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Chevalier K, Chassagnon G, Leonard-Louis S, Cohen P, Dunogue B, Regent A, Thoreau B, Mouthon L, Chaigne B. Anti-U1RNP antibodies are associated with a distinct clinical phenotype and a worse survival in patients with systemic sclerosis. J Autoimmun 2024; 146:103220. [PMID: 38642508 DOI: 10.1016/j.jaut.2024.103220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/24/2024] [Accepted: 03/31/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES To clarify the impact of anti-U1RNP antibodies on the clinical features and prognosis of patients with SSc. METHODS We conducted a monocentric case-control, retrospective, longitudinal study. For each patient with SSc and anti-U1RNP antibodies (SSc-RNP+), one patient with mixed connective tissue disease (MCTD) and 2 SSc patients without anti-U1RNP antibodies (SSc-RNP-) were matched for age, sex, and date of inclusion. RESULTS Sixty-four SSc-RNP+ patients were compared to 128 SSc-RNP- and 64 MCTD patients. Compared to SSc-RNP-, SSc-RNP+ patients were more often of Afro-Caribbean origin (31.3% vs. 11%, p < 0.01), and more often had an overlap syndrome than SSc-RNP- patients (53.1 % vs. 22.7%, p < 0.0001), overlapping with Sjögren's syndrome (n = 23, 35.9%) and/or systemic lupus erythematosus (n = 19, 29.7%). SSc-RNP+ patients were distinctly different from MCTD patients but less often had joint involvement (p < 0.01). SSc-RNP+ patients more frequently developed interstitial lung disease (ILD) (73.4% vs. 55.5% vs. 31.3%, p < 0.05), pulmonary fibrosis (PF) (60.9% vs. 37.5% vs. 10.9%, p < 0.0001), SSc associated myopathy (29.7% vs. 6.3% vs. 7.8%, p < 0.0001), and kidney involvement (10.9% vs. 2.3% vs. 1.6%, p < 0.05). Over a 200-month follow-up period, SSc-RNP+ patients had worse overall survival (p < 0.05), worse survival without PF occurrence (p < 0.01), ILD or PF progression (p < 0.01 and p < 0.0001). CONCLUSIONS In SSc patients, anti-U1RNP antibodies are associated with a higher incidence of overlap syndrome, a distinct clinical phenotype, and poorer survival compared to SSc-RNP- and MCTD patients. Our study suggests that SSc-RNP+ patients should be separated from MCTD patients and may constitute an enriched population for progressive lung disease.
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Affiliation(s)
- Kevin Chevalier
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes et Autoinflammatoires Rares d'Ile de France de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université Paris Cité, F-75014, Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Hôpital Cochin, AP-HP. Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France; Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Sarah Leonard-Louis
- Sorbonne Université, INSERM, Department of Neurormyologie and Neuropathology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pascal Cohen
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes et Autoinflammatoires Rares d'Ile de France de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université Paris Cité, F-75014, Paris, France
| | - Bertrand Dunogue
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes et Autoinflammatoires Rares d'Ile de France de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université Paris Cité, F-75014, Paris, France
| | - Alexis Regent
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes et Autoinflammatoires Rares d'Ile de France de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université Paris Cité, F-75014, Paris, France
| | - Benjamin Thoreau
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes et Autoinflammatoires Rares d'Ile de France de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université Paris Cité, F-75014, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes et Autoinflammatoires Rares d'Ile de France de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université Paris Cité, F-75014, Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes et Autoinflammatoires Rares d'Ile de France de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université Paris Cité, F-75014, Paris, France.
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Djahnine A, Lazarus C, Lederlin M, Mulé S, Wiemker R, Si-Mohamed S, Jupin-Delevaux E, Nempont O, Skandarani Y, De Craene M, Goubalan S, Raynaud C, Belkouchi Y, Afia AB, Fabre C, Ferretti G, De Margerie C, Berge P, Liberge R, Elbaz N, Blain M, Brillet PY, Chassagnon G, Cadour F, Caramella C, Hajjam ME, Boussouar S, Hadchiti J, Fablet X, Khalil A, Talbot H, Luciani A, Lassau N, Boussel L. Detection and severity quantification of pulmonary embolism with 3D CT data using an automated deep learning-based artificial solution. Diagn Interv Imaging 2024; 105:97-103. [PMID: 38261553 DOI: 10.1016/j.diii.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this study was to propose a deep learning-based approach to detect pulmonary embolism and quantify its severity using the Qanadli score and the right-to-left ventricle diameter (RV/LV) ratio on three-dimensional (3D) computed tomography pulmonary angiography (CTPA) examinations with limited annotations. MATERIALS AND METHODS Using a database of 3D CTPA examinations of 1268 patients with image-level annotations, and two other public datasets of CTPA examinations from 91 (CAD-PE) and 35 (FUME-PE) patients with pixel-level annotations, a pipeline consisting of: (i), detecting blood clots; (ii), performing PE-positive versus negative classification; (iii), estimating the Qanadli score; and (iv), predicting RV/LV diameter ratio was followed. The method was evaluated on a test set including 378 patients. The performance of PE classification and severity quantification was quantitatively assessed using an area under the curve (AUC) analysis for PE classification and a coefficient of determination (R²) for the Qanadli score and the RV/LV diameter ratio. RESULTS Quantitative evaluation led to an overall AUC of 0.870 (95% confidence interval [CI]: 0.850-0.900) for PE classification task on the training set and an AUC of 0.852 (95% CI: 0.810-0.890) on the test set. Regression analysis yielded R² value of 0.717 (95% CI: 0.668-0.760) and of 0.723 (95% CI: 0.668-0.766) for the Qanadli score and the RV/LV diameter ratio estimation, respectively on the test set. CONCLUSION This study shows the feasibility of utilizing AI-based assistance tools in detecting blood clots and estimating PE severity scores with 3D CTPA examinations. This is achieved by leveraging blood clots and cardiac segmentations. Further studies are needed to assess the effectiveness of these tools in clinical practice.
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Affiliation(s)
- Aissam Djahnine
- Philips Research France, 92150 Suresnes, France; CREATIS, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France.
| | | | | | - Sébastien Mulé
- Medical Imaging Department, Henri Mondor University Hospital, AP-HP, Créteil, France, Inserm, U955, Team 18, 94000 Créteil, France
| | | | - Salim Si-Mohamed
- Department of Radiology, Hospices Civils de Lyon, 69500 Lyon, France
| | | | | | | | | | | | | | - Younes Belkouchi
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; OPIS - Optimisation Imagerie et Santé, Université Paris-Saclay, Inria, CentraleSupélec, CVN - Centre de vision numérique, 91190 Gif-Sur-Yvette, France
| | - Amira Ben Afia
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France
| | - Clement Fabre
- Department of Radiology, Centre Hospitalier de Laval, 53000 Laval, France
| | - Gilbert Ferretti
- Universite Grenobles Alpes, Service de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - Constance De Margerie
- Université Paris Cité, 75006 Paris, France, Department of Radiology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Pierre Berge
- Department of Radiology, CHU Angers, 49000 Angers, France
| | - Renan Liberge
- Department of Radiology, CHU Nantes, 44000 Nantes, France
| | - Nicolas Elbaz
- Department of Radiology, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Maxime Blain
- Department of Radiology, Hopital Henri Mondor, AP-HP, 94000 Créteil, France
| | - Pierre-Yves Brillet
- Department of Radiology, Hôpital Avicenne, Paris 13 University, 93000 Bobigny, France
| | - Guillaume Chassagnon
- Department of Radiology, Hopital Cochin, APHP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Farah Cadour
- APHM, Hôpital Universitaire Timone, CEMEREM, 13005 Marseille, France
| | - Caroline Caramella
- Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, 75015 Paris, France
| | - Mostafa El Hajjam
- Department of Radiology, Hôpital Ambroise Paré Hospital, UMR 1179 INSERM/UVSQ, Team 3, 92100 Boulogne-Billancourt, France
| | - Samia Boussouar
- Sorbonne Université, Hôpital La Pitié-Salpêtrière, APHP, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), 75013 Paris, France
| | - Joya Hadchiti
- Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay. 94800 Villejuif, France
| | - Xavier Fablet
- Department of Radiology, CHU Rennes, 35000 Rennes, France
| | - Antoine Khalil
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France
| | - Hugues Talbot
- OPIS - Optimisation Imagerie et Santé, Université Paris-Saclay, Inria, CentraleSupélec, CVN - Centre de vision numérique, 91190 Gif-Sur-Yvette, France
| | - Alain Luciani
- Medical Imaging Department, Henri Mondor University Hospital, AP-HP, Créteil, France, Inserm, U955, Team 18, 94000 Créteil, France
| | - Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay. 94800 Villejuif, France
| | - Loic Boussel
- CREATIS, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France; Department of Radiology, Hospices Civils de Lyon, 69500 Lyon, France
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Cazier P, Chassagnon G, Dhote T, Da Silva J, Kanaan R, Honore I, Carlier N, Revel MP, Canniff E, Martin C, Burgel PR. Reversal of cylindrical bronchial dilatations in a subset of adults with cystic fibrosis treated with elexacaftor-tezacaftor-ivacaftor. Eur Respir J 2024:2301794. [PMID: 38331460 DOI: 10.1183/13993003.01794-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND This study sought to evaluate the impact of elexacaftor-tezacaftor-ivacaftor (ETI) on lung structural abnormalities in adults with cystic fibrosis (awCF) with a specific focus on the reversal of bronchial dilatations. METHODS Chest computed tomography (CT) performed prior to, and ≥12 months after initiation of ETI were visually reviewed for possible reversal of bronchial dilatations. AwCF with and without reversal of bronchial dilatation (the latter served as controls with 3 controls per case) were selected. Visual Brody score, bronchial and arterial diameters, and lung volume were measured on CT. RESULTS Reversal of bronchial dilatation was found in 12/235 (5%) awCF treated with ETI. Twelve awCF with and 36 without reversal of bronchial dilatations were further analyzed (male=56%, mean age=31.6±8.5 years, F508del/F508del CFTR =54% and mean %predicted forced expiratory volume in 1 s=58.8%±22.3). The mean±sd Brody score improved overall from 79.4±29.8 to 54.8±32.3 (p<0.001). Reversal of bronchial dilatations was confirmed by a decrease in bronchial lumen diameter in cases from 3.9±0.9 mm to 3.2±1.1 mm (p<0.001), whereas it increased in awCF without reversal of bronchial dilatation (from 3.5±1.1 mm to 3.6±1.2 mm, p=0.002). Reversal of bronchial dilatations occurred in cylindrical (not varicose or saccular) bronchial dilatations. Lung volumes decreased by -6.6±10.7% in awCF with reversal of bronchial dilatation but increased by +2.3±9.6% in controls (p=0.007). CONCLUSION Although bronchial dilatations are generally considered irreversible, ETI was associated with reversal, which was limited to the cylindrical bronchial dilatations subtype, and occurred in a small subset of awCF. Initiating ETI earlier in life may reverse early bronchial dilatations.
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Affiliation(s)
- Paul Cazier
- Radiology department, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- These authors equally contributed to this work
| | - Guillaume Chassagnon
- Radiology department, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- Université Paris Cité and Institut Cochin, Inserm U1016 85 Boulevard Saint-Germain, Paris, France
- These authors equally contributed to this work
| | - Théo Dhote
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Jennifer Da Silva
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Reem Kanaan
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Isabelle Honore
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Nicolas Carlier
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Marie-Pierre Revel
- Radiology department, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- Université Paris Cité and Institut Cochin, Inserm U1016 85 Boulevard Saint-Germain, Paris, France
| | - Emma Canniff
- Radiology department, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- Université Paris Cité and Institut Cochin, Inserm U1016 85 Boulevard Saint-Germain, Paris, France
| | - Clémence Martin
- Université Paris Cité and Institut Cochin, Inserm U1016 85 Boulevard Saint-Germain, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Pierre-Régis Burgel
- Université Paris Cité and Institut Cochin, Inserm U1016 85 Boulevard Saint-Germain, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
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Chassagnon G, Soyer P. Artificial Intelligence for the Detection of Pneumothorax on Chest Radiograph: Not yet the Panacea. Can Assoc Radiol J 2024:8465371231225123. [PMID: 38281088 DOI: 10.1177/08465371231225123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024] Open
Affiliation(s)
- Guillaume Chassagnon
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
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de Frémont GM, Monaya A, Chassagnon G, Bouam S, Canniff E, Cohen P, Casadevall M, Mouthon L, Guern VL, Revel MP. Lung fibrosis is uncommon in primary Sjögren's disease: A retrospective analysis of computed tomography features in 77 patients. Diagn Interv Imaging 2024:S2211-5684(24)00015-9. [PMID: 38262872 DOI: 10.1016/j.diii.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this study was to describe lung abnormalities observed on computed tomography (CT) in patients meeting the 2016 American College of Rheumatology/European League Against Rheumatism (EULAR) classification criteria for primary Sjögren's disease (pSD). MATERIALS AND METHODS All patients with pSD seen between January 2009 and December 2020 in the day care centre of our National Reference Center for rare systemic autoimmune diseases, who had at least one chest CT examination available for review and for whom the cumulative EULAR Sjögren's Syndrome Disease Activity Index (cumESSDAI) could be calculated were retrospectively evaluated. CT examinations were reviewed, together with clinical symptoms and pulmonary functional results. RESULTS Seventy-seven patients (73 women, four men) with a median age of 51 years at pSD diagnosis (age range: 17-79 years), a median follow-up time of 6 years and a median cumESSDAI of 7 were included. Sixty-six patients (86%) had anti-SSA antibodies. Thirty-three patients (33/77; 43%) had respiratory symptoms, without significant alteration in pulmonary function tests. Forty patients (40/77; 52%) had abnormal lung CT findings of whom almost half of them had no respiratory symptoms. Abnormalities on chest CT were more frequently observed in patients with anti-SSA positivity and a history of lymphoma. Air cysts (28/77; 36%) and mosaic perfusion (35/77; 35%) were the predominant abnormalities, whereas lung fibrosis was observed in five patients (5/77; 6%). CONCLUSION More than half of patients with pSD have abnormal CT findings, mainly air cysts and mosaic perfusion, indicative of small airways disease, whereas lung fibrosis is rare, observed in less than 10% of such patients.
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Affiliation(s)
- Grégoire Martin de Frémont
- Université Paris Cité, Faculté de Médecine, 75006 paris, France; Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, AP-HP, 75014 Paris, France
| | | | - Guillaume Chassagnon
- Université Paris Cité, Faculté de Médecine, 75006 paris, France; Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Samir Bouam
- Department of Medical Informatics, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Emma Canniff
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Marion Casadevall
- Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Luc Mouthon
- Université Paris Cité, Faculté de Médecine, 75006 paris, France; Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Véronique Le Guern
- Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Marie-Pierre Revel
- Université Paris Cité, Faculté de Médecine, 75006 paris, France; Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France.
