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Samant M, Krings JG, Lew D, Goss CW, Koch T, McGregor MC, Boomer J, Hall CS, Schechtman KB, Sheshadri A, Peterson S, Erzurum S, DePew Z, Morrow LE, Hogarth DK, Tejedor R, Trevor J, Wechsler ME, Sam A, Shi X, Choi J, Castro M. Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders. Chest 2024; 165:775-784. [PMID: 38123124 PMCID: PMC11026166 DOI: 10.1016/j.chest.2023.12.015] [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: 03/09/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are defined poorly. RESEARCH QUESTION Do baseline radiographic and clinical characteristics exist that predict response to BT? STUDY DESIGN AND METHODS We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across eight academic medical centers. Participants received three separate BT treatments and were monitored at 3-month intervals for 1 year after BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test results of ≥ 3 or Asthma Quality of Life Questionnaire of ≥ 0.5. Regression analyses were used to evaluate the association between pretreatment clinical and quantitative CT scan measures with subsequent BT response. RESULTS From 2006 through 2017, 88 participants received BT, with 70 participants (79.5%) identified as responders by Asthma Control Test or Asthma Quality of Life Questionnaire criteria. Responders were less likely to undergo an asthma-related ICU admission in the prior year (3% vs 25%; P = .01). On baseline quantitative CT imaging, BT responders showed less air trapping percentage (OR, 0.90; 95% CI, 0.82-0.99; P = .03), a greater Jacobian determinant (OR, 1.49; 95% CI, 1.05-2.11), greater SD of the Jacobian determinant (OR, 1.84; 95% CI, 1.04-3.26), and greater anisotropic deformation index (OR, 3.06; 95% CI, 1.06-8.86). INTERPRETATION To our knowledge, this is the largest study to evaluate baseline quantitative CT imaging and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on quantitative CT imaging, were predictors of future BT response. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01185275; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Maanasi Samant
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - James G Krings
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Daphne Lew
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Charles W Goss
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Tammy Koch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Mary Clare McGregor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Jonathan Boomer
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Chase S Hall
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Ken B Schechtman
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Ajay Sheshadri
- Division of Pulmonary Critical Care Medicine, Department of Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Serpil Erzurum
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Zachary DePew
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Creighton University Medical Center, Omaha, NE
| | - Lee E Morrow
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Creighton University Medical Center, Omaha, NE
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - Richard Tejedor
- Division of Pulmonary and Critical Care, Department of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Jennifer Trevor
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Afshin Sam
- Division of Pulmonary and Critical Care, Department of Medicine, University of Arizona, Tuscon, AZ
| | - Xiaosong Shi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Jiwoong Choi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS.
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Han MC, Kim J, Hong CS, Chang KH, Han SC, Park K, Kim DW, Kim H, Chang JS, Kim J, Kye S, Park RH, Chung Y, Kim JS. Performance Evaluation of Deformable Image Registration Algorithms Using Computed Tomography of Multiple Lung Metastases. Technol Cancer Res Treat 2022; 21:15330338221078464. [PMID: 35167403 PMCID: PMC9099354 DOI: 10.1177/15330338221078464] [Citation(s) in RCA: 2] [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] [Indexed: 12/25/2022] Open
Abstract
Purpose: Various deformable image registration (DIR) methods have
been used to evaluate organ deformations in 4-dimensional computed tomography
(4D CT) images scanned during the respiratory motions of a patient. This study
assesses the performance of 10 DIR algorithms using 4D CT images of 5 patients
with fiducial markers (FMs) implanted during the postoperative radiosurgery of
multiple lung metastases. Methods: To evaluate DIR algorithms, 4D
CT images of 5 patients were used, and ground-truths of FMs and tumors were
generated by physicians based on their medical expertise. The positions of FMs
and tumors in each 4D CT phase image were determined using 10 DIR algorithms,
and the deformed results were compared with ground-truth data.
Results: The target registration errors (TREs) between the FM
positions estimated by optical flow algorithms and the ground-truth ranged from
1.82 ± 1.05 to 1.98 ± 1.17 mm, which is within the uncertainty of the
ground-truth position. Two algorithm groups, namely, optical flow and demons,
were used to estimate tumor positions with TREs ranging from 1.29 ± 1.21 to
1.78 ± 1.75 mm. With respect to the deformed position for tumors, for the 2 DIR
algorithm groups, the maximum differences of the deformed positions for gross
tumor volume tracking were approximately 4.55 to 7.55 times higher than the mean
differences. Errors caused by the aforementioned difference in the Hounsfield
unit values were also observed. Conclusions: We quantitatively
evaluated 10 DIR algorithms using 4D CT images of 5 patients and compared the
results with ground-truth data. The optical flow algorithms showed reasonable
FM-tracking results in patient 4D CT images. The iterative optical flow method
delivered the best performance in this study. With respect to the tumor volume,
the optical flow and demons algorithms delivered the best performance.
