setting is similar to that of traditional pulmonary function testing. Furthermore, it can demonstrate lung injury before the alteration of pulmonary function test parameters, and it enables the classification of disease phenotypes, contributing to the customization of therapy and performance of comparative studies without the intra- and inter-observer variation that occurs with qualitative analysis. In this review, we address technical issues with QCT analysis and demonstrate the ability of this modality to answer clinical questions encountered in daily practice in the management of patients with chronic lung disease.
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22
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Alevizos MK, Danoff SK, Pappas DA, Lederer DJ, Johnson C, Hoffman EA, Bernstein EJ, Bathon JM, Giles JT. Assessing predictors of rheumatoid arthritis-associated interstitial lung disease using quantitative lung densitometry. Rheumatology (Oxford) 2022; 61:2792-2804. [PMID: 34747452 PMCID: PMC9608004 DOI: 10.1093/rheumatology/keab828] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess predictors of subclinical RA-associated interstitial lung disease (RA-ILD) using quantitative lung densitometry (qLD). METHODS RA patients underwent multi-detector row CT scanning at baseline and after an average of 39 months. Scans were analysed with qLD for the percentage of lung parenchyma with high attenuation areas (%HAA: the percentage of voxels of -600 to -250 Hounsfield units). Additionally, a pulmonary radiologist calculated an expert radiologist scoring (ERS) for RA-ILD features. Generalized linear models were used to identify indicators of baseline %HAA and predictors of %HAA change. RESULTS Baseline %HAA was assessed in 193 RA patients and 106 had repeat qLD assessment. %HAA was correlated with ERS (Spearman's rho = 0.261; P < 0.001). Significant indicators of high baseline %HAA (>10% of lung parenchyma with high attenuation) included female sex, higher pack-years of smoking, higher BMI and anti-CCP ≥200 units, collectively contributing an area under the receiver operator curve of 0.88 (95% CI 0.81, 0.95). Predictors of %HAA increase, occurring in 49% with repeat qLD, included higher baseline %HAA, presence of mucin 5B (MUC5B) minor allele and absence of HLA-DRB1 shared epitope (area under the receiver operator curve = 0.69; 95% CI 0.58, 0.79). The association of the MUC5B minor allele with %HAA change was higher among men and those with higher cumulative smoking. Within the group with increased %HAA, anti-CCP level was significantly associated with a greater increase in %HAA. CONCLUSIONS %HAA, assessed with qLD, was linked to several known risk factors for RA-ILD and may represent a more quantitative method to identify RA-ILD and track progression than expert radiologist interpretation.
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Affiliation(s)
- Michail K Alevizos
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD
| | - Dimitrios A Pappas
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY
| | - David J Lederer
- Division of Pulmonary and Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Cheilonda Johnson
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Elana J Bernstein
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY
| | - Joan M Bathon
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY
| | - Jon T Giles
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY
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23
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Barros MC, Hochhegger B, Altmayer S, Zanon M, Sartori G, Watte G, do Nascimento MHS, Chatkin JM. The Normal Lung Index From Quantitative Computed Tomography for the Evaluation of Obstructive and Restrictive Lung Disease. J Thorac Imaging 2022; 37:246-252. [PMID: 35749622 DOI: 10.1097/rti.0000000000000629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Our objective was to evaluate whether the normal lung index (NLI) from quantitative computed tomography (QCT) analysis can be used to predict mortality as well as pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). MATERIALS AND METHODS Normal subjects (n=20) and patients with COPD (n=172) and ILD (n=114) who underwent PFTs and chest CT were enrolled retrospectively in this study. QCT measures included the NLI, defined as the ratio of the lung with attenuation between -950 and -700 Hounsfield units (HU) over the total lung volume (-1024 to -250 HU, mL), high-attenuation area (-700 to -250 HU, %), emphysema index (>6% of pixels < -950 HU), skewness, kurtosis, and mean lung attenuation. Coefficients of correlation between QCT measurements and PFT results in all subjects were calculated. Univariate and multivariate survival analyses were performed to assess mortality prediction by disease. RESULTS The Pearson correlation analysis showed that the NLI correlated moderately with the forced expiratory volume in 1 second in subjects with COPD (r=0.490, P<0.001) and the forced vital capacity in subjects with ILD (r=0.452, P<0.001). Multivariate analysis revealed that the NLI of <70% was a significant independent predictor of mortality in subjects with COPD (hazard ratio=3.14, P=0.034) and ILD (hazard ratio=2.72, P=0.005). CONCLUSION QCT analysis, specifically the NLI, can also be used to predict mortality in individuals with COPD and ILD.
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Affiliation(s)
| | | | | | - Matheus Zanon
- Irmandade Santa Casa de Misericordia de Porto Alegre, Porto Alegre
| | - Gabriel Sartori
- Irmandade Santa Casa de Misericordia de Porto Alegre, Porto Alegre
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24
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Sanders JL, Axelsson G, Putman R, Menon A, Dupuis J, Xu H, Wang S, Murabito J, Vasan R, Araki T, Nishino M, Washko GR, Hatabu H, O'Connor G, Gudmundsson G, Gudnason V, Hunninghake GM. The relationship between interstitial lung abnormalities, mortality, and multimorbidity: a cohort study. Thorax 2022; 78:559-565. [PMID: 35777957 DOI: 10.1136/thoraxjnl-2021-218315] [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: 10/04/2021] [Accepted: 06/06/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Interstitial lung abnormalities (ILAs) are associated with increased mortality. It is unclear whether multimorbidity accounts for the mortality association or how strongly ILA is associated with mortality relative to other common age-associated diseases. We determined the association of ILA with all-cause mortality adjusted for multimorbidity, compared mortality associated with ILA and prevalent cardiovascular disease (CVD), diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease and cancer and also determined the association between ILA and these diseases. METHODS We measured ILA (none, indeterminant, definite) using blinded reads of CT images, prevalent chronic diseases and potential confounders in two observational cohorts, the Framingham Heart Study (FHS) (n=2449) and Age, Gene/Environment Susceptibility - Reykjavik Study (AGES-Reykjavik) (n=5180). We determined associations with mortality using Cox proportional hazards models and between ILA and diseases with multinomial logistic regression. RESULTS Over a median (IQR) follow-up of 8.8 (1.4) years in FHS and 12.0 (7.7) years in AGES-Reykjavik, in adjusted models, ILAs were significantly associated with increased mortality (HR, 95% CI 1.95, 1.23 to 3.08, p=0.0042, in FHS; HR 1.60, 1.41 to 1.82, p<0.0001, in AGES-Reykjavik) adjusted for multimorbidity. In both cohorts, the association of ILA with mortality was of similar magnitude to the association of most other diseases. In adjusted models, ILAs were associated only with prevalent kidney disease (OR, 95% CI 1.90, 1.01 to 3.57, p=0.0452) in FHS and with prevalent CVD (OR 1.42, 1.12 to 1.81, p=0.0040) in AGES-Reykjavik. CONCLUSIONS ILAs were associated with mortality adjusted for multimorbidity and were similarly associated with increased mortality compared with several common chronic diseases. ILAs were not consistently associated with the prevalence of these diseases themselves.
