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Kanne JP, Walker CM, Brixey AG, Brown KK, Chelala L, Kazerooni EA, Walsh SLF, Lynch DA. Progressive Pulmonary Fibrosis and Interstitial Lung Abnormalities: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024. [PMID: 38656115 DOI: 10.2214/ajr.24.31125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Progressive pulmonary fibrosis (PPF) and interstitial lung abnormalities (ILA) are relatively new concepts in interstitial lung disease (ILD) imaging and clinical management. Recognition of signs of PPF, as well as identification and classification of ILA, are important tasks during chest high-resolution CT interpretation, to optimize management of patients with ILD and those at risk of developing ILD. However, following professional society guidance, the role of imaging surveillance remains unclear in stable patients with ILD, asymptomatic patients with ILA who are at risk of progression, and asymptomatic patients at risk of developing ILD without imaging abnormalities. In this AJR Expert Panel Narrative Review, we summarize the current knowledge regarding PPF and ILA and describe the range of clinical practice with respect to imaging patients with ILD, those with ILA, and those at risk of developing ILD. In addition, we offer suggestions to help guide surveillance imaging in areas with an absence of published guidelines, where such decisions are currently driven primarily by local pulmonologists' preference.
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Affiliation(s)
- Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Christopher M Walker
- Department of Radiology, The University of Kansas Medical Center, Kansas City, KS
| | - Anupama G Brixey
- Department of Radiology, Portland VA Healthcare System, Oregon Health & Science University, Portland, OR
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO
| | - Lydia Chelala
- Department of Radiology, University of Chicago Medicine, Chicago, IL
| | - Ella A Kazerooni
- Departments of Radiology & Internal Medicine, University of Michigan Medical School / Michigan Medicine, Ann Arbor, MI
| | - Simon L F Walsh
- Department of Radiology, Imperial College, London, United Kingdom
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
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García Mullor MM, Arenas-Jiménez JJ, Ureña Vacas A, Gayá García-Manso I, Pérez Pérez JL, Serra Serra N, García Sevila R. Prevalence and prognostic meaning of interstitial lung abnormalities in remote CT scans of patients with interstitial lung disease treated with antifibrotic therapy. RADIOLOGIA 2024; 66 Suppl 1:S10-S23. [PMID: 38642956 DOI: 10.1016/j.rxeng.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 04/22/2024]
Abstract
OBJECTIVES To describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. METHODS We conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. RESULTS We included 50 patients. Only 1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2 months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (p = 0.04). Obvious honeycombing in the lower zones was also significantly (p < 0.05) associated with a faster progression rate. CONCLUSIONS Fibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.
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Affiliation(s)
- M M García Mullor
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - A Ureña Vacas
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - I Gayá García-Manso
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - J L Pérez Pérez
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - N Serra Serra
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - R García Sevila
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain
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Jin GY. Interstitial Lung Abnormality in Asian Population. Tuberc Respir Dis (Seoul) 2024; 87:134-144. [PMID: 38111097 PMCID: PMC10990607 DOI: 10.4046/trd.2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/05/2023] [Accepted: 12/17/2023] [Indexed: 12/20/2023] Open
Abstract
Interstitial lung abnormalities (ILAs) are radiologic abnormalities found incidentally on chest computed tomography (CT) that can be show a wide range of diseases, from subclinical lung fibrosis to early pulmonary fibrosis including definitive usual interstitial pneumonia. To clear up confusion about ILA, the Fleischner society published a position paper on the definition, clinical symptoms, increased mortality, radiologic progression, and management of ILAs based on several Western cohorts and articles. Recently, studies on long-term outcome, risk factors, and quantification of ILA to address the confusion have been published in Asia. The incidence of ILA was 7% to 10% for Westerners, while the prevalence of ILA was about 4% for Asians. ILA is closely related to various respiratory symptoms or increased rate of treatment-related complication in lung cancer. There is little difference between Westerners and Asians regarding the clinical importance of ILA. Although the role of quantitative CT as a screening tool for ILA requires further validation and standardized imaging protocols, using a threshold of 5% in at least one zone demonstrated 67.6% sensitivity, 93.3% specificity, and 90.5% accuracy, and a 1.8% area threshold showed 100% sensitivity and 99% specificity in South Korea. Based on the position paper released by the Fleischner society, I would like to report how much ILA occurs in the Asian population, what the prognosis is, and review what management strategies should be pursued in the future.
