Automated Quantification of High-Resolution CT Scan Findings in Individuals at Risk for Pulmonary Fibrosis

Rosas, Iván O.; Yao, Jianhua; Avila, Nilo A.; Chow, Catherine; Gahl, William A.; Gochuico, Bernadette R.

doi:10.1378/chest.10-2545

Cited by 59 publications

(40 citation statements)

References 34 publications

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“…The HRCT computer analysis technique that we used is able to differentiate between fibrotic and nonfibrotic areas, and honeycombing, ground glass, nodular, and emphysema-like lesions (24,30). The rationale for examining changes in LAM lung tissue in areas near the cystic lesions is based on evidence that texture changes in these areas, as determined by computer-based analysis of HRCT scans, are associated with Definition of abbreviations: DL CO = diffusion capacity for carbon monoxide; HRCT = high-resolution computed tomography.…”

Section: Discussionmentioning

confidence: 99%

Sustained Effects of Sirolimus on Lung Function and Cystic Lung Lesions in Lymphangioleiomyomatosis

Yao

Taveira-DaSilva²,

Jones³

et al. 2014

Am J Respir Crit Care Med

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Rationale: Sirolimus therapy stabilizes lung function and reduces the size of chylous effusions and lymphangioleiomyomas in patients with lymphangioleiomyomatosis.Objectives: To determine whether sirolimus has beneficial effects on lung function, cystic areas, and adjacent lung parenchyma; whether these effects are sustained; and whether sirolimus is well tolerated by patients.Methods: Lung function decline over time, lung volume occupied by cysts (cyst score), and lung tissue texture in the vicinity of the cysts were quantified with a computer-aided diagnosis system in 38 patients. Then we compared cyst scores from the last study on sirolimus with studies done on sirolimus therapy. In 12 patients, we evaluated rates of change in lung function and cyst scores off and on sirolimus.Measurements and Main Results: Sirolimus reduced yearly declines in FEV 1 (22.3 6 0.1 vs. 1.0 6 0.3% predicted; P , 0.001) and diffusing capacity of carbon monoxide (22.6 6 0.1 vs. 0.9 6 0.2% predicted; P , 0.001). Cyst scores 1.2 6 0.8 years (30.5 6 11.9%) and 2.5 6 2 years (29.7 6 12.1%) after initiating sirolimus were not significantly different from pretreatment values (28.4 6 12.5%). In 12 patients followed for 5 years, a significant reduction in rates of yearly decline in FEV 1 (21.4 6 0.2 vs. 0.3 6 0.4% predicted; P = 0.025) was observed. Analyses of 104 computed tomography scans showed a nonsignificant (P = 0.23) reduction in yearly rates of change of cyst scores (1.8 6 0.2 vs. 0.3 6 0.3%; P = 0.23) and lung texture features. Despite adverse events, most patients were able to continue sirolimus therapy.Conclusions: Sirolimus therapy slowed down lung function decline and increase in cystic lesions. Most patients were able to tolerate sirolimus therapy.Keywords: sirolimus; lung cystic destruction; LAM Lymphangioleiomyomatosis (LAM) is a multisystem disease affecting almost exclusively women, which is characterized by cystic lung destruction, renal angiomyolipomas, and lymphangioleiomyomas (1-4). Patients with LAM frequently present with dyspnea on exertion; recurrent pneumothoraces; chylous effusions; incidental detection of lung cysts on imaging studies; and, less frequently, bleeding angiomyolipomas (1, 2). The clinical course of LAM is variable but LAM is generally considered to be a chronic disease with a median transplant-free survival time spanning more than a decade (5). LAM lesions are characterized by proliferation of a neoplastic LAM cell, which has features both of smooth muscle and melanocytic cells (4). The histologic features of LAM consist of cysts and LAM cells in the walls of cysts and along blood vessels, lymphatics, and bronchioles, causing airways narrowing, vascular wall thickening, lymphatic disruption, and venous occlusion (4).The inherited form of LAM associated with tuberous sclerosis complex (TSC) is caused by mutations in the TSC1 or TSC2 suppressor genes (6-8). Sporadic LAM has been associated only with mutations of TSC2 (6-8). TSC1 and TSC2 encode, respectively, hamartin and tuberin, two Corres...