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Le Gall A, Hoang-Thi TN, Porcher R, Dunogué B, Berezné A, Guillevin L, Le Guern V, Cohen P, Chaigne B, London J, Groh M, Paule R, Chassagnon G, Vakalopoulou M, Dinh-Xuan AT, Revel MP, Mouthon L, Régent A. Prognostic value of automated assessment of interstitial lung disease on CT in systemic sclerosis. Rheumatology (Oxford) 2024; 63:103-110. [PMID: 37074923 DOI: 10.1093/rheumatology/kead164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE Stratifying the risk of death in SSc-related interstitial lung disease (SSc-ILD) is a challenging issue. The extent of lung fibrosis on high-resolution CT (HRCT) is often assessed by a visual semiquantitative method that lacks reliability. We aimed to assess the potential prognostic value of a deep-learning-based algorithm enabling automated quantification of ILD on HRCT in patients with SSc. METHODS We correlated the extent of ILD with the occurrence of death during follow-up, and evaluated the additional value of ILD extent in predicting death based on a prognostic model including well-known risk factors in SSc. RESULTS We included 318 patients with SSc, among whom 196 had ILD; the median follow-up was 94 months (interquartile range 73-111). The mortality rate was 1.6% at 2 years and 26.3% at 10 years. For each 1% increase in the baseline ILD extent (up to 30% of the lung), the risk of death at 10 years was increased by 4% (hazard ratio 1.04, 95% CI 1.01, 1.07, P = 0.004). We constructed a risk prediction model that showed good discrimination for 10-year mortality (c index 0.789). Adding the automated quantification of ILD significantly improved the model for 10-year survival prediction (P = 0.007). Its discrimination was only marginally improved, but it improved prediction of 2-year mortality (difference in time-dependent area under the curve 0.043, 95% CI 0.002, 0.084, P = 0.040). CONCLUSION The deep-learning-based, computer-aided quantification of ILD extent on HRCT provides an effective tool for risk stratification in SSc. It might help identify patients at short-term risk of death.
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Affiliation(s)
- Aëlle Le Gall
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | | | - Raphaël Porcher
- Université de Paris, Paris, France
- Service d'Epidémiologie Clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France
| | - Bertrand Dunogué
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Alice Berezné
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Véronique Le Guern
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Pascal Cohen
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Jonathan London
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Matthieu Groh
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Romain Paule
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Guillaume Chassagnon
- Service de Radiologie, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Maria Vakalopoulou
- Centre de Vision Numérique, École Centrale Supelec, Gif-sur-Yvette, France
| | - Anh-Tuan Dinh-Xuan
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Cochin, AP-HP, Paris, France
| | - Marie Pierre Revel
- Service de Radiologie, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
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Bennani S, Regnard NE, Ventre J, Lassalle L, Nguyen T, Ducarouge A, Dargent L, Guillo E, Gouhier E, Zaimi SH, Canniff E, Malandrin C, Khafagy P, Koulakian H, Revel MP, Chassagnon G. Using AI to Improve Radiologist Performance in Detection of Abnormalities on Chest Radiographs. Radiology 2023; 309:e230860. [PMID: 38085079 DOI: 10.1148/radiol.230860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Chest radiography remains the most common radiologic examination, and interpretation of its results can be difficult. Purpose To explore the potential benefit of artificial intelligence (AI) assistance in the detection of thoracic abnormalities on chest radiographs by evaluating the performance of radiologists with different levels of expertise, with and without AI assistance. Materials and Methods Patients who underwent both chest radiography and thoracic CT within 72 hours between January 2010 and December 2020 in a French public hospital were screened retrospectively. Radiographs were randomly included until reaching 500 radiographs, with about 50% of radiographs having abnormal findings. A senior thoracic radiologist annotated the radiographs for five abnormalities (pneumothorax, pleural effusion, consolidation, mediastinal and hilar mass, lung nodule) based on the corresponding CT results (ground truth). A total of 12 readers (four thoracic radiologists, four general radiologists, four radiology residents) read half the radiographs without AI and half the radiographs with AI (ChestView; Gleamer). Changes in sensitivity and specificity were measured using paired t tests. Results The study included 500 patients (mean age, 54 years ± 19 [SD]; 261 female, 239 male), with 522 abnormalities visible on 241 radiographs. On average, for all readers, AI use resulted in an absolute increase in sensitivity of 26% (95% CI: 20, 32), 14% (95% CI: 11, 17), 12% (95% CI: 10, 14), 8.5% (95% CI: 6, 11), and 5.9% (95% CI: 4, 8) for pneumothorax, consolidation, nodule, pleural effusion, and mediastinal and hilar mass, respectively (P < .001). Specificity increased with AI assistance (3.9% [95% CI: 3.2, 4.6], 3.7% [95% CI: 3, 4.4], 2.9% [95% CI: 2.3, 3.5], and 2.1% [95% CI: 1.6, 2.6] for pleural effusion, mediastinal and hilar mass, consolidation, and nodule, respectively), except in the diagnosis of pneumothorax (-0.2%; 95% CI: -0.36, -0.04; P = .01). The mean reading time was 81 seconds without AI versus 56 seconds with AI (31% decrease, P < .001). Conclusion AI-assisted chest radiography interpretation resulted in absolute increases in sensitivity for all radiologists of various levels of expertise and reduced the reading times; specificity increased with AI, except in the diagnosis of pneumothorax. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Souhail Bennani
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Nor-Eddine Regnard
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Jeanne Ventre
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Louis Lassalle
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Toan Nguyen
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Alexis Ducarouge
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Lucas Dargent
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Enora Guillo
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Elodie Gouhier
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Sophie-Hélène Zaimi
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Emma Canniff
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Cécile Malandrin
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Philippe Khafagy
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Hasmik Koulakian
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Marie-Pierre Revel
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Guillaume Chassagnon
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
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Affiliation(s)
- Marie-Pierre Revel
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France.
- Department of Radiology, Assistance Publique Des Hôpitaux de Paris, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Guillaume Chassagnon
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
- Department of Radiology, Assistance Publique Des Hôpitaux de Paris, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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9
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Chassagnon G, Billet N, Rutten C, Toussaint T, Cassius de Linval Q, Collin M, Lemouchi L, Homps M, Hedjoudje M, Ventre J, Gregory J, Canniff E, Regnard NE, Bennani S, Revel MP. Learning from the machine: AI assistance is not an effective learning tool for resident education in chest x-ray interpretation. Eur Radiol 2023; 33:8241-8250. [PMID: 37572190 DOI: 10.1007/s00330-023-10043-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES To assess whether a computer-aided detection (CADe) system could serve as a learning tool for radiology residents in chest X-ray (CXR) interpretation. METHODS Eight radiology residents were asked to interpret 500 CXRs for the detection of five abnormalities, namely pneumothorax, pleural effusion, alveolar syndrome, lung nodule, and mediastinal mass. After interpreting 150 CXRs, the residents were divided into 2 groups of equivalent performance and experience. Subsequently, group 1 interpreted 200 CXRs from the "intervention dataset" using a CADe as a second reader, while group 2 served as a control by interpreting the same CXRs without the use of CADe. Finally, the 2 groups interpreted another 150 CXRs without the use of CADe. The sensitivity, specificity, and accuracy before, during, and after the intervention were compared. RESULTS Before the intervention, the median individual sensitivity, specificity, and accuracy of the eight radiology residents were 43% (range: 35-57%), 90% (range: 82-96%), and 81% (range: 76-84%), respectively. With the use of CADe, residents from group 1 had a significantly higher overall sensitivity (53% [n = 431/816] vs 43% [n = 349/816], p < 0.001), specificity (94% [i = 3206/3428] vs 90% [n = 3127/3477], p < 0.001), and accuracy (86% [n = 3637/4244] vs 81% [n = 3476/4293], p < 0.001), compared to the control group. After the intervention, there were no significant differences between group 1 and group 2 regarding the overall sensitivity (44% [n = 309/696] vs 46% [n = 317/696], p = 0.666), specificity (90% [n = 2294/2541] vs 90% [n = 2285/2542], p = 0.642), or accuracy (80% [n = 2603/3237] vs 80% [n = 2602/3238], p = 0.955). CONCLUSIONS Although it improves radiology residents' performances for interpreting CXRs, a CADe system alone did not appear to be an effective learning tool and should not replace teaching. CLINICAL RELEVANCE STATEMENT Although the use of artificial intelligence improves radiology residents' performance in chest X-rays interpretation, artificial intelligence cannot be used alone as a learning tool and should not replace dedicated teaching. KEY POINTS • With CADe as a second reader, residents had a significantly higher sensitivity (53% vs 43%, p < 0.001), specificity (94% vs 90%, p < 0.001), and accuracy (86% vs 81%, p < 0.001), compared to residents without CADe. • After removing access to the CADe system, residents' sensitivity (44% vs 46%, p = 0.666), specificity (90% vs 90%, p = 0.642), and accuracy (80% vs 80%, p = 0.955) returned to that of the level for the group without CADe.
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Affiliation(s)
- Guillaume Chassagnon
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
- Université de Paris, 27 Rue du Faubourg Saint-Jacques, 85 Boulevard Saint-Germain, 75006, Paris, France.
| | - Nicolas Billet
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Caroline Rutten
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Thibault Toussaint
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | | | - Mégane Collin
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Leila Lemouchi
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Margaux Homps
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Mohamed Hedjoudje
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | | | - Jules Gregory
- Université de Paris, 27 Rue du Faubourg Saint-Jacques, 85 Boulevard Saint-Germain, 75006, Paris, France
- Radiology Department, FHU MOSAIC, Hôpital Beaujon, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Emma Canniff
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Nor-Eddine Regnard
- Gleamer, 117 Quai de Valmy, 75010, Paris, France
- Réseau d'Imagerie Sud Francilien, 254 Ter Avenue Henri Barbusse, 91210, Draveil, France
| | - Souhail Bennani
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
- Gleamer, 117 Quai de Valmy, 75010, Paris, France
| | - Marie-Pierre Revel
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université de Paris, 27 Rue du Faubourg Saint-Jacques, 85 Boulevard Saint-Germain, 75006, Paris, France
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Revel MP, Chassagnon G. Ten reasons to screen women at risk of lung cancer. Insights Imaging 2023; 14:176. [PMID: 37857978 PMCID: PMC10587052 DOI: 10.1186/s13244-023-01512-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/29/2023] [Indexed: 10/21/2023] Open
Abstract
This opinion piece reviews major reasons for promoting lung cancer screening in at-risk women who are smokers or ex-smokers, from the age of 50. The epidemiology of lung cancer in European women is extremely worrying, with lung cancer mortality expected to surpass breast cancer mortality in most European countries. There are conflicting data as to whether women are at increased risk of developing lung cancer compared to men who have a similar tobacco exposure. The sharp increase in the incidence of lung cancer in women exceeds the increase in their smoking exposure which is in favor of greater susceptibility. Lung and breast cancer screening could be carried out simultaneously, as the screening ages largely coincide. In addition, lung cancer screening could be carried out every 2 years, as is the case for breast cancer screening, if the baseline CT scan is negative.As well as detecting early curable lung cancer, screening can also detect coronary heart disease and osteoporosis induced by smoking. This enables preventive measures to be taken in addition to smoking cessation assistance, to reduce morbidity and mortality in the female population. Key points • The epidemiology of lung cancer in European women is very worrying.• Lung cancer is becoming the leading cause of cancer mortality in European women.• Women benefit greatly from screening in terms of reduced risk of death from lung cancer.
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Affiliation(s)
- Marie-Pierre Revel
- Université Paris Cité, 85 Boulevard Saint-Germain, Paris, 75006, France.
- Department of Radiology, Assistance publique des Hôpitaux de Paris, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, Paris, 75014, France.
| | - Guillaume Chassagnon
- Université Paris Cité, 85 Boulevard Saint-Germain, Paris, 75006, France
- Department of Radiology, Assistance publique des Hôpitaux de Paris, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, Paris, 75014, France
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Belkouchi Y, Lederlin M, Ben Afia A, Fabre C, Ferretti G, De Margerie C, Berge P, Liberge R, Elbaz N, Blain M, Brillet PY, Chassagnon G, Cadour F, Caramella C, Hajjam ME, Boussouar S, Hadchiti J, Fablet X, Khalil A, Luciani A, Cotten A, Meder JF, Talbot H, Lassau N. Detection and quantification of pulmonary embolism with artificial intelligence: The SFR 2022 artificial intelligence data challenge. Diagn Interv Imaging 2023; 104:485-489. [PMID: 37321875 DOI: 10.1016/j.diii.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE In 2022, the French Society of Radiology together with the French Society of Thoracic Imaging and CentraleSupelec organized their 13th data challenge. The aim was to aid in the diagnosis of pulmonary embolism, by identifying the presence of pulmonary embolism and by estimating the ratio between right and left ventricular (RV/LV) diameters, and an arterial obstruction index (Qanadli's score) using artificial intelligence. MATERIALS AND METHODS The data challenge was composed of three tasks: the detection of pulmonary embolism, the RV/LV diameter ratio, and Qanadli's score. Sixteen centers all over France participated in the inclusion of the cases. A health data hosting certified web platform was established to facilitate the inclusion process of the anonymized CT examinations in compliance with general data protection regulation. CT pulmonary angiography images were collected. Each center provided the CT examinations with their annotations. A randomization process was established to pool the scans from different centers. Each team was required to have at least a radiologist, a data scientist, and an engineer. Data were provided in three batches to the teams, two for training and one for evaluation. The evaluation of the results was determined to rank the participants on the three tasks. RESULTS A total of 1268 CT examinations were collected from the 16 centers following the inclusion criteria. The dataset was split into three batches of 310, 580 and 378 C T examinations provided to the participants respectively on September 5, 2022, October 7, 2022 and October 9, 2022. Seventy percent of the data from each center were used for training, and 30% for the evaluation. Seven teams with a total of 48 participants including data scientists, researchers, radiologists and engineering students were registered for participation. The metrics chosen for evaluation included areas under receiver operating characteristic curves, specificity and sensitivity for the classification task, and the coefficient of determination r2 for the regression tasks. The winning team achieved an overall score of 0.784. CONCLUSION This multicenter study suggests that the use of artificial intelligence for the diagnosis of pulmonary embolism is possible on real data. Moreover, providing quantitative measures is mandatory for the interpretability of the results, and is of great aid to the radiologists especially in emergency settings.
