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Chae KJ, Hwang HJ, Duarte Achcar R, Cooley JC, Humphries SM, Kligerman S, Lynch DA. Central Role of CT in Management of Pulmonary Fibrosis. Radiographics 2024; 44:e230165. [PMID: 38752767 DOI: 10.1148/rg.230165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
With the approval of antifibrotic medications to treat patients with idiopathic pulmonary fibrosis and progressive pulmonary fibrosis, radiologists have an integral role in diagnosing these entities and guiding treatment decisions. CT features of early pulmonary fibrosis include irregular thickening of interlobular septa, pleura, and intralobular linear structures, with subsequent progression to reticular abnormality, traction bronchiectasis or bronchiolectasis, and honeycombing. CT patterns of fibrotic lung disease can often be reliably classified on the basis of the CT features and distribution of the condition. Accurate identification of usual interstitial pneumonia (UIP) or probable UIP patterns by radiologists can obviate the need for a tissue sample-based diagnosis. Other entities that can appear as a UIP pattern must be excluded in multidisciplinary discussion before a diagnosis of idiopathic pulmonary fibrosis is made. Although the imaging findings of nonspecific interstitial pneumonia and fibrotic hypersensitivity pneumonitis can overlap with those of a radiologic UIP pattern, these entities can often be distinguished by paying careful attention to the radiologic signs. Diagnostic challenges may include misdiagnosis of fibrotic lung disease due to pitfalls such as airspace enlargement with fibrosis, paraseptal emphysema, recurrent aspiration, and postinfectious fibrosis. The radiologist also plays an important role in identifying complications of pulmonary fibrosis-pulmonary hypertension, acute exacerbation, infection, and lung cancer in particular. In cases in which there is uncertainty regarding the clinical and radiologic diagnoses, surgical biopsy is recommended, and a multidisciplinary discussion among clinicians, radiologists, and pathologists can be used to address diagnosis and management strategies. This review is intended to help radiologists diagnose and manage pulmonary fibrosis more accurately, ultimately aiding in the clinical management of affected patients. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Kum Ju Chae
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea (H.J.H.); and Department of Radiology (K.J.C., S.M.H., S.K., D.A.L.) and Department of Medicine, Divisions of Pathology (R.D.A.) and Pulmonary and Critical Care Medicine (J.C.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206
| | - Hye Jeon Hwang
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea (H.J.H.); and Department of Radiology (K.J.C., S.M.H., S.K., D.A.L.) and Department of Medicine, Divisions of Pathology (R.D.A.) and Pulmonary and Critical Care Medicine (J.C.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206
| | - Rosane Duarte Achcar
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea (H.J.H.); and Department of Radiology (K.J.C., S.M.H., S.K., D.A.L.) and Department of Medicine, Divisions of Pathology (R.D.A.) and Pulmonary and Critical Care Medicine (J.C.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206
| | - Joseph C Cooley
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea (H.J.H.); and Department of Radiology (K.J.C., S.M.H., S.K., D.A.L.) and Department of Medicine, Divisions of Pathology (R.D.A.) and Pulmonary and Critical Care Medicine (J.C.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206
| | - Stephen M Humphries
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea (H.J.H.); and Department of Radiology (K.J.C., S.M.H., S.K., D.A.L.) and Department of Medicine, Divisions of Pathology (R.D.A.) and Pulmonary and Critical Care Medicine (J.C.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206
| | - Seth Kligerman
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea (H.J.H.); and Department of Radiology (K.J.C., S.M.H., S.K., D.A.L.) and Department of Medicine, Divisions of Pathology (R.D.A.) and Pulmonary and Critical Care Medicine (J.C.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206
| | - David A Lynch
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea (H.J.H.); and Department of Radiology (K.J.C., S.M.H., S.K., D.A.L.) and Department of Medicine, Divisions of Pathology (R.D.A.) and Pulmonary and Critical Care Medicine (J.C.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206
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Miller JE, Oh E, Khatiwada A, Humphries SM, Wilson A, Vladar EK, Lynch DA, Taylor-Cousar JL, Beswick DM. Two-Year Impact of Highly Effective Modulator Therapy on Olfactory Dysfunction. Laryngoscope 2024; 134:2492-2494. [PMID: 38647113 DOI: 10.1002/lary.31447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Eugene Oh
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Aastha Khatiwada
- Department of Biostatistics, National Jewish Health, Denver, Colorado, U.S.A
| | | | - Alexandra Wilson
- Clinical Research Services, National Jewish Health, Denver, Colorado, U.S.A
| | - Eszter K Vladar
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, U.S.A
| | | | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, U.S.A
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Humphries SM, Thieke D, Baraghoshi D, Strand MJ, Swigris JJ, Chae KJ, Hwang HJ, Oh AS, Flaherty KR, Adegunsoye A, Jablonski R, Lee CT, Husain AN, Chung JH, Strek ME, Lynch DA. Deep Learning Classification of Usual Interstitial Pneumonia Predicts Outcomes. Am J Respir Crit Care Med 2024; 209:1121-1131. [PMID: 38207093 DOI: 10.1164/rccm.202307-1191oc] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
Rationale: Computed tomography (CT) enables noninvasive diagnosis of usual interstitial pneumonia (UIP), but enhanced image analyses are needed to overcome the limitations of visual assessment. Objectives: Apply multiple instance learning (MIL) to develop an explainable deep learning algorithm for prediction of UIP from CT and validate its performance in independent cohorts. Methods: We trained an MIL algorithm using a pooled dataset (n = 2,143) and tested it in three independent populations: data from a prior publication (n = 127), a single-institution clinical cohort (n = 239), and a national registry of patients with pulmonary fibrosis (n = 979). We tested UIP classification performance using receiver operating characteristic analysis, with histologic UIP as ground truth. Cox proportional hazards and linear mixed-effects models were used to examine associations between MIL predictions and survival or longitudinal FVC. Measurements and Main Results: In two cohorts with biopsy data, MIL improved accuracy for histologic UIP (area under the curve, 0.77 [n = 127] and 0.79 [n = 239]) compared with visual assessment (area under the curve, 0.65 and 0.71). In cohorts with survival data, MIL-UIP classifications were significant for mortality (n = 239, mortality to April 2021: unadjusted hazard ratio, 3.1; 95% confidence interval [CI], 1.96-4.91; P < 0.001; and n = 979, mortality to July 2022: unadjusted hazard ratio, 3.64; 95% CI, 2.66-4.97; P < 0.001). Individuals classified as UIP positive by the algorithm had a significantly greater annual decline in FVC than those classified as UIP negative (-88 ml/yr vs. -45 ml/yr; n = 979; P < 0.01), adjusting for extent of lung fibrosis. Conclusions: Computerized assessment using MIL identifies clinically significant features of UIP on CT. Such a method could improve confidence in radiologic assessment of patients with interstitial lung disease, potentially enabling earlier and more precise diagnosis.
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Affiliation(s)
| | | | | | | | - Jeffrey J Swigris
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, Colorado
| | - Kum Ju Chae
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Hye Jeon Hwang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Andrea S Oh
- Department of Radiology, University of California Los Angeles, Los Angeles, California
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Renea Jablonski
- Section of Pulmonary and Critical Care, Department of Medicine
| | - Cathryn T Lee
- Section of Pulmonary and Critical Care, Department of Medicine
| | - Aliya N Husain
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | | | - Mary E Strek
- Section of Pulmonary and Critical Care, Department of Medicine
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Miller JE, Taylor-Cousar JL, Humphries SM, Khatiwada A, Chen H, Wilson A, Vladar EK, Lynch DA, Li DA, Beswick DM. Chronic rhinosinusitis and olfaction after highly effective modulator therapy: The role of individual sinus inflammation. Int Forum Allergy Rhinol 2024; 14:986-989. [PMID: 38146638 DOI: 10.1002/alr.23299] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 12/27/2023]
Abstract
KEY POINTS Individual sinus opacification (ISO) is measurable via a convolutional neural network approach. ISO decreased through 2 years after highly effective modulator therapy was initiated. In adults with cystic fibrosis, ISO did not correlate with quality of life or olfaction.
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Affiliation(s)
- Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | | | | | - Aastha Khatiwada
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA
| | - Haidee Chen
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Alexandra Wilson
- Department of Clinical Research Services, National Jewish Health, Denver, Colorado, USA
| | - Eszter K Vladar
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, USA
| | - Douglas A Li
- Division of Pediatric Pulmonology, University of California, Los Angeles, California, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
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Desai SR, Sivarasan N, Johannson KA, George PM, Culver DA, Devaraj A, Lynch DA, Milne D, Renzoni E, Nunes H, Sverzellati N, Spagnolo P, Baughman RP, Yadav R, Piciucchi S, Walsh SLF, Kouranos V, Wells AU. High-resolution CT phenotypes in pulmonary sarcoidosis: a multinational Delphi consensus study. Lancet Respir Med 2024; 12:409-418. [PMID: 38104579 DOI: 10.1016/s2213-2600(23)00267-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/23/2023] [Accepted: 07/14/2023] [Indexed: 12/19/2023]
Abstract
One view of sarcoidosis is that the term covers many different diseases. However, no classification framework exists for the future exploration of pathogenetic pathways, genetic or trigger predilections, patterns of lung function impairment, or treatment separations, or for the development of diagnostic algorithms or relevant outcome measures. We aimed to establish agreement on high-resolution CT (HRCT) phenotypic separations in sarcoidosis to anchor future CT research through a multinational two-round Delphi consensus process. Delphi participants included members of the Fleischner Society and the World Association of Sarcoidosis and other Granulomatous Disorders, as well as members' nominees. 146 individuals (98 chest physicians, 48 thoracic radiologists) from 28 countries took part, 144 of whom completed both Delphi rounds. After rating of 35 Delphi statements on a five-point Likert scale, consensus was achieved for 22 (63%) statements. There was 97% agreement on the existence of distinct HRCT phenotypes, with seven HRCT phenotypes that were categorised by participants as non-fibrotic or likely to be fibrotic. The international consensus reached in this Delphi exercise justifies the formulation of a CT classification as a basis for the possible definition of separate diseases. Further refinement of phenotypes with rapidly achievable CT studies is now needed to underpin the development of a formal classification of sarcoidosis.
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Affiliation(s)
- Sujal R Desai
- Department of Radiology, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; Margaret Turner Warwick Centre for Fibrosing Lung Disease, Imperial College London, London, UK.
| | | | | | - Peter M George
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; Margaret Turner Warwick Centre for Fibrosing Lung Disease, Imperial College London, London, UK
| | - Daniel A Culver
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; Margaret Turner Warwick Centre for Fibrosing Lung Disease, Imperial College London, London, UK
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - David Milne
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; Margaret Turner Warwick Centre for Fibrosing Lung Disease, Imperial College London, London, UK
| | - Hilario Nunes
- Service de Pneumologie, Hôpital Avicenne, Université Sorbonne Paris Nord, Paris, France
| | | | - Paolo Spagnolo
- Section of Respiratory Diseases, University of Padova, Padova, Italy
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Ruchi Yadav
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sara Piciucchi
- Department of Radiology, GB Morgagni Hospital, Forlì, Italy
| | - Simon L F Walsh
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; Margaret Turner Warwick Centre for Fibrosing Lung Disease, Imperial College London, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; Margaret Turner Warwick Centre for Fibrosing Lung Disease, Imperial College London, London, UK
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6
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Raghu G, Ghazipura M, Fleming TR, Aronson KI, Behr J, Brown KK, Flaherty KR, Kazerooni EA, Maher TM, Richeldi L, Lasky JA, Swigris JJ, Busch R, Garrard L, Ahn DH, Li J, Puthawala K, Rodal G, Seymour S, Weir N, Danoff SK, Ettinger N, Goldin J, Glassberg MK, Kawano-Dourado L, Khalil N, Lancaster L, Lynch DA, Mageto Y, Noth I, Shore JE, Wijsenbeek M, Brown R, Grogan D, Ivey D, Golinska P, Karimi-Shah B, Martinez FJ. Meaningful Endpoints for Idiopathic Pulmonary Fibrosis (IPF) Clinical Trials: Emphasis on 'Feels, Functions, Survives'. Report of a Collaborative Discussion in a Symposium with Direct Engagement from Representatives of Patients, Investigators, the National Institutes of Health, a Patient Advocacy Organization, and a Regulatory Agency. Am J Respir Crit Care Med 2024; 209:647-669. [PMID: 38174955 DOI: 10.1164/rccm.202312-2213so] [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: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) carries significant mortality and unpredictable progression, with limited therapeutic options. Designing trials with patient-meaningful endpoints, enhancing the reliability and interpretability of results, and streamlining the regulatory approval process are of critical importance to advancing clinical care in IPF. Methods: A landmark in-person symposium in June 2023 assembled 43 participants from the US and internationally, including patients with IPF, investigators, and regulatory representatives, to discuss the immediate future of IPF clinical trial endpoints. Patient advocates were central to discussions, which evaluated endpoints according to regulatory standards and the FDA's 'feels, functions, survives' criteria. Results: Three themes emerged: 1) consensus on endpoints mirroring the lived experiences of patients with IPF; 2) consideration of replacing forced vital capacity (FVC) as the primary endpoint, potentially by composite endpoints that include 'feels, functions, survives' measures or FVC as components; 3) support for simplified, user-friendly patient-reported outcomes (PROs) as either components of primary composite endpoints or key secondary endpoints, supplemented by functional tests as secondary endpoints and novel biomarkers as supportive measures (FDA Guidance for Industry (Multiple Endpoints in Clinical Trials) available at: https://www.fda.gov/media/162416/download). Conclusions: This report, detailing the proceedings of this pivotal symposium, suggests a potential turning point in designing future IPF clinical trials more attuned to outcomes meaningful to patients, and documents the collective agreement across multidisciplinary stakeholders on the importance of anchoring IPF trial endpoints on real patient experiences-namely, how they feel, function, and survive. There is considerable optimism that clinical care in IPF will progress through trials focused on patient-centric insights, ultimately guiding transformative treatment strategies to enhance patients' quality of life and survival.
