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Johnson SR, Bernstein EJ, Bolster MB, Chung JH, Danoff SK, George MD, Khanna D, Guyatt G, Mirza RD, Aggarwal R, Allen A, Assassi S, Buckley L, Chami HA, Corwin DS, Dellaripa PF, Domsic RT, Doyle TJ, Falardeau CM, Frech TM, Gibbons FK, Hinchcliff M, Johnson C, Kanne JP, Kim JS, Lim SY, Matson S, McMahan ZH, Merck SJ, Nesbitt K, Scholand MB, Shapiro L, Sharkey CD, Summer R, Varga J, Warrier A, Agarwal SK, Antin-Ozerkis D, Bemiss B, Chowdhary V, Dematte D'Amico JE, Hallowell R, Hinze AM, Injean PA, Jiwrajka N, Joerns EK, Lee JS, Makol A, McDermott GC, Natalini JG, Oldham JM, Saygin D, Lakin KS, Singh N, Solomon JJ, Sparks JA, Turgunbaev M, Vaseer S, Turner A, Uhl S, Ivlev I. 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases. Arthritis Care Res (Hoboken) 2024; 76:1070-1082. [PMID: 38973729 DOI: 10.1002/acr.25347] [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: 08/21/2023] [Revised: 01/18/2024] [Accepted: 04/09/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE We provide evidence-based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease. METHODS We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A Voting Panel of interdisciplinary clinician experts and patients achieved consensus on the direction and strength of each recommendation. RESULTS Fifteen recommendations were developed. For screening people with these SARDs at risk for ILD, we conditionally recommend pulmonary function tests (PFTs) and high-resolution computed tomography of the chest (HRCT chest); conditionally recommend against screening with 6-minute walk test distance (6MWD), chest radiography, ambulatory desaturation testing, or bronchoscopy; and strongly recommend against screening with surgical lung biopsy. We conditionally recommend monitoring ILD with PFTs, HRCT chest, and ambulatory desaturation testing and conditionally recommend against monitoring with 6MWD, chest radiography, or bronchoscopy. We provide guidance on ILD risk factors and suggestions on frequency of testing to evaluate for the development of ILD in people with SARDs. CONCLUSION This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the screening and monitoring of ILD in people with SARDs.
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Affiliation(s)
- Sindhu R Johnson
- University of Toronto, Schroeder Arthritis Institute, Toronto Western Hospital, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Elana J Bernstein
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City
| | | | | | - Sonye K Danoff
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | - Hassan A Chami
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | - Tracy M Frech
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison
| | - John S Kim
- University of Virginia School of Medicine, Charlottesville
| | | | - Scott Matson
- University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | | | - Ross Summer
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didem Saygin
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Stacey Uhl
- ECRI, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Ilya Ivlev
- ECRI, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
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Johnson SR, Bernstein EJ, Bolster MB, Chung JH, Danoff SK, George MD, Khanna D, Guyatt G, Mirza RD, Aggarwal R, Allen A, Assassi S, Buckley L, Chami HA, Corwin DS, Dellaripa PF, Domsic RT, Doyle TJ, Falardeau CM, Frech TM, Gibbons FK, Hinchcliff M, Johnson C, Kanne JP, Kim JS, Lim SY, Matson S, McMahan ZH, Merck SJ, Nesbitt K, Scholand MB, Shapiro L, Sharkey CD, Summer R, Varga J, Warrier A, Agarwal SK, Antin-Ozerkis D, Bemiss B, Chowdhary V, Dematte D'Amico JE, Hallowell R, Hinze AM, Injean PA, Jiwrajka N, Joerns EK, Lee JS, Makol A, McDermott GC, Natalini JG, Oldham JM, Saygin D, Lakin KS, Singh N, Solomon JJ, Sparks JA, Turgunbaev M, Vaseer S, Turner A, Uhl S, Ivlev I. 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases. Arthritis Rheumatol 2024; 76:1201-1213. [PMID: 38973714 DOI: 10.1002/art.42860] [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: 08/21/2023] [Revised: 01/18/2024] [Accepted: 04/09/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE We provide evidence-based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease. METHODS We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A Voting Panel of interdisciplinary clinician experts and patients achieved consensus on the direction and strength of each recommendation. RESULTS Fifteen recommendations were developed. For screening people with these SARDs at risk for ILD, we conditionally recommend pulmonary function tests (PFTs) and high-resolution computed tomography of the chest (HRCT chest); conditionally recommend against screening with 6-minute walk test distance (6MWD), chest radiography, ambulatory desaturation testing, or bronchoscopy; and strongly recommend against screening with surgical lung biopsy. We conditionally recommend monitoring ILD with PFTs, HRCT chest, and ambulatory desaturation testing and conditionally recommend against monitoring with 6MWD, chest radiography, or bronchoscopy. We provide guidance on ILD risk factors and suggestions on frequency of testing to evaluate for the development of ILD in people with SARDs. CONCLUSION This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the screening and monitoring of ILD in people with SARDs.
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Affiliation(s)
- Sindhu R Johnson
- University of Toronto, Schroeder Arthritis Institute, Toronto Western Hospital, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Elana J Bernstein
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City
| | | | | | - Sonye K Danoff
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | - Hassan A Chami
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | - Tracy M Frech
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison
| | - John S Kim
- University of Virginia School of Medicine, Charlottesville
| | | | - Scott Matson
- University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | | | - Ross Summer
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didem Saygin
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Stacey Uhl
- ECRI, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Ilya Ivlev
- ECRI, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
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Mohammad Reza Beigi D, Pellegrino G, Loconte M, Landini N, Mattone M, Paone G, Truglia S, Di Ciommo FR, Bisconti I, Cadar M, Stefanantoni K, Panebianco V, Conti F, Riccieri V. Lung ultrasound compared to computed tomography detection and automated quantification of systemic sclerosis-associated interstitial lung disease: preliminary study. Rheumatology (Oxford) 2024; 63:1240-1245. [PMID: 37399086 DOI: 10.1093/rheumatology/kead324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is a promising tool for detecting SSc-associated interstitial lung disease (SSc-ILD). Currently, consensus on the best LUS findings and execution technique is lacking. OBJECTIVES To compare qualitative and quantitative assessment of B-lines and pleural line (PL) alterations in SSc-ILD with chest CT analysis. METHODS During 2021-2022, consecutive SSc patients according to 2013 ACR/EULAR classification criteria underwent pulmonary functional tests (PFTs). On the same day, if a CT was performed over a ± 6 months period, LUS was performed by two certified blinded operators using a 14-scans method. The ≥10 B-lines cut-off proposed by Tardella and the Fairchild's PL criteria fulfilment were selected as qualitative findings. As quantitative assessment, total B-lines number and the quantitative PL score adapted from the semi-quantitative Pinal-Fernandez score were collected. CT scans were evaluated by two thoracic radiologists for ILD presence, with further processing by automated texture analysis software (QCT). RESULTS Twenty-nine SSc patients were enrolled. Both qualitative LUS scores were significantly associated to ILD presence on CT, with Fairchild's PL criteria resulting in slightly more accuracy. Results were confirmed on multivariate analysis. All qualitative and quantitative LUS findings were found to be significantly associated with QCT ILD extension and radiological abnormalities. Mid and basal PL quantitative score correlated with mid and basal QCT ILD extents. Both B-lines and PL alterations differently correlated with PFTs and clinical variables. CONCLUSION This preliminary study suggests the utility of a comprehensive LUS assessment for SSc-ILD detection compared with CT and QCT.
