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D’Agnano V, Mariniello DF, Ruotolo M, Quarcio G, Moriello A, Conte S, Sorrentino A, Sanduzzi Zamparelli S, Bianco A, Perrotta F. Targeting Progression in Pulmonary Fibrosis: An Overview of Underlying Mechanisms, Molecular Biomarkers, and Therapeutic Intervention. Life (Basel) 2024; 14:229. [PMID: 38398739 PMCID: PMC10890660 DOI: 10.3390/life14020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Interstitial lung diseases comprise a heterogenous range of diffuse lung disorders, potentially resulting in pulmonary fibrosis. While idiopathic pulmonary fibrosis has been recognized as the paradigm of a progressive fibrosing interstitial lung disease, other conditions with a progressive fibrosing phenotype characterized by a significant deterioration of the lung function may lead to a burden of significant symptoms, a reduced quality of life, and increased mortality, despite treatment. There is now evidence indicating that some common underlying biological mechanisms can be shared among different chronic fibrosing disorders; therefore, different biomarkers for disease-activity monitoring and prognostic assessment are under evaluation. Thus, understanding the common pathways that induce the progression of pulmonary fibrosis, comprehending the diversity of these diseases, and identifying new molecular markers and potential therapeutic targets remain highly crucial assignments. The purpose of this review is to examine the main pathological mechanisms regulating the progression of fibrosis in interstitial lung diseases and to provide an overview of potential biomarker and therapeutic options for patients with progressive pulmonary fibrosis.
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Affiliation(s)
- Vito D’Agnano
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Domenica Francesca Mariniello
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Michela Ruotolo
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Gianluca Quarcio
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Alessandro Moriello
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Stefano Conte
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Antonio Sorrentino
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | | | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Fabio Perrotta
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
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Bankier AA, MacMahon H, Colby T, Gevenois PA, Goo JM, Leung AN, Lynch DA, Schaefer-Prokop CM, Tomiyama N, Travis WD, Verschakelen JA, White CS, Naidich DP. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2024; 310:e232558. [PMID: 38411514 PMCID: PMC10902601 DOI: 10.1148/radiol.232558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 02/28/2024]
Abstract
Members of the Fleischner Society have compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984, 1996, and 2008, respectively. The impetus to update the previous version arose from multiple considerations. These include an awareness that new terms and concepts have emerged, others have become obsolete, and the usage of some terms has either changed or become inconsistent to a degree that warranted a new definition. This latest glossary is focused on terms of clinical importance and on those whose meaning may be perceived as vague or ambiguous. As with previous versions, the aim of the present glossary is to establish standardization of terminology for thoracic radiology and, thereby, to facilitate communications between radiologists and clinicians. Moreover, the present glossary aims to contribute to a more stringent use of terminology, increasingly required for structured reporting and accurate searches in large databases. Compared with the previous version, the number of images (chest radiography and CT) in the current version has substantially increased. The authors hope that this will enhance its educational and practical value. All definitions and images are hyperlinked throughout the text. Click on each figure callout to view corresponding image. © RSNA, 2024 Supplemental material is available for this article. See also the editorials by Bhalla and Powell in this issue.
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Affiliation(s)
- Alexander A. Bankier
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Heber MacMahon
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Thomas Colby
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Pierre Alain Gevenois
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Jin Mo Goo
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Ann N.C. Leung
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - David A. Lynch
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Cornelia M. Schaefer-Prokop
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Noriyuki Tomiyama
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - William D. Travis
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Johny A. Verschakelen
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Charles S. White
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - David P. Naidich
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
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Lee KS, Han J, Wada N, Hata A, Lee HY, Yi C, Hino T, Doyle TJ, Franquet T, Hatabu H. Imaging of Pulmonary Fibrosis: An Update, From the AJR Special Series on Imaging of Fibrosis. AJR Am J Roentgenol 2024; 222:e2329119. [PMID: 37095673 DOI: 10.2214/ajr.23.29119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Pulmonary fibrosis is recognized as occurring in association with a wide and increasing array of conditions, and it presents with a spectrum of chest CT appearances. Idiopathic pulmonary fibrosis (IPF), which corresponds histologically with usual interstitial pneumonia and represents the most common idiopathic interstitial pneumonia, is a chronic progressive fibrotic interstitial lung disease (ILD) of unknown cause. Progressive pulmonary fibrosis (PPF) describes the radiologic development of pulmonary fibrosis in patients with ILD of a known or unknown cause other than IPF. The recognition of PPF impacts management of patients with ILD-for example, in guiding initiation of antifibrotic therapy. Interstitial lung abnormalities are an incidental CT finding in patients without suspected ILD and may represent an early intervenable form of pulmonary fibrosis. Traction bronchiectasis and/or bronchiolectasis, when detected in the setting of chronic fibrosis, is generally considered evidence of irreversible disease, and progression predicts worsening mortality risk. Awareness of the association between pulmonary fibrosis and connective tissue diseases, particularly rheumatoid arthritis, is increasing. This review provides an update on the imaging of pulmonary fibrosis, with attention given to recent advances in disease understanding with relevance to radiologic practice. The essential role of a multidisciplinary approach to clinical and radiologic data is highlighted.
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Affiliation(s)
- Kyung Soo Lee
- Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine, ChangWon, Republic of Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Noriaki Wada
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Akinori Hata
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - ChinA Yi
- Department of Radiology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Takuya Hino
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tracy J Doyle
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Tomas Franquet
- Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Hiroto Hatabu
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
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Batra K, Adams TN. Imaging Features of Idiopathic Interstitial Lung Diseases. J Thorac Imaging 2023; 38:S19-S29. [PMID: 37505195 DOI: 10.1097/rti.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Idiopathic interstitial pneumonias (IIPs) are a group of diffuse parenchymal lung diseases of unclear etiology and are distinguished from diffuse parenchymal lung diseases of known cause, such as connective tissue disease-related interstitial lung diseases or hypersensitivity pneumonitis by history, physical exam, imaging, serologic testing, and, when necessary, histopathology. The 2013 American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines are the most widely accepted classification of IIPs and include the following diagnoses: idiopathic pulmonary fibrosis, idiopathic nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, idiopathic lymphocytic interstitial pneumonia, idiopathic pleuro-parenchymal fibroelastosis, respiratory bronchiolitis-interstitial lung disease, and desquamative interstitial pneumonia. The gold standard for diagnosis of IIP involves multidisciplinary discussion among pulmonologists, radiologists, and pathologists. The focus of this review will be to discuss the imaging features of the most common IIPs and the role of multidisciplinary discussion as the gold standard for diagnosis.