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Affiliation(s)
- Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University and Medical School, Jeonju, Republic of Korea
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Martini K, Jungblut L, Sartoretti T, Langhart S, Yalynska T, Nemeth B, Frauenfelder T, Euler A. Impact of radiation dose on the detection of interstitial lung changes and image quality in low-dose chest CT - Assessment in multiple dose levels from a single patient scan. Eur J Radiol 2023; 166:110981. [PMID: 37478655 DOI: 10.1016/j.ejrad.2023.110981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/01/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To assess image quality and detectability of interstitial lung changes using multiple radiation doses from the same chest CT scan of patients with suspected interstitial lung disease (ILD). METHOD Retrospective study of consecutive adult patients with suspected ILD receiving unenhanced chest CT as single-energy dual-source acquisition at 100 kVp (Dual-split mode). 67% and 33% of the overall tube current time product were assigned to tube A and B, respectively. 100%-dose was 2.34 ± 0.97 mGy. Five different radiation doses (100%, 67%, 45%, 39%, 33%) were reconstructed from this single acquisition using linear-blending technique. Two blinded radiologists assessed reticulations, ground-glass opacities (GGO) and honeycombing as well as subjective image noise. Percentage agreement (PA) as compared to 100%-dose were calculated. Non-parametric statistical tests were used. RESULTS A total of 228 patients were included (61.2 ± 14.6 years,146 female). PA was highest for honeycombing (>96%) and independent of dose reduction (P > 0.8). PA for reticulations and GGO decreased when reducing the radiation dose from 100% to 67% for both readers (reticulations: 83.3% and 93.9%; GGO: 87.7% and 79.8% for reader 1 and 2, respectively). Additional dose reduction did not significantly change PA for both readers (all P > 0.05). Subjective image noise increased with decreasing radiation dose (Spearman Rho of ρ = 0.34 and ρ = 0.53 for reader 1 and 2, respectively, P < 0.001). CONCLUSIONS Radiation dose reduction had a stronger impact on subtle interstitial lung changes. Detectability decreased with initial dose reduction indicating that a minimum dose is needed to maintain diagnostic accuracy in chest CT for suspected ILD.
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Affiliation(s)
- Katharina Martini
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Lisa Jungblut
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas Sartoretti
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Sabinne Langhart
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Tetyana Yalynska
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Bence Nemeth
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Thomas Frauenfelder
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - André Euler
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; Department of Radiology, Kantonsspital Baden, University of Zurich, Im Ergel 1, 5404 Baden, Switzerland.
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Gao Z, Li X, Li Y, Zhang C, Li Y, Sun M, Wu Y, Li S, Zhang Y. Peripheral interstitial lung abnormalities on LDCT in an asymptomatic, nonsmoking Chinese urban cohort. Medicine (Baltimore) 2023; 102:e33630. [PMID: 37083763 PMCID: PMC10118360 DOI: 10.1097/md.0000000000033630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
To retrospectively investigate the imaging features and the related influencing factors of peripheral interstitial lung abnormalities (PILA) that caused "normal aging" by low-dose computed tomography (LDCT) in an nonsmoking, asymptomatic Chinese urban cohort. The clinical data of 733 subjects who underwent chest LDCT were retrospectively collected. The computed tomography (CT) signs of PILA (interlobular septal thickening [ILST], intralobular interstitial thickening [ILIT], ground-glass opacity [GGO], reticular shadow [RS], subpleural line [SL]) were evaluated at 6 levels and statistically analyzed. The effects of age, sex, body mass index (BMI), blood pressure (BP), and blood biochemistry parameters on ILST, ILIT, and RS were analyzed by Binary Logistic regression analysis. Significant age differences in PILA were found. None of the 5 PILA CT signs (GGO, ILST, ILIT, RS, and SL) was observed in subjects under 40 years old, while in subjects over 40 years old, the incidence of PILA increased with age. All 5 CT signs of PILA were significantly different among the subjects aged 18 to 49, 50 to 69, and 70 to 79 (P < .05). There was no significant sex difference in PILA. Among age, sex, BMI, BP, and laboratory biochemistry parameters, only age had a significant effect on ILST, ILIT, and RS. LDCT can be used as a noninvasive method to evaluate the PILA. PILA were mainly affected by age, while sex, BMI, BP, and laboratory biochemistry parameters had little effect on PILA. PILA observed before the age of 40 years should be considered an abnormal finding, whereas it is common in individuals over 70.