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Affiliation(s)
- Younes Belkouchi
- OPIS, CentraleSupelec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France; Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France.
| | | | - Amira Ben Afia
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Clement Fabre
- Department of Radiology, Centre Hospitalier de Laval, 53000 Laval, France
| | - Gilbert Ferretti
- Universite Grenobles Alpes, Service de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - Constance De Margerie
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 75010 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Pierre Berge
- Department of Radiology, CHU Angers, 49000 Angers, France
| | - Renan Liberge
- Department of Radiology, CHU Nantes, 44000 Nantes, France
| | - Nicolas Elbaz
- Department of Radiology, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Maxime Blain
- Department of Radiology, Hopital Henri Mondor, AP-HP, 94000 Créteil, France
| | - Pierre-Yves Brillet
- Department of Radiology, Hôpital Avicenne, Paris 13 University, 93000 Bobigny, France
| | - Guillaume Chassagnon
- Department of Radiology, Hopital Cochin, APHP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Farah Cadour
- APHM, Hôpital Universitaire Timone, CEMEREM, 13005 Marseille, France
| | - Caroline Caramella
- Department of Radiology, Groupe hospitalier Paris Saint-Joseph, Île-de-France, 75015 Paris, France
| | - Mostafa El Hajjam
- Department of Radiology, Ambroise Paré Hospital GH AP-HP Paris Saclay, UMR 1179 INSERM/UVSQ, Team 3, 92100 Boulogne-Billancourt, France
| | - Samia Boussouar
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), 75013 Paris, France
| | - Joya Hadchiti
- Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - Xavier Fablet
- Department of Radiology, CHU Rennes, 35000 Rennes, France
| | - Antoine Khalil
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Alain Luciani
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 94000 Créteil, France; INSERM, U955, Team 18, 94000 Créteil, France
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000 Lille, France
| | - Jean-Francois Meder
- Department of Neuroimaging, Sainte-Anne Hospital, 75013 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Hugues Talbot
- OPIS, CentraleSupelec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
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Chassagnon G, Revel MP. Artificial intelligence in thoracic imaging: the transition from research to practice. Eur Radiol 2023; 33:6318-6319. [PMID: 37186215 DOI: 10.1007/s00330-023-09635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Guillaume Chassagnon
- Radiology Department, Hôpital Cochin, Paris, France.
- Université de Paris, Paris, France.
| | - Marie-Pierre Revel
- Radiology Department, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
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Decoux A, Duron L, Habert P, Roblot V, Arsovic E, Chassagnon G, Arnoux A, Fournier L. Comparative performances of machine learning algorithms in radiomics and impacting factors. Sci Rep 2023; 13:14069. [PMID: 37640728 PMCID: PMC10462640 DOI: 10.1038/s41598-023-39738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/30/2023] [Indexed: 08/31/2023] Open
Abstract
There are no current recommendations on which machine learning (ML) algorithms should be used in radiomics. The objective was to compare performances of ML algorithms in radiomics when applied to different clinical questions to determine whether some strategies could give the best and most stable performances regardless of datasets. This study compares the performances of nine feature selection algorithms combined with fourteen binary classification algorithms on ten datasets. These datasets included radiomics features and clinical diagnosis for binary clinical classifications including COVID-19 pneumonia or sarcopenia on CT, head and neck, orbital or uterine lesions on MRI. For each dataset, a train-test split was created. Each of the 126 (9 × 14) combinations of feature selection algorithms and classification algorithms was trained and tuned using a ten-fold cross validation, then AUC was computed. This procedure was repeated three times per dataset. Best overall performances were obtained with JMI and JMIM as feature selection algorithms and random forest and linear regression models as classification algorithms. The choice of the classification algorithm was the factor explaining most of the performance variation (10% of total variance). The choice of the feature selection algorithm explained only 2% of variation, while the train-test split explained 9%.
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Affiliation(s)
- Antoine Decoux
- Université Paris Cité, PARCC UMRS 970, INSERM, Paris, France
- Unité de Recherche Clinique, Center d'Investigation Clinique 1418 Épidémiologie Clinique, Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, INSERM, Paris, France
| | - Loic Duron
- Université Paris Cité, PARCC UMRS 970, INSERM, Paris, France
- Department of Radiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Paul Habert
- Université Paris Cité, PARCC UMRS 970, INSERM, Paris, France
- Imaging Department, Hôpital Nord, APHM, Aix Marseille University, Marseille, France
- Aix Marseille Univ, LIIE, Marseille, France
| | - Victoire Roblot
- Université Paris Cité, PARCC UMRS 970, INSERM, Paris, France
| | - Emina Arsovic
- Université Paris Cité, PARCC UMRS 970, INSERM, Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Université Paris Cité, AP-HP, Hôpital Cochin, Paris, France
| | - Armelle Arnoux
- Unité de Recherche Clinique, Center d'Investigation Clinique 1418 Épidémiologie Clinique, Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, INSERM, Paris, France
| | - Laure Fournier
- Department of Radiology, Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris, France.
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14
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Chassagnon G, El Hajjam M, Boussouar S, Revel MP, Khoury R, Ghaye B, Bommart S, Lederlin M, Tran Ba S, De Margerie-Mellon C, Fournier L, Cassagnes L, Ohana M, Jalaber C, Dournes G, Cazeneuve N, Ferretti G, Talabard P, Donciu V, Canniff E, Debray MP, Crutzen B, Charriot J, Rabeau V, Khafagy P, Chocron R, Leonard Lorant I, Metairy L, Ruez-Lantuejoul L, Beaune S, Hausfater P, Truchot J, Khalil A, Penaloza A, Affole T, Brillet PY, Roy C, Pucheux J, Zbili J, Sanchez O, Porcher R. Strategies to safely rule out pulmonary embolism in COVID-19 outpatients: a multicenter retrospective study. Eur Radiol 2023; 33:5540-5548. [PMID: 36826504 PMCID: PMC9951833 DOI: 10.1007/s00330-023-09475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES The objective was to define a safe strategy to exclude pulmonary embolism (PE) in COVID-19 outpatients, without performing CT pulmonary angiogram (CTPA). METHODS COVID-19 outpatients from 15 university hospitals who underwent a CTPA were retrospectively evaluated. D-Dimers, variables of the revised Geneva and Wells scores, as well as laboratory findings and clinical characteristics related to COVID-19 pneumonia, were collected. CTPA reports were reviewed for the presence of PE and the extent of COVID-19 disease. PE rule-out strategies were based solely on D-Dimer tests using different thresholds, the revised Geneva and Wells scores, and a COVID-19 PE prediction model built on our dataset were compared. The area under the receiver operating characteristics curve (AUC), failure rate, and efficiency were calculated. RESULTS In total, 1369 patients were included of whom 124 were PE positive (9.1%). Failure rate and efficiency of D-Dimer > 500 µg/l were 0.9% (95%CI, 0.2-4.8%) and 10.1% (8.5-11.9%), respectively, increasing to 1.0% (0.2-5.3%) and 16.4% (14.4-18.7%), respectively, for an age-adjusted D-Dimer level. D-dimer > 1000 µg/l led to an unacceptable failure rate to 8.1% (4.4-14.5%). The best performances of the revised Geneva and Wells scores were obtained using the age-adjusted D-Dimer level. They had the same failure rate of 1.0% (0.2-5.3%) for efficiency of 16.8% (14.7-19.1%), and 16.9% (14.8-19.2%) respectively. The developed COVID-19 PE prediction model had an AUC of 0.609 (0.594-0.623) with an efficiency of 20.5% (18.4-22.8%) when its failure was set to 0.8%. CONCLUSIONS The strategy to safely exclude PE in COVID-19 outpatients should not differ from that used in non-COVID-19 patients. The added value of the COVID-19 PE prediction model is minor. KEY POINTS • D-dimer level remains the most important predictor of pulmonary embolism in COVID-19 patients. • The AUCs of the revised Geneva and Wells scores using an age-adjusted D-dimer threshold were 0.587 (95%CI, 0.572 to 0.603) and 0.588 (95%CI, 0.572 to 0.603). • The AUC of COVID-19-specific strategy to rule out pulmonary embolism ranged from 0.513 (95%CI: 0.503 to 0.522) to 0.609 (95%CI: 0.594 to 0.623).
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Affiliation(s)
- Guillaume Chassagnon
- Radiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Mostafa El Hajjam
- Radiology Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Samia Boussouar
- Cardiothoracic Imaging Unit, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne UniversitéLaboratoire d'imagerie Biomédicale, INSERM, ICAN Institute of Cardiometabolism and Nutrition, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Marie-Pierre Revel
- Radiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Ralph Khoury
- Radiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France
| | - Benoît Ghaye
- Radiology Department, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Sebastien Bommart
- Radiology Department, Hôpital Arnaud de Villeneuve, PHYMEDEXP - INSERM U1046 - CNRS UMR 9214, Université de Montpellier, 371 Avenue Doyen Gaston Giraud, 34090, Montpellier, France
| | - Mathieu Lederlin
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Stephane Tran Ba
- Radiology Department, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Constance De Margerie-Mellon
- Radiology Department, Hôpital Saint-Louis, AP-HP, Université Paris Cité, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Laure Fournier
- Radiology Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Lucie Cassagnes
- Radiology Department, CHU Gabriel Montpied, Institut Pascal, TGI, UMR6602 CNRS SIGMA UCA, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Mickael Ohana
- Radiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Carole Jalaber
- Radiology Department, CHU Saint Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Gael Dournes
- Department of Cardio-Thoracic Imaging, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, 1 Avenue Magellan, 33600, Pessac, France
| | - Nicolas Cazeneuve
- Radiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France
| | - Gilbert Ferretti
- Radiology Department, CHU de Grenoble Alpes, Université Grenoble Alpes, avenue des Maquis du Grésivaudan, 38700 La Tronche, 38043, Grenoble, France
| | - Pauline Talabard
- Radiology Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Victoria Donciu
- Radiology Department, Hôpital Pitié Salpêtrière, AP-HP, Sorbonne Université 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Emma Canniff
- Radiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marie-Pierre Debray
- Radiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France
| | - Bernard Crutzen
- Radiology Department, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Jeremy Charriot
- Pulmonology Department, Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 Avenue Doyen Gaston Giraud, 34090, Montpellier, France
| | - Valentin Rabeau
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Philippe Khafagy
- Radiology Department, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Richard Chocron
- Emergency Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Ian Leonard Lorant
- Radiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Loic Metairy
- Radiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France
| | - Lea Ruez-Lantuejoul
- Radiology Department, CHU de Grenoble Alpes, Université Grenoble Alpes, avenue des Maquis du Grésivaudan, 38700 La Tronche, 38043, Grenoble, France
| | - Sébastien Beaune
- Emergency Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Pierre Hausfater
- Emergency Department, Hôpital Pitié Salpêtrière, AP-HP, GRC-14 BIOSFAST Sorbonne Université, UMR INSERM 1166, IHU ICAN, Sorbonne Université, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Jennifer Truchot
- Emergency Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Antoine Khalil
- Radiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France
| | - Andrea Penaloza
- Services Des Urgences, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Thibaut Affole
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Pierre-Yves Brillet
- Radiology Department, Hôpital Avicenne, AP-HP, UMR U1272 Hypoxie Et Poumon INSERM, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Catherine Roy
- Radiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Julien Pucheux
- Radiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France
| | - Jordan Zbili
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Olivier Sanchez
- Pulmonology Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Raphael Porcher
- Center for Clinical Epidemiology, Hôtel Dieu, AP-HP, Université Paris Cité, 1 Place du Parvis de, 75004, Paris, France
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Roeser A, Sese L, Chassagnon G, Chaigne B, Dunogue B, Tran Ba S, Jebri S, Brillet PY, Revel MP, Aubourg F, Dhote R, Caux F, Annesi-Maesano I, Mouthon L, Nunes H, Uzunhan Y. The association between air pollution and the severity at diagnosis and progression of systemic sclerosis-associated interstitial lung disease: results from the retrospective ScleroPol study. Respir Res 2023; 24:151. [PMID: 37291562 DOI: 10.1186/s12931-023-02463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To investigate the association of air pollution exposure with the severity of interstitial lung disease (ILD) at diagnosis and ILD progression among patients with systemic sclerosis (SSc)-associated ILD. METHODS We conducted a retrospective two-center study of patients with SSc-associated ILD diagnosed between 2006 and 2019. Exposure to the air pollutants particulate matter of up to 10 and 2.5 µm in diameter (PM10, PM2.5), nitrogen dioxide (NO2), and ozone (O3) was assessed at the geolocalization coordinates of the patients' residential address. Logistic regression models were used to evaluate the association between air pollution and severity at diagnosis according to the Goh staging algorithm, and progression at 12 and 24 months. RESULTS We included 181 patients, 80% of whom were women; 44% had diffuse cutaneous scleroderma, and 56% had anti-topoisomerase I antibodies. ILD was extensive, according to the Goh staging algorithm, in 29% of patients. O3 exposure was associated with the presence of extensive ILD at diagnosis (adjusted OR: 1.12, 95% CI 1.05-1.21; p value = 0.002). At 12 and 24 months, progression was noted in 27/105 (26%) and 48/113 (43%) patients, respectively. O3 exposure was associated with progression at 24 months (adjusted OR: 1.10, 95% CI 1.02-1.19; p value = 0.02). We found no association between exposure to other air pollutants and severity at diagnosis and progression. CONCLUSION Our findings suggest that high levels of O3 exposure are associated with more severe SSc-associated ILD at diagnosis, and progression at 24 months.
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Affiliation(s)
- Anaïs Roeser
- Department of Pulmonology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
| | - Lucile Sese
- Department of Pulmonology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
- INSERM UMR1272 Hypoxie et poumon, Paris 13 - Université Paris Nord, Bobigny, France
| | - Guillaume Chassagnon
- Department of Radiology A, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Benjamin Chaigne
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Bertrand Dunogue
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Stéphane Tran Ba
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
| | - Salma Jebri
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
| | - Pierre-Yves Brillet
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
| | - Marie Pierre Revel
- Department of Radiology A, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Frédérique Aubourg
- Department of Physiology, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Robin Dhote
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Paris, France
| | - Frédéric Caux
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Paris, France
| | - Isabella Annesi-Maesano
- INSERM, Department of Allergic and Respiratory Disease, Montpellier University Hospital, Institute Desbrest of Epidemiology and Public Health, University of Montpellier, Montpellier, France
| | - Luc Mouthon
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Hilario Nunes
- Department of Pulmonology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
- INSERM UMR1272 Hypoxie et poumon, Paris 13 - Université Paris Nord, Bobigny, France
| | - Yurdagül Uzunhan
- Department of Pulmonology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France.
- INSERM UMR1272 Hypoxie et poumon, Paris 13 - Université Paris Nord, Bobigny, France.