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Affiliation(s)
| | - Traci N Adams
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Rajan SK, Cottin V, Dhar R, Danoff S, Flaherty KR, Brown KK, Mohan A, Renzoni E, Mohan M, Udwadia Z, Shenoy P, Currow D, Devraj A, Jankharia B, Kulshrestha R, Jones S, Ravaglia C, Quadrelli S, Iyer R, Dhooria S, Kolb M, Wells AU. Progressive pulmonary fibrosis: an expert group consensus statement. Eur Respir J 2023; 61:2103187. [PMID: 36517177 PMCID: PMC10060665 DOI: 10.1183/13993003.03187-2021] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
This expert group consensus statement emphasises the need for standardising the definition of progressive fibrosing interstitial lung diseases (F-ILDs), with an accurate initial diagnosis being of paramount importance in ensuring appropriate initial management. Equally, case-by-case decisions on monitoring and management are essential, given the varying presentations of F-ILDs and the varying rates of progression. The value of diagnostic tests in risk stratification at presentation and, separately, the importance of a logical monitoring strategy, tailored to manage the risk of progression, are also stressed. The term "progressive pulmonary fibrosis" (PPF) exactly describes the entity that clinicians often face in practice. The importance of using antifibrotic therapy early in PPF (once initial management has failed to prevent progression) is increasingly supported by evidence. Artificial intelligence software for high-resolution computed tomography analysis, although an exciting tool for the future, awaits validation. Guidance is provided on pulmonary rehabilitation, oxygen and the use of non-invasive ventilation focused specifically on the needs of ILD patients with progressive disease. PPF should be differentiated from acute deterioration due to drug-induced lung toxicity or other forms of acute exacerbations. Referral criteria for a lung transplant are discussed and applied to patient needs in severe diseases where transplantation is not realistic, either due to access limitations or transplantation contraindications. In conclusion, expert group consensus guidance is provided on the diagnosis, treatment and monitoring of F-ILDs with specific focus on the recognition of PPF and the management of pulmonary fibrosis progressing despite initial management.
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Affiliation(s)
- Sujeet K Rajan
- Bombay Hospital Institute of Medical Sciences and Bhatia Hospital, Mumbai, India
| | - Vincent Cottin
- National French Reference Coordinating Center for Rare Pulmonary Diseases, Louis Pradel Hospital Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INRAE, Member of ERN-LUNG, Lyon, France
| | | | - Sonye Danoff
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Anant Mohan
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Padmanabha Shenoy
- Department of Rheumatology, Centre for Arthritis and Rheumatism Excellence, Kochi, India
| | | | - Anand Devraj
- Department of Radiology, Royal Brompton Hospital, London, UK
| | | | - Ritu Kulshrestha
- Department of Pathology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Steve Jones
- European Idiopathic Pulmonary Fibrosis Federation (EU-IPFF), Peterborough, UK
| | - Claudia Ravaglia
- Pulmonology Unit, GB Morgagni Hospital/University of Bologna, Forlì, Italy
| | | | - Rajam Iyer
- Bhatia Hospital and PD Hinduja Hospital, Mumbai, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Martin Kolb
- Firestone Institute for Respiratory Heath, St Joseph's Healthcare and McMaster University, Hamilton, ON, Canada
- Co-senior authors
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Co-senior authors
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6
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Qin Z, Shi Y, Qiao J, Lin G, Tang B, Li X, Zhang J. CFD simulation of porous microsphere particles in the airways of pulmonary fibrosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107094. [PMID: 36087437 PMCID: PMC9436827 DOI: 10.1016/j.cmpb.2022.107094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Pulmonary fibrosis (PF) is a chronic progressive disease with an extremely high mortality rate and is a complication of COVID-19. Inhalable microspheres have been increasingly used in the treatment of lung diseases such as PF in recent years. Compared to the direct inhalation of drugs, a larger particle size is required to ensure the sustained release of microspheres. However, the clinical symptoms of PF may lead to the easier deposition of microspheres in the upper respiratory tract. Therefore, it is necessary to understand the effects of PF on the deposition of microspheres in the respiratory tract. METHODS In this study, airway models with different degrees of PF in humans and mice were established, and the transport and deposition of microspheres in the airway were simulated using computational fluid dynamics. RESULTS The simulation results showed that PF increases microsphere deposition in the upper respiratory tract and decreases bronchial deposition in both humans and mice. Porous microspheres with low density can ensure deposition in the lower respiratory tract and larger particle size. In healthy and PF humans, porous microspheres of 10 µm with densities of 700 and 400 kg/m³ were deposited most in the bronchi. Unlike in humans, microspheres larger than 4 µm are completely deposited in the upper respiratory tract of mice owing to their high inhalation velocity. For healthy and PF mice, microspheres of 6 µm with densities of and 100 kg/m³ are recommended. CONCLUSIONS The results showed that with the exacerbation of PF, it is more difficult for microsphere particles to deposit in the subsequent airway. In addition, there were significant differences in the deposition patterns among the different species. Therefore, it is necessary to process specific microspheres from different individuals. Our study can guide the processing of microspheres and achieve differentiated drug delivery in different subjects to maximize therapeutic effects.
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Affiliation(s)
- Zhilong Qin
- School of Mechanical Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China; Shandong Institute of Mechanical Design and Research, Jinan 250031, China
| | - Yanbin Shi
- School of Mechanical Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China; Shandong Institute of Mechanical Design and Research, Jinan 250031, China; School of Arts and Design, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China.
