Top

Published in:

Open Access 01-12-2015 | Research article

Clinical impact of high-attenuation and cystic areas on computed tomography in fibrotic idiopathic interstitial pneumonias

Authors: Kiminobu Tanizawa, Tomohiro Handa, Sonoko Nagai, Toyohiro Hirai, Takeshi Kubo, Tsuyoshi Oguma, Isao Ito, Yutaka Ito, Kizuku Watanabe, Kensaku Aihara, Kohei Ikezoe, Toru Oga, Kazuo Chin, Takateru Izumi, Michiaki Mishima

Published in: BMC Pulmonary Medicine | Issue 1/2015

Abstract

Background

Quantitative computed tomography (CT) analysis has been proposed as a means of objectively assessing fibrotic interstitial pneumonia (IP) including idiopathic pulmonary fibrosis (IPF). We investigated whether percentages of high-attenuation areas (HAA%) and cystic areas (CA%) quantified from CT images were useful as indices of fibrotic IP.

Methods

CT images of 74 patients with fibrotic idiopathic interstitial pneumonias (IPF, 36; non-specific interstitial pneumonia, 9; unclassifiable idiopathic interstitial pneumonia, 29) were analyzed via in-house computer software, which automatically calculated HAA%, CA%, mean lung density (MLD), standard deviation of lung density (SD-LD), kurtosis, and skewness from CT attenuation histograms. These indices were compared in each instance with physiologic measures, visual fibrosis score, clinical diagnosis, radiologic CT pattern, and prognosis.

Results

HAA% correlated significantly with physiologic measures and visual fibrosis score to a moderate extent (%forced vital capacity, r_s = −0.59; % carbon monoxide diffusion capacity, r_s = −0.43; fibrosis score, r_s = 0.23). Densitometric parameters (MLD, SD-LD, kurtosis, and skewness) correlated significantly with physiologic measures and fibrosis score (|r_s| = 0.28-0.59). CA% showed no association with pulmonary functions but differed significantly between IPF and other interstitial pneumonias (IPs) (1.50 ± 2.41 % vs. 0.41 ± 0.80 %; P < 0.01) and between the definite usual interstitial pneumonia (UIP) pattern and other patterns (1.48 ± 2.38 % vs. 0.55 ± 1.19 %; P < 0.01). On univariate analysis, HAA%, MLD, SD-LD, kurtosis, skewness, fibrosis score, and definite UIP pattern all correlated with survival, with kurtosis alone identified as a significant predictor of mortality on multivariate analysis (hazard ratio = 0.67; 95 % CI, 0.44-0.96; P = 0.03).

Conclusion

CA% and HAA% are novel quantitative CT indices with differing properties in fibrotic IP evaluations. HAA% largely reflects physiologic impairments, whereas CA% corresponds with diagnosis and HRCT pattern. Of the CT indices examined, kurtosis constituted the strongest predictor of mortality.

Hartley PG, Galvin JR, Hunninghake GW, Merchant JA, Yagla SJ, Speakman SB, et al. High-resolution CT-derived measures of lung density are valid indexes of interstitial lung disease. J Appl Physiol. 1994;76:271–7.PubMed

Best AC, Lynch AM, Bozic CM, Miller D, Grunwald GK, Lynch DA. Quantitative CT indexes in idiopathic pulmonary fibrosis: relationship with physiologic impairment. Radiology. 2003;228:407–14.CrossRefPubMed

Do KH, Lee JS, Colby TV, Kitaichi M, Kim DS. Nonspecific interstitial pneumonia versus usual interstitial pneumonia: differences in the density histogram of high-resolution CT. J Comput Assist Tomogr. 2005;29:544–8.CrossRefPubMed

Camiciottoli G, Orlandi I, Bartolucci M, Meoni E, Nacci F, Diciotti S, et al. Lung CT densitometry in systemic sclerosis: correlation with lung function, exercise testing, and quality of life. Chest. 2007;131:672–81.CrossRefPubMed

Best AC, Meng J, Lynch AM, Bozic CM, Miller D, Grunwald GK, et al. Idiopathic pulmonary fibrosis: physiologic tests, quantitative CT indexes, and CT visual scores as predictors of mortality. Radiology. 2008;246:935–40.CrossRefPubMed

Handa T, Nagai S, Hirai T, Chin K, Kubo T, Oga T, et al. Computed tomography analysis of airway dimensions and lung density in patients with sarcoidosis. Respiration. 2009;77:273–81.CrossRefPubMed

Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788–824.CrossRefPubMed

Lynch DA, Travis WD, Muller NL, Galvin JR, Hansell DM, Grenier PA, et al. Idiopathic interstitial pneumonias: CT features. Radiology. 2005;236:10–21.CrossRefPubMed

American Thoracic Society; European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med. 2002;165:277–304.CrossRef

10.

