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Bäcklin E, Gonon A, Sköld M, Smedby Ö, Breznik E, Janerot-Sjoberg B. Pulmonary volumes and signs of chronic airflow limitation in quantitative computed tomography. Clin Physiol Funct Imaging 2024; 44:340-348. [PMID: 38576112 DOI: 10.1111/cpf.12880] [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: 06/21/2022] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Computed tomography (CT) offers pulmonary volumetric quantification but is not commonly used in healthy individuals due to radiation concerns. Chronic airflow limitation (CAL) is one of the diagnostic criteria for chronic obstructive pulmonary disease (COPD), where early diagnosis is important. Our aim was to present reference values for chest CT volumetric and radiodensity measurements and explore their potential in detecting early signs of CAL. METHODS From the population-based Swedish CArdioPulmonarybioImage Study (SCAPIS), 294 participants aged 50-64, were categorized into non-CAL (n = 258) and CAL (n = 36) groups based on spirometry. From inspiratory and expiratory CT images we compared lung volumes, mean lung density (MLD), percentage of low attenuation volume (LAV%) and LAV cluster volume between groups, and against reference values from static pulmonary function test (PFT). RESULTS The CAL group exhibited larger lung volumes, higher LAV%, increased LAV cluster volume and lower MLD compared to the non-CAL group. Lung volumes significantly deviated from PFT values. Expiratory measurements yielded more reliable results for identifying CAL compared to inspiratory. Using a cut-off value of 0.6 for expiratory LAV%, we achieved sensitivity, specificity and positive/negative predictive values of 72%, 85% and 40%/96%, respectively. CONCLUSION We present volumetric reference values from inspiratory and expiratory chest CT images for a middle-aged healthy cohort. These results are not directly comparable to those from PFTs. Measures of MLD and LAV can be valuable in the evaluation of suspected CAL. Further validation and refinement are necessary to demonstrate its potential as a decision support tool for early detection of COPD.
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Affiliation(s)
- Emelie Bäcklin
- Department of Clinical Science, Intervention & Technology, Karolinska Institutet, Stockholm, Sweden
- Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Biomedical Engineering, Karolinska University Hospital, Stockholm, Sweden
| | - Adrian Gonon
- Department of Clinical Science, Intervention & Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Sköld
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Örjan Smedby
- Department of Clinical Science, Intervention & Technology, Karolinska Institutet, Stockholm, Sweden
- Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Eva Breznik
- Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Birgitta Janerot-Sjoberg
- Department of Clinical Science, Intervention & Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
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2
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Cerny V, Pagac J, Novak M, Jansa P. Semi-automatic quantification of mosaic perfusion of lung parenchyma and its correlation with haemodynamic parameters in patients with chronic thromboembolic pulmonary hypertension. Clin Radiol 2023; 78:e918-e924. [PMID: 37661531 DOI: 10.1016/j.crad.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/18/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Abstract
AIM To investigate the feasibility of semiautomatic quantification of mosaic perfusion and the associations between mosaic perfusion on computed tomography (CT; the ratio of hypoperfused parenchyma to the whole lung volume) and haemodynamic parameters through linear regression analysis. MATERIALS AND METHODS Fifty-eight consecutive patients (mean age 66 years, 28 females) diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) in General University Hospital, Prague, in 2021 were evaluated retrospectively and underwent both right heart catheterisation and CT pulmonary angiography. The parameters derived from the CT examinations were correlated with the recorded haemodynamic parameters. RESULTS A method was developed for semiautomatic detection of hypoperfused tissue from CT using widely available software and a statistically significant correlation was found between the proportion of hypoperfused parenchyma and the mean pulmonary artery pressure (mPAP; R2 0.22; p<0.01) and pulmonary vascular resistance (PVR; R2 0.09; p<0.05). CONCLUSIONS The developed method facilitates the quantification of mosaic perfusion, which is associated with important haemodynamic parameters (mPAP and PVR) in patients with CTEPH.
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Affiliation(s)
- V Cerny
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic.
| | - J Pagac
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - M Novak
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - P Jansa
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
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3
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Li CX, Chen H, Zounemat-Kermani N, Adcock IM, Sköld CM, Zhou M, Wheelock ÅM. Consensus clustering with missing labels (ccml): a consensus clustering tool for multi-omics integrative prediction in cohorts with unequal sample coverage. Brief Bioinform 2023; 25:bbad501. [PMID: 38205966 PMCID: PMC10782800 DOI: 10.1093/bib/bbad501] [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: 09/01/2023] [Revised: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
Multi-omics data integration is a complex and challenging task in biomedical research. Consensus clustering, also known as meta-clustering or cluster ensembles, has become an increasingly popular downstream tool for phenotyping and endotyping using multiple omics and clinical data. However, current consensus clustering methods typically rely on ensembling clustering outputs with similar sample coverages (mathematical replicates), which may not reflect real-world data with varying sample coverages (biological replicates). To address this issue, we propose a new consensus clustering with missing labels (ccml) strategy termed ccml, an R protocol for two-step consensus clustering that can handle unequal missing labels (i.e. multiple predictive labels with different sample coverages). Initially, the regular consensus weights are adjusted (normalized) by sample coverage, then a regular consensus clustering is performed to predict the optimal final cluster. We applied the ccml method to predict molecularly distinct groups based on 9-omics integration in the Karolinska COSMIC cohort, which investigates chronic obstructive pulmonary disease, and 24-omics handprint integrative subgrouping of adult asthma patients of the U-BIOPRED cohort. We propose ccml as a downstream toolkit for multi-omics integration analysis algorithms such as Similarity Network Fusion and robust clustering of clinical data to overcome the limitations posed by missing data, which is inevitable in human cohorts consisting of multiple data modalities. The ccml tool is available in the R language (https://CRAN.R-project.org/package=ccml, https://github.com/pulmonomics-lab/ccml, or https://github.com/ZhoulabCPH/ccml).
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Affiliation(s)
- Chuan-Xing Li
- Respiratory Medicine Unit, Department of Medicine Solna & Centre for Molecular Medicine, Karolinska Institutet
| | - Hongyan Chen
- School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, China
| | - Nazanin Zounemat-Kermani
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Data Science Institute, Imperial College London, London, United Kingdom
| | - Ian M Adcock
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Data Science Institute, Imperial College London, London, United Kingdom
| | - C Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna & Centre for Molecular Medicine, Karolinska Institutet
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Meng Zhou
- School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, China
| | - Åsa M Wheelock
- Respiratory Medicine Unit, Department of Medicine Solna & Centre for Molecular Medicine, Karolinska Institutet
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
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4
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Merikallio H, Pincikova T, Kotortsi I, Karimi R, Li CX, Forsslund H, Mikko M, Nyrén S, Lappi-Blanco E, Wheelock ÅM, Kaarteenaho R, Sköld MC. Mucins 3A and 3B Are Expressed in the Epithelium of Human Large Airway. Int J Mol Sci 2023; 24:13546. [PMID: 37686350 PMCID: PMC10487631 DOI: 10.3390/ijms241713546] [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: 07/07/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Aberrant mucus secretion is a hallmark of chronic obstructive pulmonary disease (COPD). Expression of the membrane-tethered mucins 3A and 3B (MUC3A, MUC3B) in human lung is largely unknown. In this observational cross-sectional study, we recruited subjects 45-65 years old from the general population of Stockholm, Sweden, during the years 2007-2011. Bronchial mucosal biopsies, bronchial brushings, and bronchoalveolar lavage fluid (BALF) were retrieved from COPD patients (n = 38), healthy never-smokers (n = 40), and smokers with normal lung function (n = 40). Protein expression of MUC3A and MUC3B in bronchial mucosal biopsies was assessed by immunohistochemical staining. In a subgroup of subjects (n = 28), MUC3A and MUC3B mRNAs were quantified in bronchial brushings using microarray. Non-parametric tests were used to perform correlation and group comparison analyses. A value of p < 0.05 was considered statistically significant. MUC3A and MUC3B immunohistochemical expression was localized to ciliated cells. MUC3B was also expressed in basal cells. MUC3A and MUC3B immunohistochemical expression was equal in all study groups but subjects with emphysema had higher MUC3A expression, compared to those without emphysema. Smokers had higher mRNA levels of MUC3A and MUC3B than non-smokers. MUC3A and MUC3B mRNA were higher in male subjects and correlated negatively with expiratory air flows. MUC3B mRNA correlated positively with total cell concentration and macrophage percentage, and negatively with CD4/CD8 T cell ratio in BALF. We concluded that MUC3A and MUC3B in large airways may be a marker of disease or may play a role in the pathophysiology of airway obstruction.
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Affiliation(s)
- Heta Merikallio
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, 90570 Oulu, Finland; (H.M.)
- Center of Internal Medicine and Respiratory Medicine, Medical Research Center Oulu, University Hospital of Oulu, 90220 Oulu, Finland
| | - Terezia Pincikova
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Stockholm CF-Center, Albatross, K56, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
| | - Ioanna Kotortsi
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, 171 77 Stockholm, Sweden
| | - Reza Karimi
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Chuan-Xing Li
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Helena Forsslund
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mikael Mikko
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Sven Nyrén
- Department of Molecular Medicine and Surgery, Division of Radiology, Karolinska Institutet, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden
| | - Elisa Lappi-Blanco
- Cancer and Translational Medicine Research Unit, Department of Pathology, University Hospital of Oulu, Oulu University, 90220 Oulu, Finland
| | - Åsa M. Wheelock
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, 171 77 Stockholm, Sweden
| | - Riitta Kaarteenaho
- Research Unit of Biomedicine and Internal Medicine, University of Oulu, 90570 Oulu, Finland; (H.M.)
- Center of Internal Medicine and Respiratory Medicine, Medical Research Center Oulu, University Hospital of Oulu, 90220 Oulu, Finland
| | - Magnus C. Sköld
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, 171 77 Stockholm, Sweden
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Wen H, Huapaya JA, Kanth SM, Sun J, Matthew BP, Lee SC, Do M, Chen MY, Malayeri AA, Suffredini AF. Quantitative CT Metrics Associated with Variability in the Diffusion Capacity of the Lung of Post-COVID-19 Patients with Minimal Residual Lung Lesions. J Imaging 2023; 9:150. [PMID: 37623682 PMCID: PMC10455247 DOI: 10.3390/jimaging9080150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: A reduction in the diffusion capacity of the lung for carbon monoxide is a prevalent longer-term consequence of COVID-19 infection. In patients who have zero or minimal residual radiological abnormalities in the lungs, it has been debated whether the cause was mainly due to a reduced alveolar volume or involved diffuse interstitial or vascular abnormalities. (2) Methods: We performed a cross-sectional study of 45 patients with either zero or minimal residual lesions in the lungs (total volume < 7 cc) at two months to one year post COVID-19 infection. There was considerable variability in the diffusion capacity of the lung for carbon monoxide, with 27% of the patients at less than 80% of the predicted reference. We investigated a set of independent variables that may affect the diffusion capacity of the lung, including demographic, pulmonary physiology and CT (computed tomography)-derived variables of vascular volume, parenchymal density and residual lesion volume. (3) Results: The leading three variables that contributed to the variability in the diffusion capacity of the lung for carbon monoxide were the alveolar volume, determined via pulmonary function tests, the blood vessel volume fraction, determined via CT, and the parenchymal radiodensity, also determined via CT. These factors explained 49% of the variance of the diffusion capacity, with p values of 0.031, 0.005 and 0.018, respectively, after adjusting for confounders. A multiple-regression model combining these three variables fit the measured values of the diffusion capacity, with R = 0.70 and p < 0.001. (4) Conclusions: The results are consistent with the notion that in some post-COVID-19 patients, after their pulmonary lesions resolve, diffuse changes in the vascular and parenchymal structures, in addition to a low alveolar volume, could be contributors to a lingering low diffusion capacity.
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Affiliation(s)
- Han Wen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Julio A. Huapaya
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Shreya M. Kanth
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Junfeng Sun
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Brianna P. Matthew
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Simone C. Lee
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Michael Do
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Marcus Y. Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ashkan A. Malayeri
- Radiology & Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Anthony F. Suffredini
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
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Kirkness JP, Dusting J, Eikelis N, Pirakalathanan P, DeMarco J, Shiao SL, Fouras A. Association of x-ray velocimetry (XV) ventilation analysis compared to spirometry. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1148310. [PMID: 37440838 PMCID: PMC10335741 DOI: 10.3389/fmedt.2023.1148310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/29/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction X-ray Velocimetry (XV) ventilation analysis is a 4-dimensional imaging-based method for quantifying regional ventilation, aiding in the assessment of lung function. We examined the performance characteristics of XV ventilation analysis by examining correlation to spirometry and measurement repeatability. Methods XV analysis was assessed in 27 patients receiving thoracic radiotherapy for non-lung cancer malignancies. Measurements were obtained pre-treatment and at 4 and 12-months post-treatment. XV metrics such as ventilation defect percent (VDP) and regional ventilation heterogeneity (VH) were compared to spirometry at each time point, using correlation analysis. Repeatability was assessed between multiple runs of the analysis algorithm, as well as between multiple breaths in the same patient. Change in VH and VDP in a case series over 12 months was used to determine effect size and estimate sample sizes for future studies. Results VDP and VH were found to significantly correlate with FEV1 and FEV1/FVC (range: -0.36 to -0.57; p < 0.05). Repeatability tests demonstrated that VDP and VH had less than 2% variability within runs and less than 8% change in metrics between breaths. Three cases were used to illustrate the advantage of XV over spirometry, where XV indicated a change in lung function that was either undetectable or delayed in detection by spirometry. Case A demonstrated an improvement in XV metrics over time despite stable spirometric values. Case B demonstrated a decline in XV metrics as early as 4-months, although spirometric values did not change until 12-months. Case C demonstrated a decline in XV metrics at 12 months post-treatment while spirometric values remained normal throughout the study. Based on the effect sizes in each case, sample sizes ranging from 10 to 38 patients would provide 90% power for future studies aiming to detect similar changes. Conclusions The performance and safety of XV analysis make it ideal for both clinical and research applications across most lung indications. Our results support continued research and provide a basis for powering future studies using XV as an endpoint to examine lung health and determine therapeutic efficacy.
