Chest CT scan findings in World Trade Center workers

Abstract

We examined the chest CT scans of 1,453 WTC responders using the International Classification of High-resolution CT for Occupational and Environmental Respiratory Diseases. Univariate and bivariate analyses of potential work-related pleural abnormalities were performed with pre-WTC and WTC-related occupational exposure data, spirometry, demographics and quantitative CT measurements. Logistic regression was used to evaluate occupational predictors of those abnormalities. Chest CT scans were performed first at a median of 6.8 years after 9/11/2001. Pleural abnormalities were the most frequent (21.1%) across all occupational groups In multivariable analyses, significant pre-WTC occupational asbestos exposure, and work as laborer/cleaner were predictive of pleural abnormalities, with prevalence being highest for the Polish subgroup (n = 237) of our population. Continued occupational lung disease surveillance is warranted in this cohort.

Association of quantitative CT lung density measurements and lung function decline in World Trade Center workers

“…Chronic parenchymal lung diseases associated with decreased (eg, emphysema), and increased (eg, interstitial lung diseases) lung density usually have a long latency after inciting exposures, and the included CT studies were obtained a median of 7.1 years after 11 September 2001. Our previous findings on systematic and semiquantitative readings of the CT scans, noted the prevalence of usually mild emphysema and interstitial lung disease in about 10% of this cohort, respectively 5 . Because the findings were so mild, we hypothesized that QCT density metrics corresponding to those abnormalities could be used to quantify their extent more precisely, and to assess whether they were significantly associated with adverse functional outcomes, even if quantitatively mild.…”

“…CT scans were obtained from the lung apices to the bases in a single breath hold at maximum inspiration, and we excluded those with section thicknesses exceeding 1.5 mm, contrast administration, or respiratory or motion artifacts. All deidentified and coded chest CT images were stored and cataloged during the past 5 years in the WTC PEU Chest CT Image Archive (ClinicalTrials.gov identifier NCT03295279) 5 …”

“…The predominant spirometric abnormality has been a nonspecific reduced forced vital capacity (FVC) patterns, 3,4 and findings of airflow obstruction, bronchodilator response, or airway hyperresponsiveness are less frequent 1,4 . We previously reported on mostly mild chest computed tomography (CT) parenchymal findings (eg, interstitial abnormalities and emphysema) 5 . Quantitative chest computed tomography (QCT) measurements 6 can help to characterize the presumed inflammatory changes underlying those heterogeneous WTC‐related lower airway disorders and lung function changes, even if mild.…”

Increased Airway Wall Thickness is Associated with Adverse Longitudinal First–Second Forced Expiratory Volume Trajectories of Former World Trade Center workers

“…However, most studies were performed in a very small number of scanners with an intended technical consistency, and quality control was exerted to exclude a priori studies that did not meet technical standards for QCT. We recently published the findings on systematic readings of the CT scans [9], noted the paucity of interstitial lung disease features, and the group included in the present study did not include any subject with that type of disease. Despite the richness of our data, we lacked information on other factors that can relate to airway disease outcomes, like atopy, smoking status after baseline, and smoking intensity.…”

“…CT scans were obtained from the lung apices to the bases in a single breath hold at maximum inspiration, with section thickness not exceeding 1.5 mm. All deidentified and coded chest CT images were stored and cataloged during the past 5 years in the WTC PEU Chest CT Image Archive (ClinicalTrials.gov identifier NCT03295279) [9]. …”