| | - Jinwei Qiao
- School of Mechanical Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China; Shandong Institute of Mechanical Design and Research, Jinan 250031, China
| | - Guimei Lin
- School of Pharmaceutical Science, Shandong University, Jinan 250012, China
| | - Bingtao Tang
- School of Mechanical Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China; Shandong Institute of Mechanical Design and Research, Jinan 250031, China
| | - Xuelin Li
- School of Arts and Design, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China
| | - Jing Zhang
- Key Laboratory of Modern Preparation of TCM, Jiangxi University of Chinese Medicine, Nanchang 330004, China
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7
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Current Imaging of Idiopathic Pulmonary Fibrosis. Radiol Clin North Am 2022; 60:873-888. [DOI: 10.1016/j.rcl.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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8
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Bekki A, Beauperthuy T, Martínez-García MÁ. Traction bronchiectasis: is it as benign as we think? J Bras Pneumol 2022; 48:e20220220. [PMID: 35894416 PMCID: PMC9496464 DOI: 10.36416/1806-3756/e20220220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Amina Bekki
- . Departamento de Neumología. Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Thais Beauperthuy
- . Departamento de Neumología. Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Miguel Ángel Martínez-García
- . Departamento de Neumología. Hospital Universitario y Politécnico La Fe, Valencia, España
- . Centro de Investigación Biomédica En Red de Enfermedades Respiratorias - CIBERES - Instituto de Salud Carlos III, Madrid, España
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9
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Raghu G, Remy-Jardin M, Richeldi L, Thomson CC, Inoue Y, Johkoh T, Kreuter M, Lynch DA, Maher TM, Martinez FJ, Molina-Molina M, Myers JL, Nicholson AG, Ryerson CJ, Strek ME, Troy LK, Wijsenbeek M, Mammen MJ, Hossain T, Bissell BD, Herman DD, Hon SM, Kheir F, Khor YH, Macrea M, Antoniou KM, Bouros D, Buendia-Roldan I, Caro F, Crestani B, Ho L, Morisset J, Olson AL, Podolanczuk A, Poletti V, Selman M, Ewing T, Jones S, Knight SL, Ghazipura M, Wilson KC. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2022; 205:e18-e47. [PMID: 35486072 PMCID: PMC9851481 DOI: 10.1164/rccm.202202-0399st] [Citation(s) in RCA: 839] [Impact Index Per Article: 419.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: This American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax guideline updates prior idiopathic pulmonary fibrosis (IPF) guidelines and addresses the progression of pulmonary fibrosis in patients with interstitial lung diseases (ILDs) other than IPF. Methods: A committee was composed of multidisciplinary experts in ILD, methodologists, and patient representatives. 1) Update of IPF: Radiological and histopathological criteria for IPF were updated by consensus. Questions about transbronchial lung cryobiopsy, genomic classifier testing, antacid medication, and antireflux surgery were informed by systematic reviews and answered with evidence-based recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 2) Progressive pulmonary fibrosis (PPF): PPF was defined, and then radiological and physiological criteria for PPF were determined by consensus. Questions about pirfenidone and nintedanib were informed by systematic reviews and answered with evidence-based recommendations using the GRADE approach. Results:1) Update of IPF: A conditional recommendation was made to regard transbronchial lung cryobiopsy as an acceptable alternative to surgical lung biopsy in centers with appropriate expertise. No recommendation was made for or against genomic classifier testing. Conditional recommendations were made against antacid medication and antireflux surgery for the treatment of IPF. 2) PPF: PPF was defined as at least two of three criteria (worsening symptoms, radiological progression, and physiological progression) occurring within the past year with no alternative explanation in a patient with an ILD other than IPF. A conditional recommendation was made for nintedanib, and additional research into pirfenidone was recommended. Conclusions: The conditional recommendations in this guideline are intended to provide the basis for rational, informed decisions by clinicians.
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10
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Chakraborty A, Mastalerz M, Ansari M, Schiller HB, Staab-Weijnitz CA. Emerging Roles of Airway Epithelial Cells in Idiopathic Pulmonary Fibrosis. Cells 2022; 11:cells11061050. [PMID: 35326501 PMCID: PMC8947093 DOI: 10.3390/cells11061050] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a fatal disease with incompletely understood aetiology and limited treatment options. Traditionally, IPF was believed to be mainly caused by repetitive injuries to the alveolar epithelium. Several recent lines of evidence, however, suggest that IPF equally involves an aberrant airway epithelial response, which contributes significantly to disease development and progression. In this review, based on recent clinical, high-resolution imaging, genetic, and single-cell RNA sequencing data, we summarize alterations in airway structure, function, and cell type composition in IPF. We furthermore give a comprehensive overview on the genetic and mechanistic evidence pointing towards an essential role of airway epithelial cells in IPF pathogenesis and describe potentially implicated aberrant epithelial signalling pathways and regulation mechanisms in this context. The collected evidence argues for the investigation of possible therapeutic avenues targeting these processes, which thus represent important future directions of research.
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11
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Ghio AJ, Pavlisko EN, Roggli VL, Todd NW, Sangani RG. Cigarette Smoke Particle-Induced Lung Injury and Iron Homeostasis. Int J Chron Obstruct Pulmon Dis 2022; 17:117-140. [PMID: 35046648 PMCID: PMC8763205 DOI: 10.2147/copd.s337354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
It is proposed that the mechanistic basis for non-neoplastic lung injury with cigarette smoking is a disruption of iron homeostasis in cells after exposure to cigarette smoke particle (CSP). Following the complexation and sequestration of intracellular iron by CSP, the host response (eg, inflammation, mucus production, and fibrosis) attempts to reverse a functional metal deficiency. Clinical manifestations of this response can present as respiratory bronchiolitis, desquamative interstitial pneumonitis, pulmonary Langerhans’ cell histiocytosis, asthma, pulmonary hypertension, chronic bronchitis, and pulmonary fibrosis. If the response is unsuccessful, the functional deficiency of iron progresses to irreversible cell death evident in emphysema and bronchiectasis. The subsequent clinical and pathological presentation is a continuum of lung injuries, which overlap and coexist with one another. Designating these non-neoplastic lung injuries after smoking as distinct disease processes fails to recognize shared relationships to each other and ultimately to CSP, as well as the common mechanistic pathway (ie, disruption of iron homeostasis).
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Affiliation(s)
- Andrew J Ghio
- Human Studies Facility, US Environmental Protection Agency, Chapel Hill, NC, 27514, USA
- Correspondence: Andrew J Ghio Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC, USA Email
| | | | | | - Nevins W Todd
- Department of Medicine, University of Maryland, Baltimore, MD, 21201, USA
| | - Rahul G Sangani
- Department of Medicine, West Virginia University, Morgantown, WV, USA
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12
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic pathological disorder that targets alveoli interstitial tissues and is characterized by the progressive stiffening of alveolar membrane. The median survival rate of the patients with IPF is less than 5 years. Currently, IPF has no cure and there are few options to alleviate the progress of this disease. A critical roadblock in developing new anti-fibrosis therapies is the absence of reliable cell based in vitro models that can recapitulate the progressive features of this disease. Here a novel fibrotic microtissue on a chip system is created to model the fibrotic transition of the lung interstitial tissue and the effect of anti-fibrosis drugs on such transitions. This system will not only help to expedite the efficacy analysis of anti-fibrotic therapies but also help to unveil their potential mode of action.