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Affiliation(s)
| | | | | | | | - John DeMarco
- Department of Radiation Oncology and Biomedical Sciences, Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - Stephen L. Shiao
- Department of Radiation Oncology and Biomedical Sciences, Cedar-Sinai Medical Center, Los Angeles, CA, United States
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Mirniaharikandehei S, Abdihamzehkolaei A, Choquehuanca A, Aedo M, Pacheco W, Estacio L, Cahui V, Huallpa L, Quiñonez K, Calderón V, Gutierrez AM, Vargas A, Gamero D, Castro-Gutierrez E, Qiu Y, Zheng B, Jo JA. Automated Quantification of Pneumonia Infected Volume in Lung CT Images: A Comparison with Subjective Assessment of Radiologists. Bioengineering (Basel) 2023; 10:321. [PMID: 36978712 PMCID: PMC10044796 DOI: 10.3390/bioengineering10030321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVE To help improve radiologists' efficacy of disease diagnosis in reading computed tomography (CT) images, this study aims to investigate the feasibility of applying a modified deep learning (DL) method as a new strategy to automatically segment disease-infected regions and predict disease severity. METHODS We employed a public dataset acquired from 20 COVID-19 patients, which includes manually annotated lung and infections masks, to train a new ensembled DL model that combines five customized residual attention U-Net models to segment disease infected regions followed by a Feature Pyramid Network model to predict disease severity stage. To test the potential clinical utility of the new DL model, we conducted an observer comparison study. First, we collected another set of CT images acquired from 80 COVID-19 patients and process images using the new DL model. Second, we asked two chest radiologists to read images of each CT scan and report the estimated percentage of the disease-infected lung volume and disease severity level. Third, we also asked radiologists to rate acceptance of DL model-generated segmentation results using a 5-scale rating method. RESULTS Data analysis results show that agreement of disease severity classification between the DL model and radiologists is >90% in 45 testing cases. Furthermore, >73% of cases received a high rating score (≥4) from two radiologists. CONCLUSION This study demonstrates the feasibility of developing a new DL model to automatically segment disease-infected regions and quantitatively predict disease severity, which may help avoid tedious effort and inter-reader variability in subjective assessment of disease severity in future clinical practice.
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Affiliation(s)
| | - Alireza Abdihamzehkolaei
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019-1102, USA
| | - Angel Choquehuanca
- School of Systems Engineering and Informatics, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Marco Aedo
- School of Systems Engineering and Informatics, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Wilmer Pacheco
- School of Systems Engineering and Informatics, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Laura Estacio
- School of Systems Engineering and Informatics, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Victor Cahui
- School of Systems Engineering and Informatics, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Luis Huallpa
- School of Systems Engineering and Informatics, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Kevin Quiñonez
- School of Systems Engineering and Informatics, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Valeria Calderón
- School of Systems Engineering and Informatics, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Ana Maria Gutierrez
- School of Systems Engineering and Informatics, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Ana Vargas
- Medical School, Universidad Nacional de San Agustín de Arequipa, Arequipa 04002, Peru
| | - Dery Gamero
- Medical School, Universidad Nacional de San Agustín de Arequipa, Arequipa 04002, Peru
| | - Eveling Castro-Gutierrez
- School of Systems Engineering and Informatics, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Yuchen Qiu
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019-1102, USA
| | - Bin Zheng
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019-1102, USA
| | - Javier A. Jo
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019-1102, USA
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8
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Strange C, McElvaney NG, Vogelmeier CF, Marin-Galiano M, Buch-Haensel M, Zhang X, Chen Y, Vit O, Wencker M, Chapman KR. The effect of exacerbations on lung density in α 1-antitrypsin deficiency. ERJ Open Res 2023; 9:00457-2022. [PMID: 36923570 PMCID: PMC10009703 DOI: 10.1183/23120541.00457-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Acute exacerbations of COPD (AECOPD) have unclear impacts on emphysema measurement using computed tomography (CT)-derived 15th percentile lung density (PD15). The aim of this study was to assess the influence of AECOPD on PD15 lung density in α1-antitrypsin deficiency. Methods In a post hoc analysis of the RAPID (Randomised Trial of Augmentation Therapy in α1-Proteinase Inhibitor Deficiency) trial, raw marginal residuals of PD15 (measured - predicted) were determined by fitting a regression line to individual patient CT data. These deviations from the expected slope were compared by age, sex, baseline forced expiratory volume in 1 s, diffusing capacity of the lungs for carbon monoxide % predicted and PD15, inhaled corticosteroid use and treatment group. Results Positive and negative residuals (reflecting higher or lower lung density than predicted from regression) were observed, which declined in magnitude over time following AECOPD events. Logistic regression confirmed a limited effect of patient characteristics on the absolute size of residuals, whereas AECOPD within 6 weeks of CT had a notable effect versus no AECOPD within 6 weeks (OR 5.707, 95% CI 3.375-9.652; p<0.0001). Conclusion AECOPD result in higher or lower CT lung density estimates; the effect is greatest in the 2 weeks immediately after an AECOPD and persists for <6 weeks. Patient characteristics were less relevant than AECOPD within 6 weeks, supporting the reliability of PD15 as a measure of lung density. An exacerbation-free period prior to CT scan is advisable to reduce signal-to-noise ratio in future clinical trials.
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Affiliation(s)
- Charlie Strange
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - N Gerard McElvaney
- Irish Centre for Genetic Lung Disease, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Marcos Marin-Galiano
- M.A.R.C.O. GmbH & Co. KG Institute for Clinical Research and Statistics, Düsseldorf, Germany
| | | | - Xiang Zhang
- Biostatistics, CSL Behring, King of Prussia, PA, USA
| | - Younan Chen
- Biostatistics, CSL Behring, King of Prussia, PA, USA
| | - Oliver Vit
- Clinical Research and Development, CSL Behring, Bern, Switzerland
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9
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Thakur P, Olson JD, Dugan GO, Daniel Bourland J, Kock ND, Mark Cline J. Quantitative Assessment and Comparative Analysis of Longitudinal Lung CT Scans of Chest-Irradiated Nonhuman Primates. Radiat Res 2023; 199:39-47. [PMID: 36394559 PMCID: PMC9987082 DOI: 10.1667/rade-21-00225.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022]
Abstract
Computed tomography (CT) imaging has been used to diagnose radiation-induced lung injury for decades. However, histogram-based quantitative tools have rarely been applied to assess lung abnormality due to radiation-induced lung injury (RILI). Here, we used first-order summary statistics to derive and assess threshold measures extracted from whole lung histograms of CT radiodensity in rhesus macaques. For the present study, CT scans of animals exposed to 10 Gy of whole thorax irradiation were utilized from a previous study spanning 2-9 months postirradiation. These animals were grouped into survivors and non-survivors based on their clinical and experimental endpoints. We quantified the change in lung attenuation after irradiation relative to baseline using three density parameters; average lung density (ALD), percent change in hyper-dense lung volume (PCHV), hyperdense volume as a percent of total volume (PCHV/TV) at 2-month intervals and compared each parameter between the two irradiated groups (non-survivors and survivors). We also correlated our results with histological findings. All the three indices (ALD, PCHV, PCHV/TV) obtained from density histograms showed a significant increase in lung injury in non-survivors relative to survivors, with PCHV relatively more sensitive to detect early RILI changes. We observed a significant positive correlation between histologic pneumonitis scores and each of the three CT measurements, indicating that CT density is useful as a surrogate for histologic disease severity in RILI. CT-based three density parameters, ALD, PCHV, PCHV/TV, may serve as surrogates for likely histopathology patterns in future studies of RILI disease progression.
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Affiliation(s)
- Priyanka Thakur
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
| | - John D. Olson
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
| | - Gregory O Dugan
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
| | - J. Daniel Bourland
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
| | - Nancy D. Kock
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
| | - J. Mark Cline
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
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10
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Chen L, Wu F, Huang J, Yang J, Fan W, Nie Z, Jiang H, Wang J, Xia W, Yang F. Well-Aerated Lung and Mean Lung Density Quantified by CT at Discharge to Predict Pulmonary Diffusion Function 5 Months after COVID-19. Diagnostics (Basel) 2022; 12:diagnostics12122921. [PMID: 36552928 PMCID: PMC9776504 DOI: 10.3390/diagnostics12122921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/12/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The aim of this study was to explore the predictive values of quantitative CT indices of the total lung and lung lobe tissue at discharge for the pulmonary diffusion function of coronavirus disease 2019 (COVID-19) patients at 5 months after symptom onset. Methods: A total of 90 patients with moderate and severe COVID-19 underwent CT scans at discharge, and pulmonary function tests (PFTs) were performed 5 months after symptom onset. The differences in quantitative CT and PFT results between Group 1 (patients with abnormal diffusion function) and Group 2 (patients with normal diffusion function) were compared by the chi-square test, Fisher’s exact test or Mann−Whitney U test. Univariate analysis, stepwise linear regression and logistic regression were used to determine the predictors of diffusion function in convalescent patients. Results: A total of 37.80% (34/90) of patients presented diffusion dysfunction at 5 months after symptom onset. The mean lung density (MLD) of the total lung tissue in Group 1 was higher than that in Group 2, and the percentage of the well-aerated lung (WAL) tissue volume (WAL%) of Group 1 was lower than that of Group 2 (all p < 0.05). Multiple stepwise linear regression identified only WAL and WAL% of the left upper lobe (LUL) as parameters that positively correlated with the percent of the predicted value of diffusion capacity of the lungs for carbon monoxide (WAL: p = 0.002; WAL%: p = 0.004), and multiple stepwise logistic regression identified MLD and MLDLUL as independent predictors of diffusion dysfunction (MLD: OR (95%CI): 1.011 (1.001, 1.02), p = 0.035; MLDLUL: OR (95%CI): 1.016 (1.004, 1.027), p = 0.008). Conclusion: At five months after symptom onset, more than one-third of moderate and severe COVID-19 patients presented with diffusion dysfunction. The well-aerated lung and mean lung density quantified by CT at discharge could be predictors of diffusion function in convalesce.
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Affiliation(s)
- Leqing Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Feihong Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jia Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jinrong Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Zhuang Nie
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Hongwei Jiang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiazheng Wang
- MSC Clinical & Technical Solutions, Philips Healthcare, Floor 7, Building 2, World Profit Center, Beijing 100600, China
| | - Wenfang Xia
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence: (W.X.); (F.Y.); Tel.: +86-027-85353238 (F.Y.)
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (W.X.); (F.Y.); Tel.: +86-027-85353238 (F.Y.)
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11
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Yang Z, Lafata KJ, Chen X, Bowsher J, Chang Y, Wang C, Yin FF. Quantification of lung function on CT images based on pulmonary radiomic filtering. Med Phys 2022; 49:7278-7286. [PMID: 35770964 DOI: 10.1002/mp.15837] [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: 06/14/2021] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To develop a radiomics filtering technique for characterizing spatial-encoded regional pulmonary ventilation information on lung computed tomography (CT). METHODS The lung volume was segmented on 46 CT images, and a 3D sliding window kernel was implemented across the lung volume to capture the spatial-encoded image information. Fifty-three radiomic features were extracted within the kernel, resulting in a fourth-order tensor object. As such, each voxel coordinate of the original lung was represented as a 53-dimensional feature vector, such that radiomic features could be viewed as feature maps within the lungs. To test the technique as a potential pulmonary ventilation biomarker, the radiomic feature maps were compared to paired functional images (Galligas PET or DTPA-SPECT) based on the Spearman correlation (ρ) analysis. RESULTS The radiomic feature maps GLRLM-based Run-Length Non-Uniformity and GLCOM-based Sum Average are found to be highly correlated with the functional imaging. The achieved ρ (median [range]) for the two features are 0.46 [0.05, 0.67] and 0.45 [0.21, 0.65] across 46 patients and 2 functional imaging modalities, respectively. CONCLUSIONS The results provide evidence that local regions of sparsely encoded heterogeneous lung parenchyma on CT are associated with diminished radiotracer uptake and measured lung ventilation defects on PET/SPECT imaging. These findings demonstrate the potential of radiomics to serve as a complementary tool to the current lung quantification techniques and provide hypothesis-generating data for future studies.
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Affiliation(s)
- Zhenyu Yang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Kyle J Lafata
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Radiology, Duke University, Durham, North Carolina, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
| | - Xinru Chen
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
| | - James Bowsher
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Yushi Chang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Chunhao Wang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
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12
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Cui S, Shu Z, Ma Y, Lin Y, Wang H, Cao H, Liu J, Gong X. A novel computed tomography radiomic nomogram for early evaluation of small airway dysfunction development. Front Med (Lausanne) 2022; 9:944294. [PMID: 36177331 PMCID: PMC9513435 DOI: 10.3389/fmed.2022.944294] [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: 05/15/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
The common respiratory abnormality, small airway dysfunction (fSAD), is easily neglected. Its prognostic factors, prevalence, and risk factors are unclear. This study aimed to explore the early detection of fSAD using radiomic analysis of computed tomography (CT) images to predict fSAD progress. The patients were divided into fSAD and non-fSAD groups and divided randomly into a training group (n = 190) and a validation group (n = 82) at a 7:3 ratio. Lung kit software was used for automatic delineation of regions of interest (ROI) on chest CT images. The most valuable imaging features were selected and a radiomic score was established for risk assessment. Multivariate logistic regression analysis showed that age, radiomic score, smoking, and history of asthma were significant predictors of fSAD (P < 0.05). Results suggested that the radiomic nomogram model provides clinicians with useful data and could represent a reliable reference to form fSAD clinical treatment strategies.