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16
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de Margerie-Mellon C, Chassagnon G. Artificial intelligence: A critical review of applications for lung nodule and lung cancer. Diagn Interv Imaging 2023; 104:11-17. [PMID: 36513593 DOI: 10.1016/j.diii.2022.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
Artificial intelligence (AI) is a broad concept that usually refers to computer programs that can learn from data and perform certain specific tasks. In the recent years, the growth of deep learning, a successful technique for computer vision tasks that does not require explicit programming, coupled with the availability of large imaging databases fostered the development of multiple applications in the medical imaging field, especially for lung nodules and lung cancer, mostly through convolutional neural networks (CNN). Some of the first applications of AI is this field were dedicated to automated detection of lung nodules on X-ray and computed tomography (CT) examinations, with performances now reaching or exceeding those of radiologists. For lung nodule segmentation, CNN-based algorithms applied to CT images show excellent spatial overlap index with manual segmentation, even for irregular and ground glass nodules. A third application of AI is the classification of lung nodules between malignant and benign, which could limit the number of follow-up CT examinations for less suspicious lesions. Several algorithms have demonstrated excellent capabilities for the prediction of the malignancy risk when a nodule is discovered. These different applications of AI for lung nodules are particularly appealing in the context of lung cancer screening. In the field of lung cancer, AI tools applied to lung imaging have been investigated for distinct aims. First, they could play a role for the non-invasive characterization of tumors, especially for histological subtype and somatic mutation predictions, with a potential therapeutic impact. Additionally, they could help predict the patient prognosis, in combination to clinical data. Despite these encouraging perspectives, clinical implementation of AI tools is only beginning because of the lack of generalizability of published studies, of an inner obscure working and because of limited data about the impact of such tools on the radiologists' decision and on the patient outcome. Radiologists must be active participants in the process of evaluating AI tools, as such tools could support their daily work and offer them more time for high added value tasks.
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Affiliation(s)
- Constance de Margerie-Mellon
- Université Paris Cité, Laboratory of Imaging Biomarkers, Center for Research on Inflammation, UMR 1149, INSERM, 75018 Paris, France; Department of Radiology, Hôpital Saint-Louis APHP, 75010 Paris, France
| | - Guillaume Chassagnon
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin APHP, 75014 Paris, France
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Revel MP, Abdoul H, Chassagnon G, Canniff E, Durand-Zaleski I, Wislez M. Lung CAncer SCreening in French women using low-dose CT and Artificial intelligence for DEtection: the CASCADE study protocol. BMJ Open 2022; 12:e067263. [PMID: 36600392 PMCID: PMC9743404 DOI: 10.1136/bmjopen-2022-067263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Lung cancer screening (LCS) using low-dose CT has been demonstrated to reduce lung cancer-related mortality in large randomised controlled trials. Moving from trials to practice requires answering practical questions about the level of expertise of CT readers, the need for double reading as in trials and the potential role of artificial intelligence (AI). In addition, most LCS studies have predominantly included male participants with women being under-represented, even though the benefit of screening is greater for them. Thus, this study aims to compare the performance of a single CT reading by general radiologists trained in LCS using AI as a second reader to that of a double reading by expert thoracic radiologists, in a campaign for low-dose CT screening in high-risk women. METHODS AND ANALYSIS This observational cohort study will recruit 2400 asymptomatic women aged between 50 and 74 years, current or former smokers with at least a 20 pack-year smoking history, in 4 different French district areas. Assistance with smoking cessation will be offered to current smokers. An initial low-dose CT scan will be performed, with subsequent follow-ups at 1 year and 2 years. The primary objective is to compare CT scan readings by a single LCS-trained, AI-assisted radiologist to that of an expert double reading. The secondary objectives are: to evaluate the performance of AI as a stand-alone reader; the adherence to screening of female participants; the influence on smoking cessation; the psychological consequences of screening; the detection of chronic obstructive pulmonary disease (COPD), coronary artery disease and osteoporosis on low-dose CT scans and the costs incurred by screening. ETHICS AND DISSEMINATION Ethics approval was obtained from the Comité de Protection des Personnes Sud-Est 1 (ethics approval number: 2021-A02265-36 with an amendment on 15 July 2022). Trial results will be disseminated at conferences, through relevant patient groups and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05195385.
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Affiliation(s)
- Marie-Pierre Revel
- Université Paris Cité, Paris, France
- Assistance Publique- Hopitaux de Paris, Cochin hospital Radiology department, Paris, France
| | - Hendy Abdoul
- Assistance Publique-Hopitaux de Paris, URC Necker/Cochin, Paris, France
| | - Guillaume Chassagnon
- Université Paris Cité, Paris, France
- Assistance Publique- Hopitaux de Paris, Cochin hospital Radiology department, Paris, France
| | - Emma Canniff
- Assistance Publique- Hopitaux de Paris, Cochin hospital Radiology department, Paris, France
| | - Isabelle Durand-Zaleski
- Université Paris Cité, Paris, France
- Assistance Publique- Hopitaux de Paris, Cochin hospital, Pulmonology Department, Paris, France
| | - Marie Wislez
- Université Paris Cité, Paris, France
- Pulmonology department, Cochin hospital, Assistance Publique - Hopitaux de Paris, Paris, France
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18
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London J, Chassagnon G, Puéchal X, Régent A, Legendre P, Cohen P, Revel M, Lefevre E, Borie R, Jilet L, Abdoul H, Terrier B. Évaluation de la pirfénidone chez les patients présentant une fibrose pulmonaire associée aux anticorps anti-myéloperoxydase (MPO) ou à une vascularite associée aux anti-MPO : résultats de l’essai prospectif PIRFENIVAS. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Jalaber C, Puéchal X, Saab I, Canniff E, Terrier B, Mouthon L, Cabanne E, Mghaieth S, Revel MP, Chassagnon G. Differentiating tracheobronchial involvement in granulomatosis with polyangiitis and relapsing polychondritis on chest CT: a cohort study. Arthritis Res Ther 2022; 24:241. [PMID: 36307863 PMCID: PMC9615207 DOI: 10.1186/s13075-022-02935-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background In patients with tracheobronchial involvement, the differential diagnosis between granulomatosis with polyangiitis (GPA) and relapsing polychondritis (RP) can be challenging. The aim of this study was to describe the characteristics of airway abnormalities on chest computed tomography (CT) in patients with GPA or RP and to determine whether specific imaging criteria could be used to differentiate them. Methods GPA and RP patients with tracheobronchial involvement referred to a national referral center from 2008 to 2020 were evaluated. Their chest CT images were reviewed by two radiologists who were blinded to the final diagnosis in order to analyze the characteristics of airway involvement. The association between imaging features and a diagnosis of GPA rather than RP was analyzed using a generalized linear regression model. Results Chest CTs from 26 GPA and 19 RP patients were analyzed. Involvement of the subglottic trachea (odds ratio for GPA=28.56 [95% CI: 3.17; 847.63]; P=0.001) and extensive airway involvement (odds ratio for GPA=0.02 [95% CI: 0.00; 0.43]; P=0.008) were the two independent CT features that differentiated GPA from RP in multivariate analysis. Tracheal thickening sparing the posterior membrane was significantly associated to RP (odds ratio for GPA=0.09 [95% CI: 0.02; 0.39]; P=0.003) but only in the univariate analysis and suffered from only moderate interobserver agreement (kappa=0.55). Tracheal calcifications were also associated with RP only in the univariate analysis (odds ratio for GPA=0.21 [95% CI: 0.05; 0.78]; P=0.045). Conclusion The presence of subglottic involvement and diffuse airway involvement are the two most relevant criteria in differentiating between GPA and RP on chest CT. Although generally considered to be a highly suggestive sign of RP, posterior tracheal membrane sparing is a nonspecific and an overly subjective sign. • The presence of subglottic involvement is in favor of GPA. • Extensive airway involvement is in favor of RP. • Posterior tracheal membrane sparing is a nonspecific and an overly subjective sign.
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20
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Hoang-Thi TN, Chassagnon G, Tran HD, Le-Dong NN, Dinh-Xuan AT, Revel MP. How Artificial Intelligence in Imaging Can Better Serve Patients with Bronchial and Parenchymal Lung Diseases? J Pers Med 2022; 12:jpm12091429. [PMID: 36143214 PMCID: PMC9505778 DOI: 10.3390/jpm12091429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
With the rapid development of computing today, artificial intelligence has become an essential part of everyday life, with medicine and lung health being no exception. Big data-based scientific research does not mean simply gathering a large amount of data and letting the machines do the work by themselves. Instead, scientists need to identify problems whose solution will have a positive impact on patients’ care. In this review, we will discuss the role of artificial intelligence from both physiological and anatomical standpoints, starting with automatic quantitative assessment of anatomical structures using lung imaging and considering disease detection and prognosis estimation based on machine learning. The evaluation of current strengths and limitations will allow us to have a broader view for future developments.
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Affiliation(s)
- Trieu-Nghi Hoang-Thi
- Department of Diagnostic Imaging, Vinmec Healthcare System, Ho Chi Minh City 70000, Vietnam
| | - Guillaume Chassagnon
- AP-HP. Centre, Cochin Hospital, Department of Radiology, Université de Paris, 75005 Paris, France
| | - Hai-Dang Tran
- Department of Diagnostic Imaging, Vinmec Healthcare System, Ho Chi Minh City 70000, Vietnam
| | - Nhat-Nam Le-Dong
- AP-HP. Centre, Cochin Hospital, Department of Respiratory Physiology, Université de Paris, 75005 Paris, France
| | - Anh Tuan Dinh-Xuan
- AP-HP. Centre, Cochin Hospital, Department of Respiratory Physiology, Université de Paris, 75005 Paris, France
| | - Marie-Pierre Revel
- AP-HP. Centre, Cochin Hospital, Department of Radiology, Université de Paris, 75005 Paris, France
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21
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Soyer P, Fishman EK, Rowe SP, Patlas MN, Chassagnon G. Does artificial intelligence surpass the radiologist? Diagn Interv Imaging 2022; 103:445-447. [PMID: 35973913 DOI: 10.1016/j.diii.2022.08.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006, Paris, France.
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Michael N Patlas
- Department of Radiology, Hamilton General Hospital, McMaster University Hamilton, ON, Canada L8L 2X2
| | - Guillaume Chassagnon
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006, Paris, France
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22
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Gouhier E, Canniff E, Fournel L, Revel MP, Chassagnon G. Pulmonary vein occlusion with parenchymal infarction: A misdiagnosed entity. Diagn Interv Imaging 2022; 103:440-442. [PMID: 35843837 DOI: 10.1016/j.diii.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022]
Affiliation(s)
| | - Emma Canniff
- Department of Radiology, Hôpital Cochin, AP-HP, 75014,Paris, France
| | - Ludovic Fournel
- Department of Thoracic Surgery, Hôpital Cochin, AP-HP, 75014,Paris, France; Université Paris Cité, Faculté de Médecine, 75006,Paris, France
| | | | - Guillaume Chassagnon
- Department of Radiology, Hôpital Cochin, AP-HP, 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006,Paris, France.
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23
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Icard P, Simula L, Fournel L, Leroy K, Lupo A, Damotte D, Charpentier MC, Durdux C, Loi M, Schussler O, Chassagnon G, Coquerel A, Lincet H, De Pauw V, Alifano M. The strategic roles of four enzymes in the interconnection between metabolism and oncogene activation in non-small cell lung cancer: Therapeutic implications. Drug Resist Updat 2022; 63:100852. [PMID: 35849943 DOI: 10.1016/j.drup.2022.100852] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
NSCLC is the leading cause of cancer mortality and represents a major challenge in cancer therapy. Intrinsic and acquired anticancer drug resistance are promoted by hypoxia and HIF-1α. Moreover, chemoresistance is sustained by the activation of key signaling pathways (such as RAS and its well-known downstream targets PI3K/AKT and MAPK) and several mutated oncogenes (including KRAS and EGFR among others). In this review, we highlight how these oncogenic factors are interconnected with cell metabolism (aerobic glycolysis, glutaminolysis and lipid synthesis). Also, we stress the key role of four metabolic enzymes (PFK1, dimeric-PKM2, GLS1 and ACLY), which promote the activation of these oncogenic pathways in a positive feedback loop. These four tenors orchestrating the coordination of metabolism and oncogenic pathways could be key druggable targets for specific inhibition. Since PFK1 appears as the first tenor of this orchestra, its inhibition (and/or that of its main activator PFK2/PFKFB3) could be an efficacious strategy against NSCLC. Citrate is a potent physiologic inhibitor of both PFK1 and PFKFB3, and NSCLC cells seem to maintain a low citrate level to sustain aerobic glycolysis and the PFK1/PI3K/EGFR axis. Awaiting the development of specific non-toxic inhibitors of PFK1 and PFK2/PFKFB3, we propose to test strategies increasing citrate levels in NSCLC tumors to disrupt this interconnection. This could be attempted by evaluating inhibitors of the citrate-consuming enzyme ACLY and/or by direct administration of citrate at high doses. In preclinical models, this "citrate strategy" efficiently inhibits PFK1/PFK2, HIF-1α, and IGFR/PI3K/AKT axes. It also blocks tumor growth in RAS-driven lung cancer models, reversing dedifferentiation, promoting T lymphocytes tumor infiltration, and increasing sensitivity to cytotoxic drugs.
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Affiliation(s)
- Philippe Icard
- Thoracic Surgery Department, Paris Center University Hospitals, AP-HP, Paris, France; Normandie Univ, UNICAEN, CHU de Caen Normandie, Unité de recherche BioTICLA INSERM U1086, 14000 Caen, France.