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Affiliation(s)
- Ganesh Raghu
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Department of Laboratory Medicine and Pathology, and
| | - Marya Ghazipura
- ZS Associates, Global Health Economics and Outcomes Research, New York, New York
- Division of Epidemiology and
- Division of Biostatistics, Department of Population Health, New York University Langone Health, New York, New York
| | - Thomas R Fleming
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kerri I Aronson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, Ludwig-Maximilians-University Munich, Member of the German Center for Lung Research, Munich, Germany
| | | | - Kevin R Flaherty
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ella A Kazerooni
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Detroit, Michigan
| | - Toby M Maher
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Luca Richeldi
- Divisione di Medicina Polmonare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Joseph A Lasky
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | | | - Robert Busch
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Lili Garrard
- Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, and
| | - Dong-Hyun Ahn
- Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, and
| | - Ji Li
- Division of Clinical Outcome Assessment, Office of Drug Evaluation Sciences, Office of New Drugs, and
| | - Khalid Puthawala
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Gabriela Rodal
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sally Seymour
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Nargues Weir
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Neil Ettinger
- Division of Pulmonary Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Jonathan Goldin
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | - Marilyn K Glassberg
- Department of Medicine, Stritch School of Medicine, Loyola Chicago, Chicago, Illinois
| | - Leticia Kawano-Dourado
- Hcor Research Institute - Hcor Hospital, São Paolo, Brazil
- Pulmonary Division, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Lancaster
- Division of Pulmonary, Critical Care, and Sleep Medicine, Vanderbilt University, Nashville, Tennessee
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Yolanda Mageto
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor University, Dallas, Texas
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Marlies Wijsenbeek
- Centre of Interstitial Lung Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Robert Brown
- Patient representative and patient living with IPF, Lovettsville, Virginia
| | - Daniel Grogan
- Patient representative and patient living with IPF, Charlottesville, Virginia; and
| | - Dorothy Ivey
- Patient representative and patient living with IPF, Richmond, Virginia
| | - Patrycja Golinska
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Banu Karimi-Shah
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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8
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Beswick DM, Khatiwada A, Miller JE, Humphries SM, Wilson A, Vladar EK, Lynch DA, Taylor-Cousar JL. Impact of highly effective modulator therapy on chronic rhinosinusitis and health status: 2-year follow-up. J Cyst Fibros 2024; 23:214-218. [PMID: 37805356 DOI: 10.1016/j.jcf.2023.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/24/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology, Department of Head and Neck Surgery, University of California, 10833 Le Conte Avenue, CHS 62-235, Los Angeles, CA 90095-1624, United States.
| | - Aastha Khatiwada
- Department of Biostatistics, National Jewish Health, Denver, CO, United States
| | - Jessa E Miller
- Department of Otolaryngology, Department of Head and Neck Surgery, University of California, 10833 Le Conte Avenue, CHS 62-235, Los Angeles, CA 90095-1624, United States
| | | | - Alexandra Wilson
- Clinical Research Services, National Jewish Health, Denver, CO, United States
| | - Eszter K Vladar
- Department of Medicine, Division of Pulmonary Science and Critical Care Medicine, University of Colorado, Aurora, CO, United States; Department of Cell Biology, University of Colorado School of Medicine, Aurora, CO, United States
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, United States
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9
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Bell AJ, Pal R, Labaki WW, Hoff BA, Wang JM, Murray S, Kazerooni EA, Galban S, Lynch DA, Humphries SM, Martinez FJ, Hatt CR, Han MK, Ram S, Galban CJ. Local heterogeneity of normal lung parenchyma and small airways disease are associated with COPD severity and progression. Respir Res 2024; 25:106. [PMID: 38419014 PMCID: PMC10903150 DOI: 10.1186/s12931-024-02729-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Small airways disease (SAD) is a major cause of airflow obstruction in COPD patients and has been identified as a precursor to emphysema. Although the amount of SAD in the lungs can be quantified using our Parametric Response Mapping (PRM) approach, the full breadth of this readout as a measure of emphysema and COPD progression has yet to be explored. We evaluated topological features of PRM-derived normal parenchyma and SAD as surrogates of emphysema and predictors of spirometric decline. METHODS PRM metrics of normal lung (PRMNorm) and functional SAD (PRMfSAD) were generated from CT scans collected as part of the COPDGene study (n = 8956). Volume density (V) and Euler-Poincaré Characteristic (χ) image maps, measures of the extent and coalescence of pocket formations (i.e., topologies), respectively, were determined for both PRMNorm and PRMfSAD. Association with COPD severity, emphysema, and spirometric measures were assessed via multivariable regression models. Readouts were evaluated as inputs for predicting FEV1 decline using a machine learning model. RESULTS Multivariable cross-sectional analysis of COPD subjects showed that V and χ measures for PRMfSAD and PRMNorm were independently associated with the amount of emphysema. Readouts χfSAD (β of 0.106, p < 0.001) and VfSAD (β of 0.065, p = 0.004) were also independently associated with FEV1% predicted. The machine learning model using PRM topologies as inputs predicted FEV1 decline over five years with an AUC of 0.69. CONCLUSIONS We demonstrated that V and χ of fSAD and Norm have independent value when associated with lung function and emphysema. In addition, we demonstrated that these readouts are predictive of spirometric decline when used as inputs in a ML model. Our topological PRM approach using PRMfSAD and PRMNorm may show promise as an early indicator of emphysema onset and COPD progression.
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Affiliation(s)
- Alexander J Bell
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - Ravi Pal
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - Wassim W Labaki
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin A Hoff
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - Jennifer M Wang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Susan Murray
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stefanie Galban
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | | | | | | | - MeiLan K Han
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Craig J Galban
- Department of Radiology, University of Michigan, 109 Zina Pitcher Place BSRB A506, Ann Arbor, MI, 48109-2200, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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10
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Oh AS, Lynch DA, Swigris JJ, Baraghoshi D, Dyer DS, Hale VA, Koelsch TL, Marrocchio C, Parker KN, Teague SD, Flaherty KR, Humphries SM. Deep Learning-based Fibrosis Extent on Computed Tomography Predicts Outcome of Fibrosing Interstitial Lung Disease Independent of Visually Assessed Computed Tomography Pattern. Ann Am Thorac Soc 2024; 21:218-227. [PMID: 37696027 DOI: 10.1513/annalsats.202301-084oc] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023] Open
Abstract
Rationale: Radiologic pattern has been shown to predict survival in patients with fibrosing interstitial lung disease. The additional prognostic value of fibrosis extent by quantitative computed tomography (CT) is unknown. Objectives: We hypothesized that fibrosis extent provides information beyond visually assessed CT pattern that is useful for outcome prediction. Methods: We performed a retrospective analysis of chest CT, demographics, longitudinal pulmonary function, and transplantation-free survival among participants in the Pulmonary Fibrosis Foundation Patient Registry. CT pattern was classified visually according to the 2018 usual interstitial pneumonia criteria. Extent of fibrosis was objectively quantified using data-driven textural analysis. We used Kaplan-Meier plots and Cox proportional hazards and linear mixed-effects models to evaluate the relationships between CT-derived metrics and outcomes. Results: Visual assessment and quantitative analysis were performed on 979 enrollment CT scans. Linear mixed-effect modeling showed that greater baseline fibrosis extent was significantly associated with the annual rate of decline in forced vital capacity. In multivariable models that included CT pattern and fibrosis extent, quantitative fibrosis extent was strongly associated with transplantation-free survival independent of CT pattern (hazard ratio, 1.04; 95% confidence interval, 1.04-1.05; P < 0.001; C statistic = 0.73). Conclusions: The extent of lung fibrosis by quantitative CT is a strong predictor of physiologic progression and survival, independent of visually assessed CT pattern.
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Affiliation(s)
- Andrea S Oh
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | | | - Jeffrey J Swigris
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
| | - David Baraghoshi
- Department of Biostatistics, National Jewish Health, Denver, Colorado
| | | | | | | | | | | | | | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
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11
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Sotoudeh-Paima S, Ho FC, Nejad MG, Kavuri A, O'Sullivan-Murphy B, Lynch DA, Segars WP, Samei E, Abadi E. Development and Application of a Virtual Imaging Trial Framework for Longitudinal Quantification of Emphysema in CT. Proc SPIE Int Soc Opt Eng 2024; 12925:129251H. [PMID: 38741597 PMCID: PMC11090051 DOI: 10.1117/12.3006925] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Pulmonary emphysema is a progressive lung disease that requires accurate evaluation for optimal management. This task, possible using quantitative CT, is particularly challenging as scanner and patient attributes change over time, negatively impacting the CT-derived quantitative measures. Efforts to minimize such variations have been limited by the absence of ground truth in clinical data, thus necessitating reliance on clinical surrogates, which may not have one-to-one correspondence to CT-based findings. This study aimed to develop the first suite of human models with emphysema at multiple time points, enabling longitudinal assessment of disease progression with access to ground truth. A total of 14 virtual subjects were modeled across three time points. Each human model was virtually imaged using a validated imaging simulator (DukeSim), modeling an energy-integrating CT scanner. The models were scanned at two dose levels and reconstructed with two reconstruction kernels, slice thicknesses, and pixel sizes. The developed longitudinal models were further utilized to demonstrate utility in algorithm testing and development. Two previously developed image processing algorithms (CT-HARMONICA, EmphysemaSeg) were evaluated. The results demonstrated the efficacy of both algorithms in improving the accuracy and precision of longitudinal quantifications, from 6.1±6.3% to 1.1±1.1% and 1.6±2.2% across years 0-5. Further investigation in EmphysemaSeg identified that baseline emphysema severity, defined as >5% emphysema at year 0, contributed to its reduced performance. This finding highlights the value of virtual imaging trials in enhancing the explainability of algorithms. Overall, the developed longitudinal human models enabled ground-truth based assessment of image processing algorithms for lung quantifications.
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Affiliation(s)
- Saman Sotoudeh-Paima
- Department of Radiology, Duke University School of Medicine, Durham, NC
- Department of Electrical and Computer Engineering, Duke University, Durham, NC
| | - Fong Chi Ho
- Department of Radiology, Duke University School of Medicine, Durham, NC
- Department of Electrical and Computer Engineering, Duke University, Durham, NC
| | | | - Amar Kavuri
- Department of Radiology, Duke University School of Medicine, Durham, NC
| | | | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - W Paul Segars
- Department of Radiology, Duke University School of Medicine, Durham, NC
- Department of Biomedical Engineering, Duke University, Durham, NC
- Department Physics, Duke University, Durham, NC
| | - Ehsan Samei
- Department of Radiology, Duke University School of Medicine, Durham, NC
- Department of Electrical and Computer Engineering, Duke University, Durham, NC
- Department of Biomedical Engineering, Duke University, Durham, NC
- Department Physics, Duke University, Durham, NC
- Medical Physics Graduate Program, Duke University, Durham, NC
| | - Ehsan Abadi
- Department of Radiology, Duke University School of Medicine, Durham, NC
- Department of Electrical and Computer Engineering, Duke University, Durham, NC
- Medical Physics Graduate Program, Duke University, Durham, NC
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12
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Bankier AA, MacMahon H, Colby T, Gevenois PA, Goo JM, Leung AN, Lynch DA, Schaefer-Prokop CM, Tomiyama N, Travis WD, Verschakelen JA, White CS, Naidich DP. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2024; 310:e232558. [PMID: 38411514 PMCID: PMC10902601 DOI: 10.1148/radiol.232558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 02/28/2024]
Abstract
Members of the Fleischner Society have compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984, 1996, and 2008, respectively. The impetus to update the previous version arose from multiple considerations. These include an awareness that new terms and concepts have emerged, others have become obsolete, and the usage of some terms has either changed or become inconsistent to a degree that warranted a new definition. This latest glossary is focused on terms of clinical importance and on those whose meaning may be perceived as vague or ambiguous. As with previous versions, the aim of the present glossary is to establish standardization of terminology for thoracic radiology and, thereby, to facilitate communications between radiologists and clinicians. Moreover, the present glossary aims to contribute to a more stringent use of terminology, increasingly required for structured reporting and accurate searches in large databases. Compared with the previous version, the number of images (chest radiography and CT) in the current version has substantially increased. The authors hope that this will enhance its educational and practical value. All definitions and images are hyperlinked throughout the text. Click on each figure callout to view corresponding image. © RSNA, 2024 Supplemental material is available for this article. See also the editorials by Bhalla and Powell in this issue.
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Affiliation(s)
- Alexander A. Bankier
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Heber MacMahon
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Thomas Colby
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Pierre Alain Gevenois
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Jin Mo Goo
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Ann N.C. Leung
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - David A. Lynch
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Cornelia M. Schaefer-Prokop
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Noriyuki Tomiyama
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - William D. Travis
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Johny A. Verschakelen
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Charles S. White
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - David P. Naidich
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
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13
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DeBoer EM, Weinman JP, Ley-Zaporozhan J, Griese M, Deterding R, Lynch DA, Humphries SM, Jacob J. Imaging of pulmonary fibrosis in children: A review, with proposed diagnostic criteria. Pediatr Pulmonol 2024. [PMID: 38214442 DOI: 10.1002/ppul.26857] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
Computed tomography (CT) imaging findings of pulmonary fibrosis are well established for adults and have been shown to correlate with prognosis and outcome. Recognition of fibrotic CT findings in children is more limited. With approved treatments for adult pulmonary fibrosis, it has become critical to define CT criteria for fibrosis in children, to identify patients in need of treatment and those eligible for clinical trials. Understanding how pediatric fibrosis compares with idiopathic pulmonary fibrosis and other causes of fibrosis in adults is increasingly important as these patients transition to adult care teams. Here, we review what is known regarding the features of pulmonary fibrosis in children compared with adults. Pulmonary fibrosis in children may be associated with genetic surfactant dysfunction disorders, autoimmune systemic disorders, and complications after radiation, chemotherapy, transplantation, and other exposures. Rather than a basal-predominant usual interstitial pneumonia pattern with honeycombing, pediatric fibrosis is primarily characterized by reticulation, traction bronchiectasis, architectural distortion, or cystic lucencies/abnormalities. Ground-glass opacities are more frequent in children with fibrotic interstitial lung disease than adults, and disease distribution appears more diffuse, without clearly defined axial or craniocaudal predominance. Following discussion and consensus amongst a panel of expert radiologists, pathologists and physicians, distinctive disease features were integrated to develop criteria for the first global Phase III trial in children with pulmonary fibrosis.