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Affiliation(s)
- Sijia Cui
- Rehabilitation Medicine Center, Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhenyu Shu
- Rehabilitation Medicine Center, Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yanqing Ma
- Rehabilitation Medicine Center, Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yi Lin
- Rehabilitation Medicine Center, Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Haochu Wang
- Rehabilitation Medicine Center, Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hanbo Cao
- Rehabilitation Medicine Center, Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jing Liu
- Rehabilitation Medicine Center, Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiangyang Gong
- Rehabilitation Medicine Center, Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Hangzhou Medical College, Institute of Artificial Intelligence and Remote Imaging, Hangzhou, China
- *Correspondence: Xiangyang Gong,
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13
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Inflammatory Microenvironment in Early Non-Small Cell Lung Cancer: Exploring the Predictive Value of Radiomics. Cancers (Basel) 2022; 14:cancers14143335. [PMID: 35884397 PMCID: PMC9323656 DOI: 10.3390/cancers14143335] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 01/27/2023] Open
Abstract
Patient prognosis is a critical consideration in the treatment decision-making process. Conventionally, patient outcome is related to tumor characteristics, the cancer spread, and the patients’ conditions. However, unexplained differences in survival time are often observed, even among patients with similar clinical and molecular tumor traits. This study investigated how inflammatory radiomic features can correlate with evidence-based biological analyses to provide translated value in assessing clinical outcomes in patients with NSCLC. We analyzed a group of 15 patients with stage I NSCLC who showed extremely different OS outcomes despite apparently harboring the same tumor characteristics. We thus analyzed the inflammatory levels in their tumor microenvironment (TME) either biologically or radiologically, focusing our attention on the NLRP3 cancer-dependent inflammasome pathway. We determined an NLRP3-dependent peritumoral inflammatory status correlated with the outcome of NSCLC patients, with markedly increased OS in those patients with a low rate of NLRP3 activation. We consistently extracted specific radiomic signatures that perfectly discriminated patients’ inflammatory levels and, therefore, their clinical outcomes. We developed and validated a radiomic model unleashing quantitative inflammatory features from CT images with an excellent performance to predict the evolution pattern of NSCLC tumors for a personalized and accelerated patient management in a non-invasive way.
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14
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Wu F, Chen L, Huang J, Fan W, Yang J, Zhang X, Jin Y, Yang F, Zheng C. Total Lung and Lobar Quantitative Assessment Based on Paired Inspiratory-Expiratory Chest CT in Healthy Adults: Correlation with Pulmonary Ventilatory Function. Diagnostics (Basel) 2021; 11:diagnostics11101791. [PMID: 34679488 PMCID: PMC8534441 DOI: 10.3390/diagnostics11101791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To provide the quantitative volumetric data of the total lung and lobes in inspiration and expiration from healthy adults, and to explore the value of paired inspiratory–expiratory chest CT scan in pulmonary ventilatory function and further explore the influence of each lobe on ventilation. Methods: A total of 65 adults (29 males and 36 females) with normal clinical pulmonary function test (PFT) and paired inspiratory–expiratory chest CT scan were retrospectively enrolled. The inspiratory and expiratory volumetric indexes of the total lung (TL) and 5 lobes (left upper lobe [LUL], left lower lobe [LLL], right upper lobe [RUL], right middle lobe [RML], and right lower lobe [RLL]) were obtained by Philips IntelliSpace Portal image postprocessing workstation, including inspiratory lung volume (LVin), expiratory lung volume (LVex), volume change (∆LV), and well-aerated lung volume (WAL, lung tissue with CT threshold between −950 and −750 HU in inspiratory scan). Spearman correlation analysis was used to explore the correlation between CT quantitative indexes of the total lung and ventilatory function indexes (including total lung capacity [TLC], residual volume [RV], and force vital capacity [FVC]). Multiple stepwise regression analysis was used to explore the influence of each lobe on ventilation. Results: At end-inspiratory phase, the LVin-TL was 4664.6 (4282.7, 5916.2) mL, the WALTL was 4173 (3639.6, 5250.9) mL; both showed excellent correlation with TLC (LVin-TL: r = 0.890, p < 0.001; WALTL: r = 0.879, p < 0.001). From multiple linear regression analysis with lobar CT indexes as variables, the LVin and WAL of these two lobes, LLL and RUL, showed a significant relationship with TLC. At end-expiratory phase, the LVex-TL was 2325.2 (1969.7, 2722.5) mL with good correlation with RV (r = 0.811, p < 0.001), of which the LVex of RUL and RML had a significant relationship with RV. For the volumetric change within breathing, the ∆LVTL was 2485.6 (2169.8, 3078.1) mL with good correlation with FVC (r = 0.719, p < 0.001), moreover, WALTL showed a better correlation with FVC (r = 0.817, p < 0.001) than that of ∆LVTL. Likewise, there was also a strong association between ∆LV, WAL of these two lobes (LLL and RUL), and FVC. Conclusions: The quantitative indexes derived from paired inspiratory–expiratory chest CT could reflect the clinical pulmonary ventilatory function, LLL, and RUL give greater impact on ventilation. Thus, the pulmonary functional evaluation needs to be more precise and not limited to the total lung level.
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Affiliation(s)
- Feihong Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Leqing Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jia Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jinrong Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiaohui Zhang
- Clinical Science, Philips Healthcare, No. 718 Daning Rd., Jingan District, Shanghai 200233, China;
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China;
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (F.Y.); (C.Z.); Tel.: +86-027-8535-3238 (C.Z.)
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd., Wuhan 430022, China; (F.W.); (L.C.); (J.H.); (W.F.); (J.Y.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (F.Y.); (C.Z.); Tel.: +86-027-8535-3238 (C.Z.)
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15
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Pistenmaa CL, Nardelli P, Ash SY, Come CE, Diaz AA, Rahaghi FN, Barr RG, Young KA, Kinney GL, Simmons JP, Wade RC, Wells JM, Hokanson JE, Washko GR, San José Estépar R. Pulmonary Arterial Pruning and Longitudinal Change in Percent Emphysema and Lung Function: The Genetic Epidemiology of COPD Study. Chest 2021; 160:470-480. [PMID: 33607083 PMCID: PMC8411454 DOI: 10.1016/j.chest.2021.01.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/28/2020] [Accepted: 01/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pulmonary endothelial damage has been shown to precede the development of emphysema in animals, and vascular changes in humans have been observed in COPD and emphysema. RESEARCH QUESTION Is intraparenchymal vascular pruning associated with longitudinal progression of emphysema on CT imaging or decline in lung function over 5 years? STUDY DESIGN AND METHODS The Genetic Epidemiology of COPD Study enrolled ever smokers with and without COPD from 2008 through 2011. The percentage of emphysema-like lung, or "percent emphysema," was assessed at baseline and after 5 years on noncontrast CT imaging as the percentage of lung voxels < -950 Hounsfield units. An automated CT imaging-based tool assessed and classified intrapulmonary arteries and veins. Spirometry measures are postbronchodilator. Pulmonary arterial pruning was defined as a lower ratio of small artery volume (< 5 mm2 cross-sectional area) to total lung artery volume. Mixed linear models included demographics, anthropomorphics, smoking, and COPD, with emphysema models also adjusting for CT imaging scanner and lung function models adjusting for clinical center and baseline percent emphysema. RESULTS At baseline, the 4,227 participants were 60 ± 9 years of age, 50% were women, 28% were Black, 47% were current smokers, and 41% had COPD. Median percent emphysema was 2.1 (interquartile range, 0.6-6.3) and progressed 0.24 percentage points/y (95% CI, 0.22-0.26 percentage points/y) over 5.6 years. Mean FEV1 to FVC ratio was 68.5 ± 14.2% and declined 0.26%/y (95% CI, -0.30 to -0.23%/y). Greater pulmonary arterial pruning was associated with more rapid progression of percent emphysema (0.11 percentage points/y per 1-SD increase in arterial pruning; 95% CI, 0.09-0.16 percentage points/y), including after adjusting for baseline percent emphysema and FEV1. Arterial pruning also was associated with a faster decline in FEV1 to FVC ratio (-0.04%/y per 1-SD increase in arterial pruning; 95% CI, -0.008 to -0.001%/y). INTERPRETATION Pulmonary arterial pruning was associated with faster progression of percent emphysema and more rapid decline in FEV1 to FVC ratio over 5 years in ever smokers, suggesting that pulmonary vascular differences may be relevant in disease progression. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.
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Affiliation(s)
| | - P Nardelli
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - S Y Ash
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - C E Come
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - A A Diaz
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - F N Rahaghi
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - R G Barr
- Departments of Medicine and Epidemiology, Columbia University, New York, NY
| | - K A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | - G L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | - J P Simmons
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - R C Wade
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - J M Wells
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - J E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | - G R Washko
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
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16
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Balasch A, Büttner MS, Metze P, Stumpf K, Beer M, Rottbauer W, Rasche V. Tiny golden angle stack-of-stars (tygaSoS) free-breathing functional lung imaging. Magn Reson Imaging 2021; 82:24-30. [PMID: 34153438 DOI: 10.1016/j.mri.2021.06.016] [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: 02/19/2021] [Revised: 04/21/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE MRI of the lung parenchyma is still challenging due to cardiac and respiratory motion, and the low proton density and short T2*. Clinical feasible MRI methods for functional lung assessment are of great interest. It was the objective of this study to evaluate the potential of combining the ultra-short echo-time stack-of-stars approach with tiny golden angle (tyGASoS) profile ordering for self-gated free-breathing lung imaging. METHODS Free-breathing tyGASoS data were acquired in 10 healthy volunteers (3 smoker (S), 7 non-smoker (NS)). Images in different respiratory phases were reconstructed applying an image-based self-gating technique. Resulting image quality and sharpness, and parenchyma visibility were qualitatively scored by three blinded independent reader, and the signal-to-noise ratio (SNR), proton fraction (fP) and fractional ventilation (FV) quantified. RESULT The imaging protocol was well tolerated by all volunteers. Image quality was sufficient for subsequent quantitative analysis in all cases with good to excellent inter-reader reliability. Between expiration (EX) and inspiration (IN) significant differences (p < 0.001) were observed in SNR (EX: 3.73 ± 0.89, IN: 3.14 ± 0.74) and fP (EX: 0.27 ± 0.09, IN: 0.25 ± 0.08). A significant (p < 0.05) higher fP (EX/IN: 0.22 ± 0.07/0.21 ± 0.07 (NS), 0.33 ± 0.07/0.30 ± 0.06 (S)) was observed in the smoker group. No significant FV differences resulted between S and NS. CONCLUSION The study proves the feasibility of free-breathing tyGASoS for multiphase lung imaging. Changes in fP may indicate an initial response in the smoker group and as such proves the sensitivity of the proposed technique. A major limitation in FV quantification rises from the large inter-subject variability of breathing patterns and amplitudes, requiring further consideration.
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Affiliation(s)
- A Balasch
- Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany.
| | - M S Büttner
- Department of Radiology, Ulm University Medical Centre, Ulm, Germany.
| | - P Metze
- Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany.
| | - K Stumpf
- Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany.
| | - M Beer
- Department of Radiology, Ulm University Medical Centre, Ulm, Germany.
| | - W Rottbauer
- Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany.
| | - V Rasche
- Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany.
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17
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Nguyen DT, Larsen TC, Wang M, Knutsen RH, Yang Z, Bennett EE, Mazilu D, Yu ZX, Tao X, Donahue DR, Gharib AM, Bleck CKE, Moss J, Remaley AT, Kozel BA, Wen H. X-ray microtomosynthesis of unstained pathology tissue samples. J Microsc 2021; 283:9-20. [PMID: 33482682 PMCID: PMC8248055 DOI: 10.1111/jmi.13003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/14/2020] [Accepted: 01/17/2021] [Indexed: 12/15/2022]
Abstract
In pathology protocols, a tissue block, such as one containing a mouse brain or a biopsy sample from a patient, can produce several hundred thin sections. Substantial time may be required to analyse all sections. In cases of uncertainty regarding which sections to focus on, noninvasive scout imaging of intact blocks can help in guiding the pathology procedure. The scouting step is ideally done in a time window of minutes without special sample preparation that may interfere with the pathology procedures. The challenge is to obtain some visibility of unstained tissue structures at sub‐10 µm resolution. We explored a novel x‐ray tomosynthesis method as a way to maximise contrast‐to‐noise ratio, a determinant of tissue visibility. It provided a z‐stack of thousands of images at 7.3 μm resolution (10% contrast, half‐period of 68.5 line pairs/mm), in scans of 5‐15 minutes. When compared with micro‐CT scans, the straight‐line tomosynthesis scan did not need to rotate the sample, which allowed flat samples, such as paraffin blocks, to be kept as close as possible to the x‐ray source. Thus, given the same hardware, scan time and resolution, this mode maximised the photon flux density through the sample, which helped in maximising the contrast‐to‐noise ratio. The tradeoff of tomosynthesis is incomplete 3D information. The microtomosynthesis scanner has scanned 110 unstained human and animal tissue samples as part of their respective pathology protocols. In all cases, the z‐stack of images showed tissue structures that guided sectioning or provided correlative structural information. We describe six examples that presented different levels of visibility of soft tissue structures. Additionally, in a set of coronary artery samples from an HIV patient donor, microtomosynthesis made a new discovery of isolated focal calcification in the internal elastic lamina of coronary wall, which was the onset of medial calcific sclerosis in the arteries.