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Affiliation(s)
| | - Gisli Axelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Rachel Putman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aravind Menon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Josée Dupuis
- Biostatistics Department, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Hanfei Xu
- Biostatistics Department, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Joanne Murabito
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ramachandran Vasan
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Tetsuro Araki
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - George O'Connor
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston University Medical Center, Boston, Massachusetts, USA
| | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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25
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Interstitial lung abnormalities and interstitial lung diseases associated with cigarette smoking in a rural cohort undergoing surgical resection. BMC Pulm Med 2022; 22:172. [PMID: 35488260 PMCID: PMC9055776 DOI: 10.1186/s12890-022-01961-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Cigarette smoking is a risk factor for interstitial lung abnormalities (ILAs) and interstitial lung diseases (ILDs). Investigation defining the relationships between ILAs/ILDs and clinical, radiographic, and pathologic findings in smokers have been incomplete. Employing a cohort undergoing surgical resection for lung nodules/masses, we (1) define the prevalence of ILAs/ILDs, (2) delineate their clinical, radiographic and pathologic predictors, and (3) determine their associations with mortality. Methods Patients undergoing resection of lung nodules/masses between 2017 and 2020 at a rural Appalachian, tertiary medical center were retrospectively investigated. Predictors for ILAs/ILDs and mortality were assessed using multivariate logistic regression analysis. Results In the total study cohort of 352 patients, radiographic ILAs and ILDs were observed in 35.2% and 17.6%, respectively. Among ILA patterns, subpleural reticular changes (14.8%), non-emphysematous cysts, centrilobular (CL) ground glass opacities (GGOs) (8% each), and mixed CL-GGO and subpleural reticular changes (7.4%) were common. ILD patterns included combined pulmonary fibrosis emphysema (CPFE) (3.1%), respiratory bronchiolitis (RB)-ILD (3.1%), organizing pneumonitis (2.8%) and unclassifiable (4.8%). The group with radiographic ILAs/ILDs had a significantly higher proportion of ever smokers (49% vs. 39.9%), pack years of smoking (44.57 ± 36.21 vs. 34.96 ± 26.22), clinical comorbidities of COPD (35% vs. 26.5%) and mildly reduced diffusion capacity (% predicated 66.29 ± 20.55 vs. 71.84 ± 23). Radiographic centrilobular and paraseptal emphysema (40% vs. 22.2% and 17.6% vs. 9.6%, respectively) and isolated traction bronchiectasis (10.2% vs. 4.2%) were associated with ILAs/ILDs. Pathological variables of emphysema (34.9% vs. 18.5%), any fibrosis (15.9% vs. 4.6%), peribronchiolar metaplasia (PBM, 8% vs. 1.1%), RB (10.3% vs. 2.5%), and anthracosis (21.6% vs. 14.5%) were associated with ILAs/ILDs. Histologic emphysema showed positive correlations with any fibrosis, RB, anthracosis and ≥ 30 pack year of smoking. The group with ILAs/ILDs had significantly higher mortality (9.1% vs. 2.2%, OR 4.13, [95% CI of 1.84–9.25]). Conclusions In a rural cohort undergoing surgical resection, radiographic subclinical ILAs/ILDs patterns were highly prevalent and associated with ever smoking and intensity of smoking. The presence of radiographic ILA/ILD patterns and isolated honeycomb changes were associated with increased mortality. Subclinical ILAs/ILDs and histologic fibrosis correlated with clinical COPD as well as radiographic and pathologic emphysema emphasizing the co-existence of these pulmonary injuries in a heavily smoking population. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01961-9.
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de Mattos JN, Santiago Escovar CE, Zereu M, Rubin AS, Camargo SM, Mohammed TL, Dos Santos RS, Verma N, Penha Pereira D, Guedes Pinto E, Machuca T, Medeiros TM, Hochhegger B. Computed tomography on lung cancer screening is useful for adjuvant comorbidity diagnosis in developing countries. ERJ Open Res 2022; 8:00061-2022. [PMID: 35747230 PMCID: PMC9209849 DOI: 10.1183/23120541.00061-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The aim of this study was to analyse and quantify the prevalence of six comorbidities from lung cancer screening (LCS) on computed tomography (CT) scans of patients from developing countries. Methods For this retrospective study, low-dose CT scans (n=775) were examined from patients who underwent LCS in a tertiary hospital between 2016 and 2020. An age- and sex-matched control group was obtained for comparison (n=370). Using the software, coronary artery calcification (CAC), the skeletal muscle area, interstitial lung abnormalities, emphysema, osteoporosis and hepatic steatosis were accessed. Clinical characteristics of each participant were identified. A t-test and Chi-squared test were used to examine differences between these values. Interclass correlation coefficients (ICCs) and interobserver agreement (assessed by calculating kappa coefficients) were calculated to assess the correlation of measures interpreted by two observers. p-values <0.05 were considered significant. Results One or more comorbidities were identified in 86.6% of the patients and in 40% of the controls. The most prevalent comorbidity was osteoporosis, present in 44.2% of patients and in 24.8% of controls. New diagnoses of cardiovascular disease, emphysema and osteoporosis were made in 25%, 7% and 46% of cases, respectively. The kappa coefficient for CAC was 0.906 (p<0.001). ICCs for measures of liver, spleen and bone density were 0.88, 0.93 and 0.96, respectively (p<0.001). Conclusions CT data acquired during LCS led to the identification of previously undiagnosed comorbidities. The LCS is useful to facilitate comorbidity diagnosis in developing countries, providing opportunities for its prevention and treatment. Lung cancer screening is useful to facilitate comorbidity diagnosis in developing countries, providing opportunities for its prevention and treatmenthttps://bit.ly/3KEdGuW
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Affiliation(s)
- Juliane Nascimento de Mattos
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Medical Imaging Research Lab, LABIMED, Dept of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | - Manuela Zereu
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Tan-Lucien Mohammed
- Dept of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ricardo Sales Dos Santos
- Dept of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Israelita Albert Einstein Hospital, São Paulo, Brazil
| | - Nupur Verma
- Dept of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Erique Guedes Pinto
- Dept of Radiology, Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Tiago Machuca
- Dept of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Tássia Machado Medeiros
- Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno Hochhegger
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Medical Imaging Research Lab, LABIMED, Dept of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.,Dept of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA.,Dept of Radiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Kim JS, Dashti HS, Huang T, Cade BE, Podolanczuk AJ, O’Hearn DJ, Hoffman EA, Wang H, Blaikley J, Barr RG, Redline S. Associations of sleep duration and sleep-wake rhythm with lung parenchymal abnormalities on computed tomography: The MESA study. J Sleep Res 2022; 31:e13475. [PMID: 34498326 PMCID: PMC8891036 DOI: 10.1111/jsr.13475] [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: 03/22/2021] [Revised: 07/22/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
Impairment of the circadian rhythm promotes lung inflammation and fibrosis in pre-clinical models. We aimed to examine whether short and/or long sleep duration and other markers of sleep-wake patterns are associated with a greater burden of lung parenchymal abnormalities on computed tomography among adults. We cross-sectionally examined associations of sleep duration captured by actigraphy with interstitial lung abnormalities (n = 1111) and high attenuation areas (n = 1416) on computed tomography scan in the Multi-Ethnic Study of Atherosclerosis at Exam 5 (2010-2013). We adjusted for potential confounders in logistic and linear regression models for interstitial lung abnormalities and high attenuation area, respectively. High attenuation area models were also adjusted for study site, lung volume imaged, radiation dose and stratified by body mass index. Secondary exposures were self-reported sleep duration, sleep fragmentation index, sleep midpoint and chronotype. The mean age of those with longer sleep duration (≥ 8 hr) was 70 years and the prevalence of interstitial lung abnormalities was 14%. Increasing actigraphy-based sleep duration among participants with ≥ 8 hr of sleep was associated with a higher adjusted odds of interstitial lung abnormalities (odds ratio of 2.66 per 1-hr increment, 95% confidence interval 1.42-4.99). Longer sleep duration and higher sleep fragmentation index were associated with greater high attenuation area on computed tomography among participants with a body mass index < 25 kg m-2 (p-value for interaction < 0.02). Self-reported sleep duration, later sleep midpoint and evening chronotype were not associated with outcomes. Actigraphy-based longer sleep duration and sleep fragmentation were associated with a greater burden of lung abnormalities on computed tomography scan.