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Affiliation(s)
- Zhimei Gao
- The Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xin Li
- The Department of CT, Tangshan Workers Hospital, Tangshan, China
| | - Yan Li
- The Department of CT and MRI, The Children’s Hospital of Hebei Province, Shijiazhuang, China
| | - Chenguang Zhang
- The Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yaguang Li
- The Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mengyue Sun
- The Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yalan Wu
- The Department of CT and MRI, The Children’s Hospital of Hebei Province, Shijiazhuang, China
| | - Shujing Li
- The Department of CT and MRI, The Children’s Hospital of Hebei Province, Shijiazhuang, China
| | - Yingqi Zhang
- The Department of Emergency, The First Hospital of Hebei Medical University, Shijiazhuang, China
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Rôlo Silvestre C, Custódio C, Clemente S, Rodrigues S, Furtado ST, Maio R. Interstitial lung abnormalities: Real-world evidence. Health Sci Rep 2023; 6:e1216. [PMID: 37091361 PMCID: PMC10120401 DOI: 10.1002/hsr2.1216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/25/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Affiliation(s)
| | | | | | | | | | - Rui Maio
- Hospital Beatriz ÂngeloLouresPortugal
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Baratella E, Fiorese I, Minelli P, Veiluva A, Marrocchio C, Ruaro B, Cova MA. Aging-Related Findings of the Respiratory System in Chest Imaging: Pearls and Pitfalls. CURRENT RADIOLOGY REPORTS 2023; 11:1-11. [PMID: 36471674 PMCID: PMC9713755 DOI: 10.1007/s40134-022-00405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review The purpose of this review is to describe the main features of the aging chest, studied through different imaging modalities. Recent Findings Aging-related changes of the respiratory system are inevitable. Therefore, it is mandatory to be familiar with the para-physiological changes that occurs, in order to avoid inappropriate interpretation of radiological findings that put patients at risk of over or undertreatment. Summary The role of the radiologist is fundamental in evaluating aging-related processes affecting the respiratory system and in distinguishing them from frank diseases.
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Affiliation(s)
- Elisa Baratella
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Ilaria Fiorese
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Pierluca Minelli
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Alberto Veiluva
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Cristina Marrocchio
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Barbara Ruaro
- grid.5133.40000 0001 1941 4308Department of Pulmonology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Maria Assunta Cova
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
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Lee JE, Jeong WG, Lee HJ, Kim YH, Chae KJ, Jeong YJ. Relationship between Incidental Abnormalities on Screening Thoracic Computed Tomography and Mortality: A Long-Term Follow-Up Analysis. Korean J Radiol 2022; 23:998-1008. [PMID: 36175001 PMCID: PMC9523229 DOI: 10.3348/kjr.2022.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The present study aimed to assess the relationship between incidental abnormalities on thoracic computed tomography (CT) and mortality in a general screening population using a long-term follow-up analysis. MATERIALS AND METHODS We retrospectively collected the medical records and CT images of 840 participants (mean age ± standard deviation [SD], 58.5 ± 6.7 years; 564 male) who underwent thoracic CT at a single health promotion center between 2007 and 2010. Two thoracic radiologists independently reviewed all CT images and evaluated any incidental abnormalities (interstitial lung abnormality [ILA], emphysema, coronary artery calcification [CAC], aortic valve [AV] calcification, and pulmonary nodules). Kaplan-Meier analysis with log-rank and z-tests was performed to assess the relationship between incidental CT abnormalities and all-cause mortality in the subsequent follow-up. Cox proportional hazards regression was performed to further identify risk factors of all-cause mortality among the incidental CT abnormalities and clinical factors. RESULTS Among the 840 participants, 55 (6%), 171 (20%), 288 (34%), 396 (47%), and 97 (11%) had findings of ILA, emphysema, CAC, pulmonary nodule, and AV calcification, respectively, on initial CT. The participants were followed up for a mean period ± SD of 10.9 ± 1.4 years. All incidental CT abnormalities were associated with all-cause mortality in univariable analysis (p < 0.05). However, multivariable analysis further revealed fibrotic ILA as an independent risk factor for all-cause mortality (hazard ratio, 2.52 [95% confidence interval, 1.02-6.22], p = 0.046). ILA were also identified as an independent risk factor for lung cancer or respiratory disease-related deaths. CONCLUSION Incidental abnormalities on screening thoracic CT were associated with increased mortality during the long-term follow-up. Among incidental CT abnormalities, fibrotic ILA were independently associated with increased mortality. Appropriate management and surveillance may be required for patients with fibrotic ILA on thoracic CT obtained for general screening purposes.