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Affiliation(s)
- David T Nguyen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Muyang Wang
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Russel H Knutsen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Zhihong Yang
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Eric E Bennett
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Dumitru Mazilu
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Zu-Xi Yu
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Xi Tao
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Danielle R Donahue
- Mouse Imaging Facility, National Institutes of Health, Bethesda, Maryland
| | - Ahmed M Gharib
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Christopher K E Bleck
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel Moss
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Alan T Remaley
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Beth A Kozel
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Han Wen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Dal Negro RW, Paoletti M, Pistolesi M. Standard spirometry to assess emphysema in patients with chronic obstructive pulmonary disease: the Emphysema Severity Index (ESI). Multidiscip Respir Med 2021; 16:805. [PMID: 35003734 PMCID: PMC8672489 DOI: 10.4081/mrm.2021.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a generic term identifying a condition characterized by variable changes in peripheral airways and lung parenchyma. Standard spirometry cannot discriminate the relative role of conductive airways inflammatory changes from destructive parenchymal emphysema changes. The aim of this study was to quantify the emphysema component in COPD by a simple parameter (the Emphysema Severity Index - ESI), previously proved to reflect CT-assessed emphysema. METHODS ESI was obtained by fitting the descending limb of MEFV curves by a fully automated procedure providing a 0 to 10 score of emphysema severity. ESI was computed in COPD patients enrolled in the CLIMA Study. RESULTS The vast majority of ESI values ranged from 0 to 4, compatible with no-to-mild/moderate emphysema component. A limited proportion of patients showed ESI values >4, compatible with severe-to-very severe emphysema. ESI values were greatly dispersed within each GOLD class indicating that GOLD classification cannot discriminate emphysema and conductive airways changes in patients with similar airflow limitation. ESI and diffusing capacity (DLCO) were significantly correlated (p<0.001). However, the great dispersion in their correlation suggests that ESI and DLCO reflect partially different anatomo-functional determinants in COPD. CONCLUSIONS Airflow limitation has heterogenous determinants in COPD. Inflammatory and destructive changes may combine in CT densitometric alterations that cannot be detected by standard spirometry. ESI computation from spirometric data helps to define the prevailing pathogenetic mechanism underlying the measured airflow limitation. ESI could be a reliable advancement to select large samples of patients in clinical or epidemiological trials, and to compare different pharmacological treatments.
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Affiliation(s)
- Roberto W. Dal Negro
- National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology - CESFAR, Verona
| | - Matteo Paoletti
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Massimo Pistolesi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
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19
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Li R, Qi Y, Han M, Geng B, Wang G, Han M. Computed tomography reveals microenvironment changes in premetastatic lung. Eur Radiol 2020; 31:4340-4349. [PMID: 33219849 DOI: 10.1007/s00330-020-07500-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/03/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Microenvironment changes had occurred in the metastatic organs before the arriving of the metastatic tumor cells. In this study, we evaluated the effectiveness of computed tomography (CT) images in quantifying the microenvironment changes in the premetastatic lung under both laboratory and clinical conditions. METHOD Free-breathing Balb/c mice underwent micro-CT repeatedly after the implantation of 4T1 breast tumor. CT-derived indicators (aerated lung volume, lung tissue volume, total lung volume, mean lung density, and the ratio of aerated lung volume to the total lung volume) were quantified. Hematoxylin-eosin staining was used to display the microenvironment changes in premetastatic lung. Moreover, we examined healthy adult women, adult women with histopathologically confirmed primary breast cancer, and adult women with histopathologically confirmed primary breast cancer and lung metastases in our institution to test whether the indicators derived from lung CT images changed with the growth of breast cancer. RESULTS In 4T1 tumor-bearing mice, lung density is increased before lung masses can be recognized on CT images and is correlated with the severity of inflammation in the lung microenvironment. In primary breast tumor-bearing patients, lung density is also increased before the clinical diagnosis of pulmonary metastasis and is correlated with disease score, which represents tumor progression. CONCLUSIONS CT is a reliable and quantitative tool that yields dynamic information on metastatic processes. Microenvironmental changes had occurred in patients' lung tissue before the clinical diagnosis of pulmonary metastasis. Our research will provide new insight for clinical research on the premetastatic niche. KEY POINTS • CT, which provides dynamic information on metastatic processes, is a reliable and quantitative tool to bridge laboratory and clinical studies of the premetastatic niche. • We confirmed that microenvironmental changes occurred in patients' lung tissue before clinicians could diagnose pulmonary metastasis. • Our results provide evidence for the study of the premetastatic niche by analyzing information obtained from CT images.
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Affiliation(s)
- Ranran Li
- Cancer Therapy and Research Center, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, 324 Jingwuweiqi Road, Jinan, 250021, People's Republic of China
| | - Yana Qi
- Cancer Therapy and Research Center, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, 324 Jingwuweiqi Road, Jinan, 250021, People's Republic of China
| | - Meng Han
- School of Basic Medical Sciences, Shandong First Medical University, Jinan, People's Republic of China
| | - Baocheng Geng
- Cancer Therapy and Research Center, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, 324 Jingwuweiqi Road, Jinan, 250021, People's Republic of China
| | - Guangyu Wang
- Cancer Therapy and Research Center, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, 324 Jingwuweiqi Road, Jinan, 250021, People's Republic of China
| | - Mingyong Han
- Cancer Therapy and Research Center, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, 324 Jingwuweiqi Road, Jinan, 250021, People's Republic of China.
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20
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Merikallio H, Kaarteenaho R, Lindén S, Padra M, Karimi R, Li CX, Lappi-Blanco E, Wheelock ÅM, Sköld MC. Smoking-associated increase in mucins 1 and 4 in human airways. Respir Res 2020; 21:239. [PMID: 32948202 PMCID: PMC7499856 DOI: 10.1186/s12931-020-01498-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 08/31/2020] [Indexed: 12/18/2022] Open
Abstract
Rationale Smoking-related chronic obstructive pulmonary disease (COPD) is associated with dysregulated production of mucus. Mucins (MUC) are important both for mucus secretion and epithelial defense. We have examined the distribution of MUC1 and MUC4 in the airway epithelial cells of never-smokers and smokers with and without COPD. Methods Mucosal biopsies and bronchial wash samples were obtained by bronchoscopy from age- and sex-matched COPD-patients (n = 38; GOLD I-II/A-B), healthy never-smokers (n = 40) and current smokers with normal lung function (n = 40) from the Karolinska COSMIC cohort (NCT02627872). Cell-specific expressions of MUC1, MUC4 and regulating factors, i.e., epithelial growth factor receptor (EGFR) 1 and 2, were analyzed by immunohistochemistry. Soluble MUC1 was measured by quantitative immunodetection on slot blot. Results The levels of cell-bound MUC1 expression in basal cells and in soluble MUC1 in bronchial wash were increased in smokers, regardless of airway obstruction. Patients with chronic bronchitis had higher MUC1 expression. The expression of MUC4 in cells with goblet cell phenotype was increased in smokers. The expression of EGFR2, but not that of EGFR1, was higher in never-smokers than in smokers. Conclusions Smoking history and the presence of chronic bronchitis, regardless of airway obstruction, affect both cellular and soluble MUC1 in human airways. Therefore, MUC1 may be a novel marker for smoking- associated airway disease.
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Affiliation(s)
- Heta Merikallio
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden. .,Research Unit of Internal Medicine, University of Oulu, Oulu, Finland. .,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.
| | - Riitta Kaarteenaho
- Research Unit of Internal Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Sara Lindén
- Department of Biomedical Chemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Médea Padra
- Department of Biomedical Chemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Reza Karimi
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Chuan-Xing Li
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Lappi-Blanco
- Department of Pathology, Center for Cancer Research and Translational Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Åsa M Wheelock
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus C Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
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21
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Stiehl B, Lauria M, O'Connell D, Hasse K, Barjaktarevic IZ, Lee P, Low DA, Santhanam AP. A quantitative analysis of biomechanical lung model consistency using 5DCT datasets. Med Phys 2020; 47:5555-5567. [PMID: 32521048 DOI: 10.1002/mp.14323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Lung biomechanical models are important for understanding and characterizing lung anatomy and physiology. A key parameter of biomechanical modeling is the underlying tissue elasticity distribution. While human lung elasticity estimations do not have ground truths, model consistency checks can and should be employed to gauge the stability of the estimation techniques. This work proposes such a consistency check using a set of 10 subjects. METHODS We hypothesize that lung dynamics will be stable over a 2-3 min time period and that this stability can be employed to check biomechanical estimation stability. For this purpose, two sets of 12 fast helical free breathing computed tomography scans (FHFBCT) were acquired back-to-back for each of the subjects. A published breathing motion model [five-dimensional CT (5DCT)] was generated from each set. Both of the models were used to generate two biomechanical modeling input sets: (a) The lung geometry at the end-exhalation, and (b) the voxel displacement map that mapped the end-exhalation lung geometry with the end-inhalation lung geometry. Finite element biomechanical lung models were instantiated using the end-exhalation lung geometries. The models included voxel-specific lung tissue elasticity values and were optimized using a gradient search approach until the biomechanical model-generated displacement maps matched those of the 5DCT voxel displacement maps. Finally, the two elasticity distributions associated with each of the patient 5DCTs were quantitatively compared. Because the end-exhalation geometries differed slightly between the two scan datasets, the elasticity distributions were deformably mapped to one of the exhalation datasets. RESULTS For the 10 patients, on average, 90% of parenchymal voxels had <2 kPa Young's modulus difference between the two estimations, with a mean voxel difference of only 0.6 kPa. Similarly, 97% of the parenchymal voxels had <2 mm displacement difference between the two models with a mean difference of 0.48 mm. Furthermore, overlapping elasticity histograms for voxels between -600 and -900 HU (parenchymal tissues) showed that the histograms were consistent between the two estimations. CONCLUSION In this paper, we demonstrated that biomechanical lung models can be consistently estimated when using motion-model based imaging datasets, even though the models were created from scans acquired at different breaths.
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Affiliation(s)
- Brad Stiehl
- Department of Radiation Oncology, University of California, Los Angeles, CA, 90095, USA
| | - Michael Lauria
- Department of Radiation Oncology, University of California, Los Angeles, CA, 90095, USA
| | - Dylan O'Connell
- Department of Radiation Oncology, University of California, Los Angeles, CA, 90095, USA
| | - Katelyn Hasse
- Department of Radiation Oncology, University of California, San Francisco, CA, 94115, USA
| | - Igor Z Barjaktarevic
- Department of Radiation Oncology, University of California, Los Angeles, CA, 90095, USA
| | - Percy Lee
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - Daniel A Low
- Department of Radiation Oncology, University of California, Los Angeles, CA, 90095, USA
| | - Anand P Santhanam
- Department of Radiation Oncology, University of California, Los Angeles, CA, 90095, USA
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22
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Balasch A, Metze P, Stumpf K, Beer M, Büttner SM, Rottbauer W, Speidel T, Rasche V. 2D
Ultrashort Echo‐Time Functional Lung Imaging. J Magn Reson Imaging 2020; 52:1637-1644. [DOI: 10.1002/jmri.27269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Anke Balasch
- Department of Internal Medicine II Ulm University Medical Centre Ulm Germany
| | - Patrick Metze
- Department of Internal Medicine II Ulm University Medical Centre Ulm Germany
| | - Kilian Stumpf
- Department of Internal Medicine II Ulm University Medical Centre Ulm Germany
| | - Meinrad Beer
- Department of Radiology Ulm University Medical Centre Ulm Germany
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II Ulm University Medical Centre Ulm Germany
| | - Tobias Speidel
- Core‐Facility Small Animal Imaging, Medical Faculty Ulm University Germany
| | - Volker Rasche
- Department of Internal Medicine II Ulm University Medical Centre Ulm Germany
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23
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Oh AS, Strand M, Pratte K, Regan EA, Humphries S, Crapo JD, Lynch DA. Visual Emphysema at Chest CT in GOLD Stage 0 Cigarette Smokers Predicts Disease Progression: Results from the COPDGene Study. Radiology 2020; 296:641-649. [PMID: 32633676 DOI: 10.1148/radiol.2020192429] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The clinical significance of visually evident emphysema on CT images in individuals without spirometric evidence of chronic obstructive pulmonary disease (COPD) by current diagnostic criteria is, to the knowledge of the authors, unknown. Purpose To evaluate whether participants with visually evident emphysema at CT were more likely to have progressive disease and increased mortality at 5 years compared with those without visual emphysema. Materials and Methods This secondary analysis of the prospective Genetic Epidemiology of COPD study evaluated current or former smokers enrolled between 2008 and 2011 who did not meet current criteria for COPD (defined as Global Initiative for Obstructive Lung Disease stage 0). Statistical analysis was performed by using linear mixed models to estimate mean physiologic, imaging, and clinical outcomes for those with and without visual emphysema. Hazard ratios for mortality were calculated by using Cox regression models with emphysema as the main predictor. Results Of the 4095 participants, 48.3% (1979 participants; 1096 men and 883 women; mean age, 57 years ± 8 [standard deviation]) had trace or greater visual emphysema at CT and 51.7% (2116 participants; 1068 men and 1048 women; mean age, 56 years ± 8) had no emphysema at CT. At 5 years, participants with visual emphysema at CT demonstrated progressive airflow obstruction with lower values of ratio of forced expiratory volume in 1 second (FEV1)-to-functional vital capacity (FVC) ratio (-1.7 vs -0.7) and greater progression in quantitative emphysema measured by 15th percentile lung density (-3.3 vs -0.3 HU), adjusted lung density (-3.1 vs -0.2 g/L), and percentage of lung voxels with CT attenuation less than -950 HU (0.17 vs -0.20) than participants without emphysema (P < .001 for each). The rate of quantitative emphysema progression increased with greater grades of emphysema severity within the emphysema group. Conclusion The presence of visual emphysema at CT in current and former Global Initiative for Obstructive Lung Disease stage 0 smokers predicted structural and physiologic disease progression. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Grenier in this issue.