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Affiliation(s)
- Davide Mohammad Reza Beigi
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Greta Pellegrino
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Michele Loconte
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Nicholas Landini
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo Patologiche, Sapienza University of Rome, Rome, Italy
| | - Monica Mattone
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo Patologiche, Sapienza University of Rome, Rome, Italy
| | - Gregorino Paone
- Dipartimento di Scienze Cardiovascolari e Respiratorie, Sapienza University of Rome, Rome, Italy
| | - Simona Truglia
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Francesca Romana Di Ciommo
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Ilaria Bisconti
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Marius Cadar
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Katia Stefanantoni
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Valeria Panebianco
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo Patologiche, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Conti
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Valeria Riccieri
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
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Kanne JP, Walker CM, Brixey AG, Brown KK, Chelala L, Kazerooni EA, Walsh SLF, Lynch DA. Progressive Pulmonary Fibrosis and Interstitial Lung Abnormalities: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024. [PMID: 38656115 DOI: 10.2214/ajr.24.31125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Progressive pulmonary fibrosis (PPF) and interstitial lung abnormalities (ILA) are relatively new concepts in interstitial lung disease (ILD) imaging and clinical management. Recognition of signs of PPF, as well as identification and classification of ILA, are important tasks during chest high-resolution CT interpretation, to optimize management of patients with ILD and those at risk of developing ILD. However, following professional society guidance, the role of imaging surveillance remains unclear in stable patients with ILD, asymptomatic patients with ILA who are at risk of progression, and asymptomatic patients at risk of developing ILD without imaging abnormalities. In this AJR Expert Panel Narrative Review, we summarize the current knowledge regarding PPF and ILA and describe the range of clinical practice with respect to imaging patients with ILD, those with ILA, and those at risk of developing ILD. In addition, we offer suggestions to help guide surveillance imaging in areas with an absence of published guidelines, where such decisions are currently driven primarily by local pulmonologists' preference.
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Affiliation(s)
- Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Christopher M Walker
- Department of Radiology, The University of Kansas Medical Center, Kansas City, KS
| | - Anupama G Brixey
- Department of Radiology, Portland VA Healthcare System, Oregon Health & Science University, Portland, OR
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO
| | - Lydia Chelala
- Department of Radiology, University of Chicago Medicine, Chicago, IL
| | - Ella A Kazerooni
- Departments of Radiology & Internal Medicine, University of Michigan Medical School / Michigan Medicine, Ann Arbor, MI
| | - Simon L F Walsh
- Department of Radiology, Imperial College, London, United Kingdom
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
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5
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Yu M, Zhang C, Wan S, Lu Y, Wang Y, Liu T, Wang H, Chen W, Liu Y. NEW PREDICTIVE BIOMARKERS FOR SCREENING COVID-19 PATIENTS WITH RHABDOMYOLYSIS IN COMBINATION WITH CYSTATIN C. Shock 2024; 61:549-556. [PMID: 38010067 DOI: 10.1097/shk.0000000000002258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Purpose: Cystatin C (CysC) has been linked to the prognosis of corona virus disease 2019 (COVID-19). The study aims to investigate a predictor correlated with CysC screening for poor prognosis in COVID-19 patients combined with skeletal muscle (SKM) impairment and rhabdomyolysis (RM). Methods: A single-center retrospective cohort analysis was carried out. Demographic information, clinical data, laboratory test results, and clinical outcome data were gathered and analyzed. Results: According to the inclusion and exclusion criteria, 382 patients were included in this study. The subjects were divided into three groups based on CysC tertiles. Multivariate analysis revealed that SaO 2 (hazard ratio [HR], 0.946; 95% confidence interval [CI], 0.906-0.987; P = 0.011), CysC (HR, 2.124; 95% CI, 1.223-3.689; P = 0.008), aspartate aminotransferase (AST) (HR, 1.009; 95% CI, 1.000-1.018; P = 0.041), and hypersensitive C-reactive protein (HR, 1.005; 95% CI, 1.000-1.010; P = 0.045) were significantly associated with survivals. The area under curve (AUC) in the model characterized by RM incidence was 0.819 (0.698-0.941), as shown by CysC receiver operating characteristic curves. LDH*CysC and AST*CysC had better predictive values than CysC and the best prediction for RM, with an AUC of 0.880 (0.796,0.964) for LDH*CysC ( P < 0.05, vs CysC) and 0.925 (0.878,0.972) for AST*CysC ( P < 0.05, vs CysC). Conclusion: CysC is an essential evaluation indicator for COVID-19 patients' prognosis. AST*CysC and LDH*CysC have superior predictive value to CysC for SKM, RM, and death, and optimal classification for RM.
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Affiliation(s)
- Mengyang Yu
- General Medicine Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Chengying Zhang
- General Medicine Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Sitong Wan
- Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food Quality, China Agricultural University, Beijing, China
| | - Yang Lu
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Yufei Wang
- Clinical Laboratory Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Ting Liu
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Huimin Wang
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Wei Chen
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
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Raghu G, Ghazipura M, Fleming TR, Aronson KI, Behr J, Brown KK, Flaherty KR, Kazerooni EA, Maher TM, Richeldi L, Lasky JA, Swigris JJ, Busch R, Garrard L, Ahn DH, Li J, Puthawala K, Rodal G, Seymour S, Weir N, Danoff SK, Ettinger N, Goldin J, Glassberg MK, Kawano-Dourado L, Khalil N, Lancaster L, Lynch DA, Mageto Y, Noth I, Shore JE, Wijsenbeek M, Brown R, Grogan D, Ivey D, Golinska P, Karimi-Shah B, Martinez FJ. Meaningful Endpoints for Idiopathic Pulmonary Fibrosis (IPF) Clinical Trials: Emphasis on 'Feels, Functions, Survives'. Report of a Collaborative Discussion in a Symposium with Direct Engagement from Representatives of Patients, Investigators, the National Institutes of Health, a Patient Advocacy Organization, and a Regulatory Agency. Am J Respir Crit Care Med 2024; 209:647-669. [PMID: 38174955 DOI: 10.1164/rccm.202312-2213so] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) carries significant mortality and unpredictable progression, with limited therapeutic options. Designing trials with patient-meaningful endpoints, enhancing the reliability and interpretability of results, and streamlining the regulatory approval process are of critical importance to advancing clinical care in IPF. Methods: A landmark in-person symposium in June 2023 assembled 43 participants from the US and internationally, including patients with IPF, investigators, and regulatory representatives, to discuss the immediate future of IPF clinical trial endpoints. Patient advocates were central to discussions, which evaluated endpoints according to regulatory standards and the FDA's 'feels, functions, survives' criteria. Results: Three themes emerged: 1) consensus on endpoints mirroring the lived experiences of patients with IPF; 2) consideration of replacing forced vital capacity (FVC) as the primary endpoint, potentially by composite endpoints that include 'feels, functions, survives' measures or FVC as components; 3) support for simplified, user-friendly patient-reported outcomes (PROs) as either components of primary composite endpoints or key secondary endpoints, supplemented by functional tests as secondary endpoints and novel biomarkers as supportive measures (FDA Guidance for Industry (Multiple Endpoints in Clinical Trials) available at: https://www.fda.gov/media/162416/download). Conclusions: This report, detailing the proceedings of this pivotal symposium, suggests a potential turning point in designing future IPF clinical trials more attuned to outcomes meaningful to patients, and documents the collective agreement across multidisciplinary stakeholders on the importance of anchoring IPF trial endpoints on real patient experiences-namely, how they feel, function, and survive. There is considerable optimism that clinical care in IPF will progress through trials focused on patient-centric insights, ultimately guiding transformative treatment strategies to enhance patients' quality of life and survival.
