Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa4005
Tess Kramer, Saskia Van Heumen, Lizzy Wijmans, Christopher Manley, Sandeep Bansal, Dawn Jeannerat, Martijn De Bruin, Peter Bonta, Jouke Annema
Introduction: Needle based confocal laser endomicroscopy (nCLE) allows real-time microscopic imaging at the needle tip. nCLE malignancy criteria are validated and used for bronchoscopic lung nodule detection. To date, nCLE granuloma criteria are not validated. Aim: assess the accuracy, inter-observer agreement (IOA) and intra-observer reliability (IOR) of nCLE granuloma detection Methods: In patients with suspected sarcoidosis, nCLE-imaging of mediastinal lymph nodes was performed during endoscopic ultrasound procedures, followed by needle aspiration. nCLE-videos were compared to final diagnoses for granuloma criteria identification. Blinded raters, trained in nCLE granuloma criteria, validated nCLE videos of reactive and sarcoid lymph nodes. In patients with granulomatous lung nodules, bronchoscopic nCLE-imaging was performed. Results: Five blinded raters evaluated 26 nCLE-videos of lymph nodes (n=15 sarcoid; n=11 reactive) of 19 patients twice (260 ratings). Granuloma criteria were recognized with 88.7% sensitivity and 87.3% specificity. The IOA (κ=0.63, 95%CI 0.54-0.72) and IOR (κ=0.70 ±0.06) were substantial. In 4 patients with granulomatous lung nodules similar nCLE criteria were observed. Conclusion: nCLE imaging of lymph nodes and nodules is able to visualize granulomas in-vivo. Raters accurately and consistently recognized nCLE-granuloma criteria. nCLE can be used to recognize malignancy and granulomas in peripheral lung nodules
{"title":"Needle based confocal laser endomicroscopy for real-time granuloma detection","authors":"Tess Kramer, Saskia Van Heumen, Lizzy Wijmans, Christopher Manley, Sandeep Bansal, Dawn Jeannerat, Martijn De Bruin, Peter Bonta, Jouke Annema","doi":"10.1183/13993003.congress-2023.pa4005","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4005","url":null,"abstract":"<b>Introduction:</b> Needle based confocal laser endomicroscopy (nCLE) allows real-time microscopic imaging at the needle tip. nCLE malignancy criteria are validated and used for bronchoscopic lung nodule detection. To date, nCLE granuloma criteria are not validated. <b>Aim:</b> assess the accuracy, inter-observer agreement (IOA) and intra-observer reliability (IOR) of nCLE granuloma detection <b>Methods:</b> In patients with suspected sarcoidosis, nCLE-imaging of mediastinal lymph nodes was performed during endoscopic ultrasound procedures, followed by needle aspiration. nCLE-videos were compared to final diagnoses for granuloma criteria identification. Blinded raters, trained in nCLE granuloma criteria, validated nCLE videos of reactive and sarcoid lymph nodes. In patients with granulomatous lung nodules, bronchoscopic nCLE-imaging was performed. <b>Results:</b> Five blinded raters evaluated 26 nCLE-videos of lymph nodes (n=15 sarcoid; n=11 reactive) of 19 patients twice (260 ratings). Granuloma criteria were recognized with 88.7% sensitivity and 87.3% specificity. The IOA (κ=0.63, 95%CI 0.54-0.72) and IOR (κ=0.70 ±0.06) were substantial. In 4 patients with granulomatous lung nodules similar nCLE criteria were observed. <b>Conclusion:</b> nCLE imaging of lymph nodes and nodules is able to visualize granulomas in-vivo. Raters accurately and consistently recognized nCLE-granuloma criteria. nCLE can be used to recognize malignancy and granulomas in peripheral lung nodules","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The rare but disturbing consequence of the severe COVID-19 pneumonia is progressive degradation of lung tissue as bullous-emphysematous changes or vanishing lung syndrome (VLS). Aim: to investigate the CT characteristics of vanishing lung syndrome in patients (pts) after severe COVID-19 pneumonia. Methods. 67 pts who suffered severe pneumonia during the acute period of COVID-19 and need repeated hospital admission due to respiratory failure in the term 3–6 month after disease start were examined. All pts underwent CT scan. CT scans of pts with VLS were analyzed. Results. VLS was revealed in 16 (12 (75%) men) from 67 pts aged 31 to 68 (52.6±3.3) years. The CT characteristics are shown in Table 1. Table 1. VLS CT scan changes and their frequency (n, %) Conclusion: After severe COVID-19 pneumonia not only GGO, ILST, fibrosis-like changes and lung consolidation, but the VLS occurs. Mainly VLS appears as the multiple bullas, solitary bullas and rare as bullous emphysema with diameter more 30 mm in a half of cases. The threatening complication of VLC is pneumothorax.