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Section: Discussionmentioning

confidence: 99%

Sustained Effects of Sirolimus on Lung Function and Cystic Lung Lesions in Lymphangioleiomyomatosis

Yao

Taveira-DaSilva²,

Jones³

et al. 2014

Am J Respir Crit Care Med

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“…Multiple methods exist in the literature [37,[57][58][59][60]. In support of our rationale to use the current score, the HRCT fibrosis score, obtained at the time of diagnosis, was a significant predictor of 3-year mortality in a prospective study on patients newly diagnosed with IPF [6].…”

Section: Discussionmentioning

confidence: 83%

Associated Pulmonary Hypertension Is an Independent Contributor to Exercise Intolerance in Chronic Fibrosing Interstitial Pneumonias

et al. 2018

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Background: Associated pulmonary hypertension (APH) is frequently observed in fibrosing interstitial pneumonias (FIP), such as idiopathic pulmonary fibrosis (IPF). APH is associated with worse prognosis, but it remains unclear whether it is associated with greater functional impairment. Six-minute walk distance (6MWD) is widely used to assess functional capacity in pulmonary hypertension and FIP. Objectives: To investigate if APH independently contributes to exercise intolerance in FIP, irrespective of the extent of underlying fibrosis. Methods: Patients diagnosed with FIP (September 2009 to June 2017) were included in the study if they underwent right heart catheterization, high-resolution chest computed tomography (HRCT), and 6MWD within 3 months. Recruitment was not limited only to patients undergoing lung transplant assessment. APH was defined as mean pulmonary artery pressure (mPAP) ≥25 mm Hg. The extent of fibrosis was quantified on HRCT using a visual fibrosis score by 2 separate observers. Results: Seventy-two patients (60 with IPF) were identified. Fifty-five patients had APH. mPAP was not significantly different in subgroups stratified according to the extent of fibrosis on HRCT. Pulmonary vascular resistance (PVR) was the strongest predictor of 6MWD on both univariate and stepwise regression analyses, and remained so considering only patients with normal wedge pressure (< 15 mm Hg) (n = 61). HRCT fibrosis score and pulmonary function tests did not significantly correlate with 6MWD. Conclusions: In patients with FIP, PVR is a significant contributor of 6MWD, independently from the extent of fibrosis on HRCT. These results strengthen both the rationale to use 6MWD as endpoint in FIP and to target APH with specific therapies.

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“…And the majority of these studies have been done in subjects previously visually or pathologically identified as having interstitial disease. (12, 14, 15, 22–29) The role of objective radiographic analysis tools in identifying those with interstitial lung abnormalities in a large population is, however, less clear.…”

Section: Discussionmentioning

confidence: 99%

The Objective Identification and Quantification of Interstitial Lung Abnormalities in Smokers

et al. 2017

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Rationale and Objectives Previous investigation suggests that visually detected interstitial changes in the lung parenchyma of smokers are highly clinically relevant and predict outcomes including death. Visual subjective analysis to detect these changes is time consuming, insensitive to subtle changes and requires training to enhance reproducibility. Objective detection of such changes could provide a method of disease identification without these limitations. The goal of this study was to develop and test a fully automated image processing tool to objectively identify radiographic features associated with interstitial abnormalities in the computed tomography scans of a large cohort of smokers. Materials and Methods An automated tool that uses local histogram analysis combined with distance from the pleural surface was used to detect radiographic features consistent with interstitial lung abnormalities in computed tomography scans from 2257 individuals from the Genetic Epidemiology of COPD study, a longitudinal observational study of smokers. The sensitivity and specificity of this tool was determined based on its ability to detect the visually identified presence of these abnormalities. Measurements and Main Results The tool had a sensitivity of 87.8% and a specificity of 57.5% for the detection of interstitial lung abnormalities, with a c-statistic of 0.82, and was 100% sensitive and 56.7% specific for the detection of the visual subtype of interstitial abnormalities called fibrotic parenchymal abnormalities, with a c-statistic of 0.89. Conclusions and Relevance In smokers, a fully automated image processing tool is able to identify those individuals who have interstitial lung abnormalities with moderate sensitivity and specificity.

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Automated Quantification of High-Resolution CT Scan Findings in Individuals at Risk for Pulmonary Fibrosis

Cited by 59 publications

References 34 publications

Sustained Effects of Sirolimus on Lung Function and Cystic Lung Lesions in Lymphangioleiomyomatosis

Sustained Effects of Sirolimus on Lung Function and Cystic Lung Lesions in Lymphangioleiomyomatosis

Associated Pulmonary Hypertension Is an Independent Contributor to Exercise Intolerance in Chronic Fibrosing Interstitial Pneumonias

The Objective Identification and Quantification of Interstitial Lung Abnormalities in Smokers

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