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13
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Ikezoe K, Hackett TL, Peterson S, Prins D, Hague CJ, Murphy D, LeDoux S, Chu F, Xu F, Cooper JD, Tanabe N, Ryerson CJ, Paré PD, Coxson HO, Colby TV, Hogg JC, Vasilescu DM. Small Airway Reduction and Fibrosis is an Early Pathologic Feature of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2021; 204:1048-1059. [PMID: 34343057 DOI: 10.1164/rccm.202103-0585oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE To improve disease outcomes in idiopathic pulmonary fibrosis (IPF) it is essential to understand its early pathophysiology so that it can be targeted therapeutically. OBJECTIVES Perform three-dimensional (3D) assessment of the IPF lung micro-structure using stereology and multi-resolution computed tomography (CT) imaging. METHODS Explanted lungs from IPF patients (n=8) and donor controls (n=8) were inflated with air and frozen. CT scans were used to assess large airways. Unbiased, systematic uniform random (SUR) samples (n=8/lung) were scanned with microCT for stereological assessment of small airways (number, airway wall and lumen area) and parenchymal fibrosis (volume fraction of tissue, alveolar surface area, and septal wall thickness). RESULTS The total number of airways on clinical CT was greater in IPF lungs than control lungs (p<0.01), due to an increase in the wall (p<0.05) and lumen area (p<0.05) resulting in more visible airways with a lumen larger than 2 mm. In IPF tissue samples without microscopic fibrosis, assessed by the volume fraction of tissue using microCT, there was a reduction in the number of the terminal (p<0.01) and transitional (p<0.001) bronchioles, and an increase in terminal bronchiole wall area (p<0.001) compared to control lungs. In IPF tissue samples with microscopic parenchymal fibrosis, terminal bronchioles had increased airway wall thickness (p<0.05), and dilated airway lumens (p<0.001) leading to honeycomb cyst formations. CONCLUSION This study has important implications for the current thinking on how the lung tissue is remodeled in IPF, and highlights small airways as a potential target to modify IPF outcomes.
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Affiliation(s)
- Kohei Ikezoe
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Tillie-Louise Hackett
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | | | - Dante Prins
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Cameron J Hague
- The University of British Columbia Department of Radiology, 478400, Vancouver, British Columbia, Canada
| | - Darra Murphy
- The University of British Columbia Department of Radiology, 478400, Vancouver, British Columbia, Canada
| | - Stacey LeDoux
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Fanny Chu
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Feng Xu
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Pathology and Lab Medicine, Vancouver, British Columbia, Canada
| | - Joel D Cooper
- University of Pennsylvania, 6572, Thoracic surgery, Philadelphia, Pennsylvania, United States
| | - Naoya Tanabe
- Kyoto University Graduate School of Medicine Department of Respiratory Medicine, 215651, Kyoto, Japan
| | - Christopher J Ryerson
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Medicine, Vancouver, British Columbia, Canada
| | - Peter D Paré
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Harvey O Coxson
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Thomas V Colby
- Mayo Clinic Department of Laboratory Medicine and Pathology, 195112, Rochester, Minnesota, United States
| | - James C Hogg
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Dragoş M Vasilescu
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada;
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14
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Hino T, Lee KS, Yoo H, Han J, Franks TJ, Hatabu H. Interstitial lung abnormality (ILA) and nonspecific interstitial pneumonia (NSIP). Eur J Radiol Open 2021; 8:100336. [PMID: 33796637 PMCID: PMC7995484 DOI: 10.1016/j.ejro.2021.100336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 12/19/2022] Open
Abstract
This review article aims to address mysteries existing between Interstitial Lung Abnormality (ILA) and Nonspecific Interstitial Pneumonia (NSIP). The concept and definition of ILA are based upon CT scans from multiple large-scale cohort studies, whereas the concept and definition of NSIP originally derived from pathology with evolution to multi-disciplinary diagnosis. NSIP is the diagnosis as Interstitial Lung Disease (ILD) with clinical significance, whereas only a part of subjects with ILA have clinically significant ILD. Eventually, both ILA and NSIP must be understood in the context of chronic fibrosing ILD and progressive ILD, which remains to be further investigated.
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Key Words
- AIP, acute interstitial pneumonia
- ATS/ERS, American Thoracic Society/European Respiratory Society
- BIP, bronchiolitis obliterans with interstitial pneumonia
- BOOP, bronchiolitis obliterans organizing pneumonia
- CT
- CTD, connective tissue disease
- Connective tissue disease (CTD)
- DIP, desquamative interstitial pneumonia
- GGO, ground-glass opacities
- GIP, giant cell interstitial pneumonia
- HRCT
- HRCT, high-resolution CT
- IIP, idiopathic interstitial pneumonia
- ILA, interstitial lung abnormality
- ILD, interstitial lung disease
- Interstitial lung abnormality (ILA)
- Interstitial lung disease (ILD)
- LIP, lymphoid interstitial pneumonia
- NSIP, nonspecific interstitial pneumonia
- Nonspecific interstitial pneumonia (NSIP)
- Pulmonary fibrosis
- RB-ILD, respiratory bronchiolitis-associated interstitial lung disease
- UIP, usual interstitial pneumonia
- fNSIP, fibrosing nonspecific interstitial pneumonia
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 8128582, Japan
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
| | - Hongseok Yoo
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
| | - Teri J Franks
- Pulmonary & Mediastinal Pathology, Department of Defense, The Joint Pathology Center, Silver Spring, MD, USA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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15
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Hino T, Hida T, Nishino M, Lu J, Putman RK, Gudmundsson EF, Hata A, Araki T, Valtchinov VI, Honda O, Yanagawa M, Yamada Y, Kamitani T, Jinzaki M, Tomiyama N, Ishigami K, Honda H, San Jose Estepar R, Washko GR, Johkoh T, Christiani DC, Lynch DA, Gudnason V, Gudmundsson G, Hunninghake GM, Hatabu H. Progression of traction bronchiectasis/bronchiolectasis in interstitial lung abnormalities is associated with increased all-cause mortality: Age Gene/Environment Susceptibility-Reykjavik Study. Eur J Radiol Open 2021; 8:100334. [PMID: 33748349 PMCID: PMC7960545 DOI: 10.1016/j.ejro.2021.100334] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The aim of this study is to assess the role of traction bronchiectasis/bronchiolectasis and its progression as a predictor for early fibrosis in interstitial lung abnormalities (ILA). METHODS Three hundred twenty-seven ILA participants out of 5764 in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study who had undergone chest CT twice with an interval of approximately five-years were enrolled in this study. Traction bronchiectasis/bronchiolectasis index (TBI) was classified on a four-point scale: 0, ILA without traction bronchiectasis/bronchiolectasis; 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; 2, ILA with mild to moderate traction bronchiectasis; 3, ILA and severe traction bronchiectasis and/or honeycombing. Traction bronchiectasis (TB) progression was classified on a five-point scale: 1, Improved; 2, Probably improved; 3, No change; 4, Probably progressed; 5, Progressed. Overall survival (OS) among participants with different TB Progression Score and between the TB progression group and No TB progression group was also investigated. Hazard radio (HR) was estimated with Cox proportional hazards model. RESULTS The higher the TBI at baseline, the higher TB Progression Score (P < 0.001). All five participants with TBI = 3 at baseline progressed; 46 (90 %) of 51 participants with TBI = 2 progressed. TB progression was also associated with shorter OS with statistically significant difference (adjusted HR = 1.68, P < 0.001). CONCLUSION TB progression was visualized on chest CT frequently and clearly. It has the potential to be the predictor for poorer prognosis of ILA.