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Affiliation(s)
- Emily M DeBoer
- University of Colorado Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jason P Weinman
- University of Colorado Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Julia Ley-Zaporozhan
- Department of Radiology, Pediatric Radiology, German Center for Lung Research (DZL), University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Matthias Griese
- Hauner Children's Hospital, Ludwig-Maximilian University, German Center for Lung Research (DZL), Munich, Germany
| | - Robin Deterding
- University of Colorado Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, Colorado, USA
| | | | | | - Joseph Jacob
- University College London, UCL Respiratory, London, UK
- Satsuma Lab, Centre for Medical Image Computing, University College London, London, UK
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14
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Cha MJ, Solomon JJ, Lee JE, Choi H, Chae KJ, Lee KS, Lynch DA. Chronic Lung Injury after COVID-19 Pneumonia: Clinical, Radiologic, and Histopathologic Perspectives. Radiology 2024; 310:e231643. [PMID: 38193836 PMCID: PMC10831480 DOI: 10.1148/radiol.231643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 01/10/2024]
Abstract
With the COVID-19 pandemic having lasted more than 3 years, concerns are growing about prolonged symptoms and respiratory complications in COVID-19 survivors, collectively termed post-COVID-19 condition (PCC). Up to 50% of patients have residual symptoms and physiologic impairment, particularly dyspnea and reduced diffusion capacity. Studies have also shown that 24%-54% of patients hospitalized during the 1st year of the pandemic exhibit radiologic abnormalities, such as ground-glass opacity, reticular opacity, bronchial dilatation, and air trapping, when imaged more than 1 year after infection. In patients with persistent respiratory symptoms but normal results at chest CT, dual-energy contrast-enhanced CT, xenon 129 MRI, and low-field-strength MRI were reported to show abnormal ventilation and/or perfusion, suggesting that some lung injury may not be detectable with standard CT. Histologic patterns in post-COVID-19 lung disease include fibrosis, organizing pneumonia, and vascular abnormality, indicating that different pathologic mechanisms may contribute to PCC. Therefore, a comprehensive imaging approach is necessary to evaluate and diagnose patients with persistent post-COVID-19 symptoms. This review will focus on the long-term findings of clinical and radiologic abnormalities and describe histopathologic perspectives. It also addresses advanced imaging techniques and deep learning approaches that can be applied to COVID-19 survivors. This field remains an active area of research, and further follow-up studies are warranted for a better understanding of the chronic stage of the disease and developing a multidisciplinary approach for patient management.
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Affiliation(s)
- Min Jae Cha
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Joshua J. Solomon
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Jong Eun Lee
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Hyewon Choi
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Kum Ju Chae
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Kyung Soo Lee
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - David A. Lynch
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
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15
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Vegas Sánchez-Ferrero G, Díaz AA, Ash SY, Baraghoshi D, Strand M, Crapo JD, Silverman EK, Humphries SM, Washko GR, Lynch DA, San José Estépar R. Quantification of Emphysema Progression at CT Using Simultaneous Volume, Noise, and Bias Lung Density Correction. Radiology 2024; 310:e231632. [PMID: 38165244 PMCID: PMC10831481 DOI: 10.1148/radiol.231632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
Background CT attenuation is affected by lung volume, dosage, and scanner bias, leading to inaccurate emphysema progression measurements in multicenter studies. Purpose To develop and validate a method that simultaneously corrects volume, noise, and interscanner bias for lung density change estimation in emphysema progression at CT in a longitudinal multicenter study. Materials and Methods In this secondary analysis of the prospective Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study, lung function data were obtained from participants who completed baseline and 5-year follow-up visits from January 2008 to August 2017. CT emphysema progression was measured with volume-adjusted lung density (VALD) and compared with the joint volume-noise-bias-adjusted lung density (VNB-ALD). Reproducibility was studied under change of dosage protocol and scanner model with repeated acquisitions. Emphysema progression was visually scored in 102 randomly selected participants. A stratified analysis of clinical characteristics was performed that considered groups based on their combined lung density change measured by VALD and VNB-ALD. Results A total of 4954 COPDGene participants (mean age, 60 years ± 9 [SD]; 2511 male, 2443 female) were analyzed (1329 with repeated reduced-dose acquisition in the follow-up visit). Mean repeatability coefficients were 30 g/L ± 0.46 for VALD and 14 g/L ± 0.34 for VNB-ALD. VALD measurements showed no evidence of differences between nonprogressors and progressors (mean, -5.5 g/L ± 9.5 vs -8.6 g/L ± 9.6; P = .11), while VNB-ALD agreed with visual readings and showed a difference (mean, -0.67 g/L ± 4.8 vs -4.2 g/L ± 5.5; P < .001). Analysis of progression showed that VNB-ALD progressors had a greater decline in forced expiratory volume in 1 second (-42 mL per year vs -32 mL per year; Tukey-adjusted P = .002). Conclusion Simultaneously correcting volume, noise, and interscanner bias for lung density change estimation in emphysema progression at CT improved repeatability analyses and agreed with visual readings. It distinguished between progressors and nonprogressors and was associated with a greater decline in lung function metrics. Clinical trial registration no. NCT00608764 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Goo in this issue.
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Affiliation(s)
- Gonzalo Vegas Sánchez-Ferrero
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Alejandro A. Díaz
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Samuel Y. Ash
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - David Baraghoshi
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Matthew Strand
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - James D. Crapo
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Edwin K. Silverman
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Stephen M. Humphries
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - George R. Washko
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - David A. Lynch
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Raúl San José Estépar
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
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16
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Escalon JG, Podolanczuk AJ, Aronson KI, Legasto AC, Gruden JF, Lynch DA, Rachid L, Rabkova Y, Steinberger S. Practice patterns in reporting interstitial lung abnormality at a tertiary academic medical center. Clin Imaging 2023; 104:109996. [PMID: 37862912 DOI: 10.1016/j.clinimag.2023.109996] [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: 06/11/2023] [Revised: 09/07/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Interstitial lung abnormality (ILA) is a common finding on chest CTs and is associated with higher all-cause mortality. The 2020 Fleischner Society position paper standardized the terminology and definition of ILA. Despite these published guidelines, the extent to which radiologists use this term is unknown. We evaluated practice patterns for identification of ILAs among radiologists at a tertiary academic medical center. METHODS In this retrospective review, we identified 157 radiology reports between January 1, 2010 through December 31, 2021 containing the phrase "interstitial lung abnormality" or "interstitial abnormality". After exclusions, 125 CT scans were reviewed by thoracic-trained radiologists using the sequential reading method. RESULTS Seventy-seven (62%) patients were found to have ILA (69% subpleural fibrotic, 19% subpleural non-fibrotic, and 6% non-subpleural), nine (7%) were equivocal for ILA and 39 (31%) had no ILA. The term ILA was used exclusively by thoracic-trained radiologists except for two cases. Use of the term ILA has rapidly increased since the position paper publication (none from 2010-2017, one case in 2018, 20 cases in 2019, 41 cases in 2020, and 73 cases in 2021), and cases were typically very mild (1-25% of the lung). CONCLUSION While there has been increased use of the term ILA among thoracic-trained radiologists, non-thoracic radiologists have essentially not begun to use the term. Almost one-third of cases labeled ILA on clinical reads were re-classified as not having ILA on research reads.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - Anna J Podolanczuk
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Kerri I Aronson
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - James F Gruden
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA.
| | - Leena Rachid
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Yana Rabkova
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Sharon Steinberger
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
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17
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Bell AJ, Pal R, Labaki WW, Hoff BA, Wang JM, Murray S, Kazerooni EA, Galban S, Lynch DA, Humphries SM, Martinez FJ, Hatt CR, Han MK, Ram S, Galban CJ. Quantitative CT of Normal Lung Parenchyma and Small Airways Disease Topologies are Associated With COPD Severity and Progression. medRxiv 2023:2023.05.26.23290532. [PMID: 37333382 PMCID: PMC10274970 DOI: 10.1101/2023.05.26.23290532] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Objectives Small airways disease (SAD) is a major cause of airflow obstruction in COPD patients, and has been identified as a precursor to emphysema. Although the amount of SAD in the lungs can be quantified using our Parametric Response Mapping (PRM) approach, the full breadth of this readout as a measure of emphysema and COPD progression has yet to be explored. We evaluated topological features of PRM-derived normal parenchyma and SAD as surrogates of emphysema and predictors of spirometric decline. Materials and Methods PRM metrics of normal lung (PRMNorm) and functional SAD (PRMfSAD) were generated from CT scans collected as part of the COPDGene study (n=8956). Volume density (V) and Euler-Poincaré Characteristic (χ) image maps, measures of the extent and coalescence of pocket formations (i.e., topologies), respectively, were determined for both PRMNorm and PRMfSAD. Association with COPD severity, emphysema, and spirometric measures were assessed via multivariable regression models. Readouts were evaluated as inputs for predicting FEV1 decline using a machine learning model. Results Multivariable cross-sectional analysis of COPD subjects showed that V and χ measures for PRMfSAD and PRMNorm were independently associated with the amount of emphysema. Readouts χfSAD (β of 0.106, p<0.001) and VfSAD (β of 0.065, p=0.004) were also independently associated with FEV1% predicted. The machine learning model using PRM topologies as inputs predicted FEV1 decline over five years with an AUC of 0.69. Conclusions We demonstrated that V and χ of fSAD and Norm have independent value when associated with lung function and emphysema. In addition, we demonstrated that these readouts are predictive of spirometric decline when used as inputs in a ML model. Our topological PRM approach using PRMfSAD and PRMNorm may show promise as an early indicator of emphysema onset and COPD progression.
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Affiliation(s)
- Alexander J. Bell
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Ravi Pal
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Wassim W. Labaki
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Benjamin A. Hoff
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer M. Wang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Susan Murray
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Ella A. Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Stefanie Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, CO, United States
| | | | | | | | - MeiLan K. Han
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Craig J. Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
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18
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Crapo JD, Gupta A, Lynch DA, Turner AM, Mroz RM, Janssens W, Ludwig-Sengpiel A, Koegler H, Eleftheraki A, Risse F, Diefenbach C. Baseline characteristics from a 3-year longitudinal study to phenotype subjects with COPD: the FOOTPRINTS study. Respir Res 2023; 24:290. [PMID: 37978492 PMCID: PMC10656819 DOI: 10.1186/s12931-023-02584-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND FOOTPRINTS® is a prospective, longitudinal, 3-year study assessing the association between biomarkers of inflammation/lung tissue destruction and chronic obstructive pulmonary disease (COPD) severity and progression in ex-smokers with mild-to-severe COPD. Here, we present baseline characteristics and select biomarkers of study subjects. METHODS The methodology of FOOTPRINTS® has been published previously. The study population included ex-smokers with a range of COPD severities (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages 1-3), ex-smokers with COPD and alpha-1-antitrypsin deficiency (A1ATD) and a control group of ex-smokers without airflow limitation (EwAL). At study entry, data were collected for: demographics, disease characteristics, history of comorbidities and COPD exacerbations, symptoms, lung function and volume, exercise capacity, soluble biomarkers, and quantitative and qualitative computed tomography. Baseline data are presented with descriptive statistical comparisons for soluble biomarkers in the individual GOLD and A1ATD groups versus EwAL. RESULTS In total, 463 subjects were enrolled. The per-protocol set comprised 456 subjects, mostly male (64.5%). The mean (standard deviation) age was 60.7 (6.9) years. At baseline, increasing pulmonary symptoms, worse lung function, increased residual volume, reduced diffusing capacity of the lung for carbon monoxide (DLco) and greater prevalence of centrilobular emphysema were observed with increasing disease severity amongst GOLD 1-3 subjects. Subjects with A1ATD (n = 19) had similar lung function parameters to GOLD 2-3 subjects, a high residual volume comparable to GOLD 3 subjects, and similar air trapping to GOLD 2 subjects. Compared with EwAL (n = 61), subjects with A1ATD had worse lung function, increased residual volume, reduced DLco, and a greater prevalence of confluent or advanced destructive emphysema. The soluble inflammatory biomarkers white blood cell count, fibrinogen, high-sensitivity C-reactive protein and plasma surfactant protein were higher in GOLD 1-3 groups than in the EwAL group. Interleukin-6 was expressed less often in EwAL subjects compared with subjects in the GOLD and A1ATD groups. Soluble receptor for advanced glycation end product was lowest in GOLD 3 subjects, indicative of more severe emphysema. CONCLUSIONS These findings provide context for upcoming results from FOOTPRINTS®, which aims to establish correlations between biomarkers and disease progression in a representative COPD population. TRIAL REGISTRATION NUMBER NCT02719184, study start date 13/04/2016.
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Affiliation(s)
- James D Crapo
- Department of Medicine, National Jewish Health, Denver, CO, USA.
| | - Abhya Gupta
- TA Inflammation Medicine, Boehringer Ingelheim International GmbH, Biberach an Der Riss, Germany
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Robert M Mroz
- 2nd Department of Lung Diseases and Tuberculosis, Bialystok Medical University, Bialystok, Poland
| | - Wim Janssens
- Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATH), University Hospital Leuven, Louvain, KU, Belgium
| | | | - Harald Koegler
- TA Inflammation Medicine, Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Anastasia Eleftheraki
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Frank Risse
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Claudia Diefenbach
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
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Fernández Pérez ER, Crooks JL, Lynch DA, Humphries SM, Koelsch TL, Swigris JJ, Solomon JJ, Mohning MP, Groshong SD, Fier K. Pirfenidone in fibrotic hypersensitivity pneumonitis: a double-blind, randomised clinical trial of efficacy and safety. Thorax 2023; 78:1097-1104. [PMID: 37028940 DOI: 10.1136/thorax-2022-219795] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/30/2022] [Accepted: 03/18/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Fibrotic hypersensitivity pneumonitis (FHP) is an irreversible lung disease with high morbidity and mortality. We sought to evaluate the safety and effect of pirfenidone on disease progression in such patients. METHODS We conducted a single-centre, randomised, double-blinded, placebo-controlled trial in adults with FHP and disease progression. Patients were assigned in a 2:1 ratio to receive either oral pirfenidone (2403 mg/day) or placebo for 52 weeks. The primary end point was the mean absolute change in the per cent predicted forced vital capacity (FVC%). Secondary end points included progression-free survival (PFS, time to a relative decline ≥10% in FVC and/or diffusing capacity of the lung for carbon monoxide (DLCO), acute respiratory exacerbation, a decrease of ≥50 m in the 6 min walk distance, increase or introduction of immunosuppressive drugs or death), change in FVC slope and mean DLCO%, hospitalisations, radiological progression of lung fibrosis and safety. RESULTS After randomising 40 patients, enrolment was interrupted by the COVID-19 pandemic. There was no significant between-group difference in FVC% at week 52 (mean difference -0.76%, 95% CI -6.34 to 4.82). Pirfenidone resulted in a lower rate of decline in the adjusted FVC% at week 26 and improved PFS (HR 0.26, 95% CI 0.12 to 0.60). Results for other secondary end points showed no significant difference between groups. No deaths occurred in the pirfenidone group and one death (respiratory) occurred in the placebo group. There were no treatment-emergent serious adverse events. CONCLUSIONS The trial was underpowered to detect a difference in the primary end point. Pirfenidone was found to be safe and improved PFS in patients with FHP. TRIAL REGISTRATION MUMBER NCT02958917.