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Affiliation(s)
- Ganesh Raghu
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Department of Laboratory Medicine and Pathology, and
| | - Marya Ghazipura
- ZS Associates, Global Health Economics and Outcomes Research, New York, New York
- Division of Epidemiology and
- Division of Biostatistics, Department of Population Health, New York University Langone Health, New York, New York
| | - Thomas R Fleming
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kerri I Aronson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, Ludwig-Maximilians-University Munich, Member of the German Center for Lung Research, Munich, Germany
| | | | - Kevin R Flaherty
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ella A Kazerooni
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Detroit, Michigan
| | - Toby M Maher
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Luca Richeldi
- Divisione di Medicina Polmonare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Joseph A Lasky
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | | | - Robert Busch
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Lili Garrard
- Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, and
| | - Dong-Hyun Ahn
- Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, and
| | - Ji Li
- Division of Clinical Outcome Assessment, Office of Drug Evaluation Sciences, Office of New Drugs, and
| | - Khalid Puthawala
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Gabriela Rodal
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sally Seymour
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Nargues Weir
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Neil Ettinger
- Division of Pulmonary Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Jonathan Goldin
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | - Marilyn K Glassberg
- Department of Medicine, Stritch School of Medicine, Loyola Chicago, Chicago, Illinois
| | - Leticia Kawano-Dourado
- Hcor Research Institute - Hcor Hospital, São Paolo, Brazil
- Pulmonary Division, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Lancaster
- Division of Pulmonary, Critical Care, and Sleep Medicine, Vanderbilt University, Nashville, Tennessee
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Yolanda Mageto
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor University, Dallas, Texas
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Marlies Wijsenbeek
- Centre of Interstitial Lung Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Robert Brown
- Patient representative and patient living with IPF, Lovettsville, Virginia
| | - Daniel Grogan
- Patient representative and patient living with IPF, Charlottesville, Virginia; and
| | - Dorothy Ivey
- Patient representative and patient living with IPF, Richmond, Virginia
| | - Patrycja Golinska
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Banu Karimi-Shah
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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7
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Landini N, Mattone M, De Nardo C, Ottaviani F, Mohammad Reza Beigi D, Riccieri V, Orlandi M, Cipollari S, Catalano C, Panebianco V. CT evaluation of interstitial lung disease related to systemic sclerosis: visual versus automated assessment. A systematic review. Clin Radiol 2024; 79:e440-e452. [PMID: 38143228 DOI: 10.1016/j.crad.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/23/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023]
Abstract
AIM To identify similarities and differences between visual (VA) and automated assessment (AA) of systemic sclerosis-related interstitial lung disease (SSc-ILD) at chest computed tomography (CT) in terms of clinical applicability. MATERIALS AND METHODS Medline, Embase, and Web of Science were searched to identify all studies investigating VA and AA for SSc-ILD assessment, from inception to 31 July 2022. Exclusion criteria were manuscripts not in English, absence of full-text, reviews, diseases other than ILD in SSc, CT not analysed with both VA and AA, VA and AA not adopted for the same purpose or not compared, overlap syndromes, SSc-ILD data not extractable, and studies with <10 patients. RESULTS Ten full-text studies (804 patients) were included. The most adopted VAs were the Warrick or Goh score (four studies each), while densitometry (eight studies) or lung texture analysis (LTA, two studies) were utilised as AAs. The main field of investigation was the correlation with baseline pulmonary function tests (PFT, six studies). Warrick VA showed lower correlations compared to densitometry, while Goh VA demonstrated more heterogeneous results. Compared to LTA, Goh VA obtained lower correlations with lung volumes but similar or stronger coefficients with alveolar diffusibility. CONCLUSIONS VA and AA may show heterogeneous results comparing their correlations with PFT, probably depending on the specific analysis adopted for each method. More data are needed on VA versus LTA. Comparisons between VA and AA regarding correlation with PFT follow-up and as prognostic elements, or for disease monitoring, are lacking. AAs in progressive fibrosis diagnosis remain to be tested.
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Affiliation(s)
- N Landini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy.
| | - M Mattone
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - C De Nardo
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - F Ottaviani
- School of Economics, Management and Statistics, University of Bologna, Bologna, Italy
| | - D Mohammad Reza Beigi
- Department of Internal Medicine, Anesthesiology and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - V Riccieri
- Department of Internal Medicine, Anesthesiology and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - M Orlandi
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC Careggi, University of Florence, Florence, Italy
| | - S Cipollari
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - C Catalano
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - V Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
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8
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Petelytska L, Bonomi F, Cannistrà C, Fiorentini E, Peretti S, Torracchi S, Bernardini P, Coccia C, De Luca R, Economou A, Levani J, Matucci-Cerinic M, Distler O, Bruni C. Heterogeneity of determining disease severity, clinical course and outcomes in systemic sclerosis-associated interstitial lung disease: a systematic literature review. RMD Open 2023; 9:e003426. [PMID: 37940340 PMCID: PMC10632935 DOI: 10.1136/rmdopen-2023-003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/02/2023] [Indexed: 11/10/2023] Open
Abstract
Objective The course of systemic sclerosis-associated interstitial lung disease (SSc-ILD) is highly variable and different from continuously progressive idiopathic pulmonary fibrosis (IPF). Most proposed definitions of progressive pulmonary fibrosis or SSc-ILD severity are based on the research data from patients with IPF and are not validated for patients with SSc-ILD. Our study aimed to gather the current evidence for severity, progression and outcomes of SSc-ILD.Methods A systematic literature review to search for definitions of severity, progression and outcomes recorded for SSc-ILD was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in Medline, Embase, Web of Science and Cochrane Library up to 1 August 2023.Results A total of 9054 papers were reviewed and 342 were finally included. The most frequent tools used for the definition of SSc-ILD progression and severity were combined changes of carbon monoxide diffusing capacity (DLCO) and forced vital capacity (FVC), isolated FVC or DLCO changes, high-resolution CT (HRCT) extension and composite algorithms including pulmonary function test, clinical signs and HRCT data. Mortality was the most frequently reported long-term event, both from all causes or ILD related.Conclusions The studies presenting definitions of SSc-ILD 'progression', 'severity' and 'outcome' show a large heterogeneity. These results emphasise the need for developing a standardised, consensus definition of severe SSc-ILD, to link a disease specific definition of progression as a surrogate outcome for clinical trials and clinical practice.PROSPERO registration number CRD42022379254.Cite Now.