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Affiliation(s)
- Andrea S Oh
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Matthew Strand
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Katherine Pratte
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Elizabeth A Regan
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Stephen Humphries
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - James D Crapo
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - David A Lynch
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
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- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
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The Performance of Chest CT in Evaluating the Clinical Severity of COVID-19 Pneumonia: Identifying Critical Cases Based on CT Characteristics. Invest Radiol 2020; 55:412-421. [PMID: 32304402 PMCID: PMC7173027 DOI: 10.1097/rli.0000000000000689] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives To assess the clinical severity of COVID-19 pneumonia using qualitative and/or quantitative chest CT indicators and identify the CT characteristics of critical cases. Materials and Methods Fifty-one patients with COVID-19 pneumonia including ordinary cases (group A, n=12), severe cases(group B, n=15) and critical cases (group C, n=24) were retrospectively enrolled. The qualitative and quantitative indicators from chest CT were recorded and compared using Fisher's exact test, one-way ANOVA, Kruskal-Wallis H test and receiver operating characteristic analysis. Results Depending on the severity of the disease, the number of involved lung segments and lobes, the frequencies of consolidation, crazy-paving pattern and air bronchogram increased in more severe cases. Qualitative indicators including total severity score for the whole lung and total score for crazy-paving and consolidation could distinguish groups B and C from A(69% sensitivity, 83% specificity and 73% accuracy) but were similar between group B and group C. Combined qualitative and quantitative indicators could distinguish these three groups with high sensitivity(B+C vs. A, 90%; C vs. B, 92%), specificity(100%, 87%) and accuracy(92%, 90%). Critical cases had higher total severity score(>10) and higher total score for crazy-paving and consolidation(>4) than ordinary cases, and had higher mean lung density(>-779HU) and full width at half maximum(>128HU) but lower relative volume of normal lung density(≦50%) than ordinary/severe cases. In our critical cases, eight patients with relative volume of normal lung density smaller than 40% received mechanical ventilation for supportive treatment, and two of them had died. Conclusion A rapid, accurate severity assessment of COVID-19 pneumonia based on chest CT would be feasible and could provide help for making management decisions, especially for the critical cases.
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Dosimetric evaluation of two phases of respiratory movement using a lung equivalent material for radiotherapy treatment planning. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground/aim:Radiation dosimetry requires special phantoms which are comparable with organs and tissues of a human body. The lung is one of the organs with a low density. Therefore, it is important to create and use lung equivalent phantoms in dosimetric controls. The aim of this study was to investigate the importance of using lung equivalent phantoms for different respiratory phases during measurements with both computed tomography (CT) and linear accelerator.Materials and methods:The maximum lung inhalation phantom (LIP) and lung exhalation phantom (LEP) were created for two respiratory phases. The Hounsfield Unit (HU) values based on the selected slice thickness and CT tube voltages were investigated, as well as the difference between energy and algorithms used in the treatment planning system.Results:It was found that the change in HU values according to slice thickness were more significant in measurements for respiratory phases. The dose difference between LEP and LIP at a point which is located 1 cm below the surface of the phantoms was found as 1·0% for 6 megavolt (MV) and 2·8% for 18 MV. The highest difference between the two algorithms was found to be 7·22% for 6 MV and 10·93% for 18 MV for LIP phantom.Conclusion:It can be said that the LIP and LEP phantoms prepared in accordance with respiratory phases can be a simple and inexpensive method to investigate any difference in dosimetry during respiratory phases. Also, measured and calculated dose values are in good agreement when thinner slice thickness was chosen.
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Fu F, Zhang Y, Wang S, Li Y, Wang Z, Hu H, Chen H. Computed tomography density is not associated with pathological tumor invasion for pure ground-glass nodules. J Thorac Cardiovasc Surg 2020; 162:451-459.e3. [PMID: 32711984 DOI: 10.1016/j.jtcvs.2020.04.169] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/11/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Pure ground-glass nodules are considered to be radiologically noninvasive in lung adenocarcinoma. However, some pure ground-glass nodules are found to be invasive adenocarcinoma pathologically. This study aims to identify the computed tomography parameters distinguishing invasive adenocarcinoma from adenocarcinoma in situ and minimally invasive adenocarcinoma. METHODS From May 2011 to December 2015, patients with completely resected adenocarcinoma appearing as pure ground-glass nodules were reviewed. To evaluate the association between computed tomography features and the invasiveness of pure ground-glass nodules, logistic regression analyses were conducted. RESULTS Among 432 enrolled patients, 118 (27.3%) were classified as adenocarcinoma in situ, 213 (49.3%) were classified as minimally invasive adenocarcinoma, 101 (23.4%) were classified as invasive adenocarcinoma. There was no postoperative recurrence for patients with pure ground-glass nodules. Logistic regression analyses demonstrated that computed tomography size was the only independent radiographic factor associated with adenocarcinoma in situ (odds ratio, 47.165; 95% confidence interval, 19.279-115.390; P < .001), whereas computed tomography density was not (odds ratio, 1.002; 95% confidence interval, 0.999-1.005; P = .127). Further analyses revealed that there was no distributional difference in computed tomography density among 3 groups (P = .173). Even after propensity score matching for adenocarcinoma in situ/minimally invasive adenocarcinoma and invasive adenocarcinoma, no significant difference in computed tomography density was observed (P = .741). The subanalyses for pure ground-glass nodules with 1 cm or more in size also indicated similar results. CONCLUSIONS In patients with pure ground-glass nodules, computed tomography size was the only radiographic parameter associated with tumor invasion. Measuring computed tomography density provided no advantage in differentiating invasive adenocarcinoma from adenocarcinoma in situ and minimally invasive adenocarcinoma.
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Affiliation(s)
- Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shengping Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuan Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zezhou Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hong Hu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Ko Y, Asakawa K, Tobino K, Oguma T, Hirai T, Takada T, Takahashi K, Seyama K. Quantitative analysis of computed tomography of the lungs in patients with lymphangioleiomyomatosis treated with sirolimus. Heliyon 2020; 6:e03345. [PMID: 32072050 PMCID: PMC7011043 DOI: 10.1016/j.heliyon.2020.e03345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/03/2019] [Accepted: 01/30/2020] [Indexed: 01/30/2023] Open
Abstract
Objectives We aimed to study sirolimus-related lung parenchymal changes by quantitative analysis of computed tomography (CT) of the lungs in patients with lymphangioleiomyomatosis (LAM). Methods We studied 20 participants from the Multicenter Lymphangioleiomyomatosis Sirolimus Trial for Safety study, who had undergone both thin-section CT scans and pulmonary function tests at baseline, 12, and 24 months. Quantitative CT parameters such as CT-derived total lung capacity, percentage of low attenuation area (LAA%), lung density histogram, fractal property of low attenuation area, and airway dimensions were analyzed, and correlations were conducted between the longitudinal change in each quantitative CT measurement and changes in pulmonary function were examined. Among 20 participants, pre-trial (n = 8) and post-trial (n = 16) CT data were also analyzed to deduce pathophysiologic implications of the serial changes in CT parameters during trial periods. Results FEV1 significantly increased from baseline to 24 months (slope 3.71 ± 1.50 ml/month) whereas FVC didn't during sirolimus therapy. Strikingly, LAA%, and skewness and kurtosis of density histogram significantly increased from baseline to 24 months, while mean and mode CT values significantly decreased from baseline to 24 months. Statistically significant positive correlations were found between ΔFEV1 and Δskewness (r = 0.465, p = 0.045). Taking the changes in lung density during pre-trial period into consideration, sirolimus decreases the area of -800 to -750 Housefield unit (HU) density and inhibits the decrease of -950 to -800 HU area during treatment, then producing the increased LAA% during the trial and post-trial periods. Given few sirolimus-related changes in airway dimensions, possible changes in lung mechanics may have contributed to increased FEV1. Conclusion Our study suggests that the lung density histogram parameters, kurtosis, and skewness, may be useful as indicators of the efficacy of sirolimus.
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Affiliation(s)
- Yuki Ko
- Division of Respiratory Medicine, Iizuka Hospital, Yoshio-Machi 3-83, Iizuka-Shi, Fukuoka 820-8505, Japan.,Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Hongo 3-1-3, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Katsuaki Asakawa
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Asahi-Dori 1-754, Chyuo-Ku, Niigata, 951-8520, Japan
| | - Kazunori Tobino
- Division of Respiratory Medicine, Iizuka Hospital, Yoshio-Machi 3-83, Iizuka-Shi, Fukuoka 820-8505, Japan.,Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Hongo 3-1-3, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Tsuyoshi Oguma
- Division of Respiratory Medicine, Kyoto University Faculty of Medicine and Graduate School of Medicine, Kawara-Machi 54, Seigoin, Sakyo-Ku, Kyoto 606-8507, Japan
| | - Toyohiro Hirai
- Division of Respiratory Medicine, Kyoto University Faculty of Medicine and Graduate School of Medicine, Kawara-Machi 54, Seigoin, Sakyo-Ku, Kyoto 606-8507, Japan
| | - Toshinori Takada
- Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Urasa 4132, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Kazuhisa Takahashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Hongo 3-1-3, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Kuniaki Seyama
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Hongo 3-1-3, Bunkyo-Ku, Tokyo 113-8421, Japan
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Lillington J, Brusaferri L, Kläser K, Shmueli K, Neji R, Hutton BF, Fraioli F, Arridge S, Cardoso MJ, Ourselin S, Thielemans K, Atkinson D. PET/MRI attenuation estimation in the lung: A review of past, present, and potential techniques. Med Phys 2020; 47:790-811. [PMID: 31794071 PMCID: PMC7027532 DOI: 10.1002/mp.13943] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/23/2019] [Accepted: 11/20/2019] [Indexed: 12/16/2022] Open
Abstract
Positron emission tomography/magnetic resonance imaging (PET/MRI) potentially offers several advantages over positron emission tomography/computed tomography (PET/CT), for example, no CT radiation dose and soft tissue images from MR acquired at the same time as the PET. However, obtaining accurate linear attenuation correction (LAC) factors for the lung remains difficult in PET/MRI. LACs depend on electron density and in the lung, these vary significantly both within an individual and from person to person. Current commercial practice is to use a single‐valued population‐based lung LAC, and better estimation is needed to improve quantification. Given the under‐appreciation of lung attenuation estimation as an issue, the inaccuracy of PET quantification due to the use of single‐valued lung LACs, the unique challenges of lung estimation, and the emerging status of PET/MRI scanners in lung disease, a review is timely. This paper highlights past and present methods, categorizing them into segmentation, atlas/mapping, and emission‐based schemes. Potential strategies for future developments are also presented.
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Affiliation(s)
- Joseph Lillington
- Centre for Medical Imaging, University College London, London, W1W 7TS, UK
| | - Ludovica Brusaferri
- Institute of Nuclear Medicine, University College London, London, NW1 2BU, UK
| | - Kerstin Kläser
- Centre for Medical Image Computing, University College London, London, WC1E 7JE, UK
| | - Karin Shmueli
- Magnetic Resonance Imaging Group, Department of Medical Physics & Biomedical Engineering, University College London, London, WC1E 6BT, UK
| | - Radhouene Neji
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, GU16 8QD, UK
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London, London, NW1 2BU, UK
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London, London, NW1 2BU, UK
| | - Simon Arridge
- Centre for Medical Image Computing, University College London, London, WC1E 7JE, UK
| | - Manuel Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Kris Thielemans
- Institute of Nuclear Medicine, University College London, London, NW1 2BU, UK
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, W1W 7TS, UK
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Willmering MM, Robison RK, Wang H, Pipe JG, Woods JC. Implementation of the FLORET UTE sequence for lung imaging. Magn Reson Med 2019; 82:1091-1100. [PMID: 31081961 PMCID: PMC6559861 DOI: 10.1002/mrm.27800] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/21/2019] [Accepted: 04/15/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Magnetic resonance imaging of lungs is inherently challenging, but it has become more common with the use of UTE sequences and their relative insensitivity to motion. Spiral UTE sequences have been touted recently as having greater k-space sampling efficiencies than radial UTE, but few are designed for the shorter T2 * of the lung. In this study, FLORET (Fermat looped, orthogonally encoded trajectories), a recently developed spiral 3D-UTE sequence designed for the short T2 * species, was implemented in human lungs for the first time and the images were compared with traditional radial UTE images. METHODS The FLORET sequence was implemented with parameters optimized for lung imaging on healthy and diseased (cystic fibrosis) subjects. On healthy subjects, radial UTE images (3D-radial and 2D-radial with phase encoding) were acquired for comparison to FLORET. Various metrics including SNR, vasculature contrast, diaphragm sharpness, and parenchymal density ratios were acquired and compared among the separate UTE sequences. RESULTS The FLORET sequence performed similarly to traditional radial UTE methods with a much shorter total scan time for fully sampled images (FLORET: 1 minute 55 seconds, 3D-radial: 3 minutes 25 seconds, 2D-radial with phase encoding: 7 minutes 22 seconds). Additionally, the FLORET image obtained on the cystic fibrosis subject resulted in the observation of cystic fibrosis lung pathology similar or superior to that of the other UTE-MRI techniques. CONCLUSION The FLORET sequence allows for faster acquisition of high diagnostic-quality lung images and its short T2 * components without sacrificing SNR, image quality, or tissue/disease quantification.
