The impact of slice-reduced computed tomography on histogram-based densitometry assessment of lung fibrosis in patients with systemic sclerosis

Abstract

Background: To evaluate usability of slice-reduced sequential computed tomography (CT) compared to standard high-resolution CT (HRCT) in patients with systemic sclerosis (SSc) for qualitative and quantitative assessment of interstitial lung disease (ILD) with respect to (I) detection of lung parenchymal abnormalities, (II) qualitative and semiquantitative visual assessment, (III) quantification of ILD by histograms and (IV) accuracy for the 20%-cut off discrimination. Methods: From standard chest HRCT of 60 SSc patients sequential 9-slice-computed tomography (reduced HRCT) was retrospectively reconstructed. ILD was assessed by visual scoring and quantitative histogram parameters. Results from standard and reduced HRCT were compared using non-parametric tests and analysed by univariate linear regression analyses. Results: With respect to the detection of parenchymal abnormalities, only the detection of intrapulmonary bronchiectasis was significantly lower in reduced HRCT compared to standard HRCT (P=0.039). No differences were found comparing visual scores for fibrosis severity and extension from standard and reduced HRCT (P=0.051-0.073). All scores correlated significantly (P<0.001) to histogram parameters derived from both, standard and reduced HRCT. Significant higher values of kurtosis and skewness for reduced HRCT were found (both P<0.001). In contrast to standard HRCT histogram parameters from reduced HRCT showed significant discrimination at cut-off 20% fibrosis (sensitivity 88% kurtosis and skewness; specificity 81% kurtosis and 86% skewness; cut-off kurtosis ≤26, cut-off skewness ≤4; both P<0.001). Conclusions: Reduced HRCT is a robust method to assess lung fibrosis in SSc with minimal radiation dose with no difference in scoring assessment of lung fibrosis severity and extension in comparison to standard HRCT.In contrast to standard HRCT histogram parameters derived from the approach of reduced HRCT could discriminate at a threshold of 20% lung fibrosis with high sensitivity and specificity. Hence it might be used to detect early disease progression of lung fibrosis in context of monitoring and treatment of SSc patients.Keywords: Interstitial lung disease (ILD); reduced high-resolution computed tomography of the lung (reduced HRCT of the lung); histogram parameters from reduced high-resolution computed tomography (histogram parameters from reduced HRCT); systemic sclerosis (SSc)

Predictors of progression in systemic sclerosis patients with interstitial lung disease

“…Although computed tomography (CT) scans are necessary for diagnosis, they expose patients to radiation [38]. Reduced-dose HRCT protocols may reliably detect SSc-ILD with a much lower radiation exposure than whole-chest HRCT [38,39]. While these reduced-dose protocols have become routine in some centres, further validation in larger cohorts is required.…”

Lungs nodule detection framework from computed tomography images using support vector machine

“…The small area where categorized into six categories on the basis of different statistical and fractal texture features. In Delorme, Keller‐Reichenbecher, Zuna, Schlegel, and Van Kaick () and Nguyen‐Kim et al () advocated for the use of a pixel‐based approach for classifying a lung tissue into one of the six classes based on the measures of local texture.…”

“…In Delorme, Keller-Reichenbecher, Zuna, Schlegel, and Van Kaick (1997) and Nguyen-Kim et al (2018) advocated for the use of a pixel-based approach for classifying a lung tissue into one of the six classes based on the measures of local texture.…”

Quantitative CT texture analysis for diagnosing systemic sclerosis

“…[21] Our results expand those of Nguyen-Kim et al, who recently reported that both visual and histogram-based assessment is possible on slice-reduced sequential CT. Histogram parameters such as kurtosis and skewness were capable of discriminating fibrosis (20% cut-off) with high sensitivity and specificity. [53] We included in our analysis the highest strength level for IR, namely SAFIRE 5, reported to provide a so-called “blotchy-appearance”, which could hamper not only visual but also quantitative evaluation of pulmonary abnormalities. We postulate that by applying newer generation of IR (such as model-based IR), effect of TA could be improved.…”

“…We postulate that by applying newer generation of IR (such as model-based IR), effect of TA could be improved. [21,53]…”