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Affiliation(s)
- Liubov Petelytska
- Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department Internal Medicine #3, Bogomolets National Medical University, Kiiv, Ukraine
| | - Francesco Bonomi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Carlo Cannistrà
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Elisa Fiorentini
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Silvia Peretti
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Sara Torracchi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Pamela Bernardini
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Carmela Coccia
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Riccardo De Luca
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Alessio Economou
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Juela Levani
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan, Italy
| | - Oliver Distler
- Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cosimo Bruni
- Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
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9
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Landini N, Orlandi M, Occhipinti M, Nardi C, Tofani L, Bellando-Randone S, Ciet P, Wielopolski P, Benkert T, Bruni C, Bertolo S, Moggi-Pignone A, Matucci-Cerinic M, Morana G, Colagrande S. Ultrashort Echo-Time Magnetic Resonance Imaging Sequence in the Assessment of Systemic Sclerosis-Interstitial Lung Disease. J Thorac Imaging 2023; 38:97-103. [PMID: 35482025 DOI: 10.1097/rti.0000000000000637] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To test respiratory-triggered ultrashort echo-time (UTE) Spiral VIBE-MRI sequence in systemic sclerosis-interstitial lung disease assessment compared with computed tomography (CT). MATERIAL AND METHODS Fifty four SSc patients underwent chest CT and UTE (1.5 T). Two radiologists, independently and in consensus, verified ILD presence/absence and performed a semiquantitative analysis (sQA) of ILD, ground-glass opacities (GGO), reticulations and honeycombing (HC) extents on both scans. A CT software quantitative texture analysis (QA) was also performed. For ILD detection, intra-/inter-reader agreements were computed with Cohen K coefficient. UTE sensitivity and specificity were assessed. For extent assessments, intra-/inter-reader agreements and UTE performance against CT were computed by Lin's concordance coefficient (CCC). RESULTS Three UTE were discarded for low quality, 51 subjects were included in the study. Of them, 42 QA segmentations were accepted. ILD was diagnosed in 39/51 CT. UTE intra-/inter-reader K in ILD diagnosis were 0.56 and 0.26. UTE showed 92.8% sensitivity and 75.0% specificity. ILD, GGO, and reticulation extents were 14.8%, 7.7%, and 7.1% on CT sQA and 13.0%, 11.2%, and 1.6% on CT QA. HC was <1% and not further considered. UTE intra-/inter-reader CCC were 0.92 and 0.89 for ILD extent and 0.84 and 0.79 for GGO extent. UTE RET extent intra-/inter-reader CCC were 0.22 and 0.18. UTE ILD and GGO extents CCC against CT sQA and QA were ≥0.93 and ≥0.88, respectively. RET extent CCC were 0.35 and 0.22 against sQA and QA, respectively. CONCLUSION UTE Spiral VIBE-MRI sequence is reliable in assessing ILD and GGO extents in systemic sclerosis-interstitial lung disease patients.
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Affiliation(s)
- Nicholas Landini
- Department of Radiology, Ca' Foncello General Hospital, Treviso
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Mariaelena Occhipinti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Pierluigi Ciet
- Department of Pediatric Pulmonology, Erasmus University Medical Centre, Sophia Children's Hospital
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Piotr Wielopolski
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Thomas Benkert
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Silvia Bertolo
- Department of Radiology, Ca' Foncello General Hospital, Treviso
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence & Division of Internal Medicine Unit IV AOUC, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello General Hospital, Treviso
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC
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10
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Wang Y, Li L. Rituximab for connective tissue disease-associated interstitial lung disease: A systematic review and meta-analysis. Int J Rheum Dis 2023; 26:225-235. [PMID: 36378118 DOI: 10.1111/1756-185x.14495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/21/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the efficacy of rituximab (RTX) on lung function and the prevalence of adverse events (AEs) in connective tissue disease-associated interstitial lung disease (CTD-ILD) by meta-analysis. METHODS EMBASE, Web of Science, PubMed and ClinicalKey were searched up to July 16, 2021. The lung function (forced vital capacity, FVC% predicted, and diffusing capacity of the lung for carbon monoxide, DLCO% predicted) and prevalence of AEs of RTX in CTD-ILD were analyzed by meta-analysis, and 95% confidence interval (CI) was calculated. Subgroup analyses and meta-regression were used to explore the heterogeneity. RESULTS We identified 29 studies, including 827 CTD-ILD patients with a median age of 53.05 years. In observational studies, FVC% (mean difference - 1.24, 95% CI [-2.35, -0.12]; P = .030) and DLCO% (-7.71, [-11.79, -3.63]; P = .014) of CTD-ILD decreased significantly after RTX treatment. In randomized controlled trials, FVC% of CTD-ILD decreased after RTX treatment (-5.24, [-9.94, - 0.54]; P = .029), but the difference of DLCO% was not significant (1.15, [-4.33, 6.63]; P = .681). The prevalence of AEs, all-cause mortality and infections was 29.7% (95% CI [0.17, 0.42]), 11.6% (95% CI [0.08, 0.16]) and 20.9% (95% CI [0.15, 0.27]), respectively. CONCLUSIONS RTX was associated with AEs such as decreased pulmonary function, all-cause mortality, and infections in CTD-ILD. Adverse reactions during and after RTX treatment should be carefully monitored. Further prospective studies are needed to compare RTX with other immunosuppressants, antifibrotic drugs or placebos, which can provide therapeutic approaches for CTD-ILD.
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Affiliation(s)
- Yilin Wang
- School of Medicine and Nursing, Huzhou University, Huzhou, China
| | - Liren Li
- School of Medicine, Nantong University, Nantong, China
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11
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Emilsson ÖI, Dessle A, Johansson H, Adeli S, Malinovschi A, Eloranta ML, Hansen T. Different chest HRCT scan protocols change the extent of ground glass opacities. BMC Pulm Med 2022; 22:430. [PMID: 36404311 PMCID: PMC9677886 DOI: 10.1186/s12890-022-02212-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ground glass opacity (GGO) is the main HRCT feature representing alveolitis in systemic sclerosis-associated interstitial lung disease (SSc-ILD), but may also represent other conditions such as atelectasis or edema. It is unclear how much this is affected by the HRCT scan protocol used. We aimed to compare the performance of three different HRCT protocols to evaluate the degree of SSc-ILD related changes. METHODS Eleven patients with SSc underwent chest HRCT scan by three different protocols: First, a supine scan after lying down for 15 minutes, then two scans in alternating order: A prone position scan, and a supine position scan after performing 10 deep breaths using a positive expiratory pressure (PEP) device. The HRCT scans were evaluated by the Warrick score system for ILD-related findings. RESULTS The three HRCT protocols were compared and resulted in different mean (95% CI) Warrick scores: 9.4 (5.3-13.4) in supine after rest; 7.5 (95% CI 3.8-11.1) in prone and 7.6 (95% CI 4.2-11.1) in supine after PEP. When comparing supine after rest to prone and supine after PEP, the latter two scans had a significantly lower score (p = 0.001 for both comparisons). In all cases, only sub-scores for ground glass opacities differed, while sub-scores for fibrosis-related changes did not change. CONCLUSIONS Different HRCT scan protocols significantly altered the Warrick severity score for SSc-ILD findings, primarily because of changes in ground glass opacities. These differences may be clinically meaningful.