| | - Luca Simula
- Department of Infection, Immunity and Inflammation, Cochin Institute, INSERM U1016, CNRS UMR8104, Paris University, Paris 75014, France
| | - Ludovic Fournel
- Thoracic Surgery Department, Paris Center University Hospitals, AP-HP, Paris, France; INSERM UMR-S 1124, Cellular Homeostasis and Cancer, University of Paris, Paris, France
| | - Karen Leroy
- Department of Genomic Medicine and Cancers, Georges Pompidou European Hospital, APHP, Paris, France
| | - Audrey Lupo
- Pathology Department, Paris Center University Hospitals, AP-HP, Paris, France; INSERM U1138, Integrative Cancer Immunology, University of Paris, 75006 Paris, France
| | - Diane Damotte
- Pathology Department, Paris Center University Hospitals, AP-HP, Paris, France; INSERM U1138, Integrative Cancer Immunology, University of Paris, 75006 Paris, France
| | | | - Catherine Durdux
- Radiation Oncology Department, Georges Pompidou European Hospital, APHP, Paris, France
| | - Mauro Loi
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Olivier Schussler
- Thoracic Surgery Department, Paris Center University Hospitals, AP-HP, Paris, France
| | | | - Antoine Coquerel
- INSERM U1075, COMETE " Mobilités: Attention, Orientation, Chronobiologie", Université Caen, France
| | - Hubert Lincet
- ISPB, Faculté de Pharmacie, Lyon, France, Université Lyon 1, Lyon, France; INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon (CRCL), France
| | - Vincent De Pauw
- Thoracic Surgery Department, Paris Center University Hospitals, AP-HP, Paris, France
| | - Marco Alifano
- Thoracic Surgery Department, Paris Center University Hospitals, AP-HP, Paris, France; INSERM U1138, Integrative Cancer Immunology, University of Paris, 75006 Paris, France
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24
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Martin C, Regard L, Chassagnon G, Burgel PR. Change in Lung Function after Initiation of Elexacaftor-Tezacaftor-Ivacaftor: Do Not Forget Anatomy! Am J Respir Crit Care Med 2022; 205:1365-1366. [PMID: 35358030 PMCID: PMC9873117 DOI: 10.1164/rccm.202112-2852le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Clémence Martin
- Université de ParisParis, France,Cochin HospitalParis, France,European Reference Network on Rare Respiratory DiseasesFrankfurt, Germany
| | - Lucile Regard
- Université de ParisParis, France,Cochin HospitalParis, France,European Reference Network on Rare Respiratory DiseasesFrankfurt, Germany
| | | | - Pierre-Régis Burgel
- Université de ParisParis, France,Cochin HospitalParis, France,European Reference Network on Rare Respiratory DiseasesFrankfurt, Germany,Corresponding author (e-mail: )
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25
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Tual A, Revel MP, Canniff E, Garin A, Chassagnon G. Risk of pleural and diaphragmatic complications following percutaneous radiofrequency ablation of basal lung nodules. Diagn Interv Imaging 2022; 103:324-326. [DOI: 10.1016/j.diii.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022]
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Chassagnon G, Campredon A, Vakalopoulou M, Burgel PR. Diversity of approaches in artificial intelligence: an opportunity for discoveries in thoracic imaging. Eur Respir J 2022; 60:13993003.00022-2022. [PMID: 35086838 DOI: 10.1183/13993003.00022-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Guillaume Chassagnon
- Radiology department, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France.,Université de Paris, Paris, France
| | - Alienor Campredon
- Radiology department, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France.,Université de Paris, Paris, France
| | - Maria Vakalopoulou
- OPIS - OPtimisation Imagerie et Santé; Inria Saclay, Palaiseau, France.,MICS - Mathématiques et Informatique pour la Complexité et les Systèmes; CentraleSupelec, Gif-sur-Yvette, France
| | - Pierre-Régis Burgel
- Université de Paris, Paris, France .,Respiratory Medicine and Cystic Fibrosis National Reference Center; Cochin Hospital; Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France.,ERN-Lung CF network
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27
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Revel MP, Beeker N, Porcher R, Jilet L, Fournier L, Rance B, Chassagnon G, Fontenay M, Sanchez O. What level of D-dimers can safely exclude pulmonary embolism in COVID-19 patients presenting to the emergency department? Eur Radiol 2022; 32:2704-2712. [PMID: 34994845 PMCID: PMC8739682 DOI: 10.1007/s00330-021-08377-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To identify which level of D-dimer would allow the safe exclusion of pulmonary embolism (PE) in COVID-19 patients presenting to the emergency department (ED). METHODS This retrospective study was conducted on the COVID database of Assistance Publique - Hôpitaux de Paris (AP-HP). COVID-19 patients who presented at the ED of AP-HP hospitals between March 1 and May 15, 2020, and had CTPA following D-dimer dosage within 48h of presentation were included. The D-dimer sensitivity, specificity, and positive and negative predictive values were calculated for different D-dimer thresholds, as well as the false-negative and failure rates, and the number of CTPAs potentially avoided. RESULTS A total of 781 patients (mean age 62.0 years, 53.8% men) with positive RT-PCR for SARS-Cov-2 were included and 60 of them (7.7%) had CTPA-confirmed PE. Their median D-dimer level was significantly higher than that of patients without PE (4,013 vs 1,198 ng·mL-1, p < 0.001). Using 500 ng·mL-1, or an age-adjusted cut-off for patients > 50 years, the sensitivity and the NPV were above 90%. With these thresholds, 17.1% and 31.5% of CTPAs could have been avoided, respectively. Four of the 178 patients who had a D-dimer below the age-adjusted cutoff had PE, leading to an acceptable failure rate of 2.2%. Using higher D-dimer cut-offs could have avoided more CTPAs, but would have lowered the sensitivity and increased the failure rate. CONCLUSION The same D-Dimer thresholds as those validated in non-COVID outpatients should be used to safely rule out PE. KEY POINTS • The median D-dimer level was significantly higher in COVID-19 patients with PE as compared to those without PE (4,013 ng·mL-1 vs 1,198 ng·mL-1 respectively, p < 0.001). • Using 500 ng·mL-1, or an age-adjusted D-dimer cut-off to exclude pulmonary embolism, the sensitivity and negative predictive value were above 90%. • Higher cut-offs would lead to a reduction in the sensitivity below 85% and an increase in the failure rate, especially for patients under 50 years.
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Affiliation(s)
- Marie-Pierre Revel
- Université de Paris, 75006, Paris, France. .,Radiology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Service de Radiologie27 rue du Faubourg Saint Jacques, 75014, Paris, France.
| | - Nathanael Beeker
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Recherche Clinique, Hôpital Cochin, Paris, France
| | - Raphael Porcher
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Centre d'épidémiologie clinique, Hôtel-Dieu, Paris, France
| | - Léa Jilet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Recherche Clinique, Hôpital Cochin, Paris, France
| | - Laure Fournier
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Radiologie, Hôpital Européen, Georges Pompidou, Paris, France
| | - Bastien Rance
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Département d'Informatique Médicale, Biostatistiques Et Santé Publique, Hôpital Européen Georges Pompidou, Paris, France
| | - Guillaume Chassagnon
- Université de Paris, 75006, Paris, France.,Radiology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Service de Radiologie27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Michaela Fontenay
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de d'hématologie biologique, Hôpital Cochin, Paris, France.,Institut Cochin INSERM U1016, CNRS UMR8104, Paris, France
| | - Olivier Sanchez
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Pneumologie Et Soins Intensifs, Hôpital Européen, Georges Pompidou, INSERM UMRS-1140 Innovative Therapies in Hemostasis and Biosurgical Research Lab (Carpentier Foundation), Paris, France.,F-CRIN INNOVTE, Saint-Etienne, France
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Campredon A, Battistella E, Martin C, Durieu I, Mely L, Marguet C, Belleguic C, Murris-Espin M, Chiron R, Fanton A, Bui S, Reynaud-Gaubert M, Reix P, Hoang-Thi TN, Vakalopoulou M, Revel MP, Da Silva J, Burgel PR, Chassagnon G. Using chest CT scan and unsupervised machine learning for predicting and evaluating response to lumacaftor-ivacaftor in people with cystic fibrosis. Eur Respir J 2021:2101344. [PMID: 34795038 DOI: 10.1183/13993003.01344-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Lumacaftor-ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) modulator known to improve clinical status in people with cystic fibrosis (CF). This study aimed to assess lung structural changes after one year of lumacaftor-ivacaftor treatment, and to use unsupervised machine learning to identify morphological phenotypes of lung disease that are associated with response to lumacaftor-ivacaftor. METHODS Adolescents and adults with CF from the French multicenter real-world prospective observational study evaluating the first year of treatment with lumacaftor-ivacaftor were included if they had pretherapeutic and follow-up chest computed tomography (CT)-scans available. CT scans were visually scored using a modified Bhalla score. A k-mean clustering method was performed based on 120 radiomics features extracted from unenhanced pretherapeutic chest CT scans. RESULTS A total of 283 patients were included. The Bhalla score significantly decreased after 1 year of lumacaftor-ivacaftor (-1.40±1.53 points compared with pretherapeutic CT; p<0.001). This finding was related to a significant decrease in mucus plugging (-0.35±0.62 points; p<0.001), bronchial wall thickening (-0.24±0.52 points; p<0.001) and parenchymal consolidations (-0.23±0.51 points; p<0.001). Cluster analysis identified 3 morphological clusters. Patients from cluster C were more likely to experience an increase in percent predicted forced expiratory volume in 1 sec (ppFEV1) ≥5 under lumacaftor-ivacaftor than those in the other clusters (54% of responders versus 32% and 33%; p=0.01). CONCLUSION One year treatment with lumacaftor-ivacaftor was associated with a significant visual improvement of bronchial disease on chest CT. Radiomics features on pretherapeutic CT scan may help in predicting lung function response under lumacaftor-ivacaftor.
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Affiliation(s)
- Alienor Campredon
- Radiology department, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France
- Université de Paris, Paris, France
| | - Enzo Battistella
- OPIS - OPtimisation Imagerie et Santé; Inria Saclay, Palaiseau, France
- MICS - Mathématiques et Informatique pour la Complexité et les Systèmes, Gif-sur-Yvette, France
| | - Clémence Martin
- Université de Paris, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center; Cochin Hospital; Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
- ERN-Lung CF network
| | - Isabelle Durieu
- ERN-Lung CF network
- Centre de référence Adulte de la Mucoviscidose, Service de médecine interne, Hospices civils de Lyon, Pierre Bénite, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Mely
- Hôpital Renée Sabran, Cystic Fibrosis Center, Giens, France
| | - Christophe Marguet
- Pediatric Respiratory Disease and Cystic Fibrosis Center, Hospital, UNIROUEN, Inserm EA 2656, Rouen University Hospital, Normandie Univ, Rouen, France
| | - Chantal Belleguic
- Centre de Ressources et de Compétences de la Mucoviscidose Adulte, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Marlène Murris-Espin
- Cystic Fibrosis Center, Service de Pneumologie, Pôle des Voies Respiratoires, Hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - Raphaël Chiron
- Cystic Fibrosis Center, Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Annlyse Fanton
- Department of Pulmonary Medicine, Cystic Fibrosis Resource and Competence Centre for Adults, Dijon University Hospital, France
| | - Stéphanie Bui
- Pediatric Respiratory Disease and Cystic Fibrosis Center and CIC 1401, CHU de Bordeaux, Bordeaux, France
| | - Martine Reynaud-Gaubert
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Philippe Reix
- UMR 5558 CNRS, Equipe EMET, Université Claude Bernard Lyon 1, Lyon, France
- Cystic Fibrosis Center, Hospices Civils de Lyon, Lyon, France
| | - Trieu-Nghi Hoang-Thi
- Radiology department, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France
| | - Maria Vakalopoulou
- OPIS - OPtimisation Imagerie et Santé; Inria Saclay, Palaiseau, France
- MICS - Mathématiques et Informatique pour la Complexité et les Systèmes, Gif-sur-Yvette, France
| | - Marie-Pierre Revel
- Radiology department, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France
- Université de Paris, Paris, France
| | - Jennifer Da Silva
- Respiratory Medicine and Cystic Fibrosis National Reference Center; Cochin Hospital; Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
- URC-CIC Paris Descartes Necker Cochin, AP-HP, Hôpital Cochin, Paris, France
| | - Pierre-Régis Burgel
- Université de Paris, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center; Cochin Hospital; Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
- ERN-Lung CF network
| | - Guillaume Chassagnon
- Radiology department, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France
- Université de Paris, Paris, France
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Poitevineau T, Chassagnon G, Bouam S, Jaubert P, Cheurfa C, Regard L, Canniff E, Dinh-Xuan AT, Revel MP. Computed tomography after severe COVID-19 pneumonia: findings at 6 months and beyond. ERJ Open Res 2021; 7:00488-2021. [PMID: 34703831 PMCID: PMC8474481 DOI: 10.1183/23120541.00488-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the alveolar epithelial cells causing coronavirus disease (COVID-19) pneumonia of varying severity [1, 2]. 15–30% of patients develop acute respiratory distress syndrome (ARDS) requiring hospitalisation in intensive care units (ICU) and mechanical ventilation [2, 3]. At 3 months, there are persisting computed tomography (CT) abnormalities in 17 to 91% of discharged COVID-19 patients [4–8], mainly consistent with an organising pneumonia (OP) pattern. These anomalies are more frequently reported in patients who were admitted to ICU [9]. Pulmonary fibrosis has been reported at autopsy of patients deceased from COVID-19 pneumonia, along with pulmonary microvascular thrombosis [10]. Parenchymal bands and ground-glass opacities consistent with a pattern of late organising pneumonia are frequently observed 6 months after ICU admission for #COVID19, whereas fibrotic changes of limited extent are only observed in about 1/3 of patientshttps://bit.ly/2UGOsbr
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Affiliation(s)
| | - Guillaume Chassagnon
- Service de Radiologie, Hôpital Cochin, AP-HP Centre, Paris, France.,Université de Paris, Paris, France
| | - Samir Bouam
- Département d'informatique médicale, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Paul Jaubert
- Université de Paris, Paris, France.,Service de médecine intensive-réanimation, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Chérifa Cheurfa
- Université de Paris, Paris, France.,Service de réanimation chirurgicale, Hôpital Cochin, Paris, France
| | - Lucile Regard
- Université de Paris, Paris, France.,Service de pneumologie, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Emma Canniff
- Service de Radiologie, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Anh Tuan Dinh-Xuan
- Université de Paris, Paris, France.,Département de physiologie, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Marie-Pierre Revel
- Service de Radiologie, Hôpital Cochin, AP-HP Centre, Paris, France.,Université de Paris, Paris, France
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Hoang-Thi TN, Vakalopoulou M, Christodoulidis S, Paragios N, Revel MP, Chassagnon G. Deep learning for lung disease segmentation on CT: Which reconstruction kernel should be used? Diagn Interv Imaging 2021; 102:691-695. [PMID: 34686464 DOI: 10.1016/j.diii.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to determine whether a single reconstruction kernel or both high and low frequency kernels should be used for training deep learning models for the segmentation of diffuse lung disease on chest computed tomography (CT). MATERIALS AND METHODS Two annotated datasets of COVID-19 pneumonia (323,960 slices) and interstitial lung disease (ILD) (4,284 slices) were used. Annotated CT images were used to train a U-Net architecture to segment disease. All CT slices were reconstructed using both a lung kernel (LK) and a mediastinal kernel (MK). Three different trainings, resulting in three different models were compared for each disease: training on LK only, MK only or LK+MK images. Dice similarity scores (DSC) were compared using the Wilcoxon signed-rank test. RESULTS Models only trained on LK images performed better on LK images than on MK images (median DSC = 0.62 [interquartile range (IQR): 0.54, 0.69] vs. 0.60 [IQR: 0.50, 0.70], P < 0.001 for COVID-19 and median DSC = 0.62 [IQR: 0.56, 0.69] vs. 0.50 [IQR 0.43, 0.57], P < 0.001 for ILD). Similarly, models only trained on MK images performed better on MK images (median DSC = 0.62 [IQR: 0.53, 0.68] vs. 0.54 [IQR: 0.47, 0.63], P < 0.001 for COVID-19 and 0.69 [IQR: 0.61, 0.73] vs. 0.63 [IQR: 0.53, 0.70], P < 0.001 for ILD). Models trained on both kernels performed better or similarly than those trained on only one kernel. For COVID-19, median DSC was 0.67 (IQR: =0.59, 0.73) when applied on LK images and 0.67 (IQR: 0.60, 0.74) when applied on MK images (P < 0.001 for both). For ILD, median DSC was 0.69 (IQR: 0.63, 0.73) when applied on LK images (P = 0.006) and 0.68 (IQR: 0.62, 0.72) when applied on MK images (P > 0.99). CONCLUSION Reconstruction kernels impact the performance of deep learning-based models for lung disease segmentation. Training on both LK and MK images improves the performance.