Travis WD, Costabel U, Hansell DM, King Jr TE, Lynch DA, Nicholson AG, et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013;188:733–48.CrossRefPubMed

11.

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.CrossRefPubMed

12.

The Committee of Pulmonary Physiology JRS. Guidelines for Pulmonary Function Tests: Spirometry, Flow-Volume Curve, Diffusion Capacity of the Lung. Tokyo: The Japanese Respiratory Society; 2004.

13.

Ohara T, Hirai T, Sato S, Terada K, Kinose D, Haruna A, et al. Longitudinal study of airway dimensions in chronic obstructive pulmonary disease using computed tomography. Respirology. 2008;13:372–8.CrossRefPubMed

14.

Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246:697–722.CrossRefPubMed

15.

Kazerooni EA, Martinez FJ, Flint A, Jamadar DA, Gross BH, Spizarny DL, et al. Thin-section CT obtained at 10-mm increments versus limited three-level thin-section CT for idiopathic pulmonary fibrosis: correlation with pathologic scoring. AJR Am J Roentgenol. 1997;169:977–83.CrossRefPubMed

16.

Lynch DA, Godwin JD, Safrin S, Starko KM, Hormel P, Brown KK, et al. High-resolution computed tomography in idiopathic pulmonary fibrosis: diagnosis and prognosis. Am J Respir Crit Care Med. 2005;172:488–93.CrossRefPubMed

17.

Iwasawa T, Asakura A, Sakai F, Kanauchi T, Gotoh T, Ogura T, et al. Assessment of prognosis of patients with idiopathic pulmonary fibrosis by computer-aided analysis of CT images. J Thorac Imaging. 2009;24:216–22.CrossRefPubMed

18.

Sumikawa H, Johkoh T, Yamamoto S, Yanagawa M, Inoue A, Honda O, et al. Computed tomography values calculation and volume histogram analysis for various computed tomographic patterns of diffuse lung diseases. J Comput Assist Tomogr. 2009;33:731–8.CrossRefPubMed

19.

Sumikawa H, Johkoh T, Colby TV, Ichikado K, Suga M, Taniguchi H, et al. Computed tomography findings in pathological usual interstitial pneumonia: relationship to survival. Am J Respir Crit Care Med. 2008;177:433–9.CrossRefPubMed

20.

Sumikawa H, Johkoh T, Yamamoto S, Oota M, Ueguchi T, Ogata Y, et al. Volume histogram analysis for lung thin-section computed tomography: differentiation between usual interstitial pneumonia and nonspecific interstitial pneumonia. J Comput Assist Tomogr. 2007;31:936–42.CrossRefPubMed

21.

Tanabe N, Muro S, Hirai T, Oguma T, Terada K, Marumo S, et al. Impact of exacerbations on emphysema progression in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2011;183:1653–9.CrossRefPubMed

22.

Haruna A, Muro S, Nakano Y, Ohara T, Hoshino Y, Ogawa E, et al. CT scan findings of emphysema predict mortality in COPD. Chest. 2010;138:635–40.CrossRefPubMed

23.

Ohara T, Hirai T, Muro S, Haruna A, Terada K, Kinose D, et al. Relationship between pulmonary emphysema and osteoporosis assessed by CT in patients with COPD. Chest. 2008;134:1244–9.CrossRefPubMed

24.

Matsumoto H, Niimi A, Takemura M, Ueda T, Minakuchi M, Tabuena R, et al. Relationship of airway wall thickening to an imbalance between matrix metalloproteinase-9 and its inhibitor in asthma. Thorax. 2005;60:277–81.CrossRefPubMedPubMedCentral

25.

Nakano Y, Muro S, Sakai H, Hirai T, Chin K, Tsukino M, et al. Computed tomographic measurements of airway dimensions and emphysema in smokers. Correlation with lung function. Am J Respir Crit Care Med. 2000;162:1102–8.CrossRefPubMed

26.

Mishima M, Hirai T, Itoh H, Nakano Y, Sakai H, Muro S, et al. Complexity of terminal airspace geometry assessed by lung computed tomography in normal subjects and patients with chronic obstructive pulmonary disease. Proc Natl Acad Sci U S A. 1999;96:8829–34.CrossRefPubMedPubMedCentral

27.

Maldonado F, Moua T, Rajagopalan S, Karwoski RA, Raghunath S, Decker PA, et al. Automated quantification of radiological patterns predicts survival in idiopathic pulmonary fibrosis. Eur Respir J. 2014;43:204–12.CrossRefPubMed

28.