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Affiliation(s)
- John S. Kim
- Department of Medicine, University of Virginia School of
Medicine, Charlottesville, VA, USA
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
| | - Hassan S. Dashti
- Center for Genomic Medicine and Department of Anesthesia,
Critical Care, and Pain Medicine, Center for Genomic Medicine, Massachusetts General
Hospital and Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad
Institute, Cambridge, MA, USA
| | - Tianyi Huang
- Channing Division of Network Medicine, Brigham and
Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston,
MA, USA
| | - Brian E. Cade
- Program in Medical and Population Genetics, Broad
Institute, Cambridge, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston,
MA, USA
- Division of Sleep and Circadian Disorders, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Anna J. Podolanczuk
- Division of Pulmonary and Critical Care Medicine, Weill
Cornell Medical Center, New York, NY, USA
| | - Daniel J. O’Hearn
- Department of Medicine, University of Virginia School of
Medicine, Charlottesville, VA, USA
| | - Eric A. Hoffman
- Departments of Radiology, Medicine, and Biomedical
Engineering, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Heming Wang
- Program in Medical and Population Genetics, Broad
Institute, Cambridge, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston,
MA, USA
- Division of Sleep and Circadian Disorders, Brigham and
Women’s Hospital, Boston, MA, USA
| | - John Blaikley
- Faculty of Biology, Medicine and Health, The University
of Manchester, Manchester, United Kingdom
- Manchester University National Health Service Foundation
Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - R. Graham Barr
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public
Health, New York, NY, USA
| | - Susan Redline
- Channing Division of Network Medicine, Brigham and
Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston,
MA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine,
Beth Israel Deaconess Medical Center, Boston, MA, USA
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28
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Owen DR, Sun Y, Irrer JC, Schipper MJ, Schonewolf CA, Galbán S, Jolly S, Haken RKT, Galbán C, Matuszak M. Investigating the Incidence of Pulmonary Abnormalities as Identified by Parametric Response Mapping in Lung Cancer Patients Prior to Radiation Treatment. Adv Radiat Oncol 2022; 7:100980. [PMID: 35693252 PMCID: PMC9184868 DOI: 10.1016/j.adro.2022.100980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Parametric response mapping (PRM) of high-resolution, paired inspiration and expiration computed tomography (CT) scans is a promising analytical imaging technique that is currently used in diagnostic applications and offers the ability to characterize and quantify certain pulmonary pathologies on a patient-specific basis. As one of the first studies to implement such a technique in the radiation oncology clinic, the goal of this work was to assess the feasibility for PRM analysis to identify pulmonary abnormalities in patients with lung cancer before radiation therapy (RT). Methods and Materials High-resolution, paired inspiration and expiration CT scans were acquired from 23 patients with lung cancer as part of routine treatment planning CT acquisition. When applied to the paired CT scans, PRM analysis classifies lung parenchyma, on a voxel-wise basis, as normal, small airways disease (SAD), emphysema, or parenchymal disease (PD). PRM classifications were quantified as a percent of total lung volume and were evaluated globally and regionally within the lung. Results PRM analysis of pre-RT CT scans was successfully implemented using a workflow that produced patient-specific maps and quantified specific phenotypes of pulmonary abnormalities. Through this study, a large prevalence of SAD and PD was demonstrated in this lung cancer patient population, with global averages of 10% and 17%, respectively. Moreover, PRM-classified normal and SAD in the region with primary tumor involvement were found to be significantly different from global lung values. When present, elevated levels of PD and SAD abnormalities tended to be pervasive in multiple regions of the lung, indicating a large burden of underlying disease. Conclusions Pulmonary abnormalities, as detected by PRM, were characterized in patients with lung cancer scheduled for RT. Although further study is needed, PRM is a highly accessible CT-based imaging technique that has the potential to identify local lung abnormalities associated with chronic obstructive pulmonary disease and interstitial lung disease. Further investigation in the radiation oncology setting may provide strategies for tailoring RT planning and risk assessment based on pre-existing PRM-based pathology.
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Affiliation(s)
- Daniel R. Owen
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
- Corresponding author: Daniel 'Rocky' Owen, PhD
| | - Yilun Sun
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
- Departments of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Jim C. Irrer
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Stefanie Galbán
- Departments of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Shruti Jolly
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - C.J. Galbán
- Departments of Radiology, University of Michigan, Ann Arbor, Michigan
| | - M.M. Matuszak
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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29
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Kim JS, Axelsson GT, Moll M, Anderson MR, Bernstein EJ, Putman RK, Hida T, Hatabu H, Hoffman EA, Raghu G, Kawut SM, Doyle MF, Tracy R, Launer LJ, Manichaikul A, Rich SS, Lederer DJ, Gudnason V, Hobbs BD, Cho MH, Hunninghake GM, Garcia CK, Gudmundsson G, Barr RG, Podolanczuk AJ. Associations of Monocyte Count and Other Immune Cell Types with Interstitial Lung Abnormalities. Am J Respir Crit Care Med 2022; 205:795-805. [PMID: 34929108 PMCID: PMC10394677 DOI: 10.1164/rccm.202108-1967oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Higher blood monocyte counts are associated with worse survival in adults with clinically diagnosed pulmonary fibrosis. Their association with the development and progression of interstitial lung abnormalities (ILA) in humans is unknown. Objectives: We evaluated the associations of blood monocyte count, and other immune cell types, with ILA, high-attenuation areas, and FVC in four independent cohorts. Methods: We included participants with measured monocyte counts and computed tomographic (CT) imaging enrolled in MESA (Multi-Ethnic Study of Atherosclerosis, n = 484), AGES-Reykjavik (Age/Gene Environment Susceptibility Study, n = 3,547), COPDGene (Genetic Epidemiology of COPD, n = 2,719), and the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points, n = 646). Measurements and Main Results: After adjustment for covariates, a 1-SD increment in blood monocyte count was associated with ILA in MESA (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.8), AGES-Reykjavik (OR, 1.2; 95% CI, 1.1-1.3), COPDGene (OR, 1.3; 95% CI, 1.2-1.4), and ECLIPSE (OR, 1.2; 95% CI, 1.0-1.4). A higher monocyte count was associated with ILA progression over 5 years in AGES-Reykjavik (OR, 1.2; 95% CI, 1.0-1.3). Compared with participants without ILA, there was a higher percentage of activated monocytes among those with ILA in MESA. Higher monocyte count was associated with greater high-attenuation areas in MESA and lower FVC in MESA and COPDGene. Associations of other immune cell types were less consistent. Conclusions: Higher blood monocyte counts were associated with the presence and progression of interstitial lung abnormalities and lower FVC.
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Affiliation(s)
- John S Kim
- Department of Medicine, and.,Department of Medicine, Columbia University, New York, New York
| | - Gísli Thor Axelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Matthew Moll
- Division of Pulmonary and Critical Care and.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Tomoyuki Hida
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eric A Hoffman
- Department of Radiology.,Department of Medicine, and.,Department of Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ganesh Raghu
- Department of Medicine, University of Washington, Seattle, Washington
| | - Steven M Kawut
- Department of Medicine and.,Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret F Doyle
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont
| | - Russell Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute of on Aging, National Institutes of Health, Bethesda, Maryland
| | - Ani Manichaikul
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Stephen S Rich
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Brian D Hobbs
- Division of Pulmonary and Critical Care and.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael H Cho
- Division of Pulmonary and Critical Care and.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, New York.,Department of Epidemiology, Mailman School of Public Health, New York, New York; and
| | - Anna J Podolanczuk
- Department of Medicine, Columbia University, New York, New York.,Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, New York, New York
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30
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Ghio AJ, Pavlisko EN, Roggli VL, Todd NW, Sangani RG. Cigarette Smoke Particle-Induced Lung Injury and Iron Homeostasis. Int J Chron Obstruct Pulmon Dis 2022; 17:117-140. [PMID: 35046648 PMCID: PMC8763205 DOI: 10.2147/copd.s337354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
It is proposed that the mechanistic basis for non-neoplastic lung injury with cigarette smoking is a disruption of iron homeostasis in cells after exposure to cigarette smoke particle (CSP). Following the complexation and sequestration of intracellular iron by CSP, the host response (eg, inflammation, mucus production, and fibrosis) attempts to reverse a functional metal deficiency. Clinical manifestations of this response can present as respiratory bronchiolitis, desquamative interstitial pneumonitis, pulmonary Langerhans’ cell histiocytosis, asthma, pulmonary hypertension, chronic bronchitis, and pulmonary fibrosis. If the response is unsuccessful, the functional deficiency of iron progresses to irreversible cell death evident in emphysema and bronchiectasis. The subsequent clinical and pathological presentation is a continuum of lung injuries, which overlap and coexist with one another. Designating these non-neoplastic lung injuries after smoking as distinct disease processes fails to recognize shared relationships to each other and ultimately to CSP, as well as the common mechanistic pathway (ie, disruption of iron homeostasis).