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Affiliation(s)
- Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Won Gi Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
| | - Hyo-Jae Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kum Ju Chae
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Yeon Joo Jeong
- Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Sangani RG, Ghio AJ, Parker JE. Concerns re Harris et al.: Low-dose CT-detected interstitial lung abnormalities in a population with low asbestos exposure. Am J Ind Med 2022; 65:425-426. [PMID: 35220613 DOI: 10.1002/ajim.23338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Rahul G. Sangani
- Section of Pulmonary, Critical Care and Sleep Medicine West Virginia University Morgantown West Virginia USA
| | - Andrew J. Ghio
- US Environmental Protection Agency Chapel Hill North Carolina USA
| | - John E. Parker
- Section of Pulmonary, Critical Care and Sleep Medicine West Virginia University Morgantown West Virginia USA
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Li YZ, Jin GY, Chae KJ, Han YM. Quantitative Assessment of Airway Changes in Fibrotic Interstitial Lung Abnormality Patients by Chest CT According to Cumulative Cigarette Smoking. Tomography 2022; 8:1024-1032. [PMID: 35448716 PMCID: PMC9032598 DOI: 10.3390/tomography8020082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/20/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the role of Pi10 in patients with fibrotic interstitial lung abnormality (fibrotic ILA) in a chest CT, according to cumulative cigarette smoking. Methods: We retrospectively assessed 54 fibrotic ILA patients and 18 healthy non-smokers (control) who underwent non-enhanced CT and pulmonary function tests. We quantitatively analyzed airway changes (the inner luminal area, airway inner parameter, airway wall thickness, Pi10, skewness, and kurtosis) in the chest CT of fibrotic ILA patients, and the fibrotic ILA patients were categorized into groups based on pack-years: light, moderate, heavy. Airway change data and pulmonary function tests among the three groups of fibrotic ILA patients were compared with those of the control group by one-way ANOVA. Results: Mean skewness (2.58 ± 0.36) and kurtosis (7.64 ± 2.36) in the control group were significantly different from those of the fibrotic ILA patients (1.89 ± 0.37 and 3.62 ± 1.70, respectively, p < 0.001). In fibrotic ILA group, only heavy smokers had significantly increased Pi10 (mean increase 0.04, p = 0.013), increased airway wall thickness of the segmental bronchi (mean increase 0.06 mm, p = 0.005), and decreased lung diffusing capacity for carbon monoxide (p = 0.023). Conclusion: Pi10, as a biomaker of quantitative CT in fibrotic ILA patients, can reveal that smoking affects airway remodeling.
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Affiliation(s)
- Yuan Zhe Li
- Department of Radiology, Jeonbuk National University Medical School, Jeonju 54896, Korea; (Y.Z.L.); (K.J.C.); (Y.M.H.)
| | - Gong Yong Jin
- Department of Radiology, Jeonbuk National University Medical School, Jeonju 54896, Korea; (Y.Z.L.); (K.J.C.); (Y.M.H.)
- Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Institute of Medical Science, Jeonju 54970, Korea
- Correspondence: ; Tel.: +82-063-250-2307
| | - Kum Ju Chae
- Department of Radiology, Jeonbuk National University Medical School, Jeonju 54896, Korea; (Y.Z.L.); (K.J.C.); (Y.M.H.)
- Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Institute of Medical Science, Jeonju 54970, Korea
| | - Young Min Han
- Department of Radiology, Jeonbuk National University Medical School, Jeonju 54896, Korea; (Y.Z.L.); (K.J.C.); (Y.M.H.)
- Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Institute of Medical Science, Jeonju 54970, Korea
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Jeong WG, Kim YH, Lee JE, Oh IJ, Song SY, Chae KJ, Park HM. Predictive Value of Interstitial Lung Abnormalities for Postoperative Pulmonary Complications in Elderly Patients with Early-stage Lung Cancer. Cancer Res Treat 2021; 54:744-752. [PMID: 34583454 PMCID: PMC9296932 DOI: 10.4143/crt.2021.772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/25/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Identifying pretreatment interstitial lung abnormalities (ILAs) is important because of their predictive value for complications after lung cancer treatment. This study aimed to assess the predictive value of ILAs for postoperative pulmonary complications (PPCs) in elderly patients undergoing curative resection for early-stage non-small cell lung cancer (NSCLC). Materials and Methods Elderly patients (age ≥ 70 years) who underwent curative resection for pathologic stage I or II NSCLC with normal preoperative spirometry results (pre-bronchodilator forced expiratory volume in 1 s to forced vital capacity [FVC] ratio > 0.70 and FVC ≥ 80% of the predicted value) between January 2012 and December 2019 were retrospectively identified. Univariable and multivariable regression analyses were performed to assess risk factors for PPCs. The Kaplan-Meier method and log-rank test were used to analyze the relationship between ILAs and postoperative mortality. One-way analysis of variance was performed to assess the correlation between ILAs and hospital stay duration. Results A total of 262 patients (median age, 73 [interquartile range, 71-76] years; 132 male) were evaluated. A multivariable logistic regression model revealed that, among several relevant risk factors, fibrotic ILAs independently predicted both overall PPCs (adjusted odds ratio [OR], 4.84; 95% confidence interval [CI], 1.35-17.38; p=0.016) and major PPCs (adjusted OR, 8.72; 95% CI, 1.71-44.38; p=0.009). Fibrotic ILAs were significantly associated with higher postoperative mortality and longer hospital stay (F=5.21, p=0.006). Conclusion Pretreatment fibrotic ILAs are associated with PPCs, higher postoperative mortality, and longer hospital stay.
