Quantitative CT-analysis of over aerated lung tissue and correlation with fibrosis extent in patients with idiopathic pulmonary fibrosis.

IF 5.8 2区 医学 Q1 Medicine Respiratory Research Pub Date : 2024-10-05 DOI:10.1186/s12931-024-02970-4
Roberto Tonelli, Marry R Smit, Ivana Castaniere, Giovanni Della Casa, Dario Andrisani, Filippo Gozzi, Giulia Bruzzi, Stefania Cerri, Anna Valeria Samarelli, Giulia Raineri, Paolo Spagnolo, Raffella Rizzoni, Lorenzo Ball, Frederique Paulus, Lieuwe D J Bos, Enrico Clini, Alessandro Marchioni
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引用次数: 0

Abstract

Introduction: The usual interstitial pneumonia (UIP) pattern, hallmark of idiopathic pulmonary fibrosis (IPF), may induce harmful local overdistension during mechanical ventilation given the juxtaposition of different tissue elasticities. Mechanotransduction, linking mechanical stress and strain to molecular pro-fibrotic pathways, likely contributes to fibrosis progression. Understanding the mechanical forces and aeration patterns in the lungs of IPF patients is crucial for unraveling potential mechanisms of disease progression. Quantitative lung computed tomography (CT) can accurately assess the air content of lung regions, thus informing on zonal distension. This study aims to investigate radiological evidence of lung over aeration in spontaneously breathing UIP patients compared to healthy controls during maximal inspiration.

Methods: Patients with IPF diagnosis referred to the Center for Rare Lung Diseases of the University Hospital of Modena (Italy) in the period 2020-2023 who underwent High Resolution Computed Tomography (HRCT) scans at residual volume (RV) and total lung capacity (TLC) using standardized protocols were retrospectively considered eligible. Patients with no signs of lung disease at HRCT performed with the same image acquisition protocol nor at pulmonary function test (PFTs) served as controls. Lung segmentation and quantitative analysis were performed using 3D Slicer software. Lung volumes were measured, and specific density thresholds defined over aerated and fibrotic regions. Comparison between over aerated lung at RV and TLC in the two groups and according to lung lobes was sought. Further, the correlation between aerated lung and the extent of fibrosis was assessed and compared at RV and TLC.

Results: IPF patients (N = 20) exhibited higher over aerated lung proportions than controls (N = 15) both at RV and TLC (4.5% vs. 0.7%, p < 0.0001 and 13.8% vs. 7%, p < 0.0001 respectively). Over aeration increased significantly from RV to TLC in both groups, with no intergroup difference (p = 0.67). Sensitivity analysis revealed significant variations in over aerated lung areas among lobes when passing from RV to TLC with no difference within lobes (p = 0.28). Correlation between over aeration and fibrosis extent was moderate at RV (r = 0.62, p < 0.0001) and weak at TLC (r = 0.27, p = 0.01), being the two significantly different at interpolation analysis (p < 0.0001).

Conclusions: This study provides the first evidence of radiological signs of lung over aeration in patients with UIP-pattern patients when passing from RV to TLC. These findings offer new insights into the complex interplay between mechanical forces, lung structure, and fibrosis and warrant larger and longitudinal investigations.

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特发性肺纤维化患者过度通气肺组织的定量 CT 分析及其与纤维化程度的相关性。
简介:通常的间质性肺炎(UIP)模式是特发性肺纤维化(IPF)的标志,在机械通气过程中,由于不同组织弹性并存,可能会诱发有害的局部过度张力。机械传导将机械应力和应变与促进纤维化的分子途径联系起来,可能会导致纤维化的发展。了解 IPF 患者肺部的机械力和通气模式对于揭示疾病进展的潜在机制至关重要。定量肺部计算机断层扫描(CT)可准确评估肺部区域的空气含量,从而为分区膨胀提供信息。本研究旨在调查与健康对照组相比,自主呼吸的 UIP 患者在最大吸气时肺部过度充气的放射学证据:方法:2020-2023 年期间转诊至意大利摩德纳大学医院罕见肺病中心的 IPF 诊断患者均被视为符合条件,这些患者采用标准化方案接受了残余容积(RV)和总肺活量(TLC)的高分辨率计算机断层扫描(HRCT)。采用相同图像采集方案进行的高分辨率计算机断层扫描和肺功能测试(PFTs)均无肺部疾病症状的患者作为对照组。使用 3D Slicer 软件进行肺部分割和定量分析。测量肺容积,并定义充气和纤维化区域的特定密度阈值。对两组肺叶的 RV 和 TLC 的过度充气肺进行比较。此外,还评估了充气肺与纤维化程度之间的相关性,并在 RV 和 TLC 上进行了比较:结果:IPF 患者(N = 20)在 RV 和 TLC 均表现出比对照组(N = 15)更高的过度充气肺比例(4.5% vs. 0.7%,P 结论:IPF 患者的过度充气肺比例高于对照组(N = 15):本研究首次提供了 UIP 型患者从 RV 到 TLC 时肺过度充气的放射学迹象。这些发现为机械力、肺结构和纤维化之间复杂的相互作用提供了新的见解,值得进行更大规模的纵向研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Respiratory Research
Respiratory Research RESPIRATORY SYSTEM-
CiteScore
9.70
自引率
1.70%
发文量
314
审稿时长
4-8 weeks
期刊介绍: Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.
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