{"title":"Computed tomography (CT) characteristics of vanishing lung syndrome in patients after severe COVID-19 pneumonia","authors":"Yurii Feshchenko, Viktoria Ignatieva, Mykola Lynnyk, Galyna Gumeniuk, Mykola Gumeniuk, Maryna Polianska, Svitlana Opimakh, Nataliia Musienko","doi":"10.1183/13993003.congress-2023.pa3531","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa3531","url":null,"abstract":"<b>Background:</b> The rare but disturbing consequence of the severe COVID-19 pneumonia is progressive degradation of lung tissue as bullous-emphysematous changes or vanishing lung syndrome (VLS). Aim: to investigate the CT characteristics of vanishing lung syndrome in patients (pts) after severe COVID-19 pneumonia. Methods. 67 pts who suffered severe pneumonia during the acute period of COVID-19 and need repeated hospital admission due to respiratory failure in the term 3–6 month after disease start were examined. All pts underwent CT scan. CT scans of pts with VLS were analyzed. Results. VLS was revealed in 16 (12 (75%) men) from 67 pts aged 31 to 68 (52.6±3.3) years. The CT characteristics are shown in Table 1. Table 1. VLS CT scan changes and their frequency (n, %) <b>Conclusion:</b> After severe COVID-19 pneumonia not only GGO, ILST, fibrosis-like changes and lung consolidation, but the VLS occurs. Mainly VLS appears as the multiple bullas, solitary bullas and rare as bullous emphysema with diameter more 30 mm in a half of cases. The threatening complication of VLC is pneumothorax.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa4004
AMER ALMAGHRABI, Ali Bahron, Julie Marsh, Adel Mansur
Background: CT scan of thorax often forms part of the diagnostic algorithm of difficult to treat asthma (DTA). However its diagnostic value and effect on patient management remained largely undetermined. Aim: To assess the diagnostic value of CT-Thorax in the management of DTA. Methods: Unselected patients with DTA presenting to a tertiary severe asthma centre were put through a systematic assessment protocol and undertook high resolution CT-thorax. Radiological diagnoses in addition to demographics and asthma related clinical outcomes were explored using standard statistics. Results: A cohort of 290 patients were included in the study (mean age 51±14.2 years, 62.1% females, Caucasians 74.8%, non-smokers 57.8%, BMI 31.7±7.6 kg, ACQ6 2.9±1.6, %predicted FEV 1 72.8±26, FeNO 51.62±44.8 ppb, blood eosinophils 452±459 cell/µl, severe exacerbations 5.9±4.3 per annum, maintenance oral corticosteroids 30%). The observed CT abnormalities were bronchial wall thickening 76.1%, bronchiectasis 49.4%, ground-glass 34.7%, mucus plugging 28.1%, air-trapping 29.2%, central bronchiectasis 7.2%, emphysema 5.5%, in addition to other less common diagnoses (e.g. eosinophilic pneumonia). We observed no significant difference between the bronchiectasis and non-bronchiectasis groups in terms of annual severe exacerbations (7.1±5.1 vs 6.0±3.9, p=0.1 respectively), lung function, blood eosinophils or FeNO. Conclusions: Radiological abnormalities were prevalent in DTA patients and may have impact on patient management prompting the need to consider CT-thorax as an integral part of DTA diagnostic algorithm. Further results on dynamic CT findings will be provided in the conference.