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Corresponding author.
| | - Tomoyuki Hida
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Mizuki Nishino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Junwei Lu
- Department of Biostatistics, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - Rachel K. Putman
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Akinori Hata
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Tetsuro Araki
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Vladimir I. Valtchinov
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Osamu Honda
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Raul San Jose Estepar
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - George R. Washko
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Takeshi Johkoh
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan,Department of Radiology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 6608511, Japan
| | - David C. Christiani
- Department of Environmental Health, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - David A. Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Hjartavernd, Holtasmári 1, 201, Kópavogur, Iceland,University of Iceland, Faculty of Medicine, Vatnsmyrarvegur 16, 101, Reykjavík, Iceland
| | - Gunnar Gudmundsson
- University of Iceland, Faculty of Medicine, Vatnsmyrarvegur 16, 101, Reykjavík, Iceland,Department of Respiratory Medicine, Landspitali University Hospital, Fossvogur 108, Reykjavík, Iceland
| | - Gary M. Hunninghake
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Pulmonary and Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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16
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Hino T, Lee KS, Han J, Hata A, Ishigami K, Hatabu H. Spectrum of Pulmonary Fibrosis from Interstitial Lung Abnormality to Usual Interstitial Pneumonia: Importance of Identification and Quantification of Traction Bronchiectasis in Patient Management. Korean J Radiol 2020; 22:811-828. [PMID: 33543848 PMCID: PMC8076826 DOI: 10.3348/kjr.2020.1132] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 01/18/2023] Open
Abstract
Following the introduction of a novel pathological concept of usual interstitial pneumonia (UIP) by Liebow and Carrington in 1969, diffuse interstitial pneumonia has evolved into UIP, nonspecific interstitial pneumonia (NSIP), and interstitial lung abnormality (ILA); the histopathological and CT findings of these conditions reflect the required multidisciplinary team approach, involving pulmonologists, radiologists, and pathologists, for their diagnosis and management. Concomitantly, traction bronchiectasis and bronchiolectasis have been recognized as the most persistent and important indices of the severity and prognosis of fibrotic lung diseases. The traction bronchiectasis index (TBI) can stratify the prognoses of patients with ILAs. In this review, the evolutionary concepts of UIP, NSIP, and ILAs are summarized in tables and figures, with a demonstration of the correlation between CT findings and pathologic evaluation. The CT-based UIP score is being proposed to facilitate a better understanding of the spectrum of pulmonary fibrosis, from ILAs to UIP, with emphasis on traction bronchiectasis/bronchiolectasis.
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
| | - Akinori Hata
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Pathology of Idiopathic Pulmonary Fibrosis Assessed by a Combination of Microcomputed Tomography, Histology, and Immunohistochemistry. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:2427-2435. [PMID: 32919981 DOI: 10.1016/j.ajpath.2020.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a fibrotic disease with the histology of usual interstitial pneumonia (UIP). Although the pathologist's visual inspection is central in histologic assessments, three-dimensional microcomputed tomography (microCT) assessment may complement the pathologist's scoring. We examined associations between the histopathologic features of UIP and IPF in explanted lungs and quantitative microCT measurements, including alveolar surface density, total lung volume taken up by tissue (%), and terminal bronchiolar number. Sixty frozen samples from 10 air-inflated explanted lungs with severe IPF and 36 samples from 6 donor control lungs were scanned with microCT and processed for histologic analysis. An experienced pathologist scored three major UIP criteria (patchy fibrosis, honeycomb, and fibroblastic foci), five additional pathologic changes, and immunohistochemical staining for CD68-, CD4-, CD8-, and CD79a-positive cells, graded on a 0 to 3+ scale. The alveolar surface density and terminal bronchiolar number decreased and the tissue percentage increased in lungs with IPF compared with controls. In lungs with IPF, lower alveolar surface density and higher tissue percentage were correlated with greater scores of patchy fibrosis, fibroblastic foci, honeycomb, CD79a-positive cells, and lymphoid follicles. A decreased number of terminal bronchioles was correlated with honeycomb score but not with the other scores. The three-dimensional microCT measurements reflect the pathological UIP and IPF criteria and suggest that the reduction in the terminal bronchioles may be associated with honeycomb cyst formation.
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18
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Increased Airway Wall Thickness in Interstitial Lung Abnormalities and Idiopathic Pulmonary Fibrosis. Ann Am Thorac Soc 2020; 16:447-454. [PMID: 30543456 DOI: 10.1513/annalsats.201806-424oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE There is increasing evidence that aberrant processes occurring in the airways may precede the development of idiopathic pulmonary fibrosis (IPF); however, there has been no prior confirmatory data derived from imaging studies. OBJECTIVES To assess quantitative measures of airway wall thickness (AWT) in populations characterized for interstitial lung abnormalities (ILA) and for IPF. METHODS Computed tomographic imaging of the chest and measures of AWT were available for 6,073, 615, 1,167, and 38 participants from COPDGene (Genetic Epidemiology of COPD study), ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints study), and the Framingham Heart Study (FHS) and in patients with IPF from the Brigham and Women's Hospital Herlihy Registry, respectively. To evaluate these associations, we used multivariable linear regression to compare a standardized measure of AWT (the square root of AWT for airways with an internal perimeter of 10 mm [Pi10]) and characterizations of ILA and IPF by computed tomographic imaging of the chest. RESULTS In COPDGene, ECLIPSE, and FHS, research participants with ILA had increased measures of Pi10 compared with those without ILA. Patients with IPF had mean measures of Pi10 that were even greater than those noted in research participants with ILA. After adjustment for important covariates (e.g., age, sex, race, body mass index, smoking behavior, and chronic obstructive pulmonary disease severity when appropriate), research participants with ILA had increased measures of Pi10 compared with those without ILA (0.03 mm in COPDGene, 95% confidence interval [CI], 0.02-0.03; P < 0.001; 0.02 mm in ECLIPSE, 95% CI, 0.005-0.04; P = 0.01; 0.07 mm in FHS, 95% CI, 0.01-0.1; P = 0.01). Compared with COPDGene participants without ILA older than 60 years of age, patients with IPF were also noted to have increased measures of Pi10 (2.0 mm, 95% CI, 2.0-2.1; P < 0.001). Among research participants with ILA, increases in Pi10 were correlated with reductions in lung volumes in some but not all populations. CONCLUSIONS These results demonstrate that measurable increases in AWT are consistently noted in research participants with ILA and in patients with IPF. These findings suggest that abnormalities of the airways may play a role in, or be correlated with, early pathogenesis of pulmonary fibrosis.