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Affiliation(s)
- Matthew M. Willmering
- Center for Pulmonary Imaging Research, Divisions of Pulmonary Medicine and Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Ryan K. Robison
- Department of Radiology, Phoenix Children’s Hospital, Phoenix, AZ, 85016, USA
| | - Hui Wang
- Center for Pulmonary Imaging Research, Divisions of Pulmonary Medicine and Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45229, USA
- Clinical Science, Philips Healthcare, Gainesville, FL, 32608, USA
| | - James G. Pipe
- Imaging Research, Barrow Neurological Institute, Phoenix, AZ, 85013, USA
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, Divisions of Pulmonary Medicine and Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45229, USA
- Departments of Pediatrics, Radiology, and Physics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
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An Exploratory Radiomics Approach to Quantifying Pulmonary Function in CT Images. Sci Rep 2019; 9:11509. [PMID: 31395937 PMCID: PMC6687824 DOI: 10.1038/s41598-019-48023-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/26/2019] [Indexed: 01/04/2023] Open
Abstract
Contemporary medical imaging is becoming increasingly more quantitative. The emerging field of radiomics is a leading example. By translating unstructured data (i.e., images) into structured data (i.e., imaging features), radiomics can potentially characterize clinically useful imaging phenotypes. In this paper, an exploratory radiomics approach is used to investigate the potential association between quantitative imaging features and pulmonary function in CT images. Thirty-nine radiomic features were extracted from the lungs of 64 patients as potential imaging biomarkers for pulmonary function. Collectively, these features capture the morphology of the lungs, as well as intensity variations, fine-texture, and coarse-texture of the pulmonary tissue. The extracted lung radiomics data was compared to conventional pulmonary function tests. In general, patients with larger lungs of homogeneous, low attenuating pulmonary tissue (as measured via radiomics) were found to be associated with poor spirometry performance and a lower diffusing capacity for carbon monoxide. Unsupervised dynamic data clustering revealed subsets of patients with similar lung radiomic patterns that were found to be associated with similar forced expiratory volume in one second (FEV1) measurements. This implies that patients with similar radiomic feature vectors also presented with comparable spirometry performance, and were separable by varying degrees of pulmonary function as measured by imaging.
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31
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Objectively Measured Chronic Lung Injury on Chest CT. Chest 2019; 156:1149-1159. [PMID: 31233744 DOI: 10.1016/j.chest.2019.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/20/2019] [Accepted: 05/27/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Tobacco smoke exposure is associated with emphysema and pulmonary fibrosis, both of which are irreversible. We have developed a new objective CT analysis tool that combines densitometry with machine learning to detect high attenuation changes in visually normal appearing lung (NormHA) that may precede these diseases. METHODS We trained the classification tool by placing 34,528 training points in chest CT scans from 297 COPDGene participants. The tool was then used to classify lung tissue in 9,038 participants as normal, emphysema, fibrotic/interstitial, or NormHA. Associations between the quartile of NormHA and plasma-based biomarkers, clinical severity, and mortality were evaluated using Jonckheere-Terpstra, pairwise Wilcoxon rank-sum tests, and multivariable linear and Cox regression. RESULTS A higher percentage of lung occupied by NormHA was associated with higher C-reactive protein and intercellular adhesion molecule 1 (P for trend for both < .001). In analyses adjusted for multiple covariates, including high and low attenuation area, compared with those in the lowest quartile of NormHA, those in the highest quartile had a 6.50 absolute percent lower percent predicted lower FEV1 (P < .001), an 8.48 absolute percent lower percent predicted forced expiratory volume, a 10.78-meter shorter 6-min walk distance (P = .011), and a 56% higher risk of death (P = .003). These findings were present even in those individuals without visually defined interstitial lung abnormalities. CONCLUSIONS A new class of NormHA on CT may represent a unique tissue class associated with adverse outcomes, independent of emphysema and fibrosis.
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Malherbe ST, Dupont P, Kant I, Ahlers P, Kriel M, Loxton AG, Chen RY, Via LE, Thienemann F, Wilkinson RJ, Barry CE, Griffith-Richards S, Ellman A, Ronacher K, Winter J, Walzl G, Warwick JM. A semi-automatic technique to quantify complex tuberculous lung lesions on 18F-fluorodeoxyglucose positron emission tomography/computerised tomography images. EJNMMI Res 2018; 8:55. [PMID: 29943161 PMCID: PMC6020088 DOI: 10.1186/s13550-018-0411-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/08/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a growing interest in the use of 18F-FDG PET-CT to monitor tuberculosis (TB) treatment response. However, TB causes complex and widespread pathology, which is challenging to segment and quantify in a reproducible manner. To address this, we developed a technique to standardise uptake (Z-score), segment and quantify tuberculous lung lesions on PET and CT concurrently, in order to track changes over time. We used open source tools and created a MATLAB script. The technique was optimised on a training set of five pulmonary tuberculosis (PTB) cases after standard TB therapy and 15 control patients with lesion-free lungs. RESULTS We compared the proposed method to a fixed threshold (SUV > 1) and manual segmentation by two readers and piloted the technique successfully on scans of five control patients and five PTB cases (four cured and one failed treatment case), at diagnosis and after 1 and 6 months of treatment. There was a better correlation between the Z-score-based segmentation and manual segmentation than SUV > 1 and manual segmentation in terms of overall spatial overlap (measured in Dice similarity coefficient) and specificity (1 minus false positive volume fraction). However, SUV > 1 segmentation appeared more sensitive. Both the Z-score and SUV > 1 showed very low variability when measuring change over time. In addition, total glycolytic activity, calculated using segmentation by Z-score and lesion-to-background ratio, correlated well with traditional total glycolytic activity calculations. The technique quantified various PET and CT parameters, including the total glycolytic activity index, metabolic lesion volume, lesion volumes at different CT densities and combined PET and CT parameters. The quantified metrics showed a marked decrease in the cured cases, with changes already apparent at month one, but remained largely unchanged in the failed treatment case. CONCLUSIONS Our technique is promising to segment and quantify the lung scans of pulmonary tuberculosis patients in a semi-automatic manner, appropriate for measuring treatment response. Further validation is required in larger cohorts.
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Affiliation(s)
- Stephanus T. Malherbe
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Patrick Dupont
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, Belgium
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ilse Kant
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Petri Ahlers
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Magdalena Kriel
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - André G. Loxton
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ray Y. Chen
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | - Laura E. Via
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Observatory, 7925 Republic of South Africa
| | - Friedrich Thienemann
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Observatory, 7925 Republic of South Africa
- Department of Medicine, Faculty of Health Science, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Robert J. Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Observatory, 7925 Republic of South Africa
- Department of Medicine, Faculty of Health Science, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- The Francis Crick Institute, Midland Road, London, NW1 2AT UK
- Department of Medicine, Imperial College London, London, W2 1PG UK
| | - Clifton E. Barry
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Observatory, 7925 Republic of South Africa
| | - Stephanie Griffith-Richards
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annare Ellman
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Katharina Ronacher
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Translational Research Institute, Mater Research Institute – The University of Queensland, Brisbane, QLD Australia
| | - Jill Winter
- Catalysis Foundation for Health, Emeryville, CA USA
| | - Gerhard Walzl
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James M. Warwick
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Aaltonen HL, Kindvall SS, Jakobsson JK, Löndahl J, Olsson LE, Diaz S, Zackrisson S, Wollmer P. Airspace Dimension Assessment with nanoparticles reflects lung density as quantified by MRI. Int J Nanomedicine 2018; 13:2989-2995. [PMID: 29861632 PMCID: PMC5968779 DOI: 10.2147/ijn.s160331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Airspace Dimension Assessment with inhaled nanoparticles is a novel method to determine distal airway morphology. This is the first empirical study using Airspace Dimension Assessment with nanoparticles (AiDA) to estimate distal airspace radius. The technology is relatively simple and potentially accessible in clinical outpatient settings. Method Nineteen never-smoking volunteers performed nanoparticle inhalation tests at multiple breath-hold times, and the difference in nanoparticle concentration of inhaled and exhaled gas was measured. An exponential decay curve was fitted to the concentration of recovered nanoparticles, and airspace dimensions were assessed from the half-life of the decay. Pulmonary tissue density was measured using magnetic resonance imaging (MRI). Results The distal airspace radius measured by AiDA correlated with lung tissue density as measured by MRI (ρ = −0.584; p = 0.0086). The linear intercept of the logarithm of the exponential decay curve correlated with forced expiratory volume in one second (FEV1) (ρ = 0.549; p = 0.0149). Conclusion The AiDA method shows potential to be developed into a tool to assess conditions involving changes in distal airways, eg, emphysema. The intercept may reflect airway properties; this finding should be further investigated.
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Affiliation(s)
- H Laura Aaltonen
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Simon S Kindvall
- Department of Medical Radiation Physics, Lund University, Malmö, Sweden
| | | | - Jakob Löndahl
- Department of Design Sciences, Lund University, Lund, Sweden
| | - Lars E Olsson
- Department of Medical Radiation Physics, Lund University, Malmö, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Sandra Diaz
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sophia Zackrisson
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Per Wollmer
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
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The neutrophil-mobilizing cytokine interleukin-26 in the airways of long-term tobacco smokers. Clin Sci (Lond) 2018; 132:959-983. [PMID: 29780024 PMCID: PMC6365630 DOI: 10.1042/cs20180057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 02/08/2023]
Abstract
Long-term tobacco smokers with chronic obstructive pulmonary disease (COPD) or chronic bronchitis display an excessive accumulation of neutrophils in the airways; an inflammation that responds poorly to established therapy. Thus, there is a need to identify new molecular targets for the development of effective therapy. Here, we hypothesized that the neutrophil-mobilizing cytokine interleukin (IL)-26 (IL-26) is involved in airway inflammation amongst long-term tobacco smokers with or without COPD, chronic bronchitis or colonization by pathogenic bacteria. By analyzing bronchoalveolar lavage (BAL), bronchail wash (BW) and induced sputum (IS) samples, we found increased extracellular IL-26 protein in the airways of long-term smokers in vivo without further increase amongst those with clinically stable COPD. In human alveolar macrophages (AM) in vitro, the exposure to water-soluble tobacco smoke components (WTC) enhanced IL-26 gene and protein. In this cell model, the same exposure increased gene expression of the IL-26 receptor complex (IL10R2 and IL20R1) and nuclear factor κ B (NF-κB); a proven regulator of IL-26 production. In the same cell model, recombinant human IL-26 in vitro caused a concentration-dependent increase in the gene expression of NF-κB and several pro-inflammatory cytokines. In the long-term smokers, we also observed that extracellular IL-26 protein in BAL samples correlates with measures of lung function, tobacco load, and several markers of neutrophil accumulation. Extracellular IL-26 was further increased in long-term smokers with exacerbations of COPD (IS samples), with chronic bronchitis (BAL samples ) or with colonization by pathogenic bacteria (IS and BW samples). Thus, IL-26 in the airways emerges as a promising target for improving the understanding of the pathogenic mechanisms behind several pulmonary morbidities in long-term tobacco smokers.
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Li CX, Wheelock CE, Sköld CM, Wheelock ÅM. Integration of multi-omics datasets enables molecular classification of COPD. Eur Respir J 2018; 51:13993003.01930-2017. [PMID: 29545283 DOI: 10.1183/13993003.01930-2017] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/08/2018] [Indexed: 01/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is an umbrella diagnosis caused by a multitude of underlying mechanisms, and molecular sub-phenotyping is needed to develop molecular diagnostic/prognostic tools and efficacious treatments.The objective of these studies was to investigate whether multi-omics integration improves the accuracy of molecular classification of COPD in small cohorts.Nine omics data blocks (comprising mRNA, micro RNA, proteomes and metabolomes) collected from several anatomical locations from 52 female subjects were integrated by similarity network fusion (SNF). Multi-omics integration significantly improved the accuracy of group classification of COPD patients from healthy never-smokers and from smokers with normal spirometry, reducing required group sizes from n=30 to n=6 at 95% power. Seven different combinations of four to seven omics platforms achieved >95% accuracy.For the first time, a quantitative relationship between multi-omics data integration and accuracy of data-driven classification power has been demonstrated across nine omics data blocks. Integrating five to seven omics data blocks enabled 100% correct classification of COPD diagnosis with groups as small as n=6 individuals, despite strong confounding effects of current smoking. These results can serve as guidelines for the design of future systems-based multi-omics investigations, with indications that integrating five to six data blocks from several molecular levels and anatomical locations suffices to facilitate unsupervised molecular classification in small cohorts.
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Affiliation(s)
- Chuan-Xing Li
- Respiratory Medicine Unit, Dept of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Craig E Wheelock
- Integrative Molecular Phenotyping Laboratory, Division of Physiological Chemistry II, Dept of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - C Magnus Sköld
- Respiratory Medicine Unit, Dept of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Lung-Allergy Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa M Wheelock
- Respiratory Medicine Unit, Dept of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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36
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Long-term smoking alters abundance of over half of the proteome in bronchoalveolar lavage cell in smokers with normal spirometry, with effects on molecular pathways associated with COPD. Respir Res 2018. [PMID: 29514648 PMCID: PMC5842534 DOI: 10.1186/s12931-017-0695-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Smoking represents a significant risk factor for many chronic inflammatory diseases, including chronic obstructive pulmonary disease (COPD). Methods To identify dysregulation of specific proteins and pathways in bronchoalveolar lavage (BAL) cells associated with smoking, isobaric tags for relative and absolute quantitation (iTRAQ)-based shotgun proteomics analyses were performed on BAL cells from healthy never-smokers and smokers with normal lung function from the Karolinska COSMIC cohort. Multivariate statistical modeling, multivariate correlations with clinical data, and pathway enrichment analysis were performed. Results Smoking exerted a significant impact on the BAL cell proteome, with more than 500 proteins representing 15 molecular pathways altered due to smoking. The majority of these alterations occurred in a gender-independent manner. The phagosomal- and leukocyte trans endothelial migration (LTM) pathways significantly correlated with FEV1/FVC as well as the percentage of CD8+ T-cells and CD8+CD69+ T-cells in smokers. The correlations to clinical parameters in healthy never-smokers were minor. Conclusion The significant correlations of proteins in the phagosome- and LTM pathways with activated cytotoxic T-cells (CD69+) and the level of airway obstruction (FEV1/FVC) in smokers, both hallmarks of COPD, suggests that these two pathways may play a role in the molecular events preceding the development of COPD in susceptible smokers. Both pathways were found to be further dysregulated in COPD patients from the same cohort, thereby providing further support to this hypothesis. Given that not all smokers develop COPD in spite of decades of smoking, it is also plausible that some of the molecular pathways associated with response to smoking exert protective mechanisms to smoking-related pathologies in resilient individuals. Trial registration ClinicalTrials.gov identifier NCT02627872; Retrospectively registered on December 9, 2015. Electronic supplementary material The online version of this article (10.1186/s12931-017-0695-6) contains supplementary material, which is available to authorized users.