{"title":"The clinical significance of CT-Thorax in the assessment of difficult to treat Asthma","authors":"AMER ALMAGHRABI, Ali Bahron, Julie Marsh, Adel Mansur","doi":"10.1183/13993003.congress-2023.pa4004","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4004","url":null,"abstract":"<b>Background:</b> CT scan of thorax often forms part of the diagnostic algorithm of difficult to treat asthma (DTA). However its diagnostic value and effect on patient management remained largely undetermined. <b>Aim:</b> To assess the diagnostic value of CT-Thorax in the management of DTA. <b>Methods:</b> Unselected patients with DTA presenting to a tertiary severe asthma centre were put through a systematic assessment protocol and undertook high resolution CT-thorax. Radiological diagnoses in addition to demographics and asthma related clinical outcomes were explored using standard statistics. <b>Results:</b> A cohort of 290 patients were included in the study (mean age 51±14.2 years, 62.1% females, Caucasians 74.8%, non-smokers 57.8%, BMI 31.7±7.6 kg, ACQ6 2.9±1.6, %predicted FEV 1 72.8±26, FeNO 51.62±44.8 ppb, blood eosinophils 452±459 cell/µl, severe exacerbations 5.9±4.3 per annum, maintenance oral corticosteroids 30%). The observed CT abnormalities were bronchial wall thickening 76.1%, bronchiectasis 49.4%, ground-glass 34.7%, mucus plugging 28.1%, air-trapping 29.2%, central bronchiectasis 7.2%, emphysema 5.5%, in addition to other less common diagnoses (e.g. eosinophilic pneumonia). We observed no significant difference between the bronchiectasis and non-bronchiectasis groups in terms of annual severe exacerbations (7.1±5.1 vs 6.0±3.9, p=0.1 respectively), lung function, blood eosinophils or FeNO. <b>Conclusions:</b> Radiological abnormalities were prevalent in DTA patients and may have impact on patient management prompting the need to consider CT-thorax as an integral part of DTA diagnostic algorithm. Further results on dynamic CT findings will be provided in the conference.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136260808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rationale: To date, there is limited evidence of the effects of bronchodilators on the respiratory dynamics in chronic obstructive pulmonary disease (COPD). Dynamic chest radiography (DCR) is a novel radiographic modality that provides real-time, objective, and quantifiable kinetic data, including changes in the lung area, diaphragm kinetics, and pulmonary ventilation during respiration, at a lower radiation dose than fluoroscopic or computed tomography imaging. Aim: This study aims to evaluate the effects of bronchodilator therapy on the respiratory kinetics in patients with COPD using DCR. Methods: This is an open-label, prospective, single-center, comparative study. A total of 35 patients with COPD, aged 40-85 years, with a forced expiratory volume in the first second of 30-80% will be enrolled. After a 2-week washout period, patients will receive tiotropium/olodaterol therapy for 6 weeks. Treatment effects will be evaluated based on DCR, pulmonary function tests, and patient-related outcomes obtained before and after treatment. The primary endpoint is the change in lung area during respiration as evaluated by DCR after the treatment. Secondary endpoints include differences in other DCR parameters (diaphragm kinetics, tracheal diameter change, and maximum pixel value change rate), pulmonary function test results, and patient-related outcomes between pre- and post-therapy. All adverse events will be reported. Conclusions: The EMBODY study is the first to evaluate the effects of bronchodilator therapy on the respiratory kinetics in COPD using DCR. The study could provide additional evidence of the potential of DCR for evaluating COPD therapy.