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Affiliation(s)
- Össur Ingi Emilsson
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Respiratory, allergy and sleep research, Akademiska Sjukhuset, Uppsala University, 751 85 Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Respiratory medicine and allergology, Akademiska sjukhuset, Uppsala, Sweden
| | - Angelica Dessle
- grid.8993.b0000 0004 1936 9457Institution of Surgical Sciences, Department of Radiology, Uppsala University, Uppsala, Sweden
| | - Henrik Johansson
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Respiratory, allergy and sleep research, Akademiska Sjukhuset, Uppsala University, 751 85 Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Shamisa Adeli
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Maija-Leena Eloranta
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden
| | - Tomas Hansen
- grid.8993.b0000 0004 1936 9457Institution of Surgical Sciences, Department of Radiology, Uppsala University, Uppsala, Sweden
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12
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Chan J, Auffermann WF. Artificial Intelligence in the Imaging of Diffuse Lung Disease. Radiol Clin North Am 2022; 60:1033-1040. [DOI: 10.1016/j.rcl.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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Dual-energy CT lung perfusion in systemic sclerosis: preliminary experience in 101 patients. Eur Radiol 2022; 33:401-413. [PMID: 35881181 DOI: 10.1007/s00330-022-09016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/13/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate lung perfusion in systemic sclerosis (SSc). METHODS The study population included 101 patients who underwent dual-energy CT (DECT) in the follow-up of SSc with pulmonary function tests obtained within 2 months. Fifteen patients had right heart catheterization-proven PH. RESULTS Thirty-seven patients had no SSc-related lung involvement (Group A), 56 patients had SSc-related interstitial lung disease (Group B) of variable extent (Group B mild: ≤ 10% of lung parenchyma involved: n = 17; Group B moderate: between 11 and 50%: n = 31; Group B severe: > 50%: n = 8), and 8 patients had PVOD/PCH (Group C). Lung perfusion was abnormal in 8 patients in Group A (21.6%), 14 patients in Group B (25%), and 7 patients in Group C (87.5%). In Group A and Group B mild (n = 54), (a) patients with abnormal lung perfusion (n = 14; 26%) had a higher proportion of NYHA III/IV scores of dyspnea (7 [50%] vs 7 [17.5%]; p = 0.031) and a shorter mean walking distance at the 6MWT (397.0 [291.0; 466.0] vs 495.0 [381.0; 549.0]; p = 0.042) but no evidence of difference in the DLCO% predicted (61.0 [53.0; 67.0] vs 68.0 [61.0; 78.0]; p = 0.055) when compared to patients with normal lung perfusion (n = 40; 74%); (b) a negative correlation was found between the iodine concentration in both lungs and the DLCO% predicted but it did not reach statistical significance (r = -0.27; p = 0.059) and no correlation was found with the PAPs (r = 0.16; p = 0.29) and walking distance during the 6MWT (r = -0.029; p = 0.84). CONCLUSIONS DECT lung perfusion provides complementary information to standard HRCT scans, depicting perfusion changes in SSc patients with normal or minimally infiltrated lung parenchyma. KEY POINTS • In a retrospective observational study of 101 consecutive patients with SSc, dual-energy CT pulmonary angiography was obtained to evaluate lung perfusion. • Lung perfusion was abnormal in 14 out of 54 patients (26%) with no or mild SSc-related lung infiltration. • Patients with abnormal perfusion and no or mild SSc-related lung infiltration had more severe scores of dyspnea and shorter walking distance than patients with similar lung findings and normal perfusion, suggesting the presence of small vessel vasculopathy.
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14
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Wu WJ, Huang WM, Liang CH, Yun CH. Pulmonary vascular volume is associated with DLCO and fibrotic score in idiopathic pulmonary fibrosis: an observational study. BMC Med Imaging 2022; 22:76. [PMID: 35461214 PMCID: PMC9034618 DOI: 10.1186/s12880-022-00803-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/19/2022] [Indexed: 12/12/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a disease that primarily occurs in elderly individuals. However, it is difficult to diagnose and has a complex disease course. High-resolution computed tomography (HRCT) and lung function testing are crucial for its diagnosis and follow-up. However, the correlation of HRCT findings with lung function test results has not been extensively investigated. Methods This study retrospectively analysed the medical records and images of patients with IPF. Patients with evident emphysema and lung cancer were excluded. The diagnosis of all the included cases was confirmed following a discussion among specialists from multiple disciplines. The correlation of HRCT findings, including fibrotic score, HRCT lung volume, pulmonary artery trunk (PA) diameter and pulmonary vascular volume (PVV), with lung function test parameters, such as forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), was analysed. Results A total of 32 patients were included. Higher fibrotic and PVV scores were significantly correlated with lower DLCO (r = − 0.59, p = 0.01; r = − 0.43, p = 0.03, respectively) but not with FVC. Higher PVV score significantly correlated with higher fibrotic score (r = 0.59, p < 0.01) and PA diameter (r = 0.47, p = 0.006). Conclusion Our study demonstrated the structural and functional correlation of IPF. The extent of lung fibrosis (fibrotic score) and PVV score were associated with DLCO but not with FVC. The PA diameter, which reflects the pulmonary artery pressure, was found to be associated with the PVV score.
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Affiliation(s)
- Wen-Jui Wu
- Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Wei-Ming Huang
- Department of Radiology, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Chia-Hao Liang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chun-Ho Yun
- Department of Radiology, Mackay Memorial Hospital, Taipei City, Taiwan. .,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan. .,Mackay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan.
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15
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Current and emerging artificial intelligence applications in chest imaging: a pediatric perspective. Pediatr Radiol 2022; 52:2120-2130. [PMID: 34471961 PMCID: PMC8409695 DOI: 10.1007/s00247-021-05146-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/22/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022]
Abstract
Artificial intelligence (AI) applications for chest radiography and chest CT are among the most developed applications in radiology. More than 40 certified AI products are available for chest radiography or chest CT. These AI products cover a wide range of abnormalities, including pneumonia, pneumothorax and lung cancer. Most applications are aimed at detecting disease, complemented by products that characterize or quantify tissue. At present, none of the thoracic AI products is specifically designed for the pediatric population. However, some products developed to detect tuberculosis in adults are also applicable to children. Software is under development to detect early changes of cystic fibrosis on chest CT, which could be an interesting application for pediatric radiology. In this review, we give an overview of current AI products in thoracic radiology and cover recent literature about AI in chest radiography, with a focus on pediatric radiology. We also discuss possible pediatric applications.