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Affiliation(s)
- Andrew J Ghio
- Human Studies Facility, US Environmental Protection Agency, Chapel Hill, NC, 27514, USA
- Correspondence: Andrew J Ghio Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC, USA Email
| | | | | | - Nevins W Todd
- Department of Medicine, University of Maryland, Baltimore, MD, 21201, USA
| | - Rahul G Sangani
- Department of Medicine, West Virginia University, Morgantown, WV, USA
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31
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Air Trapping versus Atelectasis in Obesity: Relationship to Late-Onset Nonallergic Asthma and Aging. Ann Am Thorac Soc 2022; 19:135-139. [PMID: 34343031 PMCID: PMC8787791 DOI: 10.1513/annalsats.202010-1317rl] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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32
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Scharm SC, Schaefer-Prokop C, Willmann M, Vogel-Claussen J, Knudsen L, Jonigk D, Fuge J, Welte T, Wacker F, Prasse A, Shin HO. Increased regional ventilation as early imaging marker for future disease progression of interstitial lung disease: a feasibility study. Eur Radiol 2022; 32:6046-6057. [PMID: 35357537 PMCID: PMC9381456 DOI: 10.1007/s00330-022-08702-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Idiopathic pulmonary fibrosis (IPF) is a disease with a poor prognosis and a highly variable course. Pathologically increased ventilation-accessible by functional CT-is discussed as a potential predecessor of lung fibrosis. The purpose of this feasibility study was to investigate whether increased regional ventilation at baseline CT and morphological changes in the follow-up CT suggestive for fibrosis indeed occur in spatial correspondence. METHODS In this retrospective study, CT scans were performed at two time points between September 2016 and November 2020. Baseline ventilation was divided into four categories ranging from low, normal to moderately, and severely increased (C1-C4). Correlation between baseline ventilation and volume and density change at follow-up was investigated in corresponding voxels. The significance of the difference of density and volume change per ventilation category was assessed using paired t-tests with a significance level of p ≤ 0.05. The analysis was performed separately for normal (NAA) and high attenuation areas (HAA). RESULTS The study group consisted of 41 patients (73 ± 10 years, 36 men). In both NAA and HAA, significant increases of density and loss of volume were seen in areas of severely increased ventilation (C4) at baseline compared to areas of normal ventilation (C2, p < 0.001). In HAA, morphological changes were more heterogeneous compared to NAA. CONCLUSION Functional CT assessing the extent and distribution of lung parenchyma with pathologically increased ventilation may serve as an imaging marker to prospectively identify lung parenchyma at risk for developing fibrosis. KEY POINTS • Voxelwise correlation of serial CT scans suggests spatial correspondence between increased ventilation at baseline and structural changes at follow-up. • Regional assessment of pathologically increased ventilation at baseline has the potential to prospectively identify tissue at risk for developing fibrosis. • Presence and extent of pathologically increased ventilation may serve as an early imaging marker of disease activity.
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Affiliation(s)
- Sarah C. Scharm
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Cornelia Schaefer-Prokop
- Department of Radiology, Radboud University, Nijmegen, The Netherlands ,Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Moritz Willmann
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany ,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Lars Knudsen
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany ,Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany ,Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany ,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany ,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany ,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Antje Prasse
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany ,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Hoen-oh Shin
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany ,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
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Moutafidis D, Gavra M, Golfinopoulos S, Kattamis A, Chrousos G, Kanaka-Gantenbein C, Kaditis AG. Low- and High-Attenuation Lung Volume in Quantitative Chest CT in Children without Lung Disease. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121172. [PMID: 34943369 PMCID: PMC8700567 DOI: 10.3390/children8121172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/21/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
In contrast to studies of adults with emphysema, application of fixed thresholds to determine low- and high-attenuation areas (air-trapping and parenchymal lung disease) in pediatric quantitative chest CT is problematic. We aimed to assess age effects on: (i) mean lung attenuation (full inspiration); and (ii) low and high attenuation thresholds (LAT and HAT) defined as mean attenuation and 1 SD below and above mean, respectively. Chest CTs from children aged 6-17 years without abnormalities were retrieved, and histograms of attenuation coefficients were analyzed. Eighty examinations were included. Inverse functions described relationships between age and mean lung attenuation, LAT or HAT (p < 0.0001). Predicted value for LAT decreased from -846 HU in 6-year-old to -950 HU in 13- to 17-year-old subjects (cut-off value for assessing emphysema in adults). %TLCCT with low attenuation correlated with age (rs = -0.31; p = 0.005) and was <5% for 9-17-year-old subjects. Inverse associations were demonstrated between: (i) %TLCCT with high attenuation and age (r2 = 0.49; p < 0.0001); (ii) %TLCCT with low attenuation and TLCCT (r2 = 0.47; p < 0.0001); (iii) %TLCCT with high attenuation and TLCCT (r2 = 0.76; p < 0.0001). In conclusion, quantitative analysis of chest CTs from children without lung disease can be used to define age-specific LAT and HAT for evaluation of pediatric lung disease severity.
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Affiliation(s)
- Dimitrios Moutafidis
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine & Agia Sofia Children’s Hospital, 115 27 Athens, Greece; (D.M.); (C.K.-G.)
| | - Maria Gavra
- CT, MRI & PET/CT Department, Agia Sofia Children’s Hospital, 115 27 Athens, Greece; (M.G.); (S.G.)
| | - Sotirios Golfinopoulos
- CT, MRI & PET/CT Department, Agia Sofia Children’s Hospital, 115 27 Athens, Greece; (M.G.); (S.G.)
| | - Antonios Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine & Agia Sofia Children’s Hospital, 115 27 Athens, Greece;
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Christina Kanaka-Gantenbein
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine & Agia Sofia Children’s Hospital, 115 27 Athens, Greece; (D.M.); (C.K.-G.)
| | - Athanasios G. Kaditis
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine & Agia Sofia Children’s Hospital, 115 27 Athens, Greece; (D.M.); (C.K.-G.)
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Axelsson GT, Gudmundsson G. Interstitial lung abnormalities - current knowledge and future directions. Eur Clin Respir J 2021; 8:1994178. [PMID: 34745461 PMCID: PMC8567914 DOI: 10.1080/20018525.2021.1994178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Efforts to grasp the significance of radiologic changes similar to interstitial lung disease (ILD) in undiagnosed individuals have intensified in the recent decade. The term interstitial lung abnormalities (ILA) is an emerging definition of such changes, defined by visual examination of computed tomography scans. Substantial insights have been made in the origins and clinical consequences of these changes, as well as automated measures of early lung fibrosis, which will likely lead to increased recognition of early fibrotic lung changes among clinicians and researchers alike. Interstitial lung abnormalities have an estimated prevalence of 7–10% in elderly populations. They correlate with many ILD risk factors, both epidemiologic and genetic. Additionally, histopathological similarities with IPF exist in those with ILA. While no established blood biomarker of ILA exists, several have been suggested. Distinct imaging patterns indicating advanced fibrosis correlate with worse clinical outcomes. ILA are also linked with adverse clinical outcomes such as increased mortality and risk of lung cancer. Progression of ILA has been noted in a significant portion of those with ILA and is associated with many of the same features as ILD, including advanced fibrosis. Those with ILA progression are at risk of accelerated FVC decline and increased mortality. Radiologic changes resembling ILD have also been attained by automated measures. Such measures associate with some, but not all the same factors as ILA. ILA and similar radiologic changes are in many ways analogous to ILD and likely represent a precursor of ILD in some cases. While warranting an evaluation for ILD, they are associated with poor clinical outcomes beyond possible ILD development and thus are by themselves a significant finding. Among the present objectives of this field are the stratification of patients with regards to progression and the discovery of biomarkers with predictive value for clinical outcomes.