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19
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Gruden JF, Naidich DP, Machnicki SC, Cohen SL, Girvin F, Raoof S. An Algorithmic Approach to the Interpretation of Diffuse Lung Disease on Chest CT Imaging: A Theory of Almost Everything. Chest 2019; 157:612-635. [PMID: 31704148 DOI: 10.1016/j.chest.2019.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/25/2019] [Accepted: 10/12/2019] [Indexed: 12/17/2022] Open
Abstract
We propose an algorithmic approach to the interpretation of diffuse lung disease on high-resolution CT. Following an initial review of pertinent lung anatomy, the following steps are included. Step 1: a preliminary review of available chest radiographs, including the "scanogram" obtained at the time of the CT examination. Step 2: a review of optimal methods of data acquisition and reconstruction, emphasizing the need for contiguous high-resolution images throughout the entire thorax. Step 3: initial uninterrupted scrolling of contiguous high-resolution images throughout the chest to establish the quality of examination as well as an overview of the presence and extent of disease. Step 4: determination of one of three predominant categories - primarily reticular disease, nodular disease, or diseases associated with diffuse alteration in lung density. Based on this determination, one of the three following Steps are followed: Step 5: evaluation of cases primarily involving diffuse lung reticulation; Step 6: evaluation of cases primarily resulting in diffuse lung nodules; and Step 7: evaluation of cases with diffuse alterations in lung density including those with diffusely diminished lung density vs those with heterogenous or diffusely increased lung density, respectively. It is anticipated that this algorithmic approach will substantially enhance initial interpretations of a wide range of pulmonary disease.
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Affiliation(s)
- James F Gruden
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - David P Naidich
- Department of Radiology, New York University-Langone Medical Center, New York, NY.
| | | | - Stuart L Cohen
- Department of Radiology, Northwell Health Radiology, Northwell Health, New York, NY
| | - Francis Girvin
- Department of Radiology, New York University-Langone Medical Center, New York, NY
| | - Suhail Raoof
- Lenox Hill Hospital, Northwell Health, New York, NY
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20
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de Margerie-Mellon C, Belin L, Boussouar S, Khafagy P, Debray MP, Levand K, Chabi ML, Khalil A, Benattia A, Israël-Biet D, Crestani B, Nunes H, Cadranel J, Grenier P, Valeyre D, Naccache JM, Brillet PY. Computed tomography assessment of peripheral traction bronchiolectasis: impact of minimal intensity projection. Eur Respir J 2019; 55:13993003.01388-2019. [PMID: 31649065 DOI: 10.1183/13993003.01388-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 10/04/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Constance de Margerie-Mellon
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Radiologie, Paris, France
| | - Lisa Belin
- Sorbonne Université, INSERM UMR 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpétrière-Charles Foix, Département Biostatistique, Santé Publique et Information Médicale, Paris, France
| | - Samia Boussouar
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpétrière-Charles Foix, Service de Radiologie, Paris, France
| | | | - Marie-Pierre Debray
- Université de Paris, INSERM UMR 1152 "Physiopathologie et épidémiologie des maladies respiratoires", Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Service de Radiologie, Paris, France
| | - Kim Levand
- Université Paris 13, INSERM UMR 1272 "Hypoxie et Poumon", Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Radiologie, Bobigny, France
| | | | - Antoine Khalil
- Université de Paris, INSERM UMR 1152 "Physiopathologie et épidémiologie des maladies respiratoires", Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Service de Radiologie, Paris, France
| | - Amira Benattia
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Pneumologie, Paris, France
| | - Dominique Israël-Biet
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Pneumologie, Paris, France
| | - Bruno Crestani
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Service de Pneumologie, Paris, France
| | - Hilario Nunes
- Université Paris 13, INSERM UMR 1272 "Hypoxie et Poumon", Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France
| | - Jacques Cadranel
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de pneumologie et Centre Constitutif des Maladies Pulmonaires Rares, Paris, France
| | - Philippe Grenier
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpétrière-Charles Foix, Service de Radiologie, Paris, France
| | - Dominique Valeyre
- Université Paris 13, INSERM UMR 1272 "Hypoxie et Poumon", Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France
| | - Jean-Marc Naccache
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de pneumologie et Centre Constitutif des Maladies Pulmonaires Rares, Paris, France
| | - Pierre-Yves Brillet
- Université Paris 13, INSERM UMR 1272 "Hypoxie et Poumon", Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Radiologie, Bobigny, France
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21
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Salvatore M, Singh A, Yip R, Fevrier E, Henschke CI, Yankelevitz D, Padilla M. Progression of probable UIP and UIP on HRCT. Clin Imaging 2019; 58:140-144. [PMID: 31326632 DOI: 10.1016/j.clinimag.2019.07.003] [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: 03/27/2019] [Revised: 06/14/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine patterns of progression of probable Usual Interstitial Pneumonitis (UIP). METHODS This HIPPA compliant, IRB-approved study draws patients from our Fibrosis Registry. All patients with a consensus diagnosis of Idiopathic Pulmonary Fibrosis (IPF) were included. Most recent CT scans and all earlier CT scans were reviewed to determine the fibrosis grade in each lobe based on probable UIP (pUIP) findings of ground glass opacities, traction bronchiolectasis and reticulations or UIP findings of subpleural basilar predominant fibrosis with honeycombing (HC) and absence of features that would suggest an alternative diagnosis. RESULTS 103 patients with a working diagnosis of IPF are the focus of this report. Among the 68 with pUIP on the initial CT, 32 (47%) progressed; median time to progression was 51 months. The risk of HC progression, adjusted for gender, of patients with emphysema was 2.53 times higher than patients without emphysema (HR = 2.53, 95% CI: 1.06-6.02). Among the 35 with HC on the initial CT scan, 20 (57%) progressed to more advanced HC; median time to progression was 31 months. Increased pulmonary artery size was significantly associated with an elevated risk for more advanced HC progression (HR = 1.16, 95% CI: 1.04-1.31). CONCLUSION Ground glass opacities, traction bronchiolectasis and reticulations, a "Probable UIP Pattern" by ATS criteria progressed to UIP in 47% of patients on follow-up imaging.
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Affiliation(s)
- Mary Salvatore
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Columbia University Medical Center, New York, NY, United States of America.
| | - Ayushi Singh
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Esther Fevrier
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - David Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Maria Padilla
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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22
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Abstract
PURPOSE OF REVIEW The application of computer-based imaging analysis in patients with idiopathic pulmonary fibrosis is a rapidly developing field. The purpose of this review is to provide insights into the problems associated with visual interpretation of HRCT patterns and describe some of the current technologies used to provide objective quantification of disease on HRCT. Future directions are also discussed. RECENT FINDINGS Although there is strong evidence that visual quantification of disease on HRCT in idiopathic pulmonary fibrosis provides prognostic information, this approach is hampered by its subjective nature and interobserver variability. In contrast, computer-based quantification of disease on HRCT provides objective and reproducible data, which may help to predict mortality and time to decline in patients with idiopathic pulmonary fibrosis. The use of these technologies may also help to stratify clinical risk in patients enrolled in drug trials. SUMMARY The future of imaging-based biomarker research in idiopathic pulmonary fibrosis is undoubtedly computer-based HRCT evaluation. However, if this field is to continue to innovate, large, well annotated imaging datasets for developing and testing. new computer-based tools are needed as well as prospective trials for biomarker validation.