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Affiliation(s)
- Min Cheol Han
- 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jihun Kim
- 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chae-Seon Hong
- 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Su Chul Han
- 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwangwoo Park
- 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hojin Kim
- 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Suk Chang
- 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jina Kim
- 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunsuk Kye
- 65661Yonsei Cancer Center, Seoul, Republic of Korea
| | | | | | - Jin Sung Kim
- 37991Yonsei University College of Medicine, Seoul, Republic of Korea
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Kizhakke Puliyakote AS, Holverda S, Sá RC, Arai TJ, Theilmann RJ, Botros L, Bogaard HJ, Prisk GK, Hopkins SR. Prone positioning redistributes gravitational stress in the lung in normal conditions and in simulations of oedema. Exp Physiol 2020; 107:771-782. [PMID: 33347661 DOI: 10.1113/ep089037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/03/2020] [Indexed: 02/01/2023]
Abstract
NEW FINDINGS What is the central question of this study? How does the interaction between posture and gravity affect the stresses on the lung, particularly in highly inflated gravitationally non-dependent regions, which are potentially vulnerable to increased mechanical stress and injury? What is the main finding and its importance? Changes in stress attributable to gravity are not well characterized between postures. Using a new metric of gravitational stress, we show that regions of the lung near maximal inflation have the greatest gravitational stresses while supine, but not while prone. In simulations of increased lung weight consistent with severe pulmonary oedema, the prone lung has lower gravitational stress in vulnerable, non-dependent regions, potentially protecting them from overinflation and injury. ABSTRACT Prone posture changes the gravitational vector, and potentially the stress induced by tissue deformation, because a larger lung volume is gravitationally dependent when supine, but non-dependent when prone. To evaluate this, 10 normal subjects (six male and four female; age, means ± SD = 27 ± 6 years; height, 171 ± 9 cm; weight, 69 ± 13 kg; forced expiratory volume in the first second/forced expiratory volume as a percentage of predicted, 93 ± 6%) were imaged at functional residual capacity, supine and prone, using magnetic resonance imaging, to quantify regional lung density. We defined regional gravitational stress as the cumulative weight, per unit area, of the column of lung tissue below each point. Gravitational stress was compared between regions of differing inflation to evaluate differences between highly stretched, and thus potentially vulnerable, regions and less stretched lung. Using reference density values for normal lungs at total lung capacity (0.10 ± 0.03 g/ml), regions were classified as highly inflated (density < 0.13 g/ml, i.e., close to total lung capacity), intermediate (0.13 ≤ density < 0.16 g/ml) or normally inflated (density ≥ 0.16 g/ml). Gravitational stress differed between inflation categories while supine (-1.6 ± 0.3 cmH2 O highly inflated; -1.4 ± 0.3 cmH2 O intermediate; -1.1 ± 0.1 cmH2 O normally inflated; P = 0.05) but not while prone (-1.4 ± 0.2 cmH2 O highly inflated; -1.3 ± 0.2 cmH2 O intermediate; -1.3 ± 0.1 cmH2 O normally inflated; P = 0.39), and increased more with height from dependent lung while supine (-0.24 ± 0.02 cmH2 O/cm supine; -0.18 ± 0.04 cmH2 O/cm prone; P = 0.05). In simulated severe pulmonary oedema, the gradient in gravitational stress increased in both postures (all P < 0.0001), was greater in the supine posture than when prone (-0.57 ± 0.21 cmH2 O/cm supine; -0.34 ± 0.16 cmH2 O/cm prone; P = 0.0004) and was similar to the gradient calculated from supine computed tomography images in a patient with acute respiratory distress syndrome (-0.51 cmH2 O/cm). The non-dependent lung has greater gravitational stress while supine and might be protected while prone, particularly in the presence of oedema.
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Affiliation(s)
- Abhilash S Kizhakke Puliyakote
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA.,The Pulmonary Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA
| | - Sebastiaan Holverda
- The Pulmonary Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA.,Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Rui C Sá
- The Pulmonary Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA.,Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Tatsuya J Arai
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA.,The Pulmonary Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA
| | - Rebecca J Theilmann
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA.,The Pulmonary Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA
| | - Liza Botros
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Harm J Bogaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G Kim Prisk
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA.,The Pulmonary Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA.,Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Susan R Hopkins
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA.,The Pulmonary Imaging Laboratory, University of California, San Diego, La Jolla, CA, USA.,Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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