{"title":"Dynamic chest radiography evaluation of the effects of tiotropium/olodaterol combination therapy in COPD: EMBODY study protocol","authors":"Jun Ikari, Megumi Katsumata, Takuro Imamoto, Yuri Suzuki, Akira Nishiyama, Hajime Yokota, Yoshihito Ozawa, Eiko Suzuki, Naoko Kawata, Seiichiro Sakao, Koichiro Tatsumi, Takuji Suzuki","doi":"10.1183/13993003.congress-2023.pa2281","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa2281","url":null,"abstract":"<b>Rationale:</b> To date, there is limited evidence of the effects of bronchodilators on the respiratory dynamics in chronic obstructive pulmonary disease (COPD). Dynamic chest radiography (DCR) is a novel radiographic modality that provides real-time, objective, and quantifiable kinetic data, including changes in the lung area, diaphragm kinetics, and pulmonary ventilation during respiration, at a lower radiation dose than fluoroscopic or computed tomography imaging. <b>Aim:</b> This study aims to evaluate the effects of bronchodilator therapy on the respiratory kinetics in patients with COPD using DCR. <b>Methods:</b> This is an open-label, prospective, single-center, comparative study. A total of 35 patients with COPD, aged 40-85 years, with a forced expiratory volume in the first second of 30-80% will be enrolled. After a 2-week washout period, patients will receive tiotropium/olodaterol therapy for 6 weeks. Treatment effects will be evaluated based on DCR, pulmonary function tests, and patient-related outcomes obtained before and after treatment. The primary endpoint is the change in lung area during respiration as evaluated by DCR after the treatment. Secondary endpoints include differences in other DCR parameters (diaphragm kinetics, tracheal diameter change, and maximum pixel value change rate), pulmonary function test results, and patient-related outcomes between pre- and post-therapy. All adverse events will be reported. <b>Conclusions:</b> The EMBODY study is the first to evaluate the effects of bronchodilator therapy on the respiratory kinetics in COPD using DCR. The study could provide additional evidence of the potential of DCR for evaluating COPD therapy.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"147 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136194848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa4010
Zuzana Šestáková, Jiri Votruba, Tomas Bruha
Introduction: An accurate diagnosis of interstitial lung disease (ILD) and its severity is crucial for both prognosis and treatment. Aims and objectives: We have attempted to correlate lung tissue density in HU for patients with ILD based on HRCT scans with average absorption of NIR in lung parenchyma measured during bronchoscopy examination. Methods: We have designed the optical probe for measurement of penetrated NIR through the lung tissue. It consists of two fibres contained in one bundle where the indicator fibre is 0.3 cm longer. We have evaluated data form 12 patients with different degree of ILD aged 48-81 years. During bronchoscopy the probe was inserted to the airways via working channel and resulting spectral curve of transmitted NIR in diagnostic window (620-700 nm) was detected. Measured signal was normalised to master signal and based on obtained value and known optical pathlenght, local absorption coefficient was calculated. Average parenchymal density value has been calculated from standard HRCT scans at target lobes. Results: Obtained values for 12 ILD patients showed regression curve with clear linear trend and satisfying correlation R2=0,931 (Figure 1). Conclusions: We proved that our novel method enables to measure lung parenchymal density in real time during bronchoscopic examination and results are in good correlation with CT densitometry.
{"title":"Endoscopic measurement of parenchymal near infrared radiation transmittance correlates with HRCT derived lung tissue density in lung fibrosis patients.","authors":"Zuzana Šestáková, Jiri Votruba, Tomas Bruha","doi":"10.1183/13993003.congress-2023.pa4010","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4010","url":null,"abstract":"<b>Introduction:</b> An accurate diagnosis of interstitial lung disease (ILD) and its severity is crucial for both prognosis and treatment. <b>Aims and objectives:</b> We have attempted to correlate lung tissue density in HU for patients with ILD based on HRCT scans with average absorption of NIR in lung parenchyma measured during bronchoscopy examination. <b>Methods:</b> We have designed the optical probe for measurement of penetrated NIR through the lung tissue. It consists of two fibres contained in one bundle where the indicator fibre is 0.3 cm longer. We have evaluated data form 12 patients with different degree of ILD aged 48-81 years. During bronchoscopy the probe was inserted to the airways via working channel and resulting spectral curve of transmitted NIR in diagnostic window (620-700 nm) was detected. Measured signal was normalised to master signal and based on obtained value and known optical pathlenght, local absorption coefficient was calculated. Average parenchymal density value has been calculated from standard HRCT scans at target lobes. <b>Results:</b> Obtained values for 12 ILD patients showed regression curve with clear linear trend and satisfying correlation R2=0,931 (Figure 1). <b>Conclusions:</b> We proved that our novel method enables to measure lung parenchymal density in real time during bronchoscopic examination and results are in good correlation with CT densitometry.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa3542
Filip Popović, Marta Koršić, Fran Seiwerth, Sonja Badovinac, Lela Bitar, Marko Jakopović, Miroslav Samaržija
Background: The etiology of exudative pleural effusion (EPE) is challenging in clinical practice, with malignancy often being suspected. Computerized tomography (CT) is reported to have a high sensitivity and specificity for determining etiology, especially in cases of suspected malignant disease and preparation for medical thoracoscopy (MT). Aims: To investigate the role of CT in the detection of malignant pleural disease before a more invasive approach in patients with EPE of undetermined etiology. Methods: Between November 2020 and December 2022, a retrospective review of MT procedures was conducted at the University hospital centre Zagreb. Forty-two patients with EPE of undetermined etiology underwent chest CT scan with contrast. CT report was evaluated for signs of malignancy by an independent radiologist. Results: Patohistological diagnosis of malignancy was determined in 29 (69 %) cases, predominantly: mesothelioma 15 (35,7 %), non-small cell lung cancer 9 (21,4 %), non-Hodgkin lymphoma 3 (7,1 %) and metastatic breast cancer 2 (4,8 %). Non-malignant causes of pleural effusion were 1 case of (2,4 %) amyloidosis and inflammatory pleuritis in 12 (28,6 %) cases. CT with malignant findings was reported in 26 cases with a sensitivity of 68.9 % and specificity of 53.8 %. Of the 16 CT scans without malignant characteristics, 9 (56,3 %) cases were false negative, and 7 (43,7 %) were reported with no signs of malignancy. Conclusion: Although our study shows lower CT sensitivity and specificity for diagnosing pleural diseases than other studies, CT still represents a necessary diagnostic tool in pleural space evaluation and preparation for MT.