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Affiliation(s)
- Simon L F Walsh
- Department of Radiology, King's College Hospital Foundation Trust, Denmark Hill, Brixton, London SE5 9RS, United Kingdom
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Ravaglia C, Bosi M, Wells AU, Gurioli C, Gurioli C, Dubini A, Piciucchi S, Puglisi S, Mascetti S, Arcadu A, Tomassetti S, Poletti V. Idiopathic pulmonary fibrosis: prognostic impact of histologic honeycombing in transbronchial lung cryobiopsy. Multidiscip Respir Med 2019; 14:3. [PMID: 30774952 PMCID: PMC6367843 DOI: 10.1186/s40248-019-0170-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/09/2019] [Indexed: 12/17/2022] Open
Abstract
Background Prognostic evaluation in idiopathic pulmonary fibrosis (IPF) may be important as it can guide management decisions, but the potential role of honeycomb changes in providing information about outcome and survival of patients with IPF, particularly if diagnosed using cryobiopsy, has not been evaluated. Aim of this study was to determinate whether a relationship exists between honeycombing on cryobiopsy and clinical/radiological picture and outcome in patients with IPF and to assess whether the same pathologic criteria that have been used to define the UIP pattern (usual interstitial pneumonia) for surgical biopsy can also be applied to cryobiopsy. Methods Sixty-three subjects with a multidisciplinary diagnosis of IPF and a UIP pattern on cryobiopsy were evaluated. Patients were classified into two sub-groups depending on the presence of honeycombing on histology. Results The presence of honeycombing on cryobiopsy did not identify a specific phenotype of patients as it did not correlate with radiological and clinical picture and it was not associated neither with the risk of death (p = 0.1192) or with the event-free survival (p = 0.827); a higher number of samples and the presence of pleura on biopsy were instead associated with an increase in the finding of honeycombing. Conclusions The same pathologic criteria that have been used to define the UIP pattern in surgical biopsies (with honeycombing changes considered as non-mandatory for the definition of the pattern itself) can be applied to cryobiopsy samples, as the presence of these changes do not define different clinical or radiological phenotypes of patients with IPF.
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Affiliation(s)
- Claudia Ravaglia
- 1Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Via C. Forlanini 34, 47121 Forlì, FC Italy
| | - Marcello Bosi
- 1Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Via C. Forlanini 34, 47121 Forlì, FC Italy
| | - Athol U Wells
- 2Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Carlo Gurioli
- 1Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Via C. Forlanini 34, 47121 Forlì, FC Italy
| | - Christian Gurioli
- 1Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Via C. Forlanini 34, 47121 Forlì, FC Italy
| | - Alessandra Dubini
- 3Department of Pathology, G.B. Morgagni - L. Pierantoni Hospital, Forlì, Italy
| | - Sara Piciucchi
- 4Department of Radiology, G.B. Morgagni - L. Pierantoni Hospital, Forlì, Italy
| | - Silvia Puglisi
- 1Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Via C. Forlanini 34, 47121 Forlì, FC Italy
| | - Susanna Mascetti
- 1Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Via C. Forlanini 34, 47121 Forlì, FC Italy
| | - Antonella Arcadu
- 1Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Via C. Forlanini 34, 47121 Forlì, FC Italy
| | - Sara Tomassetti
- 1Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Via C. Forlanini 34, 47121 Forlì, FC Italy
| | - Venerino Poletti
- 1Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Via C. Forlanini 34, 47121 Forlì, FC Italy.,5Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Hochhegger B, Marchiori E, Zanon M, Rubin AS, Fragomeni R, Altmayer S, Carvalho CRR, Baldi BG. Imaging in idiopathic pulmonary fibrosis: diagnosis and mimics. Clinics (Sao Paulo) 2019; 74:e225. [PMID: 30726312 PMCID: PMC6384526 DOI: 10.6061/clinics/2019/e225] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a chronic disease of unknown etiology that usually has a progressive course and is commonly associated with a poor prognosis. The main symptoms of idiopathic pulmonary fibrosis, including progressive dyspnea and dry cough, are often nonspecific. Chest high-resolution computed tomography is the primary modality used in the initial assessment of patients with suspected idiopathic pulmonary fibrosis and may have considerable influence on subsequent management decisions. The main role of computed tomography is to distinguish chronic fibrosing lung diseases with a usual interstitial pneumonia pattern from those presenting with a non-usual interstitial pneumonia pattern, suggesting an alternative diagnosis when possible. A usual interstitial pneumonia pattern on chest tomography is characterized by the presence subpleural and basal predominance, reticular abnormality honeycombing with or without traction bronchiectasis, and the absence of features suggestive of an alternative diagnosis. Idiopathic pulmonary fibrosis can be diagnosed according to clinical and radiological criteria in approximately 66.6% of cases. Confirmation of an idiopathic pulmonary fibrosis diagnosis is challenging, requiring the exclusion of pulmonary fibroses with known causes, such as asbestosis, connective tissue diseases, drug exposure, chronic hypersensitivity pneumonitis, and other forms of idiopathic interstitial pneumonitis. The histopathological hallmark of usual interstitial pneumonia is a heterogeneous appearance, characterized by areas of fibrosis with scarring and honeycombing alternating with areas of less affected or normal parenchyma. The aim of this article was to review the clinical, radiological, and pathological features of idiopathic pulmonary fibrosis and of diseases that might mimic idiopathic pulmonary fibrosis presentation.