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Affiliation(s)
| | - James L Crooks
- Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA
| | - David A Lynch
- Radiology, National Jewish Health, Denver, Colorado, USA
| | | | | | - Jeffrey J Swigris
- Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA
| | - Joshua J Solomon
- Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA
| | - Michael P Mohning
- Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA
| | | | - Kaitlin Fier
- Clinical and Translational Research Unit, National Jewish Health, Denver, Colorado, USA
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20
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Baraghoshi D, Strand M, Humphries SM, Estépar RSJ, Sanchez-Ferrero GV, Charbonnier JP, Latisenko R, Silverman EK, Crapo JD, Lynch DA. Erratum for: Quantitative CT Evaluation of Emphysema Progression over 10 Years in the COPDGene Study. Radiology 2023; 309:e239028. [PMID: 38015087 PMCID: PMC11006018 DOI: 10.1148/radiol.239028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- David Baraghoshi
- Division of Biostatistics, Environment and Health, National
Jewish Health, Denver, Colorado, United States
| | - Matthew Strand
- Division of Biostatistics, Environment and Health, National
Jewish Health, Denver, Colorado, United States
| | - Stephen M Humphries
- Department of Radiology, National Jewish Health, Denver,
Colorado, United States
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and
Women's Hospital, Boston, Massachusetts, United States; Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, United
States
| | - Gonzalo Vegas Sanchez-Ferrero
- Applied Chest Imaging Laboratory, Brigham and
Women's Hospital, Boston, Massachusetts, United States; Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, United
States
| | | | | | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and
Women's Hospital, Boston, Massachusetts, United States. Division of Pulmonary
and Critical Care Medicine, Department of Medicine, Brigham and Women's
Hospital, Boston, Massachusetts, United States
| | - James D Crapo
- Division of Pulmonary and Critical Care Medicine,
Department of Medicine, National Jewish Health, Denver, Colorado, United
States
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver,
Colorado, United States
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21
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Castaldi PJ, Xu Z, Young KA, Hokanson JE, Lynch DA, Humphries SM, Ross JC, Cho MH, Hersh CP, Crapo JD, Strand M, Silverman EK. Heterogeneity and Progression of Chronic Obstructive Pulmonary Disease: Emphysema-Predominant and Non-Emphysema-Predominant Disease. Am J Epidemiol 2023; 192:1647-1658. [PMID: 37160347 PMCID: PMC11063557 DOI: 10.1093/aje/kwad114] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/20/2022] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
While variation in emphysema severity between patients with chronic obstructive pulmonary disease (COPD) is well-recognized, clinically applicable definitions of the emphysema-predominant disease (EPD) and non-emphysema-predominant disease (NEPD) subtypes have not been established. To study the clinical relevance of the EPD and NEPD subtypes, we tested the association of these subtypes with prospective decline in forced expiratory volume in 1 second (FEV1) and mortality among 3,427 subjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric grade 2-4 COPD at baseline in the Genetic Epidemiology of COPD (COPDGene) Study, an ongoing national multicenter study that started in 2007. NEPD was defined as airflow obstruction with less than 5% computed tomography (CT) quantitative densitometric emphysema at -950 Hounsfield units, and EPD was defined as airflow obstruction with 10% or greater CT emphysema. Mixed-effects models for FEV1 demonstrated larger average annual FEV1 loss in EPD subjects than in NEPD subjects (-10.2 mL/year; P < 0.001), and subtype-specific associations with FEV1 decline were identified. Cox proportional hazards models showed higher risk of mortality among EPD patients versus NEPD patients (hazard ratio = 1.46, 95% confidence interval: 1.34, 1.60; P < 0.001). To determine whether the NEPD/EPD dichotomy is captured by previously described COPDGene subtypes, we used logistic regression and receiver operating characteristic (ROC) curve analysis to predict NEPD/EPD membership using these previous subtype definitions. The analysis generally showed excellent discrimination, with areas under the ROC curve greater than 0.9. The NEPD and EPD COPD subtypes capture important aspects of COPD heterogeneity and are associated with different rates of disease progression and mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Edwin K Silverman
- Correspondence to Dr. Edwin K. Silverman, Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 (e-mail: )
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22
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Motahari A, Barr RG, Han MK, Anderson WH, Barjaktarevic I, Bleecker ER, Comellas AP, Cooper CB, Couper DJ, Hansel NN, Kanner RE, Kazerooni EA, Lynch DA, Martinez FJ, Newell JD, Schroeder JD, Smith BM, Woodruff PG, Hoffman EA. Repeatability of Pulmonary Quantitative Computed Tomography Measurements in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:657-665. [PMID: 37490608 PMCID: PMC10515564 DOI: 10.1164/rccm.202209-1698pp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 07/24/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
| | - R. Graham Barr
- Department of Medicine and
- Department of Epidemiology, Columbia University College of Medicine, New York, New York
| | | | - Wayne H. Anderson
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, University of California Los Angeles Medical Center, Los Angeles, California
| | | | - Alejandro P. Comellas
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Christopher B. Cooper
- Department of Medicine and
- Department of Physiology, University of California Los Angeles, Los Angeles, California
| | - David J. Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nadia N. Hansel
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | | | - Ella A. Kazerooni
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | | | - John D. Newell
- Department of Radiology and
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | | | - Benjamin M. Smith
- Department of Medicine and
- Department of Epidemiology, Columbia University College of Medicine, New York, New York
- Department of Medicine, McGill University, Montreal, Quebec, Canada; and
| | - Prescott G. Woodruff
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Eric A. Hoffman
- Department of Radiology and
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
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23
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Rose CS, Zell-Baran LM, Cool C, Moore CM, Wolff J, Oh AS, Koelsch T, Richards JC, Krefft SD, Wilson CG, Lynch DA. Findings on High Resolution Computed Tomography in Symptomatic Veterans with Deployment-Related Lung Disease. J Thorac Imaging 2023; 38:00005382-990000000-00093. [PMID: 37732711 PMCID: PMC10940183 DOI: 10.1097/rti.0000000000000742] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE Military deployment to dusty, austere environments in Southwest Asia and Afghanistan is associated with symptomatic airways diseases including asthma and bronchiolitis. The utility of chest high-resolution computed tomographic (HRCT) imaging in lung disease diagnosis in this population is poorly understood. We investigated visual assessment of HRCT for identifying deployment-related lung disease compared with healthy controls. MATERIALS AND METHODS Chest HRCT images from 46 healthy controls and 45 symptomatic deployed military personnel with clinically confirmed asthma and/or biopsy-confirmed distal lung disease were scored by 3 independent thoracic radiologists. We compared demographic and clinical characteristics and frequency of imaging findings between deployers and controls, and between deployers with asthma and those with biopsy-confirmed distal lung disease, using χ2, Fisher exact or t tests, and logistic regression where appropriate. We also analyzed inter-rater agreement for imaging findings. RESULTS Expiratory air trapping was the only chest CT imaging finding that was significantly more frequent in deployers compared with controls. None of the 24 deployers with biopsy-confirmed bronchiolitis and/or granulomatous pneumonitis had HRCT findings of inspiratory mosaic attenuation or centrilobular nodularity. Only 2 of 21 with biopsy-proven emphysema had emphysema on HRCT. CONCLUSIONS Compared with surgical lung biopsy, visual assessment of HRCT showed few abnormalities in this small cohort of previously deployed symptomatic veterans with normal or near-normal spirometry.
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Affiliation(s)
- Cecile S Rose
- National Jewish Health, Division of Environmental and Occupational Health Sciences
- School of Medicine, University of Colorado
| | - Lauren M Zell-Baran
- National Jewish Health, Division of Environmental and Occupational Health Sciences
| | - Carlyne Cool
- National Jewish Health, Division of Environmental and Occupational Health Sciences
- School of Medicine, University of Colorado
| | - Camille M Moore
- National Jewish Health, Center for Genes, Environment and Health
- Department of Biostatistics and Informatics, University of Colorado
| | - Jenna Wolff
- National Jewish Health, Division of Environmental and Occupational Health Sciences
| | - Andrea S Oh
- National Jewish Health, Department of Radiology
| | | | - John C Richards
- National Jewish Health, Department of Radiology
- Radiology Imaging Associates
| | - Silpa D Krefft
- National Jewish Health, Division of Environmental and Occupational Health Sciences
- Veterans Administration Eastern Colorado Health Care System, Division of Pulmonary and Critical Care Medicine, Aurora, CO
| | - Carla G Wilson
- National Jewish Health, Research Informatics Services, Denver
| | - David A Lynch
- National Jewish Health, Department of Radiology
- School of Medicine, University of Colorado
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24
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Ash SY, Choi B, Oh A, Lynch DA, Humphries SM. Deep Learning Assessment of Progression of Emphysema and Fibrotic Interstitial Lung Abnormality. Am J Respir Crit Care Med 2023; 208:666-675. [PMID: 37364281 PMCID: PMC10515569 DOI: 10.1164/rccm.202211-2098oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/26/2023] [Indexed: 06/28/2023] Open
Abstract
Rationale: Although studies have evaluated emphysema and fibrotic interstitial lung abnormality individually, less is known about their combined progression. Objectives: To define clinically meaningful progression of fibrotic interstitial lung abnormality in smokers without interstitial lung disease and evaluate the effects of fibrosis and emphysema progression on mortality. Methods: Emphysema and pulmonary fibrosis were assessed on the basis of baseline and 5-year follow-up computed tomography scans of 4,450 smokers in the COPDGene Study using deep learning algorithms. Emphysema was classified as absent, trace, mild, moderate, confluent, or advanced destructive. Fibrosis was expressed as a percentage of lung volume. Emphysema progression was defined as an increase by at least one grade. A hybrid distribution and anchor-based method was used to determine the minimal clinically important difference in fibrosis. The relationship between progression and mortality was evaluated using multivariable shared frailty models using an age timescale. Measurements and Main Results: The minimal clinically important difference for fibrosis was 0.58%. On the basis of this threshold, 2,822 (63%) had progression of neither emphysema nor fibrosis, 841 (19%) had emphysema progression alone, 512 (12%) had fibrosis progression alone, and 275 (6.2%) had progression of both. Compared with nonprogressors, hazard ratios for mortality were 1.42 (95% confidence interval, 1.11-1.82) in emphysema progressors, 1.49 (1.14-1.94) in fibrosis progressors, and 2.18 (1.58-3.02) in those with progression of both emphysema and fibrosis. Conclusions: In smokers without known interstitial lung disease, small changes in fibrosis may be clinically significant, and combined progression of emphysema and fibrosis is associated with increased mortality.
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Affiliation(s)
- Samuel Y. Ash
- Department of Critical Care, South Shore Hospital, South Weymouth, Massachusetts
- Applied Chest Imaging Laboratory and
| | - Bina Choi
- Applied Chest Imaging Laboratory and
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrea Oh
- Department of Radiology, University of California, Los Angeles Health, Los Angeles, California; and
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
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25
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Oh AS, Lynch DA. Diagnostic Guidelines for Usual Interstitial Pneumonia and Progressive Pulmonary Fibrosis. J Thorac Imaging 2023; 38:W75-W76. [PMID: 37423616 DOI: 10.1097/rti.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Andrea S Oh
- Department of Radiology, UCLA, Los Angeles, CA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
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26
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Zeng S, Luo G, Lynch DA, Bowler RP, Arjomandi M. Lung volumes differentiate the predominance of emphysema versus airway disease phenotype in early COPD: an observational study of the COPDGene cohort. ERJ Open Res 2023; 9:00289-2023. [PMID: 37727675 PMCID: PMC10505951 DOI: 10.1183/23120541.00289-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 09/21/2023] Open
Abstract
Rationale Lung volumes identify the "susceptible smokers" who progress to develop spirometric COPD. However, among susceptible smokers, development of spirometric COPD seems to be heterogeneous, suggesting the presence of different pathological mechanisms during early establishment of spirometric COPD. The objective of the present study was to determine the differential patterns of radiographic pathologies among susceptible smokers. Methods We categorised smokers with preserved spirometry (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0) in the Genetic Epidemiology of COPD (COPDGene) cohort based on tertiles (low, intermediate and high) of lung volumes (either total lung capacity (TLC), functional residual capacity FRC or FRC/TLC) at baseline visit. We then examined the differential patterns of change in spirometry and the associated prevalence of computed tomography measured pathologies of emphysema and airway disease with those categories of lung volumes. Results The pattern of spirometric change differed when participants were categorised by TLC versus FRC/TLC: those in the high TLC tertile showed stable forced expiratory volume in 1 s (FEV1), but enlarging forced vital capacity (FVC), while those in the high FRC/TLC tertile showed decline in both FEV1 and FVC. When participants from the high TLC and high FRC/TLC tertiles were partitioned into mutually exclusive groups, compared to those with high TLC, those with high FRC/TLC had lesser emphysema, but greater air trapping, more self-reported respiratory symptoms and exacerbation episodes and higher likelihood of progressing to more severe spirometric disease (GOLD stages 2-4 versus GOLD stage 1). Conclusions Lung volumes identify distinct physiological and radiographic phenotypes in early disease among susceptible smokers and predict the rate of spirometric disease progression and the severity of symptoms in early COPD.
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Affiliation(s)
- Siyang Zeng
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | | | | | - Mehrdad Arjomandi
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
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27
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Arjomandi M, Zeng S, Chen J, Bhatt SP, Abtin F, Barjaktarevic I, Barr RG, Bleecker ER, Buhr RG, Criner GJ, Comellas AP, Couper DJ, Curtis JL, Dransfield MT, Fortis S, Han MK, Hansel NN, Hoffman EA, Hokanson JE, Kaner RJ, Kanner RE, Krishnan JA, Labaki WW, Lynch DA, Ortega VE, Peters SP, Woodruff PG, Cooper CB, Bowler RP, Paine III R, Rennard SI, Tashkin DP. Changes in Lung Volumes with Spirometric Disease Progression in COPD. Chronic Obstr Pulm Dis 2023; 10:270-285. [PMID: 37199719 PMCID: PMC10484496 DOI: 10.15326/jcopdf.2022.0363] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 05/19/2023]
Abstract
Background Abnormal lung volumes representing air trapping identify the subset of smokers with preserved spirometry who develop spirometric chronic obstructive pulmonary disease (COPD) and adverse outcomes. However, how lung volumes evolve in early COPD as airflow obstruction develops remains unclear. Methods To establish how lung volumes change with the development of spirometric COPD, we examined lung volumes from the pulmonary function data (seated posture) available in the U.S. Department of Veterans Affairs electronic health records (n=71,356) and lung volumes measured by computed tomography (supine posture) available from the COPD Genetic Epidemiology (COPDGene®) study (n=7969) and the SubPopulations and InterMediate Outcome Measures In COPD Study (SPIROMICS) (n=2552) cohorts, and studied their cross-sectional distributions and longitudinal changes across the airflow obstruction spectrum. Patients with preserved ratio-impaired spirometry (PRISm) were excluded from this analysis. Results Lung volumes from all 3 cohorts showed similar patterns of distributions and longitudinal changes with worsening airflow obstruction. The distributions for total lung capacity (TLC), vital capacity (VC), and inspiratory capacity (IC) and their patterns of change were nonlinear and included different phases. When stratified by airflow obstruction using Global initiative for chronic Obstructive Lung Disease (GOLD) stages, patients with GOLD 1 (mild) COPD had larger lung volumes (TLC, VC, IC) compared to patients with GOLD 0 (smokers with preserved spirometry) or GOLD 2 (moderate) disease. In longitudinal follow-up of baseline GOLD 0 patients who progressed to spirometric COPD, those with an initially higher TLC and VC developed mild obstruction (GOLD 1) while those with an initially lower TLC and VC developed moderate obstruction (GOLD 2). Conclusions In COPD, TLC, and VC have biphasic distributions, change in nonlinear fashions as obstruction worsens, and could differentiate those GOLD 0 patients at risk for more rapid spirometric disease progression.