{"title":"Computerized tomography evaluation of pleural effusion before medical thoracoscopy","authors":"Filip Popović, Marta Koršić, Fran Seiwerth, Sonja Badovinac, Lela Bitar, Marko Jakopović, Miroslav Samaržija","doi":"10.1183/13993003.congress-2023.pa3542","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa3542","url":null,"abstract":"<b>Background:</b> The etiology of exudative pleural effusion (EPE) is challenging in clinical practice, with malignancy often being suspected. Computerized tomography (CT) is reported to have a high sensitivity and specificity for determining etiology, especially in cases of suspected malignant disease and preparation for medical thoracoscopy (MT). <b>Aims:</b> To investigate the role of CT in the detection of malignant pleural disease before a more invasive approach in patients with EPE of undetermined etiology. <b>Methods:</b> Between November 2020 and December 2022, a retrospective review of MT procedures was conducted at the University hospital centre Zagreb. Forty-two patients with EPE of undetermined etiology underwent chest CT scan with contrast. CT report was evaluated for signs of malignancy by an independent radiologist. <b>Results:</b> Patohistological diagnosis of malignancy was determined in 29 (69 %) cases, predominantly: mesothelioma 15 (35,7 %), non-small cell lung cancer 9 (21,4 %), non-Hodgkin lymphoma 3 (7,1 %) and metastatic breast cancer 2 (4,8 %). Non-malignant causes of pleural effusion were 1 case of (2,4 %) amyloidosis and inflammatory pleuritis in 12 (28,6 %) cases. CT with malignant findings was reported in 26 cases with a sensitivity of 68.9 % and specificity of 53.8 %. Of the 16 CT scans without malignant characteristics, 9 (56,3 %) cases were false negative, and 7 (43,7 %) were reported with no signs of malignancy. <b>Conclusion:</b> Although our study shows lower CT sensitivity and specificity for diagnosing pleural diseases than other studies, CT still represents a necessary diagnostic tool in pleural space evaluation and preparation for MT.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa4003
Hailan Liu, Daiwei Han, Marleen Vonder, Marjolein Heuvelmans, Jaeyoun Yi, Zhaoxiang Ye, Harry De Koning, Matthijs Oudkerk
Introduction: Visual CT emphysema scoring has been shown to improve the prediction of lung cancer mortality and COPD death, but optimal Hounsfield unit (HU) threshold for emphysema detection has not been determined for lung cancer screening (LCS) subjects. Objectives: To find the optimal HU threshold for the early detection of emphysema in a low dose CT (LDCT) LCS dataset. Methods: 352 participants were selected from a LCS dataset with LDCT using Definition AS, at inspiration in spiral mode at 120 kVp and 35 mAs. Images were reconstructed with B30f kernel at 2.0/1.0 mm thickness. Emphysema was quantified below a range of HU thresholds from −900 to −1,024 HU, while excluding the vessels and bronchus. One radiologist (reader A) and two trainees (reader B and C) visually scored emphysema according to the Fleischner criteria. Kappa statistics, Spearman analysis and ROC (Receiver operating characteristic) are used to assess the correlation between quantified emphysema under different HU thresholds and visual emphysema. Results: High agreement in the detection of emphysema was found (Kappa: 0.728 – 0.835). The spearman analysis demonstrated that emphysema volume under different thresholds is significantly correlated to the visual classification (P<0,05). ROC showed -1000 HU to be optimal for discrimination between normal and emphysematous lung parenchyma when correlated to visual scoring for all readers, by excluding all influence of noise on voxel quantification. Despite of noise correction, the emphysema voxel counting suffers from this threshold. Conclusions: The optimal threshold for noise cancelation in emphysema quantification was established to be -1000 HU in a LDCT LCS dataset.