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Karampitsakos T, Kalogeropoulou C, Tzilas V, Papaioannou O, Kazantzi A, Koukaki E, Katsaras M, Bouros E, Tsiri P, Tsirikos G, Zarkadi E, Ntoulias N, Sotiropoulou V, Efthymiou P, Chrysikos S, Malakounidou E, Sampsonas F, Bouros D, Tzouvelekis A. Safety and Effectiveness of Mycophenolate Mofetil in Interstitial Lung Diseases: Insights from a Machine Learning Radiographic Model. Respiration 2021; 101:262-271. [PMID: 34592744 DOI: 10.1159/000519215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Treatment of interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF) often includes systemic corticosteroids. Use of steroid-sparing agents is amenable to avoid potential side effects. METHODS Functional indices and high-resolution computed tomography (HRCT) patterns of patients with non-IPF ILDs receiving mycophenolate mofetil (MMF) with a minimum follow-up of 1 year were analyzed. Two independent radiologists and a machine learning software system (Imbio 1.4.2.) evaluated HRCT patterns. RESULTS Fifty-five (n = 55) patients were included in the analysis (male: 30 [55%], median age: 65.0 [95% CI: 59.7-70.0], mean forced vital capacity %predicted [FVC %pred.] ± standard deviation [SD]: 69.4 ± 18.3, mean diffusing capacity of lung for carbon monoxide %pred. ± SD: 40.8 ± 14.3, hypersensitivity pneumonitis: 26, connective tissue disease-ILDs [CTD-ILDs]: 22, other ILDs: 7). There was no significant difference in mean FVC %pred. post-6 months (1.59 ± 2.04) and 1 year (-0.39 ± 2.49) of treatment compared to baseline. Radiographic evaluation showed no significant difference between baseline and post-1 year %ground glass opacities (20.0 [95% CI: 14.4-30.0] vs. 20.0 [95% CI: 14.4-25.6]) and %reticulation (5.0 [95% CI: 2.0-15.6] vs. 7.5 [95% CI: 2.0-17.5]). A similar performance between expert radiologists and Imbio software analysis was observed in assessing ground glass opacities (intraclass correlation coefficient [ICC] = 0.73) and reticulation (ICC = 0.88). Fourteen patients (25.5%) reported at least one side effect and 8 patients (14.5%) switched to antifibrotics due to disease progression. CONCLUSION Our data suggest that MMF is a safe and effective steroid-sparing agent leading to disease stabilization in a proportion of patients with non-IPF ILDs. Machine learning software systems may exhibit similar performance to specialist radiologists and represent fruitful diagnostic and prognostic tools.
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Affiliation(s)
| | | | - Vasilios Tzilas
- First Academic Department of Pneumonology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Athens Medical Center, Athens, Greece
| | - Ourania Papaioannou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | | | - Evangelia Koukaki
- First Academic Department of Pneumonology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Matthaios Katsaras
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Evangelos Bouros
- First Academic Department of Pneumonology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Athens Medical Center, Athens, Greece
| | - Panagiota Tsiri
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Georgios Tsirikos
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Eirini Zarkadi
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Nikolaos Ntoulias
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | | | - Panagiotis Efthymiou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Serafeim Chrysikos
- 5th Department of Pneumonology, Hospital for Thoracic Diseases "SOTIRIA,", Athens, Greece
| | - Elli Malakounidou
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Fotios Sampsonas
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Athens Medical Center, Athens, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
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17
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Stoleriu MG, Gerckens M, Obereisenbuchner F, Zaimova I, Hetrodt J, Mavi SC, Schmidt F, Schoenlebe AA, Heinig-Menhard K, Koch I, Jörres RA, Spiro J, Nowak L, Hatz R, Behr J, Gesierich W, Heiß-Neumann M, Dinkel J. Automated quantitative thin slice volumetric low dose CT analysis predicts disease severity in COVID-19 patients. Clin Imaging 2021; 79:96-101. [PMID: 33910141 PMCID: PMC8058052 DOI: 10.1016/j.clinimag.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/07/2021] [Accepted: 04/08/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE This study aimed to identify predictive (bio-)markers for COVID-19 severity derived from automated quantitative thin slice low dose volumetric CT analysis, clinical chemistry and lung function testing. METHODS Seventy-four COVID-19 patients admitted between March 16th and June 3rd 2020 to the Asklepios Lung Clinic Munich-Gauting, Germany, were included in the study. Patients were categorized in a non-severe group including patients hospitalized on general wards only and in a severe group including patients requiring intensive care treatment. Fully automated quantification of CT scans was performed via IMBIO CT Lung Texture analysis™ software. Predictive biomarkers were assessed with receiver-operator-curve and likelihood analysis. RESULTS Fifty-five patients (44% female) presented with non-severe COVID-19 and 19 patients (32% female) with severe disease. Five fatalities were reported in the severe group. Accurate automated CT analysis was possible with 61 CTs (82%). Disease severity was linked to lower residual normal lung (72.5% vs 87%, p = 0.003), increased ground glass opacities (GGO) (8% vs 5%, p = 0.031) and increased reticular pattern (8% vs 2%, p = 0.025). Disease severity was associated with advanced age (76 vs 59 years, p = 0.001) and elevated serum C-reactive protein (CRP, 92.2 vs 36.3 mg/L, p < 0.001), lactate dehydrogenase (LDH, 485 vs 268 IU/L, p < 0.001) and oxygen supplementation (p < 0.001) upon admission. Predictive risk factors for the development of severe COVID-19 were oxygen supplementation, LDH >313 IU/L, CRP >71 mg/L, <70% normal lung texture, >12.5% GGO and >4.5% reticular pattern. CONCLUSION Automated low dose CT analysis upon admission might be a useful tool to predict COVID-19 severity in patients.
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Affiliation(s)
- Mircea Gabriel Stoleriu
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Marchioninistr, 15, 81377 Munich and Robert-Koch-Allee 2, 82131 Gauting, Germany; Comprehensive Pneumology Center, Helmholtz Center Munich, Max-Lebsche-Platz 31, 81377 Munich, Germany(1).