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Affiliation(s)
- Gisli Thor Axelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
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Associations of D-Dimer with Computed Tomographic Lung Abnormalities, Serum Biomarkers of Lung Injury, and Forced Vital Capacity: MESA Lung Study. Ann Am Thorac Soc 2021; 18:1839-1848. [PMID: 33861685 PMCID: PMC8641831 DOI: 10.1513/annalsats.202012-1557oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Rationale: The coagulation cascade may play a role in the pathogenesis of interstitial lung disease through increased production of thrombin and fibrin deposition. Whether circulating coagulation cascade factors are linked to lung inflammation and scarring among community-dwelling adults is unknown. Objectives: To test the hypothesis that higher baseline D-dimer concentrations are associated with markers of early lung injury and scarring. Methods: Using the MESA (Multi-Ethnic Study of Atherosclerosis) cohort (n = 6,814), we examined associations of baseline D-dimer concentrations with high attenuation areas from examination 1 (2000-2002; n = 6,184) and interstitial lung abnormalities from examination 5 computed tomographic (CT) scans (2010-2012; n = 2,227), and serum MMP-7 (matrix metalloproteinase-7) and SP-A (surfactant protein-A) from examination 1 (n = 1,098). We examined longitudinal change in forced vital capacity (FVC) from examinations 3-6 (2004-2018, n = 3,562). We used linear logistic regression and linear mixed models to examine associations and adjust for potential confounders. Results: The mean (standard deviation) age of the cohort was 62 (10) years, and the D-dimer concentration was 0.35 (0.69) ug/ml. For every 10% increase in D-dimer concentration, there was an increase in high attenuation area percentage of 0.27 (95% confidence interval (CI), 0.08-0.47) after adjustment for covariates. Associations were stronger among those older than 65 years (P values for interaction < 0.001). A 10% increase in D-dimer concentration was associated with an odds ratio of 1.05 for interstitial lung abnormalities (95% CI, 0.99-1.11). Higher D-dimer concentrations were associated with higher serum MMP-7 and a faster decline in FVC. D-dimer was not associated with SP-A. Conclusions: Higher D-dimer concentrations were associated with a greater burden of lung parenchymal abnormalities detected on CT scan, MMP-7, and FVC decline among community-dwelling adults.
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Zhang D, Newton CA. Familial Pulmonary Fibrosis: Genetic Features and Clinical Implications. Chest 2021; 160:1764-1773. [PMID: 34186035 PMCID: PMC8628177 DOI: 10.1016/j.chest.2021.06.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary fibrosis comprises a wide range of fibrotic lung diseases with unknown pathogenesis and poor prognosis. Familial pulmonary fibrosis (FPF) represents a unique subgroup of patients in which at least one other relative is also affected. Patients with FPF exhibit a wide range of pulmonary fibrosis phenotypes, although idiopathic pulmonary fibrosis is the most common subtype. Despite variable disease manifestations, patients with FPF experience worse survival compared with their counterparts with the sporadic disease form. Therefore, ascertaining a positive family history not only provides prognostic value but should also raise suspicion for the inheritance of an underlying causative genetic variant within kindreds. By focusing on FPF kindreds, rare variants within surfactant metabolism and telomere maintenance genes have been discovered. However, such genetic variation is not solely restricted to FPF, as similar rare variants are found in patients with seemingly sporadic pulmonary fibrosis, further supporting the idea of genetic susceptibility underlying pulmonary fibrosis as a whole. Researchers are beginning to show how the presence of rare variants may inform clinical management, such as informing predisposition risk for yet unaffected relatives as well as informing prognosis and therapeutic strategy for those already affected. Despite these advances, rare variants in surfactant and telomere-related genes only explain the genetic basis in about one-quarter of FPF kindreds. Therefore, research is needed to identify the missing genetic contributors of pulmonary fibrosis, which would not only improve our understanding of disease pathobiology but may offer additional opportunities to improve the health of patients.
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Affiliation(s)
- David Zhang
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Chad A Newton
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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37
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Liu Q, Zhang H, Han B, Jiang H, Chung KF, Li F. Interstitial lung abnormalities: What do we know and how do we manage? Expert Rev Respir Med 2021; 15:1551-1561. [PMID: 34689661 DOI: 10.1080/17476348.2021.1997598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Interstitial lung abnormalities (ILAs), which refer to mild or subtle nongravity-dependent interstitial changes, may be neglected by some clinicians due to many reasons, such as lack of diagnostic criteria for ILAs and absence of available treatments and surveillance strategies. However, without intervention, some ILAs may progress to interstitial lung disease (ILD). This review summarizes our current knowledge of this condition and ways of diagnosing it together with current management. We hope that this will lead to better recognition of ILAs. AREAS COVERED We reviewed the literature on PubMed between 2008 and 2020 focusing on prevalence, etiology, symptoms, diagnostic biomarkers, clinical associations, and management of ILAs. EXPERT OPINION Timely diagnosis with close monitoring of ILAs and appropriate intervention should be recognized as the management approach to ILAs. Research into ILAs should continue to improve its management.
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Affiliation(s)
- Qi Liu
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Hai Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Baohui Han
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Handong Jiang
- Department of Respiratory and Critical Care Medicine, Shanghai Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Kian Fan Chung
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, UK
| | - Feng Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
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Hata A, Schiebler ML, Lynch DA, Hatabu H. Interstitial Lung Abnormalities: State of the Art. Radiology 2021; 301:19-34. [PMID: 34374589 DOI: 10.1148/radiol.2021204367] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The clinical importance of interstitial lung abnormality (ILA) is increasingly recognized. In July 2020, the Fleischner Society published a position paper about ILA. The purposes of this article are to summarize the definition, existing evidence, clinical management, and unresolved issues for ILA from a radiologic standpoint and to provide a practical guide for radiologists. ILA is a common incidental finding at CT and is often progressive and associated with worsened clinical outcomes. The hazard ratios for mortality range from 1.3 to 2.7 in large cohorts. Risk factors for ILA include age, smoking status, other inhalational exposures, and genetic factors (eg, gene encoding mucin 5B variant). Radiologists should systematically record the presence, morphologic characteristics, distribution, and subcategories of ILA (ie, nonsubpleural, subpleural nonfibrotic, and subpleural fibrotic), as these are informative for predicting progression and mortality. Clinically significant interstitial lung disease should not be considered ILA. Individuals with ILA are triaged into higher- and lower-risk groups depending on their risk factors for progression, and systematic follow-up, including CT, should be considered for the higher-risk group. Artificial intelligence-based automated analysis for ILA may be helpful, but further validation and improvement are needed. Radiologists have a central role in clinical management and research on ILA.