{"title":"Optimized detection of pulmonary emphysema on CT scans of lung cancer screening participants","authors":"Hailan Liu, Daiwei Han, Marleen Vonder, Marjolein Heuvelmans, Jaeyoun Yi, Zhaoxiang Ye, Harry De Koning, Matthijs Oudkerk","doi":"10.1183/13993003.congress-2023.pa4003","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4003","url":null,"abstract":"<b>Introduction:</b> Visual CT emphysema scoring has been shown to improve the prediction of lung cancer mortality and COPD death, but optimal Hounsfield unit (HU) threshold for emphysema detection has not been determined for lung cancer screening (LCS) subjects. <b>Objectives:</b> To find the optimal HU threshold for the early detection of emphysema in a low dose CT (LDCT) LCS dataset. <b>Methods:</b> 352 participants were selected from a LCS dataset with LDCT using Definition AS, at inspiration in spiral mode at 120 kVp and 35 mAs. Images were reconstructed with B30f kernel at 2.0/1.0 mm thickness. Emphysema was quantified below a range of HU thresholds from −900 to −1,024 HU, while excluding the vessels and bronchus. One radiologist (reader A) and two trainees (reader B and C) visually scored emphysema according to the Fleischner criteria. Kappa statistics, Spearman analysis and ROC (Receiver operating characteristic) are used to assess the correlation between quantified emphysema under different HU thresholds and visual emphysema. <b>Results:</b> High agreement in the detection of emphysema was found (Kappa: 0.728 – 0.835). The spearman analysis demonstrated that emphysema volume under different thresholds is significantly correlated to the visual classification (P<0,05). ROC showed -1000 HU to be optimal for discrimination between normal and emphysematous lung parenchyma when correlated to visual scoring for all readers, by excluding all influence of noise on voxel quantification. Despite of noise correction, the emphysema voxel counting suffers from this threshold. <b>Conclusions:</b> The optimal threshold for noise cancelation in emphysema quantification was established to be -1000 HU in a LDCT LCS dataset.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2019, around 10 million people were diagnosed with tuberculosis worldwide, resulting in 1.2 million deaths (WHO, 2020). Among imaging methods, chest X-ray (CXR) is the choice for the initial assessment of pulmonary tuberculosis (PTB). Recent advancement in the field of artificial intelligence has stimulated studies evaluating the performance of machine learning (ML) for medical diagnosis. This study aimed to validate a new original Brazilian tool, titled xmarTB, applied to CXR images to support the diagnosis of pulmonary tuberculosis (PTB). The model was trained on 3800 normal images, 3800 altered without PTB and 1376 with manifestations of PTB, from the publicly available TBX11K database. The binary classification model could distinguish between normal and abnormal CXR with a sensitivity of 99.42% and specificity of 99.40%. To detect cases of tuberculosis among CXR with alterations, the xmarTB tool obtained a sensitivity of 98.11% and a specificity of 99.74%. Therefore, applying this diagnostic tool to CXR images can accurately and automatically detect abnormal radiographs and differentiate pulmonary tuberculosis from other pulmonary diseases satisfactorily. This tool offers great potential to assist the diagnosis made by the radiologist, offering more certainty and agility, thus increasing the excellence of the professional9s performance. As emphasized by the European Society of Radiology (ESR. Insights Imaging 2022; 13:43), diagnostic ML should not replace radiologists, since beyond the diagnosis there is still the need for patient communication and interaction, human judgment for intervention and treatment, quality control, continued education and policy formulation.