| | - Michael Gerckens
- Comprehensive Pneumology Center, Helmholtz Center Munich, Max-Lebsche-Platz 31, 81377 Munich, Germany(1); Department of Internal Medicine V, Ludwig-Maximilians-University Munich (LMU), Marchioninistr, 15, 81377 Munich, Germany
| | - Florian Obereisenbuchner
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Iva Zaimova
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Justin Hetrodt
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Sarah-Christin Mavi
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Felicitas Schmidt
- Department of Intensive Care Medicine, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Anna Auguste Schoenlebe
- Department of Intensive Care Medicine, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Katharina Heinig-Menhard
- Department of Intensive Care Medicine, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Ina Koch
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Marchioninistr, 15, 81377 Munich and Robert-Koch-Allee 2, 82131 Gauting, Germany; Comprehensive Pneumology Center, Helmholtz Center Munich, Max-Lebsche-Platz 31, 81377 Munich, Germany(1)
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich (LMU), Ziemssenstraße 1, 80336 Munich, Germany
| | - Judith Spiro
- Department of Radiology, Ludwig-Maximilians-University Munich (LMU), Marchioninistr, 15, 81377 Munich, Germany
| | - Lorenz Nowak
- Department of Intensive Care Medicine, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Rudolf Hatz
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Marchioninistr, 15, 81377 Munich and Robert-Koch-Allee 2, 82131 Gauting, Germany; Comprehensive Pneumology Center, Helmholtz Center Munich, Max-Lebsche-Platz 31, 81377 Munich, Germany(1)
| | - Jürgen Behr
- Comprehensive Pneumology Center, Helmholtz Center Munich, Max-Lebsche-Platz 31, 81377 Munich, Germany(1); Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany; Department of Internal Medicine V, Ludwig-Maximilians-University Munich (LMU), Marchioninistr, 15, 81377 Munich, Germany
| | - Wolfgang Gesierich
- Comprehensive Pneumology Center, Helmholtz Center Munich, Max-Lebsche-Platz 31, 81377 Munich, Germany(1); Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Marion Heiß-Neumann
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Julien Dinkel
- Comprehensive Pneumology Center, Helmholtz Center Munich, Max-Lebsche-Platz 31, 81377 Munich, Germany(1); Department of Radiology, Ludwig-Maximilians-University Munich (LMU), Marchioninistr, 15, 81377 Munich, Germany; Department of Radiology, Asklepios Lung Clinic Munich-Gauting, Robert-Koch-Allee 2, 82131 Gauting, Germany
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18
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Loarce-Martos J, Leon-Roman F, Garrote-Corral S. Recent advances in quantitative computerized tomography and home spirometry for diagnosing and monitoring of interstitial lung disease associated with connective tissue diseases: A narrative review. INDIAN JOURNAL OF RHEUMATOLOGY 2021. [DOI: 10.4103/injr.injr_304_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Ariani A, Sverzellati N, Becciolni A, Milanese G, Silva M. Using quantitative computed tomography to predict mortality in patients with interstitial lung disease related to systemic sclerosis: implications for personalized medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2021.1858053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Nicola Sverzellati
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Andrea Becciolni
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Gianluca Milanese
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Mario Silva
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
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20
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Carvalho ARS, Guimarães A, Werberich GM, de Castro SN, Pinto JSF, Schmitt WR, França M, Bozza FA, Guimarães BLDS, Zin WA, Rodrigues RS. COVID-19 Chest Computed Tomography to Stratify Severity and Disease Extension by Artificial Neural Network Computer-Aided Diagnosis. Front Med (Lausanne) 2020; 7:577609. [PMID: 33344471 PMCID: PMC7746855 DOI: 10.3389/fmed.2020.577609] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose: This work aims to develop a computer-aided diagnosis (CAD) to quantify the extent of pulmonary involvement (PI) in COVID-19 as well as the radiological patterns referred to as lung opacities in chest computer tomography (CT). Methods: One hundred thirty subjects with COVID-19 pneumonia who underwent chest CT at hospital admission were retrospectively studied (141 sets of CT scan images). Eighty-eight healthy individuals without radiological evidence of acute lung disease served as controls. Two radiologists selected up to four regions of interest (ROI) per patient (totaling 1,475 ROIs) visually regarded as well-aerated regions (472), ground-glass opacity (GGO, 413), crazy paving and linear opacities (CP/LO, 340), and consolidation (250). After balancing with 250 ROIs for each class, the density quantiles (2.5, 25, 50, 75, and 97.5%) of 1,000 ROIs were used to train (700), validate (150), and test (150 ROIs) an artificial neural network (ANN) classifier (60 neurons in a single-hidden-layer architecture). Pulmonary involvement was defined as the sum of GGO, CP/LO, and consolidation volumes divided by total lung volume (TLV), and the cutoff of normality between controls and COVID-19 patients was determined with a receiver operator characteristic (ROC) curve. The severity of pulmonary involvement in COVID-19 patients was also assessed by calculating Z scores relative to the average volume of parenchymal opacities in controls. Thus, COVID-19 cases were classified as mild (
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Affiliation(s)
- Alysson Roncally S. Carvalho
- UnIC, Faculty of Medicine, Cardiovascular R&D Center, Centro Hospitalar Universitário Do Porto (CHUP), Porto University, Porto, Portugal
- Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alan Guimarães
- Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Stephane Nery de Castro
- Hospital Barra D'Or, Rio de Janeiro, Brazil
- National Institute of Infectious Disease, Oswaldo Cruz Foundation (INI/Fiocruz), Rio de Janeiro, Brazil
| | - Joana Sofia F. Pinto
- Radiology Department, Centro Hospitalar Complexo Universitário Do Porto (CHUP), Porto, Portugal
| | | | - Manuela França
- Radiology Department, Centro Hospitalar Complexo Universitário Do Porto (CHUP), Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto University, Porto, Portugal
| | - Fernando Augusto Bozza
- National Institute of Infectious Disease, Oswaldo Cruz Foundation (INI/Fiocruz), Rio de Janeiro, Brazil
- IDOR - D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | | | - Walter Araujo Zin
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosana Souza Rodrigues
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- IDOR - D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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21
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Carvalho ARS, Guimarães AR, Sztajnbok FR, Rodrigues RS, Silva BRA, Lopes AJ, Zin WA, Almeida I, França MM. Automatic Quantification of Interstitial Lung Disease From Chest Computed Tomography in Systemic Sclerosis. Front Med (Lausanne) 2020; 7:577739. [PMID: 33102508 PMCID: PMC7546366 DOI: 10.3389/fmed.2020.577739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Interstitial lung disease (ILD) is a common complication in patients with systemic sclerosis (SSc), and its diagnosis contributes to early treatment decisions. Purposes: To quantify ILD associated with SSc (SSc-ILD) from chest CT images using an automatic quantification method based on the computation of the weight of interstitial lung opacities. Methods: Ninety-four patients with SSc underwent CT, forced vital capacity (FVC), and carbon monoxide diffusion capacity (DLCO) tests. Seventy-three healthy individuals without radiological evidence of lung disease served as controls. After lung and airway segmentation, the ratio between the weight of interstitial opacities [densities between −500 and +50 Hounsfield units (HU)] and the total lung weight (densities between −1,000 and +50 HU) was used as an ILD indicator (ILD[%] = 100 × [LW(−500 to +50HU)/LW(−1, 000 to +50HU)]). The cutoff of normality between controls and SSc was determined with a receiver operator characteristic curve. The severity of pulmonary involvement in SSc patients was also assessed by calculating Z scores of ILD relative to the average interstitial opacities in controls. Accordingly, SSc-ILD was classified as SSc Limited-ILD (Z score < 3) and SSc Extensive-ILD (Z score ≥ 3 or FVC < 70%). Results: Seventy-eight (83%) SSc patients were classified as presenting SSc-ILD (optimal ILD threshold of 23.4%, 0.83 sensitivity, 0.92 specificity, and 0.94 area under the receiver operator characteristic curve, 95% CI from 0.89 to 0.96, 0.93 positive predictive value, and 0.81 negative predictive value, p < 0.001) and exhibited radiological attenuations compatible with interstitial pneumonia dispersed in the lung parenchyma. Thirty-six (38%) patients were classified as SSc Extensive-ILD (ILD threshold ≥ 29.6% equivalent to a Z score ≥ 3) and 42 (45%) as SSc Limited-ILD. Eighteen (50%) patients with SSc Extensive-ILD presented FVC < 70%, being only five patients classified exclusively based on FVC. SSc Extensive-ILD also presented lower DLCO (57.9 ± 17.9% vs. 73.7 ± 19.8%; p < 0.001) and total lung volume (2,916 ± 674 vs. 4,286 ± 1,136, p < 0.001) compared with SSc Limited-ILD. Conclusion: The proposed method seems to provide an alternative to identify and quantify the extension of ILD in patients with SSc, mitigating the subjectivity of semiquantitative analyzes based on visual scores.