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Yang M, Kohler M, Heyder T, Forsslund H, Garberg HK, Karimi R, Grunewald J, Berven FS, Nyrén S, Magnus Sköld C, Wheelock ÅM. Proteomic profiling of lung immune cells reveals dysregulation of phagocytotic pathways in female-dominated molecular COPD phenotype. Respir Res 2018. [PMID: 29514663 PMCID: PMC5842633 DOI: 10.1186/s12931-017-0699-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Smoking is the main risk factor for chronic obstructive pulmonary disease (COPD). Women with COPD who smoke experienced a higher risk of hospitalization and worse decline of lung function. Yet the mechanisms of these gender-related differences in clinical presentations in COPD remain unknown. The aim of our study is to identify proteins and molecular pathways associated with COPD pathogenesis, with emphasis on elucidating molecular gender difference. Method We employed shotgun isobaric tags for relative and absolute quantitation (iTRAQ) proteome analyses of bronchoalveolar lavage (BAL) cells from smokers with normal lung function (n = 25) and early stage COPD patients (n = 18). Multivariate modeling, pathway enrichment analysis, and correlation with clinical characteristics were performed to identify specific proteins and pathways of interest. Results More pronounced alterations both at the protein- and pathway- levels were observed in female COPD patients, involving dysregulation of the FcγR-mediated phagocytosis-lysosomal axis and increase in oxidative stress. Alterations in pathways of the phagocytosis-lysosomal axis associated with a female-dominated COPD phenotype correlated well with specific clinical features: FcγR-mediated phagocytosis correlated with FEV1/FVC, the lysosomal pathway correlated with CT < −950 Hounsfield Units (HU), and regulation of actin cytoskeleton correlated with FEV1 and FEV1/FVC in female COPD patients. Alterations observed in the corresponding male cohort were minor. Conclusion The identified molecular pathways suggest dysregulation of several phagocytosis-related pathways in BAL cells in female COPD patients, with correlation to both the level of obstruction (FEV1/FVC) and disease severity (FEV1) as well as emphysema (CT < −950 HU) in women. Trial registration No.: NCT02627872, retrospectively registered on December 9, 2015. Electronic supplementary material The online version of this article (10.1186/s12931-017-0699-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mingxing Yang
- Respiratory Medicine Unit, Department of Medicine Solna & Center for Molecular Medicine, Karolinska Institutet, Lung Research Lab L4:01, SE-171 76, Stockholm, Sweden.
| | - Maxie Kohler
- Respiratory Medicine Unit, Department of Medicine Solna & Center for Molecular Medicine, Karolinska Institutet, Lung Research Lab L4:01, SE-171 76, Stockholm, Sweden
| | - Tina Heyder
- Respiratory Medicine Unit, Department of Medicine Solna & Center for Molecular Medicine, Karolinska Institutet, Lung Research Lab L4:01, SE-171 76, Stockholm, Sweden
| | - Helena Forsslund
- Respiratory Medicine Unit, Department of Medicine Solna & Center for Molecular Medicine, Karolinska Institutet, Lung Research Lab L4:01, SE-171 76, Stockholm, Sweden
| | - Hilde K Garberg
- Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Reza Karimi
- Respiratory Medicine Unit, Department of Medicine Solna & Center for Molecular Medicine, Karolinska Institutet, Lung Research Lab L4:01, SE-171 76, Stockholm, Sweden
| | - Johan Grunewald
- Respiratory Medicine Unit, Department of Medicine Solna & Center for Molecular Medicine, Karolinska Institutet, Lung Research Lab L4:01, SE-171 76, Stockholm, Sweden
| | - Frode S Berven
- Proteomics Unit (PROBE), Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Sven Nyrén
- Department of Molecular Medicine and Surgery, Division of Radiology, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - C Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna & Center for Molecular Medicine, Karolinska Institutet, Lung Research Lab L4:01, SE-171 76, Stockholm, Sweden
| | - Åsa M Wheelock
- Respiratory Medicine Unit, Department of Medicine Solna & Center for Molecular Medicine, Karolinska Institutet, Lung Research Lab L4:01, SE-171 76, Stockholm, Sweden.
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Dittmann H, Kopp D, Kupferschlaeger J, Feil D, Groezinger G, Syha R, Weissinger M, la Fougère C. A Prospective Study of Quantitative SPECT/CT for Evaluation of Lung Shunt Fraction Before SIRT of Liver Tumors. J Nucl Med 2018; 59:1366-1372. [DOI: 10.2967/jnumed.117.205203] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/05/2018] [Indexed: 12/26/2022] Open
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Meyerholz DK, Sieren JC, Beck AP, Flaherty HA. Approaches to Evaluate Lung Inflammation in Translational Research. Vet Pathol 2017; 55:42-52. [PMID: 28812529 DOI: 10.1177/0300985817726117] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammation is a common feature in several types of lung disease and is a frequent end point to validate lung disease models, evaluate genetic or environmental impact on disease severity, or test the efficacy of new therapies. Questions relevant to a study should be defined during experimental design and techniques selected to specifically address these scientific queries. In this review, the authors focus primarily on the breadth of techniques to evaluate lung inflammation that have both clinical and preclinical applications. Stratification of approaches to assess lung inflammation can diminish weaknesses inherent to each technique, provide data validation, and increase the reproducibility of a study. Specialized techniques (eg, imaging, pathology) often require experienced personnel to collect, evaluate, and interpret the data; these experts should be active contributors to the research team through reporting of the data. Scoring of tissue lesions is a useful method to transform observational pathologic data into semiquantitative or quantitative data for statistical analysis and enhanced rigor. Each technique to evaluate lung inflammation has advantages and limitations; understanding these parameters can help identify approaches that best complement one another to increase the rigor and translational significance of data.
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Affiliation(s)
- David K Meyerholz
- 1 Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jessica C Sieren
- 2 Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,3 Department of Biomedical Engineering, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Amanda P Beck
- 4 Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Heather A Flaherty
- 5 Department of Veterinary Pathology, Iowa State University, Ames, IA, USA
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Naz S, Kolmert J, Yang M, Reinke SN, Kamleh MA, Snowden S, Heyder T, Levänen B, Erle DJ, Sköld CM, Wheelock ÅM, Wheelock CE. Metabolomics analysis identifies sex-associated metabotypes of oxidative stress and the autotaxin-lysoPA axis in COPD. Eur Respir J 2017. [PMID: 28642310 PMCID: PMC5898938 DOI: 10.1183/13993003.02322-2016] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease and a leading cause of mortality and morbidity worldwide. The aim of this study was to investigate the sex dependency of circulating metabolic profiles in COPD. Serum from healthy never-smokers (healthy), smokers with normal lung function (smokers), and smokers with COPD (COPD; Global Initiative for Chronic Obstructive Lung Disease stages I–II/A–B) from the Karolinska COSMIC cohort (n=116) was analysed using our nontargeted liquid chromatography–high resolution mass spectrometry metabolomics platform. Pathway analyses revealed that several altered metabolites are involved in oxidative stress. Supervised multivariate modelling showed significant classification of smokers from COPD (p=2.8×10−7). Sex stratification indicated that the separation was driven by females (p=2.4×10−7) relative to males (p=4.0×10−4). Significantly altered metabolites were confirmed quantitatively using targeted metabolomics. Multivariate modelling of targeted metabolomics data confirmed enhanced metabolic dysregulation in females with COPD (p=3.0×10−3) relative to males (p=0.10). The autotaxin products lysoPA (16:0) and lysoPA (18:2) correlated with lung function (forced expiratory volume in 1 s) in males with COPD (r=0.86; p<0.0001), but not females (r=0.44; p=0.15), potentially related to observed dysregulation of the miR-29 family in the lung. These findings highlight the role of oxidative stress in COPD, and suggest that sex-enhanced dysregulation in oxidative stress, and potentially the autotaxin–lysoPA axis, are associated with disease mechanisms and/or prevalence. Oxidative stress and the autotaxin–lysoPA axis evidence sex-associated metabotypes in the serum of COPD patientshttp://ow.ly/kAeE309MpdI
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Affiliation(s)
- Shama Naz
- Division of Physiological Chemistry 2, Dept of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Kolmert
- Division of Physiological Chemistry 2, Dept of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden.,Division of Experimental Asthma and Allergy Research, Institute of Environmental Medicine, Karolinska Instituet, Stockholm, Sweden
| | - Mingxing Yang
- Respiratory Medicine Unit, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stacey N Reinke
- Division of Physiological Chemistry 2, Dept of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Muhammad Anas Kamleh
- Division of Physiological Chemistry 2, Dept of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Stuart Snowden
- Division of Physiological Chemistry 2, Dept of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Tina Heyder
- Respiratory Medicine Unit, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bettina Levänen
- Respiratory Medicine Unit, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - David J Erle
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine and Lung Biology Center, University of California San Francisco, San Francisco, CA, USA
| | - C Magnus Sköld
- Respiratory Medicine Unit, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Åsa M Wheelock
- Respiratory Medicine Unit, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Both authors contributed equally
| | - Craig E Wheelock
- Division of Physiological Chemistry 2, Dept of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden .,Both authors contributed equally
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Copot D, De Keyser R, Derom E, Ionescu C. Structural changes in the COPD lung and related heterogeneity. PLoS One 2017; 12:e0177969. [PMID: 28542377 PMCID: PMC5444650 DOI: 10.1371/journal.pone.0177969] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/06/2017] [Indexed: 11/25/2022] Open
Abstract
This paper proposes a mathematical framework for understanding how the structural changes in the COPD lung reflect in model parameters. The core of the analysis is a correlation between the heterogeneity in the lung as COPD degree changes (GOLD II, III and IV) and the nonlinearity index evaluated using the forced oscillation technique. A low frequency evaluation of respiratory impedance models and nonlinearity degree is performed since changes in tissue mechanics are related to viscoelastic properties. Simulation analysis of our model indicates a good correlation to expected changes in heterogeneity and nonlinear effects. A total of 43 COPD diagnosed patients are evaluated, distributed as GOLD II (18), GOLD III (15) and GOLD IV (10). Experimental data supports the claims and indicate that the proposed model and index for nonlinearity is well-suited to capture COPD structural changes.
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Affiliation(s)
- Dana Copot
- Department of Electrical energy, Systems and Automation, Ghent University, Technologiepark 914, 9052, Ghent, Belgium
- * E-mail:
| | - Robin De Keyser
- Department of Electrical energy, Systems and Automation, Ghent University, Technologiepark 914, 9052, Ghent, Belgium
| | - Eric Derom
- Ghent University Hospital, Department of Respiratory Diseases, De Pintelaan 185, 7K12, 9000, Ghent, Belgium
| | - Clara Ionescu
- Department of Electrical energy, Systems and Automation, Ghent University, Technologiepark 914, 9052, Ghent, Belgium
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Washko GR, Kinney GL, Ross JC, San José Estépar R, Han MK, Dransfield MT, Kim V, Hatabu H, Come CE, Bowler RP, Silverman EK, Crapo J, Lynch DA, Hokanson J, Diaz AA. Lung Mass in Smokers. Acad Radiol 2017; 24:386-392. [PMID: 27940230 DOI: 10.1016/j.acra.2016.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 01/21/2023]
Abstract
RATIONALE AND OBJECTIVE Emphysema is characterized by airspace dilation, inflammation, and irregular deposition of elastin and collagen in the interstitium. Computed tomographic studies have reported that lung mass (LM) may be increased in smokers, a finding attributed to inflammatory and parenchymal remodeling processes observed on histopathology. We sought to examine the epidemiologic and clinical associations of LM in smokers. MATERIALS AND METHODS Baseline epidemiologic, clinical, and computed tomography (CT) data (n = 8156) from smokers enrolled into the COPDGene Study were analyzed. LM was calculated from the CT scan. Changes in lung function at 5 years' follow-up were available from 1623 subjects. Regression analysis was performed to assess for associations of LM with forced expiratory volume in 1 second (FEV1) and FEV1 decline. RESULTS Subjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 chronic obstructive pulmonary disease had greater LM than either smokers with normal lung function or those with GOLD 2-4 chronic obstructive pulmonary disease (P < 0.001 for both comparisons). LM was predictive of the rate of the decline in FEV1 (decline per 100 g, -4.7 ± 1.7 mL/y, P = 0.006). CONCLUSIONS Our cross-sectional data suggest the presence of a biphasic radiological remodeling process in smokers: the presence of such nonlinearity must be accounted for in longitudinal computed tomographic studies. Baseline LM predicts the decline in lung function.
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Affiliation(s)
- George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, Colorado
| | - James C Ross
- Surgical Planning Laboratory, Laboratory of Mathematics in Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Raúl San José Estépar
- Surgical Planning Laboratory, Laboratory of Mathematics in Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - MeiLan K Han
- Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan
| | - Mark T Dransfield
- Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Victor Kim
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carolyn E Come
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Russell P Bowler
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colorado
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Crapo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colorado
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, Colorado
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.
