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European Radiology
Published in: European Radiology 5/2020

01-05-2020 | Idiopathic Pulmonary Fibrosis | Chest

Stratification of long-term outcome in stable idiopathic pulmonary fibrosis by combining longitudinal computed tomography and forced vital capacity

Authors: Nicola Sverzellati, Mario Silva, Valeria Seletti, Carlotta Galeone, Stefano Palmucci, Sara Piciucchi, Carlo Vancheri, Venerino Poletti, Sara Tomassetti, Ronald Karwoski, Brian J. Bartholmai

Published in: European Radiology | Issue 5/2020

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Abstract

Objectives

To test HRCT with either visual or quantitative analysis in both short-term and long-term follow-up of stable IPF against long-term (transplant-free) survival, beyond 2 years of disease stability.

Methods

Fifty-eight IPF patients had FVC measurements and HRCTs at baseline (HRCT0), 10–14 months (HRCT1) and 22–26 months (HRCT2). Visual scoring, CALIPER quantitative analysis of HRCT measures, and their deltas were evaluated against combined all-cause mortality and lung transplantation by adjusted Cox proportional hazard models at each time interval.

Results

At HRCT1, a ≥ 20% relative increase in CALIPER-total lung fibrosis yielded the highest radiological association with outcome (C-statistic 0.62). Moreover, the model combining FVC% drop ≥ 10% and ≥ 20% relative increase of CALIPER-total lung fibrosis improved the stratification of outcome (C-statistic 0.69, high-risk category HR 12.1; landmark analysis at HRCT1 C-statistic 0.66, HR 14.9 and at HRCT2 C-statistic 0.61, HR 21.8). Likewise, at HRCT2, the model combining FVC% decrease trend and ≥ 20% relative increase of CALIPER-pulmonary vessel–related volume (VRS) improved the stratification of outcome (C-statistic 0.65, HR 11.0; landmark analysis at HRCT1 C-statistic 0.62, HR 13.8 and at HRCT2 C-statistic 0.58, HR 12.6). A less robust stratification of outcome distinction was also demonstrated with the categorical visual scoring of disease change.

Conclusions

Annual combined CALIPER -FVC changes showed the greatest stratification of long-term outcome in stable IPF patients, beyond 2 years.

Key Points

• Longitudinal high-resolution computed tomography (HRCT) data is more helpful than baseline HRCT alone for stratification of long-term outcome in IPF.
• HRCT changes by visual or quantitative analysis can be added with benefit to the current spirometric reference standard to improve stratification of long-term outcome in IPF.
• HRCT follow-up at 12–14 months is more helpful than HRCT follow-up at 23–26 months in clinically stable subjects with IPF.
Appendix
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Metadata
Title
Stratification of long-term outcome in stable idiopathic pulmonary fibrosis by combining longitudinal computed tomography and forced vital capacity
Authors
Nicola Sverzellati
Mario Silva
Valeria Seletti
Carlotta Galeone
Stefano Palmucci
Sara Piciucchi
Carlo Vancheri
Venerino Poletti
Sara Tomassetti
Ronald Karwoski
Brian J. Bartholmai
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06619-5

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