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Affiliation(s)
- Akinori Hata
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.H., H.H.); Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (A.H.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Mark L Schiebler
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.H., H.H.); Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (A.H.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - David A Lynch
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.H., H.H.); Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (A.H.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Hiroto Hatabu
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.H., H.H.); Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (A.H.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
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Sanders JL, Putman RK, Dupuis J, Xu H, Murabito JM, Araki T, Nishino M, Benjamin EJ, Levy DL, Ramachandran VS, Washko GR, Curtis JL, Freeman CM, Bowler RP, Hatabu H, O'Connor GT, Hunninghake GM. The Association of Aging Biomarkers, Interstitial Lung Abnormalities, and Mortality. Am J Respir Crit Care Med 2021; 203:1149-1157. [PMID: 33080140 DOI: 10.1164/rccm.202007-2993oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Rationale: The association between aging and idiopathic pulmonary fibrosis has been established. The associations between aging-related biomarkers and interstitial lung abnormalities (ILA) have not been comprehensively evaluated.Objectives: To evaluate the associations among aging biomarkers, ILA, and all-cause mortality.Methods: In the FHS (Framingham Heart Study), we evaluated associations among plasma biomarkers (IL-6, CRP [C-reactive protein], TNFR [tumor necrosis factor α receptor II], GDF15 [growth differentiation factor 15], cystatin-C, HGBA1C [Hb A1C], insulin, IGF1 [insulin-like growth factor 1], and IGFBP1 [IGF binding protein 1] and IGFBP3]), ILA, and mortality. Causal inference analysis was used to determine whether biomarkers mediated age. GDF15 results were replicated in the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) Study.Measurements and Main Results: In the FHS, there were higher odds of ILA per increase in natural log-transformed GDF15 (odds ratio [95% confidence interval], 3.4 [1.8-6.4]; P = 0.0002), TNFR (3.1 [1.6-5.8]; P = 0.004), IL-6 (1.8 [1.4-2.4]; P < 0.0001), and CRP (1.7 [1.3-2.0]; P < 0.0001). In the FHS, after adjustment for multiple comparisons, no biomarker was associated with increased mortality, but the associations of GDF15 (hazard ratio, 2.0 [1.1-3.5]; P = 0.02), TNFR (1.8 [1.0-3.3]; P = 0.05), and IGFBP1 (1.3 [1.1-1.7]; P = 0.01) approached significance. In the COPDGene Study, higher natural log-transformed GDF15 was associated with ILA (odds ratio, 8.1 [3.1-21.4]; P < 0.0001) and mortality (hazard ratio, 1.6 [1.1-2.2]; P = 0.01). Causal inference analysis showed that the association of age with ILA was mediated by IL-6 (P < 0.0001) and TNFR (P = 0.002) and was likely mediated by GDF15 (P = 0.008) in the FHS and was mediated by GDF15 (P = 0.001) in the COPDGene Study.Conclusions: Some aging-related biomarkers are associated with ILA. GDF15, in particular, may explain some of the associations among age, ILA, and mortality.
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Affiliation(s)
| | | | - Josée Dupuis
- Department of Biostatistics, School of Public Health
| | - Hanfei Xu
- Department of Biostatistics, School of Public Health
| | - Joanne M Murabito
- Department of Medicine, and.,Framingham Heart Study, Framingham, Massachusetts
| | - Tetsuro Araki
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emelia J Benjamin
- Department of Medicine, and.,Framingham Heart Study, Framingham, Massachusetts
| | - Daniel L Levy
- Department of Medicine, and.,Framingham Heart Study, Framingham, Massachusetts
| | | | | | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan.,Medical Service and
| | - Christine M Freeman
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan.,Research Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Russell P Bowler
- Department of Medicine, National Jewish Health-Health Sciences Center, University of Colorado at Denver, Denver, Colorado
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Pulmonary Functional Imaging, Brigham and Women's Hospital-Harvard Medical School, Harvard University, Boston, Massachusetts; and
| | - George T O'Connor
- Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts.,Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston Medical Center, Boston, Massachusetts
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine and.,Center for Pulmonary Functional Imaging, Brigham and Women's Hospital-Harvard Medical School, Harvard University, Boston, Massachusetts; and
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Automated Diseased Lung Volume Percentage Calculation in Quantitative CT Evaluation of Chronic Obstructive Pulmonary Disease and Idiopathic Pulmonary Fibrosis. J Comput Assist Tomogr 2021; 45:649-658. [PMID: 34176875 DOI: 10.1097/rct.0000000000001182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several software-based quantitative computed tomography (CT) analysis methods have been developed for assessing emphysema and interstitial lung disease. Although the texture classification method appeared to be more successful than the other methods, the software programs are not commercially available, to our knowledge. Therefore, this study aimed to investigate the usefulness of a commercially available software program for quantitative CT analyses. METHODS This prospective cohort study included 80 patients with chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF). RESULTS The percentage of low attenuation volume and high attenuation volume had high sensitivity and high specificity for detecting emphysema and pulmonary fibrosis, respectively. The percentage of diseased lung volume (DLV%) was significantly correlated with the lung diffusion capacity for carbon monoxide in all patients with COPD and IPF patients. CONCLUSIONS The quantitative CT analysis may improve the precision of the assessment of DLV%, which itself could be a useful tool in predicting lung diffusion capacity in patients with the clinical diagnosis of COPD or IPF.
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Abstract
Cellular level changes that lead to interstitial lung disease (ILD) may take years to become clinically apparent and have been termed preclinical ILD. Incidentally identified interstitial lung abnormalities (ILA) are increasingly being recognized on chest computed tomographic scans done as part of lung cancer screening and for other purposes. Many individuals found to have ILA will progress to clinically significant ILD. ILA are independently associated with greater risk of death, lung function decline, and incident lung cancer. Current management recommendations focus on identifying individuals with ILA at high risk of progression, through a combination of clinical and radiological features.
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Affiliation(s)
- Anna J Podolanczuk
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, 1305 York Avenue, Y-1053, Box 96, New York, NY 10021, USA
| | - Rachel K Putman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Thorn 908D, Boston, MA 02115, USA.
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Fujikura K, Albini A, Barr RG, Parikh M, Kern J, Hoffman E, Hiura GT, Bluemke DA, Carr J, Lima JAC, Michos ED, Gomes AS, Prince MR. Aortic enlargement in chronic obstructive pulmonary disease (COPD) and emphysema: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD study. Int J Cardiol 2021; 331:214-220. [PMID: 33587941 PMCID: PMC8026709 DOI: 10.1016/j.ijcard.2021.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 12/25/2020] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of abdominal aortic aneurysm is high in chronic obstructive pulmonary disease (COPD) population. Emphysema involves proteolytic destruction of elastic fibers. Therefore, emphysema may also contribute to thoracic aorta dilatation. This study assessed aorta dilation in smokers stratified by presence of COPD, emphysema and airway thickening. METHODS Aorta diameters were measured on 3D magnetic resonance angiography in smokers recruited from the Multi-Ethnic Study of Atherosclerosis (MESA), the Emphysema and Cancer Action Project (EMCAP), and the local community. COPD was defined by standard spirometric criteria; emphysema was measured quantitatively on computed tomography and bronchitis was determined from medical history. RESULTS Participants (n = 315, age 58-79) included 150 with COPD and 165 without COPD, of whom 56% and 19%, respectively, had emphysema. Subjects in the most severe quartile of emphysematous change showed the largest diameter at all four aorta locations compared to those in the least severe quartiles (all p < 0.001). Comparing subjects with and without COPD, aorta diameters were larger in participants with severe COPD in ascending and arch (both p < 0.001), and abdominal aorta (p = 0.001). Chronic bronchitis and bronchial wall thickness did not correlate with aorta diameter. In subjects with emphysema, subjects with coexistence of COPD showed larger aorta than those without COPD in ascending (p = 0.003), arch (p = 0.002), and abdominal aorta (p = 0.04). CONCLUSIONS This study showed larger aorta diameter in subjects with COPD and severe emphysema compared to COPD related to chronic bronchitis or bronchial wall thickening.
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Affiliation(s)
- Kana Fujikura
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, ML, USA
| | | | - R Graham Barr
- Department of Medicine, Columbia University, New York, USA
| | - Megha Parikh
- Department of Medicine, Columbia University, New York, USA
| | - Julia Kern
- Department of Medicine, Columbia University, New York, USA
| | - Eric Hoffman
- Department of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, USA
| | - Grant T Hiura
- Department of Medicine, Columbia University, New York, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin, Madison, USA
| | - James Carr
- Department of Radiology, Northwestern University, Chicago, USA
| | - João A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, USA
| | - Antoinette S Gomes
- Department of Radiology, University of California-Los Angeles, School of Medicine, Los Angeles, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medicine, NY, New York, USA.