Watadani T, Sakai F, Johkoh T, Noma S, Akira M, Fujimoto K, et al. Interobserver variability in the CT assessment of honeycombing in the lungs. Radiology. 2013;266:936–44.CrossRefPubMed

29.

Sumikawa H, Johkoh T, Nagareda T, Sekiguchi J, Matsuo K, Fujita Y, et al. Pulmonary adenocarcinomas with ground-glass attenuation on thin-section CT: quantification by three-dimensional image analyzing method. Eur J Radiol. 2008;65:104–11.CrossRefPubMed

30.

Martinez FJ, de Andrade JA, Anstrom KJ, King Jr TE, Raghu G, Idiopathic Pulmonary Fibrosis Clinical Research N. Randomized trial of acetylcysteine in idiopathic pulmonary fibrosis. N Engl J Med. 2014;370:2093–101.CrossRefPubMedPubMedCentral

31.

Nishiyama O, Taniguchi H, Kondoh Y, Kimura T, Kato K, Kataoka K, et al. A simple assessment of dyspnoea as a prognostic indicator in idiopathic pulmonary fibrosis. Eur Respir J. 2010;36:1067–72.CrossRefPubMed

32.

Lama VN, Flaherty KR, Toews GB, Colby TV, Travis WD, Long Q, et al. Prognostic value of desaturation during a 6-minute walk test in idiopathic interstitial pneumonia. Am J Respir Crit Care Med. 2003;168:1084–90.CrossRefPubMed

33.

Ley B, Collard HR, King Jr TE. Clinical course and prediction of survival in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2011;183:431–40.CrossRefPubMed

34.

du Bois RM, Weycker D, Albera C, Bradford WZ, Costabel U, Kartashov A, et al. Ascertainment of individual risk of mortality for patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2011;184:459–66.CrossRefPubMed

35.

Hamada K, Nagai S, Tanaka S, Handa T, Shigematsu M, Nagao T, et al. Significance of pulmonary arterial pressure and diffusion capacity of the lung as prognosticator in patients with idiopathic pulmonary fibrosis. Chest. 2007;131:650–6.CrossRefPubMed

36.

Collard HR, King Jr TE, Bartelson BB, Vourlekis JS, Schwarz MI, Brown KK. Changes in clinical and physiologic variables predict survival in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2003;168:538–42.CrossRefPubMed

37.

Lee JS, Ryu JH, Elicker BM, Lydell CP, Jones KD, Wolters PJ, et al. Gastroesophageal reflux therapy is associated with longer survival in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2011;184:1390–4.CrossRefPubMedPubMedCentral

38.

Jegal Y, Kim DS, Shim TS, Lim CM, Do Lee S, Koh Y, et al. Physiology is a stronger predictor of survival than pathology in fibrotic interstitial pneumonia. Am J Respir Crit Care Med. 2005;171:639–44.CrossRefPubMed

39.

Taniguchi H, Kondoh Y, Ebina M, Azuma A, Ogura T, Taguchi Y, et al. The clinical significance of 5% change in vital capacity in patients with idiopathic pulmonary fibrosis: extended analysis of the pirfenidone trial. Respir Res. 2011;12:93.CrossRefPubMedPubMedCentral

Title: Clinical impact of high-attenuation and cystic areas on computed tomography in fibrotic idiopathic interstitial pneumonias
Authors: Kiminobu Tanizawa
Tomohiro Handa
Sonoko Nagai
Toyohiro Hirai
Takeshi Kubo
Tsuyoshi Oguma
Isao Ito
Yutaka Ito
Kizuku Watanabe
Kensaku Aihara
Kohei Ikezoe
Toru Oga
Kazuo Chin
Takateru Izumi
Michiaki Mishima
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Pulmonary Medicine / Issue 1/2015
Electronic ISSN: 1471-2466
DOI: https://doi.org/10.1186/s12890-015-0069-0

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Clinical impact of high-attenuation and cystic areas on computed tomography in fibrotic idiopathic interstitial pneumonias

Abstract

Background

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2015

Impact of obstructive sleep apnea on lung volumes and mechanical properties of the respiratory system in overweight and obese individuals

Anemia and hemoglobin serum levels are associated with exercise capacity and quality of life in chronic obstructive pulmonary disease

Protocadherin-1 is a glucocorticoid-responsive critical regulator of airway epithelial barrier function

Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival

Prevalence of asthma in Saudi adults: findings from a national household survey, 2013

Immune response to Propionibacterium acnes in patients with sarcoidosis – in vivo and in vitro

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page