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Affiliation(s)
- Won Gi Jeong
- Lung and Esophageal Cancer Clinic, Chonnam National University, Hwasun Hospital, Hwasun, Korea.,Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - In-Jae Oh
- Lung and Esophageal Cancer Clinic, Chonnam National University, Hwasun Hospital, Hwasun, Korea.,Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Yun Song
- Lung and Esophageal Cancer Clinic, Chonnam National University, Hwasun Hospital, Hwasun, Korea.,Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Kum Ju Chae
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Hye Mi Park
- Lung and Esophageal Cancer Clinic, Chonnam National University, Hwasun Hospital, Hwasun, Korea.,Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
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Cereser L, Passarotti E, De Pellegrin A, Patruno V, Poi ED, Marchesini F, Zuiani C, Girometti R. Chest high-resolution computed tomography in patients with connective tissue disease: pulmonary conditions beyond "the usual suspects". Curr Probl Diagn Radiol 2021; 51:759-767. [PMID: 34579993 DOI: 10.1067/j.cpradiol.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/18/2021] [Indexed: 11/22/2022]
Abstract
The term "connective tissue diseases" (CTDs) refers to a heterogeneous group of autoimmune disorders, including systemic sclerosis, rheumatoid arthritis, Sjögren's syndrome, systemic lupus erythematosus, polymyositis, dermatomyositis, antisynthetase syndrome, and mixed connective tissue disease. Chest high-resolution computed tomography (HRCT) is the imaging method of choice for evaluating patients with known or suspected CTD-related interstitial lung disease (CTD-ILD), a complication accounting for substantial morbidity and mortality. While specific HRCT patterns and signs of CTD-ILD have been extensively described (hence the designation "the usual suspects"), the knowledge of various, less frequent conditions involving the lungs in patients with CTD would help the radiologist produce a clinically valuable report, thus potentially influencing patient management. This paper aims to provide an up-to-date review of various unusual pulmonary CTD-related conditions the radiologist should be aware of; namely, acute exacerbation of CTD-ILD, CTD-related interstitial lung abnormalities, lung amyloidosis, MALT lymphoma, antisynthetase syndrome, pleuroparenchymal fibroelastosis-like lesion, drug-induced ILD, combined pulmonary fibrosis and emphysema, and pulmonary hypertension. For each condition, the chest HRCT appearance and the key histopathological and clinical features are resumed, helping the radiologist participate actively in the multidisciplinary discussion of complex clinical cases.
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Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy.
| | - Emanuele Passarotti
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Alessandro De Pellegrin
- Department of Pathology, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Department, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Emma Di Poi
- Rheumatology Clinic, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Filippo Marchesini
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
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Nam BD, Hwang JH. Update in Diagnosis of Idiopathic Pulmonary Fibrosis and Interstitial Lung Abnormality. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:770-790. [PMID: 36238071 PMCID: PMC9514410 DOI: 10.3348/jksr.2021.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 11/15/2022]
Abstract
최신 국제 임상진료지침을 기반으로 한 특발폐섬유증의 진단은 부합하는 임상 소견과 함께 고해상 CT에서 전형적인 상용간질폐렴 소견을 보일 때 조직학적 폐 생검 없이 진단 가능하다. 영상 검사는 특발폐섬유증의 평가 및 진단에 중추적인 역할을 하며, 정확한 진단을 위하여 임상적, 영상의학적 및 병리학적 소견에 대한 다학제 검토의 중요성이 강조된다. 간질성 폐이상(interstitial lung abnormality)은 우연히 발견된 영상의학적 이상 소견을 지칭하며, 간질성폐이상과 임상적으로 의미 있는 간질폐질환에 대한 구분은 적절한 임상 평가를 기반으로 이루어져야 한다. 저자들은 이번 종설을 통하여 특발폐섬유증 진단의 최신 지견 및 간질성폐이상에 대한 이해를 도움으로써 미만성 간질폐섬유증 환자의 정확한 진단과 치료 및 예후 증진에 도움이 되고자 한다.
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Affiliation(s)
- Bo Da Nam
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
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