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Affiliation(s)
- Alysson Roncally S Carvalho
- Department of Radiology, Medical School, Centro Hospitalar Universitário do Porto (CHUP), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto University, Porto, Portugal.,Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alan R Guimarães
- Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávio R Sztajnbok
- Division of Pediatric Rheumatology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosana Souza Rodrigues
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,IDOR - D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Bruno Rangel Antunes Silva
- Graduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Graduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Walter Araujo Zin
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabel Almeida
- Clinical Immunology Unit, Deptartment of Medicine, Centro Hospitalar Universitário do Porto (CHUP), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto University, Porto, Portugal
| | - Manuela Maria França
- Radiology Department, Centro Hospitalar Universitário do Porto (CHUP), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto University, Porto, Portugal
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22
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Hoffmann-Vold AM, Allanore Y, Bendstrup E, Bruni C, Distler O, Maher TM, Wijsenbeek M, Kreuter M. The need for a holistic approach for SSc-ILD - achievements and ambiguity in a devastating disease. Respir Res 2020; 21:197. [PMID: 32703199 PMCID: PMC7379834 DOI: 10.1186/s12931-020-01459-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/17/2020] [Indexed: 12/13/2022] Open
Abstract
Systemic sclerosis (SSc) is a multi-organ autoimmune disease with complex interactions between immune-mediated inflammatory processes and vascular pathology leading to small vessel obliteration, promoting uncontrolled fibrosis of skin and internal organs. Interstitial lung disease (ILD) is a common but highly variable manifestation of SSc and is associated with high morbidity and mortality. Treatment approaches have focused on immunosuppressive therapies, which have shown some efficacy on lung function. Recently, a large phase 3 trial showed that treatment with nintedanib was associated with a reduction in lung function decline. None of the conducted randomized clinical trials have so far shown convincing efficacy on other outcome measures including quality of life determined by patient reported outcomes. Little evidence is available for non-pharmacological treatment and supportive care specifically for SSc-ILD patients, including pulmonary rehabilitation, supplemental oxygen, symptom relief and adequate information. Improved management of SSc-ILD patients based on a holistic approach is necessary to support patients in maintaining as much quality of life as possible throughout the disease course and to improve long-term outcomes.
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Affiliation(s)
- Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Pb 4950 Nydalen, 0424, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Yannick Allanore
- Rheumatology Department, Cochin Hospital, University of PARIS and INSERM U1016, Paris, France
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Toby M Maher
- Inflammation, Repair, and Development Section, National Heart and Lung Institute, Imperial College London, London, UK
- National Institute for Health Research Respiratory Clinical Research Facility, Royal Brompton Hospital, London, UK
- Keck School of Medicine, University of Southern California, 2020 Zonal Avenue, Los Angeles, California, USA
| | - Marlies Wijsenbeek
- Center for Interstitial lung disease and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, Heidelberg University Hospital and German Center for Lung Research, Heidelberg, Germany
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23
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Occhipinti M, Bruni C, Camiciottoli G, Bartolucci M, Bellando-Randone S, Bassetto A, Cuomo G, Giuggioli D, Ciardi G, Fabbrizzi A, Tomassetti S, Lavorini F, Pistolesi M, Colagrande S, Matucci-Cerinic M. Quantitative analysis of pulmonary vasculature in systemic sclerosis at spirometry-gated chest CT. Ann Rheum Dis 2020; 79:1210-1217. [PMID: 32606043 DOI: 10.1136/annrheumdis-2020-217359] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To prospectively investigate whether differences in pulmonary vasculature exist in systemic sclerosis (SSc) and how they are distributed in patients with different pulmonary function. METHODS Seventy-four patients with SSc undergoing chest CT scan for interstitial lung disease (ILD) screening or follow-up were prospectively enrolled. A thorough clinical, laboratory and functional evaluation was performed the same day. Chest CT was spirometry gated at total lung capacity and images were analysed by two automated software programs to quantify emphysema, ILD patterns (ground-glass, reticular, honeycombing), and pulmonary vascular volume (PVV). Patients were divided in restricted (FVC% <80, DLco%<80), isolated DLco% reduction (iDLco- FVC%≥80, DLco%<80) and normals (FVC%≥80, DLco%≥80). Spearman ρ, Mann-Whitney tests and logistic regressions were used to assess for correlations, differences among groups and relationships between continuous variables. RESULTS Absolute and lung volume normalised PVV (PVV/LV) correlated inversely with functional parameters and positively with all ILD patterns (ρ=0.75 with ground glass, ρ=0.68 with reticular). PVV/LV was the only predictor of DLco at multivariate analysis (p=0.007). Meanwhile, the reticular pattern prevailed in peripheral regions and lower lung thirds, PVV/LV prevailed in central regions and middle lung thirds. iDLco group had a significantly higher PVV/LV (2.2%) than normal (1.6%), but lower than restricted ones (3.8%). CONCLUSIONS Chest CT in SSc detects a progressive increase in PVV/LV as DLco decreases. Redistribution of perfusion to less affected lung regions rather than angiogenesis nearby fibrotic lung may explain the results. Further studies to ascertain whether the increase in PVV/LV reflects a real increase in blood volume are needed.
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Affiliation(s)
- Mariaelena Occhipinti
- Dept Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Biomedicine, Division of Rheumatology, University of Florence, Florence, Italy.,Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianna Camiciottoli
- Dept Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy.,Dept CardioThoracoVascular, AOUC, Florence, Italy
| | | | - Silvia Bellando-Randone
- Biomedicine, Division of Rheumatology, University of Florence, Florence, Italy.,Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Bassetto
- Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanna Cuomo
- Precision Medicine, Universita degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, Policlinico di Modena, Universita degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Sara Tomassetti
- Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Dept CardioThoracoVascular, AOUC, Florence, Italy
| | - Federico Lavorini
- Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Dept CardioThoracoVascular, AOUC, Florence, Italy
| | - Massimo Pistolesi
- Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Colagrande
- Dept Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy.,Radiology Unit, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Dept Internal Medicine, University of Florence, Florence, Italy
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