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Affiliation(s)
- Trieu-Nghi Hoang-Thi
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, AP-HP.centre, 75014 Paris, France
| | - Maria Vakalopoulou
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 3 91190 Gif-sur-Yvette, France
| | - Stergios Christodoulidis
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 3 91190 Gif-sur-Yvette, France
| | - Nikos Paragios
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 3 91190 Gif-sur-Yvette, France; TheraPanacea, 75014 Paris, France
| | - Marie-Pierre Revel
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, AP-HP.centre, 75014 Paris, France
| | - Guillaume Chassagnon
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, AP-HP.centre, 75014 Paris, France.
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Chung C, Bommart S, Marchand-Adam S, Lederlin M, Fournel L, Charpentier MC, Groussin L, Wislez M, Revel MP, Chassagnon G. Long-Term Imaging Follow-Up in DIPNECH: Multicenter Experience. J Clin Med 2021; 10:jcm10132950. [PMID: 34209147 PMCID: PMC8268818 DOI: 10.3390/jcm10132950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022] Open
Abstract
Diffuse pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pre-invasive disease whose pathophysiology remains unclear. We aimed to assess long-term evolution in imaging of DIPNECH, in order to propose follow-up recommendations. Patients with histologically confirmed DIPNECH from four centers, evaluated between 2001 and 2020, were enrolled if they had at least two available chest computed tomography (CT) exams performed at least 24 months apart. CT exams were analyzed for the presence and the evolution of DIPNECH-related CT findings. Twenty-seven patients, mostly of female gender (n = 25/27; 93%) were included. Longitudinal follow-up over a median 63-month duration (IQR: 31–80 months) demonstrated an increase in the size of lung nodules in 19 patients (19/27, 70%) and the occurrence of metastatic spread in three patients (3/27, 11%). The metastatic spread was limited to mediastinal lymph nodes in one patient, whereas the other two patients had both lymph node and distant metastases. The mean time interval between baseline CT scan and metastatic spread was 70 months (14, 74 and 123 months). Therefore, long-term annual imaging follow-up of DIPNECH might be appropriate to encompass the heterogeneous longitudinal behavior of this disease.
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Affiliation(s)
- Cécile Chung
- Department of Radiology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France; (C.C.); (M.-P.R.)
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
| | - Sébastien Bommart
- Radiology Department, CHU Montpellier, Hôpital Arnaud de Villeneuve, 34090 Montpellier, France;
- Université de Montpellier, PHYMEDEXP-INSERM U1046-CNRS UMR 9214, 34000 Montpellier, France
| | - Sylvain Marchand-Adam
- Pulmonology Department, Université François Rabelais, CHU Tours, Hôpital Bretonneau, 37000 Tours, France;
| | - Mathieu Lederlin
- Department of Radiology, University of Rennes, University Hospital of Rennes, 35033 Rennes, France;
| | - Ludovic Fournel
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Thoracic Surgery Department, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France
| | | | - Lionel Groussin
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Department of Endocrinology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France
| | - Marie Wislez
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Oncology Thoracic Unit Pulmonology Department, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France
- Université de Paris, Centre de Recherche des Cordeliers, Inserm, «Inflammation, Complement, and Cancer», 75006 Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France; (C.C.); (M.-P.R.)
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
| | - Guillaume Chassagnon
- Department of Radiology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France; (C.C.); (M.-P.R.)
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Correspondence:
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Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, Chassagnon G, Milon A, Lederlin M, Bennani S, Molière S, Debray MP, Bompard F, Dangeard S, Hani C, Ohana M, Bommart S, Jalaber C, El Hajjam M, Petit I, Fournier L, Khalil A, Brillet PY, Bellin MF, Redheuil A, Rocher L, Bousson V, Rousset P, Grégory J, Deux JF, Dion E, Valeyre D, Porcher R, Jilet L, Abdoul H. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology 2021; 301:E361-E370. [PMID: 34184935 PMCID: PMC8267782 DOI: 10.1148/radiol.2021210384] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background There are conflicting data regarding the diagnostic performance of Chest computed tomography (CT) for COVID-19 pneumonia. Disease extent on CT has been reported to influence prognosis. Purpose To create a large publicly available dataset and assess the diagnostic and prognostic value of CT in COVID-19 pneumonia. Materials and Methods This multicenter observational retrospective cohort study (ClinicalTrials.gov: NCT04355507) involved 20 French university hospitals. Eligible subjects presented at the emergency departments of the hospitals involved between March 1st and April 30th, 2020 and underwent both thoracic CT and RT-PCR for suspected COVID-19 pneumonia. CT images were read blinded to initial reports, RT-PCR, demographic characteristics, clinical symptoms, and outcome. Readers classified CT scans as positive or negative for COVID-19, based on criteria published by the French Society of Radiology. Multivariable logistic regression was used to develop a model predicting severe outcome (intubation or death) at 1-month follow-up in subjects positive for both RT-PCR and CT, using clinical and radiological features. Results Of 10,930 subjects screened for eligibility, 10,735 (median age 65 years, interquartile range, 51-77 years; 6,147 men) were included and 6,448 (60.0%) had a positive RT-PCR result. With RT-PCR as reference, the sensitivity and specificity and CT were 80.2% (95%CI: 79.3, 81.2) and 79.7% (95%CI: 78.5, 80.9), respectively with strong agreement between junior and senior radiologists (Gwet's AC1 coefficient: 0.79) Of all the variables analysed, the extent of pneumonia on CT (OR 3.25, 95%CI: 2.71, 3.89) was the best predictor of severe outcome at one month. A score based solely on clinical variables predicted a severe outcome with an AUC of 0.64 (95%CI: 0.62, 0.66), improving to 0.69 (95%CI: 0.6, 0.71) when it also included the extent of pneumonia and coronary calcium score on CT. Conclusion Using pre-defined criteria, CT reading is not influenced by reader's experience and helps predict the outcome at one month. Published under a CC BY 4.0 license. See also the editorial by Rubin.
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Affiliation(s)
- Marie-Pierre Revel
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Samia Boussouar
- Sorbonne Université, APHP, Hôpital Pitié Salpétrière, Dept of Radiology, Paris, France
| | | | - Inès Saab
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Thibaut Lapotre
- Université Rennes1, Hôpital Pontchaillou, Dept of Radiology, Rennes, France
| | - Dominique Mompoint
- Université Paris-Saclay, APHP, Hôpital Raymond Poincaré, Dept of Radiology, Garches, France
| | | | - Audrey Milon
- Sorbonne Université, APHP, Hôpital Tenon, Dept of Radiology, Paris, France
| | - Mathieu Lederlin
- Université Rennes1, Hôpital Pontchaillou, Dept of Radiology, Rennes, France
| | - Souhail Bennani
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Sébastien Molière
- Université de Strasbourg, Hôpital de Hautepierre, Dept of Radiology, Strasbourg, France
| | | | - Florian Bompard
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Severine Dangeard
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Chahinez Hani
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Mickaël Ohana
- Université de Strasbourg, Nouvel Hôpital Civil, Dept of Radiology, Strasbourg, France
| | - Sébastien Bommart
- Université de Montpellier, Hôpital Arnaud de Villeneuve, Dept of Radiology, Montpellier France
| | - Carole Jalaber
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Mostafa El Hajjam
- Université Paris-Saclay, APHP, Hôpital Ambroise Paré, Dept of Radiology, Boulogne, France
| | - Isabelle Petit
- Université de Lorraine, Hôpital Brabois, Dept of Radiology, Vandoeuvre, France
| | - Laure Fournier
- Université de Paris, APHP, Hôpital Européen Georges Pompidou, Dept of Radiology, INSERM U970, PARCC, Paris, France
| | - Antoine Khalil
- Université de Paris, APHP, Hôpital Bichat, Dept of Radiology, Paris, France
| | - Pierre-Yves Brillet
- Sorbonne Université, APHP, Hôpital Avicenne, Dept of Radiology, Bobigny, France
| | - Marie-France Bellin
- Université Paris-Saclay, APHP, Hôpital Bicêtre, Dept of Radiology, Le Kremlin-Bicêtre, France
| | - Alban Redheuil
- Sorbonne Université, APHP, Hôpital Pitié Salpétrière, Dept of Radiology, Paris, France
| | - Laurence Rocher
- Université Paris-Saclay, APHP, Hôpital Antoine Béclère, Dept of Radiology, Clamart, France
| | - Valérie Bousson
- Université de Paris, APHP, Hôpital Lariboisière, Dept of Radiology, Paris, France
| | - Pascal Rousset
- Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Lyon Sud, Dept of Radiology, Pierre-Benite, France
| | - Jules Grégory
- Université de Paris, APHP, Hôpital Beaujon, Dept of Radiology, Clichy, France
| | - Jean-François Deux
- Université Paris Est, APHP, Dept of Radiology, Hôpital Henri Mondor, Créteil, France
| | - Elisabeth Dion
- Université de Paris, APHP, Hôtel-Dieu, Dept of Radiology, Paris, France
| | - Dominique Valeyre
- Sorbonne Université, APHP, Hôpital Avicenne, Dept of Pneumology, Bobigny, INSERM UMR 1272, France
| | - Raphael Porcher
- Université de Paris, APHP, Hôtel-Dieu, Dept of Clinical Epidemiology, Paris, France
| | - Léa Jilet
- Université de Paris APHP, Clinical Research Unit Paris Centre, Paris, France
| | - Hendy Abdoul
- Université de Paris APHP, Clinical Research Unit Paris Centre, Paris, France
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Sartorelli S, Chassagnon G, Cohen P, Dunogué B, Puéchal X, Régent A, Mouthon L, Guillevin L, Terrier B. Revisiting characteristics, treatment and outcome of cardiomyopathy in eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Rheumatology (Oxford) 2021; 61:1175-1184. [PMID: 34156464 DOI: 10.1093/rheumatology/keab514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Eosinophilic granulomatosis with polyangiitis (EGPA) is a necrotizing eosinophil-rich vasculitis. Specific cardiomyopathy (CM) was described in old studies as the most important predictor of mortality. We aimed to revisit EGPA-related CM and its outcome in recent decades. METHODS We reviewed all EGPA patients managed from 2000 to 2019 in our vasculitis clinic. Baseline characteristics and outcomes were analyzed. EGPA-related CM was defined as clinical or extra-clinical manifestations of patent myocardial involvement, after exclusion of other causes. RESULTS We included 176 patients. Median age was 47 years (IQR 36-58 years). Specific CM was observed in 70 patients (40%). Cardiac symptoms were observed in 81% of CM+ patients, including mainly typical or atypical chest pain and peripheral edema. Abnormal EKG, TTE and cardiac magnetic resonance imaging (CMRI) were found in 72%, 72% and 99% in CM+ patients, respectively, contrasting with abnormalities in 32%, 38% and 60% in CM-negative patients. Late gadolinium enhancement (LGE) was the most frequent abnormality on CMRI (70%). CM+ patients were less frequently ANCA-positive, had less frequent peripheral neuropathy and had higher eosinophil count. Major adverse cardiovascular events (MACE) occurred in 13%, both in CM+ and CM- patients. Abnormal EKG and LGE on CMRI were associated with the occurrence of MACE. Four patients died, but none from cardiac causes. CONCLUSIONS Specific cardiomyopathy is frequent in EGPA, especially in ANCA-negative patients with high eosinophil counts. Long-term outcome was better than previously reported. Abnormal EKG and LGE on CMRI were associated with the occurrence of MACE.
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Affiliation(s)
- Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare disease, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Guillaume Chassagnon
- Department of Radiology, Cochin Hospital, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Bertrand Dunogué
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Luc Mouthon
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Benjamin Terrier
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
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Garin A, Chassagnon G, Tual A, Revel MP. CT features of fibrosing mediastinitis. Diagn Interv Imaging 2021; 102:759-762. [PMID: 34167927 DOI: 10.1016/j.diii.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alexandre Garin
- Department of Radiology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France.
| | - Guillaume Chassagnon
- Department of Radiology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Arnaud Tual
- Department of Radiology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France
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35
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Affiliation(s)
- Guillaume Chassagnon
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg St Jacques, 75014 Paris, France.
| | - Lucile Regard
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Pulmonology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Philippe Soyer
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg St Jacques, 75014 Paris, France
| | - Marie-Pierre Revel
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg St Jacques, 75014 Paris, France
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36
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Chassagnon G, Burgel PR. Mucus Plugs in Medium-sized Airways: A Novel Imaging Biomarker for Phenotyping Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 203:932-934. [PMID: 33264069 PMCID: PMC8048760 DOI: 10.1164/rccm.202011-4178ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Guillaume Chassagnon
- Cochin Hospital Assistance Publique Hôpitaux de Paris Paris, France.,Université de Paris Paris, France and
| | - Pierre-Régis Burgel
- Cochin Hospital Assistance Publique Hôpitaux de Paris Paris, France.,Institut Cochin, Inserm U1016 Université de Paris Paris, France
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37
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Abstract
Lung cancer is the leading cause of cancer deaths in Europe and around the world. Although available therapies have undergone considerable development in the past decades, the five-year survival rate for lung cancer remains low. This sobering outlook results mainly from the advanced stages of cancer most patients are diagnosed with. As the population at risk is relatively well defined and early stage disease is potentially curable, lung cancer outcomes may be improved by screening. Several studies already show that lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality. However, for a successful implementation of LCS programmes, several challenges have to be overcome: selection of high-risk individuals, standardization of nodule classification and measurement, specific training of radiologists, optimization of screening intervals and screening duration, handling of ancillary findings are some of the major points which should be addressed. Last but not least, the psychological impact of screening on screened individuals and the impact of potential false positive findings should not be neglected. The aim of this review is to discuss the different challenges of implementing LCS programmes and to give some hints on how to overcome them. Finally, we will also discuss the psychological impact of screening on quality of life and the importance of smoking cessation.