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Affiliation(s)
- Mehrdad Arjomandi
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Medicine, University of California, San Francisco, California, United States
| | - Siyang Zeng
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
| | - Jianhong Chen
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Medicine, University of California, San Francisco, California, United States
| | - Surya P. Bhatt
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Fereidoun Abtin
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Igor Barjaktarevic
- Department of Medicine, University of California, Los Angeles, California, United States
| | - R. Graham Barr
- Columbia-Presbyterian Medical Center, New York, New York, United States
| | - Eugene R. Bleecker
- University of Arizona, College of Medicine, Tucson, Arizona, United States
| | - Russell G. Buhr
- Department of Medicine, University of California, Los Angeles, California, United States
| | | | | | - David J. Couper
- University of North Carolina, Chapel Hill, North Carolina, United States
| | - Jeffrey L. Curtis
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | | | | | - MeiLan K. Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Nadia N. Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, United States
| | | | - John E. Hokanson
- Department of Epidemiology, School of Public Health, University of Colorado, United States
| | - Robert J. Kaner
- Weill Cornell Medical Center, New York, New York, United States
| | | | | | - Wassim W. Labaki
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - David A. Lynch
- Department of Radiology, National Jewish Health Systems, Denver, Colorado, United States
| | | | - Stephen P. Peters
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Prescott G. Woodruff
- Department of Medicine, University of California, San Francisco, California, United States
| | - Christopher B. Cooper
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Russell P. Bowler
- Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States
| | - Robert Paine III
- University of Utah, Salt Lake City, Utah, United States
- Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States
| | | | - Donald P. Tashkin
- Columbia-Presbyterian Medical Center, New York, New York, United States
| | - the COPDGene and SPIROMICS Investigators.
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Medicine, University of California, San Francisco, California, United States
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
- University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, University of California, Los Angeles, California, United States
- Columbia-Presbyterian Medical Center, New York, New York, United States
- University of Arizona, College of Medicine, Tucson, Arizona, United States
- Temple University, Philadelphia, Pennsylvania, United States
- University of Iowa, Iowa City, Iowa, United States
- University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
- Department of Medicine, Johns Hopkins University, Baltimore, United States
- Department of Epidemiology, School of Public Health, University of Colorado, United States
- Weill Cornell Medical Center, New York, New York, United States
- University of Utah, Salt Lake City, Utah, United States
- University of Illinois at Chicago, Chicago, Illinois, United States
- Department of Radiology, National Jewish Health Systems, Denver, Colorado, United States
- Mayo Clinic, Scottsdale, Arizona, United States
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States
- University of Nebraska Medical Center, Omaha, Nebraska, United States
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Comellas AP, Newell JD, Kirby M, Sieren JP, Peterson S, Hatt C, Galban CJ, Kazerooni EA, Lynch DA, Han MK, Hoffman EA. Residual Volume versus FRC Computed Tomography Assessment of Functional Small Airway Disease in Smokers with and without Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 207:1536-1539. [PMID: 36977314 PMCID: PMC11009613 DOI: 10.1164/rccm.202210-1852le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Affiliation(s)
| | - John D Newell
- Department of Radiology, and
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | | | | | - Charles Hatt
- Imbio, Minneapolis, Minnesota
- Department of Radiology and
| | | | - Ella A Kazerooni
- Department of Radiology and
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - MeiLan K Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Eric A Hoffman
- Department of Internal Medicine
- Department of Radiology, and
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
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29
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Hata A, Hino T, Li Y, Johkoh T, Christiani DC, Lynch DA, Cho MH, Silverman EK, Hunninghake GM, Hatabu H. Traction Bronchiectasis/Bronchiolectasis in Interstitial Lung Abnormality: Follow-up in the COPDGene Study. Am J Respir Crit Care Med 2023; 207:1395-1398. [PMID: 36898128 PMCID: PMC10595461 DOI: 10.1164/rccm.202211-2061le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Affiliation(s)
- Akinori Hata
- Center for Pulmonary Functional Imaging, Department of Radiology
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan
| | - David C Christiani
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | | | | | - Gary M Hunninghake
- Center for Pulmonary Functional Imaging, Department of Radiology
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology
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Abadi E, Jadick G, Lynch DA, Segars WP, Samei E. Emphysema Quantifications With CT Scan: Assessing the Effects of Acquisition Protocols and Imaging Parameters Using Virtual Imaging Trials. Chest 2023; 163:1084-1100. [PMID: 36462532 PMCID: PMC10206513 DOI: 10.1016/j.chest.2022.11.033] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 11/01/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND CT scan has notable potential to quantify the severity and progression of emphysema in patients. Such quantification should ideally reflect the true attributes and pathologic conditions of subjects, not scanner parameters. To achieve such an objective, the effects of the scanner conditions need to be understood so the influence can be mitigated. RESEARCH QUESTION How do CT scan imaging parameters affect the accuracy of emphysema-based quantifications and biomarkers? STUDY DESIGN AND METHODS Twenty anthropomorphic digital phantoms were developed with diverse anatomic attributes and emphysema abnormalities informed by a real COPD cohort. The phantoms were input to a validated CT scan simulator (DukeSim), modeling a commercial scanner (Siemens Flash). Virtual images were acquired under various clinical conditions of dose levels, tube current modulations (TCM), and reconstruction techniques and kernels. The images were analyzed to evaluate the effects of imaging parameters on the accuracy of density-based quantifications (percent of lung voxels with HU < -950 [LAA-950] and 15th percentile of lung histogram HU [Perc15]) across varied subjects. Paired t tests were performed to explore statistical differences between any two imaging conditions. RESULTS The most accurate imaging condition corresponded to the highest acquired dose (100 mAs) and iterative reconstruction (SAFIRE) with the smooth kernel of I31, where the measurement errors (difference between measurement and ground truth) were 35 ± 3 Hounsfield Units (HU), -4% ± 5%, and 26 ± 10 HU (average ± SD), for the mean lung HU, LAA-950, and Perc15, respectively. Without TCM and at the I31 kernel, increase of dose (20 to 100 mAs) improved the lung mean absolute error (MAE) by 4.2 ± 2.3 HU (average ± SD). TCM did not contribute to a systematic improvement of lung MAE. INTERPRETATION The results highlight that although CT scan quantification is possible, its reliability is impacted by the choice of imaging parameters. The developed virtual imaging trial platform in this study enables comprehensive evaluation of CT scan methods in reliable quantifications, an effort that cannot be readily made with patient images or simplistic physical phantoms.
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Affiliation(s)
- Ehsan Abadi
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, NC; Department of Electrical & Computer Engineering, Duke University, Durham, NC; Medical Physics Graduate Program, Duke University, Durham, NC.
| | - Giavanna Jadick
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, NC
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - W Paul Segars
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, NC; Medical Physics Graduate Program, Duke University, Durham, NC; Department of Biomedical Engineering, Duke University, Durham, NC
| | - Ehsan Samei
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University School of Medicine, Durham, NC; Department of Electrical & Computer Engineering, Duke University, Durham, NC; Medical Physics Graduate Program, Duke University, Durham, NC; Department of Biomedical Engineering, Duke University, Durham, NC; Department of Physics, Duke University, Durham, NC
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31
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Koslow M, Lynch DA, Cool CD, Groshong SD, Downey GP. Lymphangioleiomyomatosis and Other Cystic Lung Diseases. Immunol Allergy Clin North Am 2023; 43:359-377. [PMID: 37055093 PMCID: PMC10863428 DOI: 10.1016/j.iac.2023.01.003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Cysts and cavities in the lung are commonly encountered on chest imaging. It is necessary to distinguish thin-walled lung cysts (≤2 mm) from cavities and characterize their distribution as focal or multifocal versus diffuse. Focal cavitary lesions are often caused by inflammatory, infectious, or neoplastic processes in contrast to diffuse cystic lung diseases. An algorithmic approach to diffuse cystic lung disease can help narrow the differential diagnosis, and additional testing such as skin biopsy, serum biomarkers, and genetic testing can be confirmatory. An accurate diagnosis is essential for the management and disease surveillance of extrapulmonary complications.
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Affiliation(s)
- Matthew Koslow
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA; Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA.
| | - David A Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Carlyne D Cool
- Department of Pathology, University of Colorado School of Medicine Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; Division of Pathology, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Steve D Groshong
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Gregory P Downey
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA; Department of Pediatrics, National Jewish Health; Department of Immunology and Genomic Medicine, National Jewish Health
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32
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Baraghoshi D, Strand M, Humphries SM, San José Estépar R, Vegas Sanchez-Ferrero G, Charbonnier JP, Latisenko R, Silverman EK, Crapo JD, Lynch DA. Quantitative CT Evaluation of Emphysema Progression over 10 Years in the COPDGene Study. Radiology 2023; 307:e222786. [PMID: 37039685 PMCID: PMC10286952 DOI: 10.1148/radiol.222786] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 04/12/2023]
Abstract
Background Long-term studies of chronic obstructive pulmonary disease (COPD) can evaluate emphysema progression. Adjustment for differences in equipment and scanning protocols of individual CT examinations have not been studied extensively. Purpose To evaluate emphysema progression in current and former smokers in the COPDGene cohort over three imaging points obtained at 5-year intervals accounting for individual CT parameters. Materials and Methods Current and former cigarette smokers enrolled between 2008 and 2011 from the COPDGene study were prospectively followed for 10 years between 2008 and 2020. Extent of emphysema as adjusted lung density (ALD) from quantitative CT was measured at baseline and at 5- and 10-year follow-up. Linear mixed models adjusted for CT technical characteristics were constructed to evaluate emphysema progression. Mean annual changes in ALD over consecutive 5-year study periods were estimated by smoking status and baseline emphysema. Results Of 8431 participants at baseline (mean age, 60 years ± 9 [SD]; 3905 female participants), 4913 were at 5-year follow-up and 1544 participants were at 10-year follow-up. There were 4134 (49%) participants who were current smokers, and 4449 (53%) participants had more than trace emphysema at baseline. Current smokers with more than trace emphysema showed the largest decline in ALD, with mean annual decreases of 1.4 g/L (95% CI: 1.2, 1.5) in the first 5 years and 0.9 g/L (95% CI: 0.7, 1.2) in the second 5 years. Accounting for CT noise, field of view, and scanner model improved model fit for estimation of emphysema progression (P < .001 by likelihood ratio test). Conclusion Evaluation at CT of emphysema progression in the COPDGene study showed that, during the span of 10 years, participants with pre-existing emphysema who continued smoking had the largest decline in ALD. Adjusting for CT equipment and protocol factors improved these longitudinal estimates. Clinical trial registration no. NCT00608764 © RSNA, 2023 Supplemental material is available for this article. See the editorial by Parraga and Kirby in this issue.
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Affiliation(s)
- David Baraghoshi
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Matthew Strand
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Stephen M. Humphries
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Raúl San José Estépar
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Gonzalo Vegas Sanchez-Ferrero
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Jean-Paul Charbonnier
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Rudolfs Latisenko
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Edwin K. Silverman
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - James D. Crapo
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - David A. Lynch
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
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Steele MP, Peljto AL, Mathai SK, Humphries S, Bang TJ, Oh A, Teague S, Cicchetti G, Sigakis C, Kropski JA, Loyd JE, Blackwell TS, Brown KK, Schwarz MI, Warren RA, Powers J, Walts AD, Markin C, Fingerlin TE, Yang IV, Lynch DA, Lee JS, Schwartz DA. Incidence and Progression of Fibrotic Lung Disease in an At-Risk Cohort. Am J Respir Crit Care Med 2023; 207:587-593. [PMID: 36094461 PMCID: PMC10870916 DOI: 10.1164/rccm.202206-1075oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Rationale: Relatives of patients with familial interstitial pneumonia (FIP) are at increased risk for pulmonary fibrosis and develop preclinical pulmonary fibrosis (PrePF). Objectives: We defined the incidence and progression of new-onset PrePF and its relationship to survival among first-degree relatives of families with FIP. Methods: This is a cohort study of family members with FIP who were initially screened with a health questionnaire and chest high-resolution computed tomography (HRCT) scan, and approximately 4 years later, the evaluation was repeated. A total of 493 asymptomatic first-degree relatives of patients with FIP were evaluated at baseline, and 296 (60%) of the original subjects participated in the subsequent evaluation. Measurements and Main Results: The median interval between HRCTs was 3.9 years (interquartile range, 3.5-4.4 yr). A total of 252 subjects who agreed to repeat evaluation were originally determined not to have PrePF at baseline; 16 developed PrePF. A conservative estimate of the annual incidence of PrePF is 1,023 per 100,000 person-years (95% confidence interval, 511-1,831 per 100,000 person-years). Of 44 subjects with PrePF at baseline, 38.4% subjects had worsening dyspnea compared with 15.4% of those without PrePF (P = 0.002). Usual interstitial pneumonia by HRCT (P < 0.0002) and baseline quantitative fibrosis score (P < 0.001) are also associated with worsening dyspnea. PrePF at the initial screen is associated with decreased survival (P < 0.001). Conclusions: The incidence of PrePF in this at-risk population is at least 100-fold higher than that reported for sporadic idiopathic pulmonary fibrosis (IPF). Although PrePF and IPF represent distinct entities, our study demonstrates that PrePF, like IPF, is progressive and associated with decreased survival.