{"title":"Machine learning applied to chest x-rays to support the diagnosis of pulmonary tuberculosis","authors":"Marcelo Fouad Rabahi, Poliana Parreira, Afonso Fonseca, Fabrizzio Soares, Marcus Barreto Conte","doi":"10.1183/13993003.congress-2023.pa2288","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa2288","url":null,"abstract":"In 2019, around 10 million people were diagnosed with tuberculosis worldwide, resulting in 1.2 million deaths (WHO, 2020). Among imaging methods, chest X-ray (CXR) is the choice for the initial assessment of pulmonary tuberculosis (PTB). Recent advancement in the field of artificial intelligence has stimulated studies evaluating the performance of machine learning (ML) for medical diagnosis. This study aimed to validate a new original Brazilian tool, titled xmarTB, applied to CXR images to support the diagnosis of pulmonary tuberculosis (PTB). The model was trained on 3800 normal images, 3800 altered without PTB and 1376 with manifestations of PTB, from the publicly available TBX11K database. The binary classification model could distinguish between normal and abnormal CXR with a sensitivity of 99.42% and specificity of 99.40%. To detect cases of tuberculosis among CXR with alterations, the xmarTB tool obtained a sensitivity of 98.11% and a specificity of 99.74%. Therefore, applying this diagnostic tool to CXR images can accurately and automatically detect abnormal radiographs and differentiate pulmonary tuberculosis from other pulmonary diseases satisfactorily. This tool offers great potential to assist the diagnosis made by the radiologist, offering more certainty and agility, thus increasing the excellence of the professional9s performance. As emphasized by the European Society of Radiology (ESR. Insights Imaging 2022; 13:43), diagnostic ML should not replace radiologists, since beyond the diagnosis there is still the need for patient communication and interaction, human judgment for intervention and treatment, quality control, continued education and policy formulation.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136200809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa2287
So Ri Kim, Nguyen Quoc Hung, Kum Ju Chae, Gong Yong Jin, Sanghun Choi
Spirometric parameters in pulmonary function test (PFT) can provide information on fixed airflow obstruction (FAO) usually associated with difficulty in treatment, an accelerated decline in lung function, and excess morbidity in asthmatic patients. Recently, quantitative computed tomography (QCT) and its post-processing become a useful tools to derive more detailed airway structure, parenchymal function, as well as computational flow features. In this study, we aimed to demonstrate structural and functional differences between asthma with FAO and asthma without FAO. Two sets of the QCT images of asthmatic patients without FAO (group A, N=40) and with FAO (group B, N=12) were employed. Structural and functional QCT-derived variables of airways were extracted to assess lung function. A one-dimensional (1D) computational fluid dynamics (CFD) model considering airway deformation was applied to compare the pressure distribution and hysteresis curve between the two groups. For QCT-derived structures, the airway wall in small regions was thicker in group B during inspiration. The 1D CFD-derived pressures showed strong correlations with the PFT-based metrics, while QCT-derived structural variables were not correlated. The computational pressure indicated that the narrowed airways of Group B caused a greater pressure drop and workload during breathing. In conclusion, asthmatics with and without FAO showed different lung functions, airway structures, and pressure distribution in small airways which may improve our understanding of the irreversible airway obstructive mechanism and aid in the development of future therapies for this type of disease.