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Affiliation(s)
- Bruno Hochhegger
- Departamento de Radiologia, Laboratorio de Pesquisas em Imagens Medicas (LABIMED), Irmandade Santa Casa de Misericordia de Porto Alegre, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR
| | - Edson Marchiori
- Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - Matheus Zanon
- Departamento de Radiologia, Laboratorio de Pesquisas em Imagens Medicas (LABIMED), Irmandade Santa Casa de Misericordia de Porto Alegre, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR
- *Corresponding author. E-mail:
| | - Adalberto Sperb Rubin
- Departamento de Pneumologia, Irmandade Santa Casa de Misericordia de Porto Alegre, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR
| | - Renata Fragomeni
- Departamento de Patologia, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR
| | - Stephan Altmayer
- Departamento de Radiologia, Laboratorio de Pesquisas em Imagens Medicas (LABIMED), Irmandade Santa Casa de Misericordia de Porto Alegre, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR
| | - Carlos Roberto Ribeiro Carvalho
- Divisao Pulmonar, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Bruno Guedes Baldi
- Divisao Pulmonar, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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25
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Quantitative CT analysis using functional imaging is superior in describing disease progression in idiopathic pulmonary fibrosis compared to forced vital capacity. Respir Res 2018; 19:213. [PMID: 30400950 PMCID: PMC6218992 DOI: 10.1186/s12931-018-0918-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/21/2018] [Indexed: 12/14/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is chronic fibrosing pneumonia with an unpredictable natural disease history. Functional respiratory imaging (FRI) has potential to better characterize this disease. The aim of this study was to identify FRI parameters, which predict FVC decline in patients with IPF. Methods An IPF-cohort (treated with pamrevlumab for 48 weeks) was retrospectively studied using FRI. Serial CT’s were compared from 66 subjects. Post-hoc analysis was performed using FRI, FVC and mixed effects models. Results Lung volumes, determined by FRI, correlated with FVC (lower lung volumes with lower FVC) (R2 = 0.61, p < 0.001). A negative correlation was observed between specific image based airway radius (siRADaw) at total lung capacity (TLC) and FVC (R2 = 0.18, p < 0.001). Changes in FVC correlated significantly with changes in lung volumes (R2 = 0.18, p < 0.001) and siRADaw (R2 = 0.15, p = 0.002) at week 24 and 48, with siRADaw being more sensitive to change than FVC. Loss in lobe volumes (R2 = 0.33, p < 0.001), increasing fibrotic tissue (R2 = 0.33, p < 0.001) and airway radius (R2 = 0.28, p < 0.001) at TLC correlated with changes in FVC but these changes already occur in the lower lobes when FVC is still considered normal. Conclusion This study indicates that FRI is a superior tool than FVC in capturing of early and clinically relevant, disease progression in a regional manner. Electronic supplementary material The online version of this article (10.1186/s12931-018-0918-5) contains supplementary material, which is available to authorized users.
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Diffuse Parenchymal Lung Diseases in the Elderly. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Asmani M, Velumani S, Li Y, Wawrzyniak N, Hsia I, Chen Z, Hinz B, Zhao R. Fibrotic microtissue array to predict anti-fibrosis drug efficacy. Nat Commun 2018; 9:2066. [PMID: 29802256 PMCID: PMC5970268 DOI: 10.1038/s41467-018-04336-z] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/23/2018] [Indexed: 02/07/2023] Open
Abstract
Fibrosis is a severe health problem characterized by progressive stiffening of tissues which causes organ malfunction and failure. A major bottleneck in developing new anti-fibrosis therapies is the lack of in vitro models that recapitulate dynamic changes in tissue mechanics during fibrogenesis. Here we create membranous human lung microtissues to model key biomechanical events occurred during lung fibrogenesis including progressive stiffening and contraction of alveolar tissue, decline in alveolar tissue compliance and traction force-induced bronchial dilation. With these capabilities, we provide proof of principle for using this fibrotic tissue array for multi-parameter, phenotypic analysis of the therapeutic efficacy of two anti-fibrosis drugs recently approved by the FDA. Preventative treatments with Pirfenidone and Nintedanib reduce tissue contractility and prevent tissue stiffening and decline in tissue compliance. In a therapeutic treatment regimen, both drugs restore tissue compliance. These results highlight the pathophysiologically relevant modeling capability of our novel fibrotic microtissue system.
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Affiliation(s)
- Mohammadnabi Asmani
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, 14260, USA
| | - Sanjana Velumani
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, 14260, USA
| | - Yan Li
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, 14260, USA
| | - Nicole Wawrzyniak
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, 14260, USA
| | - Isaac Hsia
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, 14260, USA
| | - Zhaowei Chen
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, 14260, USA
| | - Boris Hinz
- Laboratory of Tissue Repair and Regeneration, Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Toronto, ON, M5S 3E2, Canada.,Institute of Biomaterials & Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Ruogang Zhao
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, 14260, USA.
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Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. THE LANCET RESPIRATORY MEDICINE 2018; 6:138-153. [DOI: 10.1016/s2213-2600(17)30433-2] [Citation(s) in RCA: 559] [Impact Index Per Article: 93.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 12/18/2022]
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de Andrade JA, Luckhardt T. What Is in a Pattern? That Which We Call Idiopathic Pulmonary Fibrosis by Any Other Pattern Would Behave Alike! Am J Respir Crit Care Med 2017; 195:10-12. [PMID: 28035849 DOI: 10.1164/rccm.201606-1277ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Joao A de Andrade
- 1 Department of Medicine University of Alabama at Birmingham Birmingham, Alabama and.,2 Birmingham Veterans Affairs Medical Center Birmingham, Alabama
| | - Tracy Luckhardt
- 1 Department of Medicine University of Alabama at Birmingham Birmingham, Alabama and
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Texture analysis using proton density and T2 relaxation in patients with histological usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP). PLoS One 2017; 12:e0177689. [PMID: 28520778 PMCID: PMC5433738 DOI: 10.1371/journal.pone.0177689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 05/02/2017] [Indexed: 12/31/2022] Open
Abstract
Objectives The purpose of our study was to assess proton density (PD) and T2 relaxation time of usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) and to evaluate their utility in differentiating the two patterns. Furthermore, we aim to investigate whether these two parameters could help differentiate active-inflammatory and stable-fibrotic lesions in NSIP. Methods 32 patients (mean age: 69 years; M:F, 1:1) with pathologically proven disease (UIP:NSIP, 1:1), underwent thoracic thin-section multislice CT scan and 1.5T MRI. A total of 437 regions-of-interest (ROIs) were classified at CT as advanced, moderate or mild alterations. Based on multi-echo single-shot TSE sequence acquired at five echo times, with breath-holding at end-expiration and ECG-triggering, entire lung T2 and PD maps were generated from each subject. The T2 relaxation time and the respective signal intensity were quantified by performing a ROI measurement on the T2 and PD maps in the corresponding CT selected areas of the lung. Results UIP and NSIP regional patterns could not be differentiated by T2 relaxation times or PD values alone. Overall, a strong positive correlation was found between T2 relaxation and PD in NSIP, r = 0.64, p<0.001; however, this correlation was weak in UIP, r = 0.20, p = 0.01. T2 relaxation showed significant statistical difference between active-inflammatory and stable-fibrotic NSIP regions at all levels, p<0.05, while for the analysis of ventral lesions PD proved no statistical difference, p>0.05. Conclusions T2 relaxation times and PD values may provide helpful quantitative information for differentiating NSIP from UIP pattern. These parameters have the potential to differentiate active-inflammatory and stable-fibrotic lesions in NSIP.
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Homer R, Lederer DJ. Diagnosing idiopathic pulmonary fibrosis without a lung biopsy: honeycombing not required. Thorax 2017; 72:391-392. [DOI: 10.1136/thoraxjnl-2016-209831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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