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Affiliation(s)
| | | | - Susan K. Mathai
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center at Dallas, Dallas, Texas
| | | | | | | | | | - Giuseppe Cicchetti
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Fondazione Policlinico University Gemelli, Rome, Italy
| | - Christopher Sigakis
- Department of Regional Radiology, Cleveland Clinic Imaging Institute, Cleveland, Ohio; and
| | | | - James E. Loyd
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | | | | | | | | | | | | | - Cheryl Markin
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Tasha E. Fingerlin
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colorado
| | | | | | | | - David A. Schwartz
- Department of Medicine
- Department of Microbiology and Immunology, University of Colorado School of Medicine, Aurora, Colorado
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Rose JA, Menon AA, Hino T, Hata A, Nishino M, Lynch DA, Rosas IO, El-Chemaly S, Raby BA, Ash SY, Choi B, Washko GR, Silverman EK, Cho MH, Hatabu H, Putman RK, Hunninghake GM. Suspected Interstitial Lung Disease in COPDGene Study. Am J Respir Crit Care Med 2023; 207:60-68. [PMID: 35930450 PMCID: PMC9952869 DOI: 10.1164/rccm.202203-0550oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/04/2022] [Indexed: 02/03/2023] Open
Abstract
Rationale: Although interstitial lung abnormalities (ILA), specific patterns of incidentally-detected abnormal density on computed tomography, have been associated with abnormal lung function and increased mortality, it is unclear if a subset with incidental interstitial lung disease (ILD) accounts for these adverse consequences. Objectives: To define the prevalence and risk factors of suspected ILD and assess outcomes. Methods: Suspected ILD was evaluated in the COPDGene (Chronic Obstructive Pulmonary Disease Genetic Epidemiology) study, defined as ILA and at least one additional criterion: definite fibrosis on computed tomography, FVC less than 80% predicted, or DLCO less than 70% predicted. Multivariable linear, longitudinal, and Cox proportional hazards regression models were used to assess associations with St. George's Respiratory Questionnaire, 6-minute-walk test, supplemental oxygen use, respiratory exacerbations, and mortality. Measurements and Main Results: Of 4,361 participants with available data, 239 (5%) had evidence for suspected ILD, whereas 204 (5%) had ILA without suspected ILD. In multivariable analyses, suspected ILD was associated with increased St. George's Respiratory Questionnaire score (mean difference [MD], 3.9 points; 95% confidence interval [CI], 0.6-7.1; P = 0.02), reduced 6-minute-walk test (MD, -35 m; 95% CI, -56 m to -13 m; P = 0.002), greater supplemental oxygen use (odds ratio [OR], 2.3; 95% CI, 1.1-5.1; P = 0.03) and severe respiratory exacerbations (OR, 2.9; 95% CI, 1.1-7.5; P = 0.03), and higher mortality (hazard ratio, 2.4; 95% CI, 1.2-4.6; P = 0.01) compared with ILA without suspected ILD. Risk factors associated with suspected ILD included self-identified Black race (OR, 2.0; 95% CI, 1.1-3.3; P = 0.01) and pack-years smoking history (OR, 1.2; 95% CI, 1.1-1.3; P = 0.0005). Conclusions: Suspected ILD is present in half of those with ILA in COPDGene and is associated with exercise decrements and increased symptoms, supplemental oxygen use, severe respiratory exacerbations, and mortality.
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Affiliation(s)
| | | | | | - Akinori Hata
- Department of Radiology, Osaka University, Osaka, Japan
| | | | | | - Ivan O. Rosas
- Pulmonary Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas; and
| | | | - Benjamin A. Raby
- Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Bina Choi
- Pulmonary and Critical Care Division
| | | | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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35
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Choi B, Adan N, Doyle TJ, San José Estépar R, Harmouche R, Humphries SM, Moll M, Cho MH, Putman RK, Hunninghake GM, Kalhan R, Liu GY, Diaz AA, Mason SE, Rahaghi FN, Pistenmaa CL, Enzer N, Poynton C, Sánchez-Ferrero GV, Ross JC, Lynch DA, Martinez FJ, Han MK, Bowler RP, Wilson DO, Rosas IO, Washko GR, San José Estépar R, Ash SY. Quantitative Interstitial Abnormality Progression and Outcomes in the Genetic Epidemiology of COPD and Pittsburgh Lung Screening Study Cohorts. Chest 2023; 163:164-175. [PMID: 35780812 PMCID: PMC9859724 DOI: 10.1016/j.chest.2022.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/25/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The risk factors and clinical outcomes of quantitative interstitial abnormality progression over time have not been characterized. RESEARCH QUESTIONS What are the associations of quantitative interstitial abnormality progression with lung function, exercise capacity, and mortality? What are the demographic and genetic risk factors for quantitative interstitial abnormality progression? STUDY DESIGN AND METHODS Quantitative interstitial abnormality progression between visits 1 and 2 was assessed from 4,635 participants in the Genetic Epidemiology of COPD (COPDGene) cohort and 1,307 participants in the Pittsburgh Lung Screening Study (PLuSS) cohort. We used multivariable linear regression to determine the risk factors for progression and the longitudinal associations between progression and FVC and 6-min walk distance, and Cox regression models for the association with mortality. RESULTS Age at enrollment, female sex, current smoking status, and the MUC5B minor allele were associated with quantitative interstitial abnormality progression. Each percent annual increase in quantitative interstitial abnormalities was associated with annual declines in FVC (COPDGene: 8.5 mL/y; 95% CI, 4.7-12.4 mL/y; P < .001; PLuSS: 9.5 mL/y; 95% CI, 3.7-15.4 mL/y; P = .001) and 6-min walk distance, and increased mortality (COPDGene: hazard ratio, 1.69; 95% CI, 1.34-2.12; P < .001; PLuSS: hazard ratio, 1.28; 95% CI, 1.10-1.49; P = .001). INTERPRETATION The objective, longitudinal measurement of quantitative interstitial abnormalities may help identify people at greatest risk for adverse events and most likely to benefit from early intervention.
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Affiliation(s)
- Bina Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
| | - Najma Adan
- Department of Biology, University of Washington, Bothell, WA
| | - Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ruben San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Rola Harmouche
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Matthew Moll
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rachel K Putman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gabrielle Y Liu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Stefanie E Mason
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Carrie L Pistenmaa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Nicholas Enzer
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Clare Poynton
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Gonzalo Vegas Sánchez-Ferrero
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Russell P Bowler
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ivan O Rosas
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
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36
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Bhatt SP, Bodduluri S, Dransfield MT, Reinhardt JM, Crapo JD, Silverman EK, Humphries S, Lynch DA, Strand MJ. Acute Exacerbations Are Associated with Progression of Emphysema. Ann Am Thorac Soc 2022; 19:2108-2111. [PMID: 35914221 PMCID: PMC9743469 DOI: 10.1513/annalsats.202112-1385rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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37
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Humphries SM, Mackintosh JA, Jo HE, Walsh SLF, Silva M, Calandriello L, Chapman S, Ellis S, Glaspole I, Goh N, Grainge C, Hopkins PMA, Keir GJ, Moodley Y, Reynolds PN, Walters EH, Baraghoshi D, Wells AU, Lynch DA, Corte TJ. Quantitative computed tomography predicts outcomes in idiopathic pulmonary fibrosis. Respirology 2022; 27:1045-1053. [PMID: 35875881 PMCID: PMC9796832 DOI: 10.1111/resp.14333] [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] [Received: 12/29/2021] [Accepted: 07/03/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Prediction of disease course in patients with progressive pulmonary fibrosis remains challenging. The purpose of this study was to assess the prognostic value of lung fibrosis extent quantified at computed tomography (CT) using data-driven texture analysis (DTA) in a large cohort of well-characterized patients with idiopathic pulmonary fibrosis (IPF) enrolled in a national registry. METHODS This retrospective analysis included participants in the Australian IPF Registry with available CT between 2007 and 2016. CT scans were analysed using the DTA method to quantify the extent of lung fibrosis. Demographics, longitudinal pulmonary function and quantitative CT metrics were compared using descriptive statistics. Linear mixed models, and Cox analyses adjusted for age, gender, BMI, smoking history and treatment with anti-fibrotics were performed to assess the relationships between baseline DTA, pulmonary function metrics and outcomes. RESULTS CT scans of 393 participants were analysed, 221 of which had available pulmonary function testing obtained within 90 days of CT. Linear mixed-effect modelling showed that baseline DTA score was significantly associated with annual rate of decline in forced vital capacity and diffusing capacity of carbon monoxide. In multivariable Cox proportional hazard models, greater extent of lung fibrosis was associated with poorer transplant-free survival (hazard ratio [HR] 1.20, p < 0.0001) and progression-free survival (HR 1.14, p < 0.0001). CONCLUSION In a multi-centre observational registry of patients with IPF, the extent of fibrotic abnormality on baseline CT quantified using DTA is associated with outcomes independent of pulmonary function.
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Affiliation(s)
| | - John A. Mackintosh
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia,NHMRC Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
| | - Helen E. Jo
- NHMRC Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia,Department of Respiratory MedicineRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Simon L. F. Walsh
- Department of RadiologyKing's College Hospital Foundation TrustLondonUK
| | - Mario Silva
- Section of "Scienze Radiologiche", Department of Medicine and Surgery (DiMeC)University of ParmaParmaItaly,Department of RadiologyUniversity of Massachusetts Medical School, UMass Memorial Health CareWorcesterMassachusettsUSA
| | - Lucio Calandriello
- Dipartimento di Diagnostica per immagini, Radioterapia, Oncologia ed EmatologiaFondazione Policlinico Universitario A. Gemelli, IRCCSRomeItaly
| | - Sally Chapman
- Respiratory ConsultantsAdelaideSouth AustraliaAustralia
| | - Samantha Ellis
- Department of RadiologyAlfred HealthMelbourneVictoriaAustralia
| | - Ian Glaspole
- NHMRC Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia,Department of Allergy and Respiratory MedicineAlfred HospitalMelbourneVictoriaAustralia
| | - Nicole Goh
- Respiratory and Sleep MedicineAustin HospitalMelbourneVictoriaAustralia
| | - Christopher Grainge
- Department of Respiratory MedicineJohn Hunter HospitalNewcastleNew South WalesAustralia
| | - Peter M. A. Hopkins
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia,Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Gregory J. Keir
- Department of Respiratory MedicinePrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Yuben Moodley
- School of Medicine & PharmacologyUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Paul N. Reynolds
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - E. Haydn Walters
- Department of MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | - David Baraghoshi
- Division of BiostatisticsNational Jewish HealthDenverColoradoUSA
| | - Athol U. Wells
- Royal Brompton and Harefield NHS Foundation TrustLondonUK,National Heart and Lung InstituteImperial College LondonLondonUK
| | - David A. Lynch
- Department of RadiologyNational Jewish HealthDenverColoradoUSA
| | - Tamera J. Corte
- NHMRC Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia,Department of Respiratory MedicineRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
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38
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Remy-Jardin M, Leung ANC, Lynch DA. Chest Imaging. Semin Respir Crit Care Med 2022; 43:763. [PMID: 36442472 DOI: 10.1055/s-0042-1757884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Martine Remy-Jardin
- Department of Radiology, Faculty of Medicine, University of Lille, France.,Department of Thoracic Imaging, University Hospital Center of Lille, France
| | - Ann N C Leung
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - David A Lynch
- Department of Radiology National Jewish Health, Denver, Colorado
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39
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Marrocchio C, Lynch DA. High-Resolution Computed Tomography of Nonfibrotic Interstitial Lung Disease. Semin Respir Crit Care Med 2022; 43:780-791. [PMID: 36442473 DOI: 10.1055/s-0042-1755564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nonfibrotic interstitial lung diseases include a heterogeneous group of conditions that can result in various patterns of lung involvement. When approaching the computed tomographic (CT) scan of a patient with a suspected or known interstitial lung disease, the use of the appropriate radiological terms and a systematic, structured approach to the interpretation of the imaging findings are essential to reach a confident diagnosis or to limit the list of differentials to few possibilities. The large number of conditions that cause nonfibrotic interstitial lung diseases prevents a thorough discussion of all these entities. Therefore, this article will focus on the most common chronic lung diseases that can cause these CT findings. A pattern-based approach is used, with a discussion of nodular pattern, consolidation, crazy paving, ground-glass opacities, septal thickening, and calcifications. The different clinical conditions will be described based on their predominant pattern, with particular attention to findings that can help in the differential diagnosis.
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Affiliation(s)
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
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40
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Beswick DM, Humphries SM, Miller JE, Balkissoon CD, Khatiwada A, Vladar EK, Ramakrishnan VR, Lynch DA, Taylor‐Cousar JL. Objective and patient-based measures of chronic rhinosinusitis in people with cystic fibrosis treated with highly effective modulator therapy. Int Forum Allergy Rhinol 2022; 12:1435-1438. [PMID: 35595546 PMCID: PMC9790219 DOI: 10.1002/alr.23016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Daniel M. Beswick
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of CaliforniaLos AngelesCA
| | | | - Jessa E. Miller
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of CaliforniaLos AngelesCA
| | | | | | - Eszter K. Vladar
- Department of MedicineDivision of Pulmonary Sciences and Critical Care MedicineAuroraCO,Department of Cell and Developmental BiologyUniversity of Colorado School of MedicineAuroraCO
| | | | | | - Jennifer L. Taylor‐Cousar
- Department of MedicineNational Jewish HealthDenverCO,Department of PediatricsNational Jewish HealthDenverCO
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41
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Lynch DA, Brown M, Saperstein A, Stefancic A, Medalia A. Assessing metamotivation in schizophrenia: A pilot study of the Brief Regulation of Motivation Scale (BRoMS). Psychiatry Res 2022; 317:114799. [PMID: 36037743 PMCID: PMC10660851 DOI: 10.1016/j.psychres.2022.114799] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
Metamotivation is defined as the ability to identify, monitor, and self-regulate motivation in service of goal attainment. As metamotivation is becoming an area of increased interest for intervention among people with psychiatric disorders, there is a need for valid and reliable self-report measures. The current pilot study adapted the Brief Regulation of Motivation Scale (BRoMS; Kim et al., 2018), a self-report measure validated among college students, for use with individuals with schizophrenia spectrum disorders, as a first step towards identifying a metamotivation measure. Thirty-four participants diagnosed with schizophrenia or schizoaffective disorder completed the adapted BRoMS measure and a measure of community functioning. The BRoMS was found to be acceptable, feasible and internally consistent. Higher BRoMs scores were associated with better work related skills. Concurrent and predictive validity were further evaluated among a subsample (n = 21), with comparisons between the BRoMS and participant responses on a semi-structured interview, and measures of self-motivation, and quality of life. The BRoMS demonstrated limited concurrent validity with the interview responses and motivation-related subscales; however, there was modest predictive validity regarding quality of life. This pilot data informs the need for continued efforts to develop and validate metamotivation scales.