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Karimi R, Tornling G, Forsslund H, Mikko M, Wheelock ÅM, Nyrén S, Sköld CM. Differences in regional air trapping in current smokers with normal spirometry. Eur Respir J 2017; 49:49/1/1600345. [DOI: 10.1183/13993003.00345-2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/13/2016] [Indexed: 12/20/2022]
Abstract
We investigated regional air trapping on computed tomography in current smokers with normal spirometry. It was hypothesised that presence of regional air trapping may indicate a specific manifestation of smoking-related changes.40 current smokers, 40 patients with chronic obstructive pulmonary disease (COPD), and 40 healthy never- smokers underwent computed tomography scans. Regional air trapping was assessed on end-expiratory scans and emphysema, micronodules and bronchial wall thickening on inspiratory scans. The ratio of expiratory and inspiratory mean lung attenuation (E/I) was calculated as a measure of static (fixed) air trapping.Regional air trapping was present in 63% of current smokers, in 45% of never smokers and in 8% of COPD patients (p<0.001). Current smokers with and without regional air trapping had E/I ratio of 0.81 and 0.91, respectively (p<0.001). Forced expiratory volume in 1 s (FEV1) was significantly higher and emphysema less frequent in current smokers with regional air trapping.Current smokers with regional air trapping had higher FEV1 and less emphysema on computed tomography. In contrast, current smokers without regional air trapping resembled COPD. Our results highlight heterogeneity among smokers with normal spirometry and may contribute to early detection of smoking related structural changes in the lungs.
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Forsslund H, Yang M, Mikko M, Karimi R, Nyrén S, Engvall B, Grunewald J, Merikallio H, Kaarteenaho R, Wahlström J, Wheelock ÅM, Sköld CM. Gender differences in the T-cell profiles of the airways in COPD patients associated with clinical phenotypes. Int J Chron Obstruct Pulmon Dis 2016; 12:35-48. [PMID: 28053515 PMCID: PMC5191844 DOI: 10.2147/copd.s113625] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
T lymphocytes are believed to play an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). How T cells are recruited to the lungs and contribute to the inflammatory process is largely unknown. COPD is a heterogeneous disease, and discriminating disease phenotypes based on distinct molecular and cellular pathways may provide new approaches for individualized diagnosis and therapies. Bronchoalveolar lavage (BAL) and blood samples were obtained from 40 never-smokers, 40 smokers with normal lung function, and 38 COPD patients. T-cell chemokine receptor expression was analyzed with flow cytometry, and soluble BAL cytokines and chemokines were measured using a cytokine multiplex assay. Correlations with gender and clinical characteristics including lung imaging were investigated using multivariate modeling. Th1/Tc1- and Th2/Tc2-associated soluble analytes and T-cell chemokine receptors were analyzed as cumulative Th1/Tc1 and Th2/Tc2 immune responses. A higher expression of chemokine receptor CCR5 on CD8+ T cells in BAL and higher percentage of CXCR3+CD8+ T cells in blood was found in female smokers with COPD compared to those without COPD. CCR5 expression on CD4+ and CD8+ T cells was lower in BAL from male smokers with COPD compared to those without COPD. Among female smokers with COPD, Th1/Tc1 immune response was linked to BAL macrophage numbers and goblet cell density, and Th2/Tc2 response was associated with the measures of emphysema on high-resolution computed tomography. The highly gender-dependent T-cell profile in COPD indicates different links between cellular events and clinical manifestations in females compared to males. Our findings may reveal mechanisms of importance for the difference in clinical course in female COPD patients compared to males.
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Affiliation(s)
- Helena Forsslund
- Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit
| | - Mingxing Yang
- Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit
| | - Mikael Mikko
- Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit
| | - Reza Karimi
- Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit
| | - Sven Nyrén
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Benita Engvall
- Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit
| | - Johan Grunewald
- Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit
| | - Heta Merikallio
- Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit; Respiratory Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Riitta Kaarteenaho
- Respiratory Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Unit of Medicine and Clinical Research, Pulmonary Division, University of Eastern Finland; Center for Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Jan Wahlström
- Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit
| | - Åsa M Wheelock
- Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit
| | - C Magnus Sköld
- Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit
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Lee JG, Park S, Bae CH, Jang WS, Lee SJ, Lee DN, Myung JK, Kim CH, Jin YW, Lee SS, Shim S. Development of a minipig model for lung injury induced by a single high-dose radiation exposure and evaluation with thoracic computed tomography. JOURNAL OF RADIATION RESEARCH 2016; 57:201-209. [PMID: 26712795 PMCID: PMC4915533 DOI: 10.1093/jrr/rrv088] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 06/05/2023]
Abstract
Radiation-induced lung injury (RILI) due to nuclear or radiological exposure remains difficult to treat because of insufficient clinical data. The goal of this study was to establish an appropriate and efficient minipig model and introduce a thoracic computed tomography (CT)-based method to measure the progression of RILI. Göttingen minipigs were allocated to control and irradiation groups. The most obvious changes in the CT images after irradiation were peribronchial opacification, interlobular septal thickening, and lung volume loss. Hounsfield units (HU) in the irradiation group reached a maximum level at 6 weeks and decreased thereafter, but remained higher than those of the control group. Both lung area and cardiac right lateral shift showed significant changes at 22 weeks post irradiation. The white blood cell (WBC) count, a marker of pneumonitis, increased and reached a maximum at 6 weeks in both peripheral blood and bronchial alveolar lavage fluid. Microscopic findings at 22 weeks post irradiation were characterized by widening of the interlobular septum, with dense fibrosis and an increase in the radiation dose-dependent fibrotic score. Our results also showed that WBC counts and microscopic findings were positively correlated with the three CT parameters. In conclusion, the minipig model can provide useful clinical data regarding RILI caused by the adverse effects of high-dose radiotherapy. Peribronchial opacification, interlobular septal thickening, and lung volume loss are three quantifiable CT parameters that can be used as a simple method for monitoring the progression of RILI.
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Affiliation(s)
- Jong-Geol Lee
- Laboratory of Radiation Exposure and Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 215-4, Gongneung-dong, Nowon-gu, Seoul, Republic of Korea
| | - Sunhoo Park
- Laboratory of Radiation Exposure and Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 215-4, Gongneung-dong, Nowon-gu, Seoul, Republic of Korea Department of Pathology, Korea Cancer Center Hospital, KIRAMS, Seoul, Republic of Korea
| | - Chang-Hwan Bae
- Laboratory of Radiation Exposure and Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 215-4, Gongneung-dong, Nowon-gu, Seoul, Republic of Korea
| | - Won-Suk Jang
- Laboratory of Radiation Exposure and Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 215-4, Gongneung-dong, Nowon-gu, Seoul, Republic of Korea
| | - Sun-Joo Lee
- Laboratory of Radiation Exposure and Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 215-4, Gongneung-dong, Nowon-gu, Seoul, Republic of Korea
| | - Dal Nim Lee
- Laboratory of Radiation Exposure and Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 215-4, Gongneung-dong, Nowon-gu, Seoul, Republic of Korea
| | - Jae Kyung Myung
- Department of Pathology, Korea Cancer Center Hospital, KIRAMS, Seoul, Republic of Korea
| | - Cheol Hyeon Kim
- Division of Pulmonology, Department of Internal Medicine, Korea Cancer Center Hospital, KIRAMS, Seoul, Republic of Korea
| | - Young-Woo Jin
- Laboratory of Radiation Exposure and Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 215-4, Gongneung-dong, Nowon-gu, Seoul, Republic of Korea
| | - Seung-Sook Lee
- Laboratory of Radiation Exposure and Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 215-4, Gongneung-dong, Nowon-gu, Seoul, Republic of Korea Department of Pathology, Korea Cancer Center Hospital, KIRAMS, Seoul, Republic of Korea
| | - Sehwan Shim
- Laboratory of Radiation Exposure and Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 215-4, Gongneung-dong, Nowon-gu, Seoul, Republic of Korea
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Ostridge K, Wilkinson TMA. Present and future utility of computed tomography scanning in the assessment and management of COPD. Eur Respir J 2016; 48:216-28. [PMID: 27230448 DOI: 10.1183/13993003.00041-2016] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/21/2016] [Indexed: 01/08/2023]
Abstract
Computed tomography (CT) is the modality of choice for imaging the thorax and lung structure. In chronic obstructive pulmonary disease (COPD), it used to recognise the key morphological features of emphysema, bronchial wall thickening and gas trapping. Despite this, its place in the investigation and management of COPD is yet to be determined, and it is not routinely recommended. However, lung CT already has important clinical applications where it can be used to diagnose concomitant pathology and determine which patients with severe emphysema are appropriate for lung volume reduction procedures. Furthermore, novel quantitative analysis techniques permit objective measurements of pulmonary and extrapulmonary manifestations of the disease. These techniques can give important insights into COPD, and help explore the heterogeneity and underlying mechanisms of the condition. In time, it is hoped that these techniques can be used in clinical trials to help develop disease-specific therapy and, ultimately, as a clinical tool in identifying patients who would benefit most from new and existing treatments. This review discusses the current clinical applications for CT imaging in COPD and quantification techniques, and its potential future role in stratifying disease for optimal outcome.
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Affiliation(s)
- Kristoffer Ostridge
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Tom M A Wilkinson
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
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47
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Yamashiro T, Moriya H, Tsubakimoto M, Matsuoka S, Murayama S. Continuous quantitative measurement of the proximal airway dimensions and lung density on four-dimensional dynamic-ventilation CT in smokers. Int J Chron Obstruct Pulmon Dis 2016; 11:755-64. [PMID: 27110108 PMCID: PMC4835141 DOI: 10.2147/copd.s100658] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Four-dimensional dynamic-ventilation computed tomography (CT) imaging demonstrates continuous movement of the airways and lungs, which cannot be depicted with conventional CT. We aimed to investigate continuous changes in lung density and airway dimensions and to assess the correlation with spirometric values in smokers. Materials and methods This retrospective study was approved by the Institutional Review Board, and informed consent was waived. Twenty-one smokers including six patients with COPD underwent four-dimensional dynamic-ventilation CT during free breathing (160 mm in length). The mean lung density (MLD) of the scanned lung and luminal areas (Ai) of fixed points in the trachea and the right proximal bronchi (main bronchus, upper bronchus, bronchus intermedius, and lower bronchus) were continuously measured. Concordance between the time curve of the MLD and that of the airway Ai values was expressed by cross-correlation coefficients. The associations between these quantitative measurements and the forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) values were assessed by Spearman’s rank correlation analysis. Results On the time curve for the MLD, the Δ-MLD1.05 values between the peak inspiratory frame to the later third frame (1.05 seconds later) were strongly correlated with the FEV1/FVC (ρ=0.76, P<0.0001). The cross-correlation coefficients between the airway Ai and MLD values were significantly correlated with the FEV1/FVC (ρ=−0.56 to −0.66, P<0.01), except for the right upper bronchus. This suggested that the synchrony between the airway and lung movement was lost in patients with severe airflow limitation. Conclusion Respiratory changes in the MLD and synchrony between the airway Ai and the MLD measured with dynamic-ventilation CT were correlated with patient’s spirometric values.
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Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima-shi, Fukushima, Japan
| | - Maho Tsubakimoto
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Shin Matsuoka
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
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Balgoma D, Yang M, Sjödin M, Snowden S, Karimi R, Levänen B, Merikallio H, Kaarteenaho R, Palmberg L, Larsson K, Erle DJ, Dahlén SE, Dahlén B, Sköld CM, Wheelock ÅM, Wheelock CE. Linoleic acid-derived lipid mediators increase in a female-dominated subphenotype of COPD. Eur Respir J 2016; 47:1645-56. [DOI: 10.1183/13993003.01080-2015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/13/2016] [Indexed: 12/11/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality; however, the role of inflammatory mediators in its pathobiology remains unclear. The aim of this study was to investigate the influence of gender in COPD on lipid mediator levels.Bronchoalveolar lavage fluid (BALF) and serum were obtained from healthy never-smokers, smokers and COPD patients (Global Initiative for Chronic Obstructive Lung Disease stage I–II/A–B) (n=114). 94 lipid mediators derived from the cytochrome-P450, lipoxygenase, and cyclooxygenase pathways were analysed by liquid chromatography-mass spectrometry.Multivariate modelling identified a 9-lipid panel in BALF that classified female smokers with COPD from healthy female smokers (p=6×10−6). No differences were observed for the corresponding male population (p=1.0). These findings were replicated in an independent cohort with 92% accuracy (p=0.005). The strongest drivers were the cytochrome P450-derived epoxide products of linoleic acid (leukotoxins) and their corresponding soluble epoxide hydrolase (sEH)-derived products (leukotoxin-diols). These species correlated with lung function (r=0.87; p=0.0009) and mRNA levels of enzymes putatively involved in their biosynthesis (r=0.96; p=0.003). Leukotoxin levels correlated with goblet cell abundance (r=0.72; p=0.028).These findings suggest a mechanism by which goblet cell-associated cytochrome-P450 and sEH activity produce elevated leukotoxin-diol levels, which play a putative role in the clinical manifestations of COPD in a female-dominated disease sub-phenotype.
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Abstract
Imaging of the lung is a mainstay of respiratory medicine. It provides local information about morphology and function of the lung parenchyma that is unchallenged by other noninvasive techniques. During the 2014 European Respiratory Society International Congress in Munich, Germany, a Clinical Year in Review session was held focusing on the latest developments in pulmonary imaging. This review summarises some of the main findings of peer-reviewed articles that were published in the 12-month period prior to the 2014 International Congress.
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Affiliation(s)
- Sebastian Ley
- Dept of Diagnostic and Interventional Radiology, Chirurgische Klinik Dr. Rinecker, Munich, Germany Dept of Clinical Radiology, Ludwig Maximilians University, Munich, Germany
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Mascalchi M. Pulmonary function tests and computed tomography lung attenuation in chronic obstructive pulmonary disease. J Thorac Dis 2015; 7:1882-4. [PMID: 26716024 DOI: 10.3978/j.issn.2072-1439.2015.11.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mario Mascalchi
- 1 Quantitative and Functional Radiology Research program at the Careggi and Meyer Children Hospitals of Florence, Italy ; 2 "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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