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Affiliation(s)
- Katharina Martini
- Radiology Department, Hôpital Cochin, APHP.Centre-Université de Paris, Paris, France.,Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Guillaume Chassagnon
- Radiology Department, Hôpital Cochin, APHP.Centre-Université de Paris, Paris, France
| | - Thomas Frauenfelder
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Marie-Pierre Revel
- Radiology Department, Hôpital Cochin, APHP.Centre-Université de Paris, Paris, France
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38
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Prieto M, Chassagnon G, Lupo A, Charpentier MC, Cabanne E, Groussin L, Wislez M, Alifano M, Fournel L. Lung carcinoid tumors with Diffuse Idiopathic Pulmonary NeuroEndocrine Cell Hyperplasia (DIPNECH) exhibit pejorative pathological features. Lung Cancer 2021; 156:117-121. [PMID: 33940544 DOI: 10.1016/j.lungcan.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/02/2021] [Accepted: 04/25/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Diffuse Idiopathic Pulmonary NeuroEndocrine Cell Hyperplasia (DIPNECH) is a rare disease often associated with carcinoid tumors. We aimed at evaluating the impact of DIPNECH on characteristics and prognosis of patients who underwent radical treatment of pulmonary carcinoid tumors. MATERIAL AND METHODS We reviewed all patients operated on for curative-intent resection of carcinoid tumor in our department from 2001 to 2020. Cases exhibiting both pathological and radiological features of DIPNECH, as assessed by respective thoracic expert physicians, were analyzed separately. RESULTS 172 cases of resected carcinoid tumors were identified, including 25 (14.5 %) harboring pathological criteria of DIPNECH and radiologic features like mosaic attenuation (92.0 %), multiple nodules < 5 mm (76.0 %), and mucoid impactions (32 %). In DIPNECH patients, major pulmonary resections were usually performed (92.0 %) and resected tumors were mostly classified as pT1 (92 %). Mean Ki67 staining was 3.7 ± 5.2 %. The early postoperative period was mostly uneventful (96.0 %) and 5-year survival was 92.9 ± 6.9 %. Compared to non-DIPNECH cases, we found that patients were older (mean 65.6 ± 9.3 versus 54.1 ± 17.9, p = 0.002), more frequently female (84.0 % versus 56.5 %, p = 0.009), and exhibiting diabetes mellitus (45.8 % versus 18.5 %, p < 0.001) or hypertension (45.8 % versus 24.1 %, p = 0.039). The rate of atypical carcinoid tumors was significantly higher in DIPNECH patients (40.0 % versus 19.9 %, p = 0.027), as well as rate of mediastinal lymph-nodes involvement (pN2+) (36.0 % versus 4.1 %, p < 0.001). At multivariate analysis, only DIPNECH pattern and atypical histology were independent factors of pN2 invasion which was the only predictor of poorer prognosis on Log-Rank test. CONCLUSION Carcinoid tumors with proven DIPNECH are associated with negative pathological features and may deserve a dedicated perioperative management.
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Affiliation(s)
- Mathilde Prieto
- Department of Thoracic Surgery, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Guillaume Chassagnon
- Department of Chest Radiology, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Audrey Lupo
- Department of Pathology, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | | | - Eglantine Cabanne
- Department of Chest Radiology, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Lionel Groussin
- Department of Endocrinology, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Marie Wislez
- Department of Respiratory Medicine and Thoracic Oncology, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Hôpital Cochin, APHP.CUP, Université de Paris, France
| | - Ludovic Fournel
- Department of Thoracic Surgery, Hôpital Cochin, APHP.CUP, Université de Paris, France.
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Jalaber C, Chassagnon G, Hani C, Dangeard S, Babin M, Launay O, Revel MP. Is COVID-19 pneumonia differentiable from other viral pneumonia on CT scan? Respir Med Res 2021; 79:100824. [PMID: 33971431 PMCID: PMC8078041 DOI: 10.1016/j.resmer.2021.100824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
Affiliation(s)
- C Jalaber
- Department of radiology, University Hospital of Saint-Etienne, University Jean Monnet, Avenue Albert Raimond, 42270 Saint Priest en Jarez, France.
| | - G Chassagnon
- Department of radiology, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
| | - C Hani
- Department of radiology, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
| | - S Dangeard
- Department of radiology, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
| | - M Babin
- Department of radiology, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
| | - O Launay
- Department of Infectious Diseases, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
| | - M-P Revel
- Department of radiology, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
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Daffrè E, Prieto M, Martini K, Hoang-Thi TN, Halm N, Dermine H, Bobbio A, Chassagnon G, Revel MP, Alifano M. Total Psoas Area and Total Muscular Parietal Area Affect Long-Term Survival of Patients Undergoing Pneumonectomy for Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13081888. [PMID: 33920022 PMCID: PMC8071015 DOI: 10.3390/cancers13081888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 12/25/2022] Open
Abstract
There is no standardization in methods to assess sarcopenia; in particular the prognostic significance of muscular fatty infiltration in lung cancer patients undergoing surgery has not been evaluated so far. We thus performed several computed tomography (CT)-based morphometric measurements of sarcopenia in 238 consecutive non-small cell lung-cancer patients undergoing pneumonectomy from 1 January 2007 to 31 December 2015. Sarcopenia was assessed by the following CT-based parameters: cross-sectional total psoas area (TPA), cross-sectional total muscle area (TMA), and total parietal muscle area (TPMA), defined as TMA without TPA. Measures were performed at the level of the third lumbar vertebra and were obtained for the entire muscle surface, as well as by excluding fatty infiltration based on CT attenuation. Findings were stratified for gender, and a threshold of the 33rd percentile was set to define sarcopenia. Furthermore, we assessed the possibility of being sarcopenic at both the TPA and TPMA level, or not, by taking into account of not fatty infiltration. Five-year survival was 39.1% for the whole population. Lower TPA, TMA, and TPA were associated with lower survival at univariate analysis; taking into account muscular fatty infiltration did not result in more powerful discrimination. Being sarcopenic at both psoas and parietal muscle level had the optimum discriminating power. At the multivariable analysis, being sarcopenic at both psoas and parietal muscles (considering the whole muscle areas, including muscular fat), male sex, increasing age, and tumor stage, as well as Charlson Comorbidity Index (CCI), were independently associated with worse long-term outcomes. We conclude that sarcopenia is a powerful negative prognostic factor in patients with lung cancer treated by pneumonectomy.
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Affiliation(s)
- Elisa Daffrè
- Department of Thoracic Surgery, Paris Centre University Hospitals, AP-HP, 75014 Paris, France; (E.D.); (M.P.); (A.B.)
| | - Mathilde Prieto
- Department of Thoracic Surgery, Paris Centre University Hospitals, AP-HP, 75014 Paris, France; (E.D.); (M.P.); (A.B.)
| | - Katharina Martini
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland;
| | - Trieu-Nghi Hoang-Thi
- Department of Radiology, Paris Centre University Hospitals, AP-HP, 75014 Paris, France; (T.-N.H.-T.); (N.H.); (G.C.); (M.P.R.)
| | - Nara Halm
- Department of Radiology, Paris Centre University Hospitals, AP-HP, 75014 Paris, France; (T.-N.H.-T.); (N.H.); (G.C.); (M.P.R.)
| | - Hervè Dermine
- Department of Anesthesiology and Intensive Care, Paris Centre University Hospitals, AP-HP, 75014 Paris, France;
| | - Antonio Bobbio
- Department of Thoracic Surgery, Paris Centre University Hospitals, AP-HP, 75014 Paris, France; (E.D.); (M.P.); (A.B.)
| | - Guillaume Chassagnon
- Department of Radiology, Paris Centre University Hospitals, AP-HP, 75014 Paris, France; (T.-N.H.-T.); (N.H.); (G.C.); (M.P.R.)
- Faculty of Medicine, University of Paris, 75006 Paris, France
| | - Marie Pierre Revel
- Department of Radiology, Paris Centre University Hospitals, AP-HP, 75014 Paris, France; (T.-N.H.-T.); (N.H.); (G.C.); (M.P.R.)
- Faculty of Medicine, University of Paris, 75006 Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Paris Centre University Hospitals, AP-HP, 75014 Paris, France; (E.D.); (M.P.); (A.B.)
- Faculty of Medicine, University of Paris, 75006 Paris, France
- Correspondence:
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Hoang-Thi TN, Chassagnon G, Hua-Huy T, Boussaud V, Dinh-Xuan AT, Revel MP. Chronic Lung Allograft Dysfunction Post Lung Transplantation: A Review of Computed Tomography Quantitative Methods for Detection and Follow-Up. J Clin Med 2021; 10:jcm10081608. [PMID: 33920108 PMCID: PMC8069908 DOI: 10.3390/jcm10081608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 12/27/2022] Open
Abstract
Chronic lung allograft dysfunction (CLAD) remains the leading cause of morbidity and mortality after lung transplantation. The term encompasses both obstructive and restrictive phenotypes, as well as mixed and undefined phenotypes. Imaging, in addition to pulmonary function tests, plays a major role in identifying the CLAD phenotype and is essential for follow-up after lung transplantation. Quantitative imaging allows for the performing of reader-independent precise evaluation of CT examinations. In this review article, we will discuss the role of quantitative imaging methods for evaluating the airways and the lung parenchyma on computed tomography (CT) images, for an early identification of CLAD and for prognostic estimation. We will also discuss their limits and the need for novel approaches to predict, understand, and identify CLAD in its early stages.
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Affiliation(s)
- Trieu-Nghi Hoang-Thi
- AP-HP.Centre, Hôpital Cochin, Department of Radiology, Université de Paris, 75014 Paris, France; (T.-N.H.-T.); (G.C.)
- Department of Diagnostic Imaging, Vinmec Central Park Hospital, Ho Chi Minh City 70000, Vietnam
- AP-HP.Centre, Hôpital Cochin, Department of Respiratory Physiology, Université de Paris, 75014 Paris, France; (T.H.-H.); (A.-T.D.-X.)
| | - Guillaume Chassagnon
- AP-HP.Centre, Hôpital Cochin, Department of Radiology, Université de Paris, 75014 Paris, France; (T.-N.H.-T.); (G.C.)
| | - Thong Hua-Huy
- AP-HP.Centre, Hôpital Cochin, Department of Respiratory Physiology, Université de Paris, 75014 Paris, France; (T.H.-H.); (A.-T.D.-X.)
| | - Veronique Boussaud
- AP-HP.Centre, Hôpital Cochin, Department of Pneumology, Université de Paris, 75014 Paris, France;
| | - Anh-Tuan Dinh-Xuan
- AP-HP.Centre, Hôpital Cochin, Department of Respiratory Physiology, Université de Paris, 75014 Paris, France; (T.H.-H.); (A.-T.D.-X.)
| | - Marie-Pierre Revel
- AP-HP.Centre, Hôpital Cochin, Department of Radiology, Université de Paris, 75014 Paris, France; (T.-N.H.-T.); (G.C.)
- Correspondence: ; Tel.: +33-1-5841-2471
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Khansa R, Lupo A, Chassagnon G. Lung adenocarcinoma mimicking hamartoma on CT. Diagn Interv Imaging 2021; 102:581-582. [PMID: 33745854 DOI: 10.1016/j.diii.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Rémi Khansa
- Department of Radiology, Hôpital Cochin, AP-HP centre, 75014 Paris, France
| | - Audrey Lupo
- Department of Radiology, Hôpital Cochin, AP-HP centre, 75014 Paris, France; Department of Pathology, Hôpital Cochin, AP-HP centre, 75014 Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Hôpital Cochin, AP-HP centre, 75014 Paris, France; Université de Paris, 75006 Paris, France.
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Barat M, Chassagnon G, Dohan A, Gaujoux S, Coriat R, Hoeffel C, Cassinotto C, Soyer P. Correction to: Artificial intelligence: a critical review of current applications in pancreatic imaging. Jpn J Radiol 2021; 39:524-526. [PMID: 33694081 DOI: 10.1007/s11604-021-01102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France.,Université de Paris, Descartes-Paris 5, 75006, Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France.,Université de Paris, Descartes-Paris 5, 75006, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France.,Université de Paris, Descartes-Paris 5, 75006, Paris, France
| | - Sébastien Gaujoux
- Université de Paris, Descartes-Paris 5, 75006, Paris, France.,Department of Abdominal Surgery, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Romain Coriat
- Université de Paris, Descartes-Paris 5, 75006, Paris, France.,Department of Gastroenterology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Christine Hoeffel
- Department of Radiology, Robert Debré Hospital, 51092, Reims, France
| | - Christophe Cassinotto
- Department of Radiology, CHU Montpellier, University of Montpellier, Saint-Éloi Hospital, 34000, Montpellier, France
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France. .,Université de Paris, Descartes-Paris 5, 75006, Paris, France.
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Barat M, Chassagnon G, Dohan A, Gaujoux S, Coriat R, Hoeffel C, Cassinotto C, Soyer P. Artificial intelligence: a critical review of current applications in pancreatic imaging. Jpn J Radiol 2021; 39:514-523. [PMID: 33550513 DOI: 10.1007/s11604-021-01098-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 12/11/2022]
Abstract
The applications of artificial intelligence (AI), including machine learning and deep learning, in the field of pancreatic disease imaging are rapidly expanding. AI can be used for the detection of pancreatic ductal adenocarcinoma and other pancreatic tumors but also for pancreatic lesion characterization. In this review, the basic of radiomics, recent developments and current results of AI in the field of pancreatic tumors are presented. Limitations and future perspectives of AI are discussed.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France
- Université de Paris, Descartes-Paris 5, 75006, Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France
- Université de Paris, Descartes-Paris 5, 75006, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France
- Université de Paris, Descartes-Paris 5, 75006, Paris, France
| | - Sébastien Gaujoux
- Université de Paris, Descartes-Paris 5, 75006, Paris, France
- Department of Abdominal Surgery, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Romain Coriat
- Université de Paris, Descartes-Paris 5, 75006, Paris, France
- Department of Gastroenterology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Christine Hoeffel
- Department of Radiology, Robert Debré Hospital, 51092, Reims, France
| | - Christophe Cassinotto
- Department of Radiology, CHU Montpellier, University of Montpellier, Saint-Éloi Hospital, 34000, Montpellier, France
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France.
- Université de Paris, Descartes-Paris 5, 75006, Paris, France.
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Meunier B, Boënnec R, Dujardin PA, Rafin JM, Sirinelli D, Chassagnon G, Morel B. A Dose Simulation X-Ray Software: An Innovating Tool to Reduce Chest Radiograph Exposure in Children. J Thorac Imaging 2021; 36:37-42. [PMID: 32453279 DOI: 10.1097/rti.0000000000000536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Chest radiography is one of the most frequent x-ray examinations performed on children. Reducing the delivered dose is always a major task. The objective of our study was to determine the minimum dose to be delivered while maintaining the image quality of chest radiographs, using dose reduction simulation software. MATERIALS AND METHODS We included 60 children who had had a chest radiography in 5 groups established according to the diagnostic reference levels equitably represented by weight ranges. The software simulated for each radiograph 6 additional simulated photonic noise images corresponding to 100%, 80%, 64%, 50%, 40%, and 32% of the initial dose. The 360 radiographs were blindly scored by 2 radiologists, according to the 7 European quality criteria and a subjective criterion of interpretability, using a semiquantitative visual Lickert scale. RESULTS There was no significant difference in scoring between the reference radiograph (100%) and simulated radiographs at 80% of the dose in children between 5 and 20 kg, 50% of the dose in children between 20 and 30 kg, and between simulated radiographs at 40% of the dose in children over 30 kg. Interobserver reproducibility was moderate to excellent. CONCLUSION Chest radiography dose might be reduced by 20% in children between 5 and 20 kg, 50% in children between 20 and 30 kg, and 60% in children over 30 kg, without any difference in the image quality appreciation. Software that produced simulated x-ray with decreasing delivered dose is an innovating tool for an optimization process.