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Affiliation(s)
- David A Lynch
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 5 Columbus Circle, New York, NY 10019, United States
| | - Marie Brown
- Department of Psychiatry, New York University Grossman School of Medicine, 550 1st Ave, New York, NY 10016, United States
| | - Alice Saperstein
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Ana Stefancic
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, Box 100, New York, NY 10032, United States.
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42
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Hata A, Hino T, Putman RK, Yanagawa M, Hida T, Menon AA, Honda O, Yamada Y, Nishino M, Araki T, Valtchinov VI, Jinzaki M, Honda H, Ishigami K, Johkoh T, Tomiyama N, Christiani DC, Lynch DA, San José Estépar R, Washko GR, Cho MH, Silverman EK, Hunninghake GM, Hatabu H. Traction Bronchiectasis/Bronchiolectasis on CT Scans in Relationship to Clinical Outcomes and Mortality: The COPDGene Study. Radiology 2022; 304:694-701. [PMID: 35638925 PMCID: PMC9434811 DOI: 10.1148/radiol.212584] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 01/16/2023]
Abstract
Background The clinical impact of interstitial lung abnormalities (ILAs) on poor prognosis has been reported in many studies, but risk stratification in ILA will contribute to clinical practice. Purpose To investigate the association of traction bronchiectasis/bronchiolectasis index (TBI) with mortality and clinical outcomes in individuals with ILA by using the COPDGene cohort. Materials and Methods This study was a secondary analysis of prospectively collected data. Chest CT scans of participants with ILA for traction bronchiectasis/bronchiolectasis were evaluated and outcomes were compared with participants without ILA from the COPDGene study (January 2008 to June 2011). TBI was classified as follows: TBI-0, ILA without traction bronchiectasis/bronchiolectasis; TBI-1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; TBI-2, ILA with mild to moderate traction bronchiectasis; and TBI-3, ILA with severe traction bronchiectasis and/or honeycombing. Clinical outcomes and overall survival were compared among the TBI groups and the non-ILA group by using multivariable linear regression model and Cox proportional hazards model, respectively. Results Overall, 5295 participants (median age, 59 years; IQR, 52-66 years; 2779 men) were included, and 582 participants with ILA and 4713 participants without ILA were identified. TBI groups were associated with poorer clinical outcomes such as quality of life scores in the multivariable linear regression model (TBI-0: coefficient, 3.2 [95% CI: 0.6, 5.7; P = .01]; TBI-1: coefficient, 3.3 [95% CI: 1.1, 5.6; P = .003]; TBI-2: coefficient, 7.6 [95% CI: 4.0, 11; P < .001]; TBI-3: coefficient, 32 [95% CI: 17, 48; P < .001]). The multivariable Cox model demonstrated that ILA without traction bronchiectasis (TBI-0-1) and with traction bronchiectasis (TBI-2-3) were associated with shorter overall survival (TBI-0-1: hazard ratio [HR], 1.4 [95% CI: 1.0, 1.9; P = .049]; TBI-2-3: HR, 3.8 [95% CI: 2.6, 5.6; P < .001]). Conclusion Traction bronchiectasis/bronchiolectasis was associated with poorer clinical outcomes compared with the group without interstitial lung abnormalities; TBI-2 and 3 were associated with shorter survival. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Lee and Im in this issue.
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Affiliation(s)
- Akinori Hata
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Takuya Hino
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Rachel K. Putman
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Masahiro Yanagawa
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Tomoyuki Hida
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Aravind A. Menon
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Osamu Honda
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Yoshitake Yamada
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Mizuki Nishino
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Tetsuro Araki
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Vladimir I. Valtchinov
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Masahiro Jinzaki
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Hiroshi Honda
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Kousei Ishigami
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Takeshi Johkoh
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Noriyuki Tomiyama
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - David C. Christiani
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - David A. Lynch
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Raúl San José Estépar
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - George R. Washko
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Michael H. Cho
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Edwin K. Silverman
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Gary M. Hunninghake
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - Hiroto Hatabu
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
| | - for the COPDGene Investigators
- From the Ctr for Pulmonary Functional Imaging, Dept of Radiology
(A.H., T. Hino, T. Hida, M.N., V.I.V., G.M.H., H. Hatabu), Pulmonary and
Critical Care Division (R.K.P., A.A.M., G.R.W., G.M.H.), Dept of Radiology
(R.S.J.E.), and Channing Division of Network Medicine (M.H.C., E.K.S.), Brigham
and Women’s Hospital and Harvard Medical School, Boston, Mass; Dept of
Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita,
Osaka 5650871, Japan (A.H., M.Y., N.T.); Dept of Clinical Radiology, Graduate
School of Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hida, H.
Honda, K.I.); Dept of Radiology, Kansai Medical University, Hirakata, Japan
(O.H.); Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
(Y.Y., M.J.); Dept of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (T.A.); Dept of Radiology, Kansai Rosai Hospital, Amagasaki,
Japan (T.J.); Dept of Environmental Health, Harvard TH Chan School of Public
Health, Boston, Mass (D.C.C.); and Dept of Radiology, National Jewish Health,
Denver, Colo (D.A.L.)
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Oh AS, Lynch DA. Interstitial Lung Abnormality—Why Should I Care and What Should I Do About It? Radiol Clin North Am 2022; 60:889-899. [DOI: 10.1016/j.rcl.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Oh AS, Baraghoshi D, Lynch DA, Ash SY, Crapo JD, Humphries SM. Emphysema Progression at CT by Deep Learning Predicts Functional Impairment and Mortality: Results from the COPDGene Study. Radiology 2022; 304:672-679. [PMID: 35579519 PMCID: PMC9434819 DOI: 10.1148/radiol.213054] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022]
Abstract
Background Visual assessment remains the standard for evaluating emphysema at CT; however, it is time consuming, is subjective, requires training, and is affected by variability that may limit sensitivity to longitudinal change. Purpose To evaluate the clinical and imaging significance of increasing emphysema severity as graded by a deep learning algorithm on sequential CT scans in cigarette smokers. Materials and Methods A secondary analysis of the prospective Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study participants was performed and included baseline and 5-year follow-up CT scans from 2007 to 2017. Emphysema was classified automatically according to the Fleischner emphysema grading system at baseline and 5-year follow-up using a deep learning model. Baseline and change in clinical and imaging parameters at 5-year follow-up were compared in participants whose emphysema progressed versus those who did not. Kaplan-Meier analysis and multivariable Cox regression were used to assess the relationship between emphysema score progression and mortality. Results A total of 5056 participants (mean age, 60 years ± 9 [SD]; 2566 men) were evaluated. At 5-year follow-up, 1293 of the 5056 participants (26%) had emphysema progression according to the Fleischner grading system. This group demonstrated progressive airflow obstruction (forced expiratory volume in 1 second [percent predicted]: -3.4 vs -1.8), a greater decline in 6-minute walk distance (-177 m vs -124 m), and greater progression in quantitative emphysema extent (adjusted lung density: -1.4 g/L vs 0.5 g/L; percentage of lung voxels with CT attenuation less than -950 HU: 0.6 vs 0.2) than those with nonprogressive emphysema (P < .001 for each). Multivariable Cox regression analysis showed a higher mortality rate in the group with emphysema progression, with an estimated hazard ratio of 1.5 (95% CI: 1.2, 1.8; P < .001). Conclusion An increase in Fleischner emphysema grade on sequential CT scans using an automated deep learning algorithm was associated with increased functional impairment and increased risk of mortality. ClinicalTrials.gov registration no. NCT00608764 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Grenier in this issue.
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Affiliation(s)
- Andrea S. Oh
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - David Baraghoshi
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - David A. Lynch
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - Samuel Y. Ash
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - James D. Crapo
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - Stephen M. Humphries
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - for the COPDGene Investigators
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
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Walsh SL, Mackintosh JA, Calandriello L, Silva M, Sverzellati N, Larici AR, Humphries SM, Lynch DA, Jo HE, Glaspole I, Grainge C, Goh N, Hopkins PMA, Moodley Y, Reynolds PN, Zappala C, Keir G, Cooper WA, Mahar AM, Ellis S, Wells AU, Corte TJ. Deep Learning-based Outcome Prediction in Progressive Fibrotic Lung Disease Using High-resolution Computed Tomography. Am J Respir Crit Care Med 2022; 206:883-891. [PMID: 35696341 DOI: 10.1164/rccm.202112-2684oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Reliable outcome prediction in patients with fibrotic lung disease using baseline high-resolution computed tomography (HRCT) data remains challenging. OBJECTIVES To evaluate the prognostic accuracy of a deep learning algorithm (SOFIA), trained and validated in the identification of UIP-like features on HRCT (UIP probability), in a large cohort of well characterised patients with progressive fibrotic lung disease, drawn from a national registry. METHODS SOFIA and radiologist-UIP probabilities were converted to PIOPED-based UIP probability categories (UIP not included in the differential: 0-4%, low probability of UIP: 5-29%, intermediate probability of UIP: 30-69%, high probability of UIP: 70-94%, and pathognomonic for UIP:95-100%) and their prognostic utility assessed using Cox proportional hazards modelling. MEASUREMENTS AND MAIN RESULTS On multivariable analysis adjusting for age, gender, guideline based radiologic diagnosis and disease severity (using total ILD extent on HRCT, %predicted FVC, DLco or the CPI), only SOFIA-UIP probability PIOPED categories predicted survival. SOFIA-PIOPED UIP probability categories remained prognostically significant in patients considered indeterminate (n=83) by expert radiologist consensus (HR1.73, p<0.0001, 95%CI 1.40-2.14). In patients undergoing surgical lung biopsy (SLB) (n=86), after adjusting for guideline-based histologic pattern and total ILD extent on HRCT, only SOFIA-PIOPED probabilities were predictive of mortality (HR1.75, p<0.0001, 95%CI 1.37-2.25). CONCLUSIONS Deep learning-based UIP probability on HRCT provides enhanced outcome prediction in patients with progressive fibrotic lung disease when compared to expert radiologist evaluation or guideline-based histologic pattern. In principle this tool may be useful in multidisciplinary characterisation of fibrotic lung disease. The utility of this technology as a decision support system when ILD expertise is unavailable requires further investigation.
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Affiliation(s)
- Simon Lf Walsh
- Imperial College London, 4615, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland;
| | | | - Lucio Calandriello
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 18654, Dipartimento di Diagnostica per immagini, Roma, Italy
| | - Mario Silva
- Universita degli Studi di Parma, 9370, Section of Radiology, Department of Medicine and Surgery, Parma, Italy
| | - Nicola Sverzellati
- Department of Surgical Sciences, Ospedale Maggiore di Parma, Parma, Italy
| | - Anna Rita Larici
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 18654, Dipartimento di Diagnostica per immagini, Roma, Italy
| | | | - David A Lynch
- National Jewish Health, Radiology, Denver, Colorado, United States
| | - Helen E Jo
- Centre of Research Excellence in Pulmonary Fibrosis, Camperdown , New South Wales, Australia.,The University of Sydney, 4334, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, 2205, Department of Respiratory and Sleep Medicine, Camperdown, New South Wales, Australia
| | - Ian Glaspole
- The Alfred Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Christopher Grainge
- John Hunter Hospital, 37024, New Lambton Heights, New South Wales, Australia
| | - Nicole Goh
- Austin Health, Department of Respiratory and Sleep Medicine, Heidelberg, Victoria, Australia.,Alfred Health, 5392, Allergy, Immunology & Respiratory Medicine Department, Melbourne, Victoria, Australia
| | - Peter M A Hopkins
- The Prince Charles Hospital, 67567, Chermside, Queensland, Australia
| | - Yuben Moodley
- The University of Western Australia, Respiratory Medicine, Perth, Western Australia, Australia
| | - Paul N Reynolds
- Royal Adelaide Hospital, Thoracic Medicine, Adelaide, South Australia, Australia
| | | | - Gregory Keir
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Wendy A Cooper
- Royal Prince Alfred Hospital, 2205, Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Camperdown, New South Wales, Australia
| | - Annabelle M Mahar
- Royal Prince Alfred Hospital, 2205, Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Camperdown, New South Wales, Australia
| | - Samantha Ellis
- Alfred Health, 5392, Department of Radiology, Melbourne, Victoria, Australia
| | - Athol U Wells
- Royal Brompton Hospital, Interstitial Lung Disease Unit, London, United Kingdom of Great Britain and Northern Ireland
| | - Tamera J Corte
- Royal Prince Alfred Hospital, 2205, Department of Respiratory and Sleep Medicine, Camperdown, New South Wales, Australia
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46
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Nick JA, Dedrick RM, Gray AL, Vladar EK, Smith BE, Freeman KG, Malcolm KC, Epperson LE, Hasan NA, Hendrix J, Callahan K, Walton K, Vestal B, Wheeler E, Rysavy NM, Poch K, Caceres S, Lovell VK, Hisert KB, de Moura VC, Chatterjee D, De P, Weakly N, Martiniano SL, Lynch DA, Daley CL, Strong M, Jia F, Hatfull GF, Davidson RM. Host and pathogen response to bacteriophage engineered against Mycobacterium abscessus lung infection. Cell 2022; 185:1860-1874.e12. [PMID: 35568033 PMCID: PMC9840467 DOI: 10.1016/j.cell.2022.04.024] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/05/2022] [Accepted: 04/14/2022] [Indexed: 01/17/2023]
Abstract
Two mycobacteriophages were administered intravenously to a male with treatment-refractory Mycobacterium abscessus pulmonary infection and severe cystic fibrosis lung disease. The phages were engineered to enhance their capacity to lyse M. abscessus and were selected specifically as the most effective against the subject's bacterial isolate. In the setting of compassionate use, the evidence of phage-induced lysis was observed using molecular and metabolic assays combined with clinical assessments. M. abscessus isolates pre and post-phage treatment demonstrated genetic stability, with a general decline in diversity and no increased resistance to phage or antibiotics. The anti-phage neutralizing antibody titers to one phage increased with time but did not prevent clinical improvement throughout the course of treatment. The subject received lung transplantation on day 379, and systematic culturing of the explanted lung did not detect M. abscessus. This study describes the course and associated markers of a successful phage treatment of M. abscessus in advanced lung disease.