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43
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Liu GY, Kalhan R. Impaired Respiratory Health and Life Course Transitions From Health to Chronic Lung Disease. Chest 2021; 160:879-889. [PMID: 33865834 DOI: 10.1016/j.chest.2021.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 12/21/2022] Open
Abstract
Primary prevention and interception of chronic lung disease are essential in the effort to reduce the morbidity and mortality caused by respiratory conditions. In this review, we apply a life course approach that examines exposures across the life span to identify risk factors that are associated with not only chronic lung disease but also an intermediate phenotype between ideal lung health and lung disease, termed "impaired respiratory health." Notably, risk factors such as exposure to tobacco smoke and air pollution, as well as obesity and physical fitness, affect respiratory health across the life course by being associated with both abnormal lung growth and lung function decline. We then discuss the importance of disease interception and identifying those at highest risk of developing chronic lung disease. This work begins with understanding and detecting impaired respiratory health, and we review several promising molecular biomarkers, predictive symptoms, and early imaging findings that may lead to a better understanding of this intermediate phenotype.
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Affiliation(s)
- Gabrielle Y Liu
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Ravi Kalhan
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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44
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Anderson MR, Kim JS, Allison M, Giles JT, Hoffman EA, Ding J, Barr RG, Podolanczuk A. Adiposity and Interstitial Lung Abnormalities in Community-Dwelling Adults: The MESA Cohort Study. Chest 2021; 160:582-594. [PMID: 33844978 DOI: 10.1016/j.chest.2021.03.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/13/2021] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Obesity is associated with restrictive ventilatory defects and a faster rate of decline in FVC. This association is not exclusively mediated by mechanical factors and may reflect direct pulmonary injury by adipose-derived mediators. RESEARCH QUESTION Is adipose tissue involved in the pathogenesis of interstitial lung disease (ILD)? STUDY DESIGN AND METHODS We evaluated the association of CT measures of pericardial, abdominal visceral, and abdominal subcutaneous adipose tissue with high-attenuation areas (HAAs) and interstitial lung abnormalities (ILAs) in a large multicenter cohort study of community-dwelling adults, using multivariable-adjusted models. We secondarily evaluated the association of adipose depot size with FVC and biomarkers of obesity and inflammation. RESULTS In fully adjusted models, every doubling in pericardial adipose tissue volume was associated with a 63.4-unit increase in HAA (95% CI, 55.5-71.3), 20% increased odds of ILA (95% CI, -2% to 50%), and a 5.5% decrease in percent predicted FVC (95% CI, -6.8% to -4.3%). IL-6 levels accounted for 8% of the association between pericardial adipose tissue and HAA. Every doubling in visceral adipose tissue area was associated with a 41.5-unit increase in HAA (95% CI, 28.3-54.7), 30% increased odds of ILA (95% CI, -10% to 80%), and a 5.4% decrease in percent predicted FVC (95% CI, -6.6% to -4.3%). IL-6 and leptin accounted for 17% and 18%, respectively, of the association between visceral adipose tissue and HAA. INTERPRETATION Greater amounts of pericardial and abdominal visceral adipose tissue were associated with CT measures of early lung injury and lower FVC in a cohort of community-dwelling adults. Adipose tissue may represent a modifiable risk factor for ILD.
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Affiliation(s)
| | - John S Kim
- Department of Medicine, University of Virginia, Charlottesville, VA
| | - Matthew Allison
- Department of Preventive Medicine, University of California San Diego, San Diego, CA
| | - Jon T Giles
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Des Moines, IA
| | - Jingzhong Ding
- Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, NC; Department of Gerontology and Geriatric Science, Wake Forest University, Winston-Salem, NC
| | - R Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, NY; Department of Epidemiology, Columbia University Medical Center, New York, NY
| | - Anna Podolanczuk
- Department of Medicine, Weill Cornell Medical College, New York, NY
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Scharm SC, Vogel-Claussen J, Schaefer-Prokop C, Dettmer S, Knudsen L, Jonigk D, Fuge J, Apel RM, Welte T, Wacker F, Prasse A, Shin HO. Quantification of dual-energy CT-derived functional parameters as potential imaging markers for progression of idiopathic pulmonary fibrosis. Eur Radiol 2021; 31:6640-6651. [PMID: 33725189 PMCID: PMC8379131 DOI: 10.1007/s00330-021-07798-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/04/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The individual course of disease in idiopathic pulmonary fibrosis (IPF) is highly variable. Assessment of disease activity and prospective estimation of disease progression might have the potential to improve therapy management and indicate the onset of treatment at an earlier stage. The aim of this study was to evaluate whether regional ventilation, lung perfusion, and late enhancement can serve as early imaging markers for disease progression in patients with IPF. METHODS In this retrospective study, contrast-enhanced dual-energy CT scans of 32 patients in inspiration and delayed expiration were performed at two time points with a mean interval of 15.4 months. The pulmonary blood volume (PBV) images obtained in the arterial and delayed perfusion phase served as a surrogate for arterial lung perfusion and parenchymal late enhancement. The virtual non-contrast (VNC) images in inspiration and expiration were non-linearly registered to provide regional ventilation images. Image-derived parameters were correlated with longitudinal changes of lung function (FVC%, DLCO%), mean lung density in CT, and CT-derived lung volume. RESULTS Regional ventilation and late enhancement at baseline preceded future change in lung volume (R - 0.474, p 0.006/R - 0.422, p 0.016, respectively) and mean lung density (R - 0.469, p 0.007/R - 0.402, p 0.022, respectively). Regional ventilation also correlated with a future change in FVC% (R - 0.398, p 0.024). CONCLUSION CT-derived functional parameters of regional ventilation and parenchymal late enhancement are potential early imaging markers for idiopathic pulmonary fibrosis progression. KEY POINTS • Functional CT parameters at baseline (regional ventilation and late enhancement) correlate with future structural changes of the lung as measured with loss of lung volume and increase in lung density in serial CT scans of patients with idiopathic pulmonary fibrosis. • Functional CT parameter measurements in high-attenuation areas (- 600 to - 250 HU) are significantly different from normal-attenuation areas (- 950 to - 600 HU) of the lung. • Mean regional ventilation in functional CT correlates with a future change in forced vital capacity (FVC) in pulmonary function tests.
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Affiliation(s)
- Sarah C Scharm
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Cornelia Schaefer-Prokop
- Department of Radiology, Radboud University, Nijmegen, The Netherlands.,Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Sabine Dettmer
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Lars Knudsen
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Rosa-Marie Apel
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Antje Prasse
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Hoen-Oh Shin
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany. .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.
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Hino T, Lee KS, Yoo H, Han J, Franks TJ, Hatabu H. Interstitial lung abnormality (ILA) and nonspecific interstitial pneumonia (NSIP). Eur J Radiol Open 2021; 8:100336. [PMID: 33796637 PMCID: PMC7995484 DOI: 10.1016/j.ejro.2021.100336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 12/19/2022] Open
Abstract
This review article aims to address mysteries existing between Interstitial Lung Abnormality (ILA) and Nonspecific Interstitial Pneumonia (NSIP). The concept and definition of ILA are based upon CT scans from multiple large-scale cohort studies, whereas the concept and definition of NSIP originally derived from pathology with evolution to multi-disciplinary diagnosis. NSIP is the diagnosis as Interstitial Lung Disease (ILD) with clinical significance, whereas only a part of subjects with ILA have clinically significant ILD. Eventually, both ILA and NSIP must be understood in the context of chronic fibrosing ILD and progressive ILD, which remains to be further investigated.