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Affiliation(s)
- Benjamin Meunier
- Pediatric Radiology Department, Clocheville Hospital, CHRU of Tours
| | - Ronan Boënnec
- Pediatric Radiology Department, Clocheville Hospital, CHRU of Tours
| | | | - Jean M Rafin
- Pediatric Radiology Department, Clocheville Hospital, CHRU of Tours
| | | | - Guillaume Chassagnon
- Radiology Department, Groupe Hospitalier Cochin-Hôtel Dieu, AP-HP, Université Paris Descartes, Paris, France
| | - Baptiste Morel
- Pediatric Radiology Department, Clocheville Hospital, CHRU of Tours
- UMR 1253, iBrain, Université de Tours, Inserm, Tours
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Aissaoui M, Lupo A, Coriat R, Terris B, Bennani S, Chassagnon G, Revel MP. CT features of lung metastases from pancreatic adenocarcinoma: Correlation with histopathologic findings. Diagn Interv Imaging 2020; 102:371-377. [PMID: 33358342 DOI: 10.1016/j.diii.2020.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/01/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the prevalence of an atypical, alveolar presentation of pulmonary metastases from pancreatic adenocarcinoma (PDAC) on computed tomography (CT) and to correlate CT features with those obtained at histopathologic analysis. MATERIAL AND METHODS A total of 76 patients with lung metastases from PDAC over a 10-year period (2009-2019) in a French university hospital were retrospectively included. There were 34 men and 42 women with a mean age of 67.6±11.3 (SD) years (range: 38-89 years). CT features of PDAC were classified according to their presentations as usual metastatic pattern or atypical alveolar pattern; the atypical alveolar pattern corresponding to either ground glass nodules or opacities, solid nodules with a halo sign, "air-space" nodules with air bronchogram, or parenchymal consolidation. Imaging-histopathologic correlation was performed when tissue samples were available. RESULTS Pulmonary metastases were synchronous in 36 patients (36/76; 47%) and metachronous in 40 patients (40/76; 53%). A predominant alveolar presentation on CT was observed in 17 patients (17/76, 22%). Nodules with halo sign were the predominant alveolar pattern in 7 patients (7/17; 41%), air-space nodules were predominant in 4 patients (4/17; 24%) whereas pure ground glass nodules and consolidations were observed as predominant features in 3 patients (3/17; 18%) each. For 5 patients who had histopathological confirmation, alveolar metastases of PDAC were characterized by columnar tumor cells lining the alveolar wall, which was not seen in other radiological presentations, whereas there were no differences regarding mucin secretion between pulmonary metastases with alveolar presentation and those with typical pattern. CONCLUSIONS Lung metastases from PDAC may present with a so-called "alveolar" pattern on CT. This misleading CT features is found in 22% of patients with lung metastases from PDAC and is due to lepidic growth of the metastatic cells.
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Affiliation(s)
- Mathilde Aissaoui
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France.
| | - Audrey Lupo
- Université de Paris, 75006 Paris, France; Department of Pathology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Romain Coriat
- Université de Paris, 75006 Paris, France; Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Benoit Terris
- Université de Paris, 75006 Paris, France; Department of Pathology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Souhail Bennani
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France
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Chassagnon G, Zacharaki EI, Bommart S, Burgel PR, Chiron R, Dangeard S, Paragios N, Martin C, Revel MP. Quantification of Cystic Fibrosis Lung Disease with Radiomics-based CT Scores. Radiol Cardiothorac Imaging 2020; 2:e200022. [PMID: 33778637 DOI: 10.1148/ryct.2020200022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 09/10/2020] [Accepted: 10/30/2020] [Indexed: 11/11/2022]
Abstract
Purpose To develop radiomics-based CT scores for assessing lung disease severity and exacerbation risk in adult patients with cystic fibrosis (CF). Materials and Methods This two-center retrospective observational study was approved by an institutional ethics committee, and the need for patient consent was waived. A total of 215 outpatients with CF referred for unenhanced follow-up chest CT were evaluated in two different centers between January 2013 and December 2016. After lung segmentation, chest CT scans from center 1 (training cohort, 162 patients [median age, 29 years; interquartile range {IQR}, 24-36 years; 84 men]) were used to build CT scores from 38 extracted CT features, using five different machine learning techniques trained to predict a clinical prognostic score, the Nkam score. The correlations between the developed CT scores, two different clinical prognostic scores (Liou and CF-ABLE), forced expiratory volume in 1 second (FEV1), and risk of respiratory exacerbations were evaluated in the test cohort (center 2, 53 patients [median age, 27 years; IQR, 22-35 years; 34 men]) using the Spearman rank coefficient. Results In the test cohort, all radiomics-based CT scores showed moderate to strong correlation with the Nkam score (R = 0.57 to 0.63, P < .001) and Liou scores (R = -0.55 to -0.65, P < .001), whereas the correlation with CF-ABLE score was weaker (R = 0.28 to 0.38, P = .005 to .048). The developed CT scores showed strong correlation with predicted FEV1 (R = -0.62 to -0.66, P < .001) and weak to moderate correlation with the number of pulmonary exacerbations to occur in the 12 months after the CT examination (R = 0.38 to 0.55, P < .001 to P = .006). Conclusion Radiomics can be used to build automated CT scores that correlate to clinical severity and exacerbation risk in adult patients with CF.Supplemental material is available for this article.See also the commentary by Elicker and Sohn in this issue.© RSNA, 2020.
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Affiliation(s)
- Guillaume Chassagnon
- Department of Radiology (G.C., S.D., M.P.R.) and Respiratory Medicine and National Cystic Reference Center (P.R.B.), Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Grande Voie des Vignes, Chatenay Malabry, France (G.C., E.I.Z., N.P.); U1016 Inserm, Institut Cochin, Paris, France (G.C., P.R.B., C.M., M.P.R.); Radiology Department (S.B.) and Pulmonary Department (R.C.), Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, Montpellier, France; ERN-Lung CF Network, France (P.R.B., C.M.); and TheraPanacea, Paris-Biotech-Santé, Paris, France (N.P.)
| | - Evangelia I Zacharaki
- Department of Radiology (G.C., S.D., M.P.R.) and Respiratory Medicine and National Cystic Reference Center (P.R.B.), Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Grande Voie des Vignes, Chatenay Malabry, France (G.C., E.I.Z., N.P.); U1016 Inserm, Institut Cochin, Paris, France (G.C., P.R.B., C.M., M.P.R.); Radiology Department (S.B.) and Pulmonary Department (R.C.), Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, Montpellier, France; ERN-Lung CF Network, France (P.R.B., C.M.); and TheraPanacea, Paris-Biotech-Santé, Paris, France (N.P.)
| | - Sébastien Bommart
- Department of Radiology (G.C., S.D., M.P.R.) and Respiratory Medicine and National Cystic Reference Center (P.R.B.), Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Grande Voie des Vignes, Chatenay Malabry, France (G.C., E.I.Z., N.P.); U1016 Inserm, Institut Cochin, Paris, France (G.C., P.R.B., C.M., M.P.R.); Radiology Department (S.B.) and Pulmonary Department (R.C.), Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, Montpellier, France; ERN-Lung CF Network, France (P.R.B., C.M.); and TheraPanacea, Paris-Biotech-Santé, Paris, France (N.P.)
| | - Pierre-Régis Burgel
- Department of Radiology (G.C., S.D., M.P.R.) and Respiratory Medicine and National Cystic Reference Center (P.R.B.), Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Grande Voie des Vignes, Chatenay Malabry, France (G.C., E.I.Z., N.P.); U1016 Inserm, Institut Cochin, Paris, France (G.C., P.R.B., C.M., M.P.R.); Radiology Department (S.B.) and Pulmonary Department (R.C.), Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, Montpellier, France; ERN-Lung CF Network, France (P.R.B., C.M.); and TheraPanacea, Paris-Biotech-Santé, Paris, France (N.P.)
| | - Raphael Chiron
- Department of Radiology (G.C., S.D., M.P.R.) and Respiratory Medicine and National Cystic Reference Center (P.R.B.), Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Grande Voie des Vignes, Chatenay Malabry, France (G.C., E.I.Z., N.P.); U1016 Inserm, Institut Cochin, Paris, France (G.C., P.R.B., C.M., M.P.R.); Radiology Department (S.B.) and Pulmonary Department (R.C.), Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, Montpellier, France; ERN-Lung CF Network, France (P.R.B., C.M.); and TheraPanacea, Paris-Biotech-Santé, Paris, France (N.P.)
| | - Séverine Dangeard
- Department of Radiology (G.C., S.D., M.P.R.) and Respiratory Medicine and National Cystic Reference Center (P.R.B.), Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Grande Voie des Vignes, Chatenay Malabry, France (G.C., E.I.Z., N.P.); U1016 Inserm, Institut Cochin, Paris, France (G.C., P.R.B., C.M., M.P.R.); Radiology Department (S.B.) and Pulmonary Department (R.C.), Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, Montpellier, France; ERN-Lung CF Network, France (P.R.B., C.M.); and TheraPanacea, Paris-Biotech-Santé, Paris, France (N.P.)
| | - Nikos Paragios
- Department of Radiology (G.C., S.D., M.P.R.) and Respiratory Medicine and National Cystic Reference Center (P.R.B.), Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Grande Voie des Vignes, Chatenay Malabry, France (G.C., E.I.Z., N.P.); U1016 Inserm, Institut Cochin, Paris, France (G.C., P.R.B., C.M., M.P.R.); Radiology Department (S.B.) and Pulmonary Department (R.C.), Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, Montpellier, France; ERN-Lung CF Network, France (P.R.B., C.M.); and TheraPanacea, Paris-Biotech-Santé, Paris, France (N.P.)
| | - Clémence Martin
- Department of Radiology (G.C., S.D., M.P.R.) and Respiratory Medicine and National Cystic Reference Center (P.R.B.), Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Grande Voie des Vignes, Chatenay Malabry, France (G.C., E.I.Z., N.P.); U1016 Inserm, Institut Cochin, Paris, France (G.C., P.R.B., C.M., M.P.R.); Radiology Department (S.B.) and Pulmonary Department (R.C.), Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, Montpellier, France; ERN-Lung CF Network, France (P.R.B., C.M.); and TheraPanacea, Paris-Biotech-Santé, Paris, France (N.P.)
| | - Marie-Pierre Revel
- Department of Radiology (G.C., S.D., M.P.R.) and Respiratory Medicine and National Cystic Reference Center (P.R.B.), Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Grande Voie des Vignes, Chatenay Malabry, France (G.C., E.I.Z., N.P.); U1016 Inserm, Institut Cochin, Paris, France (G.C., P.R.B., C.M., M.P.R.); Radiology Department (S.B.) and Pulmonary Department (R.C.), Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, Montpellier, France; ERN-Lung CF Network, France (P.R.B., C.M.); and TheraPanacea, Paris-Biotech-Santé, Paris, France (N.P.)
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Tordjman M, Mekki A, Mali RD, Saab I, Chassagnon G, Guillo E, Burns R, Eshagh D, Beaune S, Madelin G, Bessis S, Feydy A, Mihoubi F, Doumenc B, Mouthon L, Carlier RY, Drapé JL, Revel MP. Pre-test probability for SARS-Cov-2-related infection score: The PARIS score. PLoS One 2020; 15:e0243342. [PMID: 33332360 PMCID: PMC7745977 DOI: 10.1371/journal.pone.0243342] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In numerous countries, large population testing is impossible due to the limited availability of RT-PCR kits and CT-scans. This study aimed to determine a pre-test probability score for SARS-CoV-2 infection. METHODS This multicenter retrospective study (4 University Hospitals) included patients with clinical suspicion of SARS-CoV-2 infection. Demographic characteristics, clinical symptoms, and results of blood tests (complete white blood cell count, serum electrolytes and CRP) were collected. A pre-test probability score was derived from univariate analyses of clinical and biological variables between patients and controls, followed by multivariate binary logistic analysis to determine the independent variables associated with SARS-CoV-2 infection. RESULTS 605 patients were included between March 10th and April 30th, 2020 (200 patients for the training cohort, 405 consecutive patients for the validation cohort). In the multivariate analysis, lymphocyte (<1.3 G/L), eosinophil (<0.06 G/L), basophil (<0.04 G/L) and neutrophil counts (<5 G/L) were associated with high probability of SARS-CoV-2 infection but no clinical variable was statistically significant. The score had a good performance in the validation cohort (AUC = 0.918 (CI: [0.891-0.946]; STD = 0.014) with a Positive Predictive Value of high-probability score of 93% (95%CI: [0.89-0.96]). Furthermore, a low-probability score excluded SARS-CoV-2 infection with a Negative Predictive Value of 98% (95%CI: [0.93-0.99]). The performance of the score was stable even during the last period of the study (15-30th April) with more controls than infected patients. CONCLUSIONS The PARIS score has a good performance to categorize the pre-test probability of SARS-CoV-2 infection based on complete white blood cell count. It could help clinicians adapt testing and for rapid triage of patients before test results.
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Affiliation(s)
| | - Ahmed Mekki
- Department of Radiology, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Rahul D. Mali
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, United States of America
| | - Ines Saab
- Department of Radiology, Cochin Hospital, APHP, Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Cochin Hospital, APHP, Paris, France
- Université de Paris, Paris, France
| | - Enora Guillo
- Department of Radiology, Cochin Hospital, APHP, Paris, France
| | - Robert Burns
- Department of Radiology, Cochin Hospital, APHP, Paris, France
| | - Deborah Eshagh
- Department of Internal Medicine, Saint Antoine Hospital, APHP, Paris, France
| | - Sebastien Beaune
- Emergency Department, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Guillaume Madelin
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, United States of America
| | - Simon Bessis
- Department of Infectious diseases, Raymond Poincaré Hospital, APHP, Garches, France
| | - Antoine Feydy
- Department of Radiology, Cochin Hospital, APHP, Paris, France
- Université de Paris, Paris, France
| | - Fadila Mihoubi
- Department of Radiology, Cochin Hospital, APHP, Paris, France
| | - Benoit Doumenc
- Emergency Department, Cochin Hospital, APHP, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, Cochin Hospital, APHP, Paris, France
| | - Robert-Yves Carlier
- Department of Radiology, Ambroise Paré Hospital, APHP, Boulogne, France
- Department of Radiology, Raymond Poincaré Hospital, APHP, Garches, France
- DMU Smart Imaging, APHP, Paris, France
| | - Jean-Luc Drapé
- Department of Radiology, Cochin Hospital, APHP, Paris, France
- Université de Paris, Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, Cochin Hospital, APHP, Paris, France
- Université de Paris, Paris, France
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Lassau N, Bousaid I, Chouzenoux E, Lamarque J, Charmettant B, Azoulay M, Cotton F, Khalil A, Lucidarme O, Pigneur F, Benaceur Y, Sadate A, Lederlin M, Laurent F, Chassagnon G, Ernst O, Ferreti G, Diascorn Y, Brillet P, Creze M, Cassagnes L, Caramella C, Loubet A, Dallongeville A, Abassebay N, Ohana M, Banaste N, Cadi M, Behr J, Boussel L, Fournier L, Zins M, Beregi J, Luciani A, Cotten A, Meder J. Three artificial intelligence data challenges based on CT and MRI. Diagn Interv Imaging 2020; 101:783-788. [DOI: 10.1016/j.diii.2020.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023]
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