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Affiliation(s)
- Jerry A Nick
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Rebekah M Dedrick
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Alice L Gray
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Eszter K Vladar
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Bailey E Smith
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Krista G Freeman
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Kenneth C Malcolm
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - L Elaine Epperson
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA
| | - Nabeeh A Hasan
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA
| | - Jo Hendrix
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA; Computational Bioscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kimberly Callahan
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA
| | - Kendra Walton
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA
| | - Brian Vestal
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA
| | - Emily Wheeler
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Noel M Rysavy
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Silvia Caceres
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Valerie K Lovell
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Katherine B Hisert
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | - Delphi Chatterjee
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO 80523, USA
| | - Prithwiraj De
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, 1682 Campus Delivery, Fort Collins, CO 80523, USA
| | - Natalia Weakly
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA
| | - Stacey L Martiniano
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO 80206, USA
| | - Charles L Daley
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Michael Strong
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA
| | - Fan Jia
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA
| | - Graham F Hatfull
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| | - Rebecca M Davidson
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO 80206, USA
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47
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Raghu G, Remy-Jardin M, Richeldi L, Thomson CC, Inoue Y, Johkoh T, Kreuter M, Lynch DA, Maher TM, Martinez FJ, Molina-Molina M, Myers JL, Nicholson AG, Ryerson CJ, Strek ME, Troy LK, Wijsenbeek M, Mammen MJ, Hossain T, Bissell BD, Herman DD, Hon SM, Kheir F, Khor YH, Macrea M, Antoniou KM, Bouros D, Buendia-Roldan I, Caro F, Crestani B, Ho L, Morisset J, Olson AL, Podolanczuk A, Poletti V, Selman M, Ewing T, Jones S, Knight SL, Ghazipura M, Wilson KC. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2022; 205:e18-e47. [PMID: 35486072 PMCID: PMC9851481 DOI: 10.1164/rccm.202202-0399st] [Citation(s) in RCA: 683] [Impact Index Per Article: 341.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: This American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax guideline updates prior idiopathic pulmonary fibrosis (IPF) guidelines and addresses the progression of pulmonary fibrosis in patients with interstitial lung diseases (ILDs) other than IPF. Methods: A committee was composed of multidisciplinary experts in ILD, methodologists, and patient representatives. 1) Update of IPF: Radiological and histopathological criteria for IPF were updated by consensus. Questions about transbronchial lung cryobiopsy, genomic classifier testing, antacid medication, and antireflux surgery were informed by systematic reviews and answered with evidence-based recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 2) Progressive pulmonary fibrosis (PPF): PPF was defined, and then radiological and physiological criteria for PPF were determined by consensus. Questions about pirfenidone and nintedanib were informed by systematic reviews and answered with evidence-based recommendations using the GRADE approach. Results:1) Update of IPF: A conditional recommendation was made to regard transbronchial lung cryobiopsy as an acceptable alternative to surgical lung biopsy in centers with appropriate expertise. No recommendation was made for or against genomic classifier testing. Conditional recommendations were made against antacid medication and antireflux surgery for the treatment of IPF. 2) PPF: PPF was defined as at least two of three criteria (worsening symptoms, radiological progression, and physiological progression) occurring within the past year with no alternative explanation in a patient with an ILD other than IPF. A conditional recommendation was made for nintedanib, and additional research into pirfenidone was recommended. Conclusions: The conditional recommendations in this guideline are intended to provide the basis for rational, informed decisions by clinicians.
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48
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Zell-Baran LM, Humphries SM, Moore CM, Lynch DA, Charbonnier JP, Oh AS, Rose CS. Quantitative imaging analysis detects subtle airway abnormalities in symptomatic military deployers. BMC Pulm Med 2022; 22:163. [PMID: 35477425 PMCID: PMC9047334 DOI: 10.1186/s12890-022-01960-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Exposure to inhalational hazards during post-9/11 deployment to Southwest Asia and Afghanistan puts military personnel at risk for respiratory symptoms and disease. Pulmonary function and qualitative chest high resolution computed tomography (HRCT) are often normal in “deployers” with persistent respiratory symptoms. We explored the utility of quantitative HRCT imaging markers of large and small airways abnormalities, including airway wall thickness, emphysema, and air trapping, in symptomatic deployers with clinically-confirmed lung disease compared to controls. Methods Chest HRCT images from 45 healthy controls and 82 symptomatic deployers with asthma, distal lung disease or both were analyzed using Thirona Lung quantification software to calculate airway wall thickness (by Pi10), emphysema (by percentage of lung volume with attenuation < -950 Hounsfield units [LAA%-950]), and three parameters of air trapping (expiratory/inspiratory total lung volume and mean lung density ratios, and LAA%-856). SAS v.9.4 was used to compare demographic and clinical characteristics between deployers and controls using Chi-Square, Fisher Exact or t-tests. Linear regression was used to assess relationships between pulmonary function and quantitative imaging findings. Results Gender and smoking status were not statistically significantly different between groups, but deployers were significantly younger than controls (42 vs 58 years, p < 0.0001), had higher body mass index (31 vs 28 kg/m2, p = 0.01), and had fewer total smoking pack-years (8 vs. 26, p = 0.007). Spirometric measures were not statistically significantly different between groups. Pi10 and LAA%-950 were significantly elevated in deployers compared to controls in unadjusted analyses, with the emphysema measure remaining significantly higher in deployers after adjustment for age, sex, smoking, BMI, and expiratory total lung volume. Air trapping parameters were more common in control images, likely due to differences in age and smoking between groups. Among deployers, LAA%-950 and Pi10 were significantly correlated with spirometric markers of obstruction based on ratio of forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) and/or percent predicted FEV1. Conclusions Quantitative chest HRCT imaging analysis identifies emphysema in deployers with asthma and distal lung disease, and may be useful in detecting and monitoring deployment-related lung disease in a population where spirometry is typically normal.
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Affiliation(s)
- Lauren M Zell-Baran
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO, USA.
| | | | - Camille M Moore
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA.,Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Andrea S Oh
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
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49
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Pinsky PF, Lynch DA, Gierada DS. Incidental Findings on Low-Dose CT Scan Lung Cancer Screenings and Deaths From Respiratory Diseases. Chest 2022; 161:1092-1100. [PMID: 34838524 PMCID: PMC9005861 DOI: 10.1016/j.chest.2021.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Incidental respiratory disease-related findings are frequently observed on low-dose CT (LDCT) lung cancer screenings. This study analyzed data from the National Lung Screening Trial (NLST) to assess the relationship between such findings and respiratory disease mortality (RDM), excluding lung cancer. RESEARCH QUESTION Are incidental respiratory findings on LDCT scanning associated with increased RDM? STUDY DESIGN AND METHODS Subjects in the NLST LDCT arm received three annual screens. Trial radiologists noted findings related to possible lung cancer, as well as respiratory-related incidental findings. Demographic characteristics, smoking history, and medical history were captured in a baseline questionnaire. Kaplan-Meier curves were used to assess cumulative RDM. Multivariate proportional hazards models were used to assess risk factors for RDM; in addition to incidental CT scan findings, variables included respiratory disease history (COPD/emphysema, and asthma), smoking history, and demographic factors (age, race, sex, and BMI). RESULTS Of 26,722 subjects in the NLST LDCT arm, 25,002 received the baseline screen and a subsequent LDCT screen. Overall, 59% were male, 26.5% were aged ≥ 65 years at baseline, and 10.6% reported a history of COPD/emphysema. Emphysema on LDCT scanning was reported in 30.7% of subjects at baseline and in 44.2% at any screen. Of those with emphysema on baseline LDCT scanning, 18% reported a history of COPD/emphysema. Median mortality follow-up was 10.3 years. There were 3,639 deaths, and 708 were from respiratory diseases. Among subjects with no history of COPD/emphysema, 10-year cumulative RDM ranged from 3.9% for subjects with emphysema and reticular opacities to 1.1% for those with neither condition; the corresponding range among subjects with a COPD/emphysema history was 17.3% (both) to 3.7% (neither). Emphysema on LDCT imaging was associated with a significantly elevated RDM hazard ratio (2.27; 95% CI, 1.92-2.7) in the multivariate model. Reticular opacities (including honeycombing/fibrosis/scar) also had a significantly elevated hazard ratio (1.39; 95% CI, 1.19-1.62). INTERPRETATION Incidental respiratory disease-related findings observed on NLST LDCT screens were frequent and associated with increased mortality from respiratory diseases.
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Affiliation(s)
- Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD.
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - David S Gierada
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
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50
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Cottin V, Tomassetti S, Valenzuela C, Walsh S, Antoniou K, Bonella F, Brown KK, Collard HR, Corte TJ, Flaherty K, Johannson KA, Kolb M, Kreuter M, Inoue Y, Jenkins G, Lee JS, Lynch DA, Maher TM, Martinez FJ, Molina-Molina M, Myers J, Nathan SD, Poletti V, Quadrelli S, Raghu G, Rajan SK, Ravaglia C, Remy-Jardin M, Renzoni E, Richeldi L, Spagnolo P, Troy L, Wijsenbeek M, Wilson KC, Wuyts W, Wells AU, Ryerson C. Integrating Clinical Probability into the Diagnostic Approach to Idiopathic Pulmonary Fibrosis: An International Working Group Perspective. Am J Respir Crit Care Med 2022; 206:247-259. [PMID: 35353660 DOI: 10.1164/rccm.202111-2607pp] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND When considering the diagnosis of idiopathic pulmonary fibrosis (IPF), experienced clinicians integrate clinical features that help to differentiate IPF from other fibrosing interstitial lung diseases, thus generating a "pre-test" probability of IPF. The aim of this international working group perspective was to summarize these features using a tabulated approach similar to chest HRCT and histopathologic patterns reported in the international guidelines for the diagnosis of IPF, and to help formally incorporate these clinical likelihoods into diagnostic reasoning to facilitate the diagnosis of IPF. METHODS The committee group identified factors that influence the clinical likelihood of a diagnosis of IPF, which was categorized as a pre-test clinical probability of IPF into "high" (70-100%), "intermediate" (30-70%), or "low" (0-30%). After integration of radiological and histopathological features, the post-test probability of diagnosis was categorized into "definite" (90-100%), "high confidence" (70-89%), "low confidence" (51-69%), or "low" (0-50%) probability of IPF. FINDINGS A conceptual Bayesian framework was created, integrating the clinical likelihood of IPF ("pre-test probability of IPF") with the HRCT pattern, the histopathology pattern when available, and/or the pattern of observed disease behavior into a "post-test probability of IPF". The diagnostic probability of IPF was expressed using an adapted diagnostic ontology for fibrotic interstitial lung diseases. INTERPRETATION The present approach will help incorporate the clinical judgement into the diagnosis of IPF, thus facilitating the application of IPF diagnostic guidelines and, ultimately improving diagnostic confidence and reducing the need for invasive diagnostic techniques.
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Affiliation(s)
- Vincent Cottin
- Louis Pradel University Hospital, Respiratory Medicine, Lyon, France;
| | | | - Claudia Valenzuela
- Servicio de Neumología, Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Madrid, Spain
| | - Simon Walsh
- Imperial College London, 4615, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Katerina Antoniou
- Medical School, University of Crete, Heraklion, Greece, Department of Thoracic Medicine, Laboratory of Molecular and Cellular Pneumonology, Heraklion, Greece.,University Hospital of Heraklion, Heraklion, Greece, Department of Thoracic Medicine, Heraklion, Greece
| | | | - Kevin K Brown
- National Jewish Health, 2930, Denver, Colorado, United States
| | - Harold R Collard
- University of California, San Francisco, Department of Medicine, San Francisco, California, United States
| | - Tamera J Corte
- Royal Prince Alfred Hospital, Department of Respiratory Medicine, Sydney, New South Wales, Australia.,University of Sydney, 4334, Medical School, Sydney, New South Wales, Australia
| | - Kevin Flaherty
- University of Michigan, Division of Pulmonary and Critical Care Medicine, Ann Arbor, Michigan, United States
| | | | - Martin Kolb
- McMaster University, Hamilton, Ontario, Canada
| | - Michael Kreuter
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research Germany, Heidelberg, Germany
| | - Yoshikazu Inoue
- National Hospital Organization, Kinki-Chuo Chest Medical Center, Clinical Research Center, Osaka, Japan
| | - Gisli Jenkins
- Imperial College London, 4615, National Heart & Lung Institute, London, United Kingdom of Great Britain and Northern Ireland.,NIHR Nottingham Biomedical Research Centre, 574111, Respiratory Research Unit, Nottingham, United Kingdom of Great Britain and Northern Ireland.,University of Nottingham School of Medicine, 170718, Division of Respiratory Medicine, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Joyce S Lee
- University of Colorado, School of Medicine, Department of Medicine, Aurora, Colorado, United States
| | - David A Lynch
- National Jewish Health, Radiology, Denver, Colorado, United States
| | - Toby M Maher
- University of Southern California Keck School of Medicine, 12223, PCCSM, Los Angeles, California, United States
| | | | - Maria Molina-Molina
- Pneumology, ILD Unit. University Hospital of Bellvitge, Hospitalet de Llobregat, Spain
| | - Jeff Myers
- University of Michigan, Division of Anatomic Pathology, Ann Arbor, Michigan, United States
| | - Steven D Nathan
- Inova Fairfax Hospital, 23146, Advanced Lung Disease and Transplant Program, Falls Church, Virginia, United States
| | - Venerino Poletti
- GB MORGAGNI HOSPITAL, Department of Diseases of the Thorax, FORLI, Italy
| | - Silvia Quadrelli
- Sanatorio Guemes, 62948, Pulmonary Medicine, Buenos Aires, Argentina
| | - Ganesh Raghu
- University of Washington Medical Center, 21617, Division of Pulmonary and Critical Care Medicine, Seattle, Washington, United States
| | - Sujeet K Rajan
- Bombay Hospital Institute f Medical Sciences and Bhatia Hospital, Mumbai, India
| | | | | | - Elisabetta Renzoni
- Royal Brompton Hospital, Interstitial Lung Disease Unit, London, United Kingdom of Great Britain and Northern Ireland
| | - Luca Richeldi
- Universita Cattolica del Sacro Cuore Sede di Roma, 96983, Pulmonary Medicine, Roma, Italy
| | - Paolo Spagnolo
- Canton Hospital Baselland, and University of Basel, Medical University Clinic, Liestal, Switzerland
| | - Lauren Troy
- Royal Prince Alfred Hospital, 2205, Respiratory Medicine, Sydney, New South Wales, Australia
| | - Marlies Wijsenbeek
- Erasmus University Rotterdam, 6984, Rotterdam, Zuid-Holland, Netherlands
| | - Kevin C Wilson
- American Thoracic Society, 44197, Documents Department, New York, New York, United States.,Boston University, Medicine, Boston, Massachusetts, United States
| | - Wim Wuyts
- K U Leuven, respiratory medicine, Leuven, Belgium
| | - Athol U Wells
- Royal Brompton Hospital, Interstitial Lung Disease Unit, London, United Kingdom of Great Britain and Northern Ireland
| | - Christopher Ryerson
- University of British Columbia, Medicine, Vancouver, British Columbia, Canada
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