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Key Words
- AIP, acute interstitial pneumonia
- ATS/ERS, American Thoracic Society/European Respiratory Society
- BIP, bronchiolitis obliterans with interstitial pneumonia
- BOOP, bronchiolitis obliterans organizing pneumonia
- CT
- CTD, connective tissue disease
- Connective tissue disease (CTD)
- DIP, desquamative interstitial pneumonia
- GGO, ground-glass opacities
- GIP, giant cell interstitial pneumonia
- HRCT
- HRCT, high-resolution CT
- IIP, idiopathic interstitial pneumonia
- ILA, interstitial lung abnormality
- ILD, interstitial lung disease
- Interstitial lung abnormality (ILA)
- Interstitial lung disease (ILD)
- LIP, lymphoid interstitial pneumonia
- NSIP, nonspecific interstitial pneumonia
- Nonspecific interstitial pneumonia (NSIP)
- Pulmonary fibrosis
- RB-ILD, respiratory bronchiolitis-associated interstitial lung disease
- UIP, usual interstitial pneumonia
- fNSIP, fibrosing nonspecific interstitial pneumonia
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 8128582, Japan
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
| | - Hongseok Yoo
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
| | - Teri J Franks
- Pulmonary & Mediastinal Pathology, Department of Defense, The Joint Pathology Center, Silver Spring, MD, USA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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47
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Newton CA. Pulmonary fibrosis screening: quantifying the psychological impact. Thorax 2021; 76:532-533. [PMID: 33622980 DOI: 10.1136/thoraxjnl-2021-216863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Chad A Newton
- Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
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48
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Nagpal P, Guo J, Shin KM, Lim JK, Kim KB, Comellas AP, Kaczka DW, Peterson S, Lee CH, Hoffman EA. Quantitative CT imaging and advanced visualization methods: potential application in novel coronavirus disease 2019 (COVID-19) pneumonia. BJR Open 2021; 3:20200043. [PMID: 33718766 PMCID: PMC7931412 DOI: 10.1259/bjro.20200043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
Increasingly, quantitative lung computed tomography (qCT)-derived metrics are providing novel insights into chronic inflammatory lung diseases, including chronic obstructive pulmonary disease, asthma, interstitial lung disease, and more. Metrics related to parenchymal, airway, and vascular anatomy together with various measures associated with lung function including regional parenchymal mechanics, air trapping associated with functional small airways disease, and dual-energy derived measures of perfused blood volume are offering the ability to characterize disease phenotypes associated with the chronic inflammatory pulmonary diseases. With the emergence of COVID-19, together with its widely varying degrees of severity, its rapid progression in some cases, and the potential for lengthy post-COVID-19 morbidity, there is a new role in applying well-established qCT-based metrics. Based on the utility of qCT tools in other lung diseases, previously validated supervised classical machine learning methods, and emerging unsupervised machine learning and deep-learning approaches, we are now able to provide desperately needed insight into the acute and the chronic phases of this inflammatory lung disease. The potential areas in which qCT imaging can be beneficial include improved accuracy of diagnosis, identification of clinically distinct phenotypes, improvement of disease prognosis, stratification of care, and early objective evaluation of intervention response. There is also a potential role for qCT in evaluating an increasing population of post-COVID-19 lung parenchymal changes such as fibrosis. In this work, we discuss the basis of various lung qCT methods, using case-examples to highlight their potential application as a tool for the exploration and characterization of COVID-19, and offer scanning protocols to serve as templates for imaging the lung such that these established qCT analyses have the best chance at yielding the much needed new insights.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | | | | | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ki Beom Kim
- Department of Radiology, Daegu Fatima Hospital, Daegu, South Korea
| | - Alejandro P Comellas
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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Buendía-Roldán I, Fernandez R, Mejía M, Juarez F, Ramirez-Martinez G, Montes E, Pruneda AKS, Martinez-Espinosa K, Alarcon-Dionet A, Herrera I, Becerril C, Chavez-Galan L, Preciado M, Pardo A, Selman M. Risk factors associated with the development of interstitial lung abnormalities. Eur Respir J 2021; 58:13993003.03005-2020. [PMID: 33446609 DOI: 10.1183/13993003.03005-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/22/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Around 8-10% of individuals over 50 years of age present interstitial lung abnormalities (ILAs), but their risk factors are uncertain. METHODS From 817 individuals recruited in our lung ageing programme at the Mexican National Institute of Respiratory Diseases, 80 (9.7%) showed ILAs and were compared with 564 individuals of the same cohort with normal high-resolution computed tomography to evaluate demographic and functional differences, and with 80 individuals randomly selected from the same cohort for biomarkers. We evaluated MUC5B variant rs35705950, telomere length, and serum levels of matrix metalloproteinase (MMP)-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-12, MMP-13, interleukin (IL)-6, surfactant protein (SP)-D, α-Klotho and resistin. RESULTS Individuals with ILAs were usually males (p<0.005), older than controls (p<0.0001), smokers (p=0.01), with a greater frequency of MUC5B rs35705950 (OR 3.5, 95% CI 1.3-9.4; p=0.01), and reduced diffusing capacity of the lung for carbon monoxide and oxygen saturation. Resistin, IL-6, SP-D, MMP-1, MMP-7 and MMP-13 were significantly increased in individuals with ILAs. Resistin (12±5 versus 9±4 ng·mL-1; p=0.0005) and MMP-13 (357±143 versus 298±116 pg·mL-1; p=0.004) were the most increased biomarkers. On follow-up (24±18 months), 18 individuals showed progression which was associated with gastro-oesophageal reflux disease (OR 4.1, 95% CI 1.2-12.9; p=0.02) and in females with diabetes mellitus (OR 5.3, 95% CI 1.0-27.4; p=0.01). CONCLUSIONS Around 10% of respiratory asymptomatic individuals enrolled in our lung ageing programme show ILAs. Increased serum concentrations of pro-inflammatory molecules and MMPs are associated with ILAs.
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Affiliation(s)
- Ivette Buendía-Roldán
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico.,These two authors contributed equally to this article as lead authors and supervised the work
| | - Rosario Fernandez
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Mayra Mejía
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Fortunato Juarez
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | | | - Eduardo Montes
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Ana Karem S Pruneda
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Karen Martinez-Espinosa
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Aime Alarcon-Dionet
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Iliana Herrera
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Carina Becerril
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Leslie Chavez-Galan
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Mario Preciado
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Annie Pardo
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Moisés Selman
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico.,These two authors contributed equally to this article as lead authors and supervised the work
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50
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Barrera CA, Andronikou S, Tapia IE, White AM, Biko DM, Rapp JB, Zhu X, Otero HJ. Normal age-related quantitative CT values in the pediatric lung: from the first breath to adulthood. Clin Imaging 2021; 75:111-118. [PMID: 33524938 DOI: 10.1016/j.clinimag.2020.12.021] [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: 11/01/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To characterize the normal progression of quantitative CT parameters in normal children from birth to adulthood. MATERIALS AND METHODS Patients aged 0-18 years with non-contrast-enhanced chest CT and evidence of normal lung parenchyma were included. Patients with respiratory symptoms, incomplete anthropometric measurements, or sub-optimal imaging technique were excluded. Segmentation was performed using an open-source software with an automated threshold segmentation. The following parameters were obtained: mean lung density, kurtosis, skewness, lung volume, and mass. Linear and exponential regression models were calculated with age and height as independent variables. A p-value of <0.05 was considered significant. RESULTS 220 patients (111 females, 109 males) were included. Mean age was 9.6 ± 5.9 years and mean height was 133.9 ± 35.1 cm. Simple linear regression showed a significant relationship between mean lung density with age (R 2 = 0.70) and height (R 2 = 0.73). Kurtosis displayed a significant exponential correlation with age (R 2 = 0.70) and height (R 2 = 0.71). Skewness showed a significant exponential correlation with age (R 2 = 0.71) and height (R 2 = 0.73). Lung mass showed a correlation with age (R 2 = 0.93) and height (R 2 = 0.92). Exponential regression showed a significant relationship between lung volume with age (R 2 = 0.88) and height (R 2 = 0.93). CONCLUSION Quantitative CT parameters of the lung parenchyma demonstrate changes from birth to adulthood. As children grow, the mean lung density decreases, and the lung parenchyma becomes more homogenous.
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Affiliation(s)
| | | | - Ignacio E Tapia
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Ammie M White
- Department of Radiology, Children's Hospital of Philadelphia, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, USA
| | - Xiaowei Zhu
- Department of Radiology, Children's Hospital of Philadelphia, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, USA
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