{"title":"Computational fluid dynamics analysis of computed tomography images in asthma","authors":"So Ri Kim, Nguyen Quoc Hung, Kum Ju Chae, Gong Yong Jin, Sanghun Choi","doi":"10.1183/13993003.congress-2023.pa2287","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa2287","url":null,"abstract":"Spirometric parameters in pulmonary function test (PFT) can provide information on fixed airflow obstruction (FAO) usually associated with difficulty in treatment, an accelerated decline in lung function, and excess morbidity in asthmatic patients. Recently, quantitative computed tomography (QCT) and its post-processing become a useful tools to derive more detailed airway structure, parenchymal function, as well as computational flow features. In this study, we aimed to demonstrate structural and functional differences between asthma with FAO and asthma without FAO. Two sets of the QCT images of asthmatic patients without FAO (group A, N=40) and with FAO (group B, N=12) were employed. Structural and functional QCT-derived variables of airways were extracted to assess lung function. A one-dimensional (1D) computational fluid dynamics (CFD) model considering airway deformation was applied to compare the pressure distribution and hysteresis curve between the two groups. For QCT-derived structures, the airway wall in small regions was thicker in group B during inspiration. The 1D CFD-derived pressures showed strong correlations with the PFT-based metrics, while QCT-derived structural variables were not correlated. The computational pressure indicated that the narrowed airways of Group B caused a greater pressure drop and workload during breathing. In conclusion, asthmatics with and without FAO showed different lung functions, airway structures, and pressure distribution in small airways which may improve our understanding of the irreversible airway obstructive mechanism and aid in the development of future therapies for this type of disease.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"175 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa2278
Sarah Scharm, Cornelia Schaefer-Prokop, Anton Schreuder, Jonathan Ehmig, Jan Fuge, Frank Wacker, Antje Prasse, Hoen-Oh Shin
To determine whether alveolar collapse, defined as an abnormal increase in CT attenuation during expiration, can be detected using paired attenuation histograms in inspiration and expiration and used as a potential predictive marker in IPF patients. Methods Sixty-six individuals with IPF obtained CT scans during inspiration and expiration. Density histograms were created and analyzed. After each respective 3-year observation period, the patient population was split into two subgroups according to their status (endpoints: death/transplantation vs still under clinical surveillance). An independent t-test was used to compare the CT-derived histogram parameters of attenuation between the two subgroups (ratio of mean attenuation in expiration/inspiration (meanHUratio) and SD, skewness and kurtosis in expiration). Results After the individual observation period of 3 years, 37 patients were still under clinical surveillance while 29 had died or received a transplantation. All baseline characteristics (meanHUratio and SD, skewness and kurtosis of expiratory attenuation histograms) were significantly different between the subgroups (p = 0.004, p = 0.009, p < 0.001 and p < 0.001, respectively). Conclusion Expiratory attenuation histogram analysis can be used to demonstrate the concept of alveolar collapse as a potential prognostic marker in IPF patients.
为了确定肺泡塌陷(定义为呼气时CT衰减异常增加)是否可以通过吸气和呼气时的配对衰减直方图检测到，并将其作为IPF患者的潜在预测指标。,方法对66例IPF患者进行吸气和呼气CT扫描。创建密度直方图并进行分析。在每个3年的观察期后，根据患者的状态(终点:死亡/移植vs仍在临床监测中)将患者人群分为两个亚组。采用独立t检验比较两亚组间ct直方图衰减参数(呼气/吸气平均衰减比(meanHUratio)和SD、呼气偏度和峰度)。结果经过3年的个体观察期，37例患者仍在临床观察中，29例患者死亡或接受移植。所有基线特征(呼气衰减直方图的平均比值和标准差、偏度和峰度)在亚组之间均有显著差异(p = 0.004, p = 0.009, p <0.001和p <分别为0.001)。,结论呼气衰减直方图分析可以证明肺泡塌陷是IPF患者潜在的预后指标。
{"title":"CT-based assessment of alveolar collapse using attenuation histograms in inspiration and expiration: Evaluation as a prognostic imaging marker in IPF patients","authors":"Sarah Scharm, Cornelia Schaefer-Prokop, Anton Schreuder, Jonathan Ehmig, Jan Fuge, Frank Wacker, Antje Prasse, Hoen-Oh Shin","doi":"10.1183/13993003.congress-2023.pa2278","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa2278","url":null,"abstract":"To determine whether alveolar collapse, defined as an abnormal increase in CT attenuation during expiration, can be detected using paired attenuation histograms in inspiration and expiration and used as a potential predictive marker in IPF patients. Methods Sixty-six individuals with IPF obtained CT scans during inspiration and expiration. Density histograms were created and analyzed. After each respective 3-year observation period, the patient population was split into two subgroups according to their status (endpoints: death/transplantation vs still under clinical surveillance). An independent t-test was used to compare the CT-derived histogram parameters of attenuation between the two subgroups (ratio of mean attenuation in expiration/inspiration (meanHUratio) and SD, skewness and kurtosis in expiration). <b>Results</b> After the individual observation period of 3 years, 37 patients were still under clinical surveillance while 29 had died or received a transplantation. All baseline characteristics (meanHUratio and SD, skewness and kurtosis of expiratory attenuation histograms) were significantly different between the subgroups (p = 0.004, p = 0.009, p < 0.001 and p < 0.001, respectively). Conclusion Expiratory attenuation histogram analysis can be used to demonstrate the concept of alveolar collapse as a potential prognostic marker in IPF patients.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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