Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.oa4857
Laura Saunders, Guilhem Collier, Ho-Fung Chan, Paul Hughes, Laurie Smith, Helen Marshall, Martin Brook, Alberto Biancardi, Madhwesha Rao, Graham Norquay, Neil Stewart, James Grist, Kher Lik Ng, Amanda Goodwin, Jonathan Brooke, Galina Pavlovskaya, Iain Stewart, Andrew Swift, Smitha Rajaram, Phil Molyneaux, Kevin Johnson, Joseph Jacob, Fergus Gleeson, Ian Hall, Thomas Meersmann, Ling-Pei Ho, A A Roger Thompson, Gisli Jenkins, Jim Wild
Introduction: Interstitial lung changes persist in some patients after COVID-19 hospitalisation. Aim: To characterise longitudinal pulmonary changes due to COVID-19 using 129Xe and 1H MRI. Methods: Patients with abnormal CT or 1H MRI underwent MRI and PFTs up to 106 weeks after hospitalisation. MRI protocol: 129Xe gas transfer (key metric: red blood cell to membrane fraction, RBC:M), 129Xe ventilation, lung perfusion and structural imaging. Longitudinal comparisons (24 vs 52 weeks) and correlations were assessed using Wilcoxon Signed Rank and Spearman9s rank. Results: 23 patients (median age: 68(range: 53-78) years, 87% male) underwent MRI at 23(6-33)(n=13), 54(42-71)(n=18) and 106(98-117)(n=7) weeks after hospital admission. Patients had decreased RBC: M compared to older controls and low transfer factor Z-score at 24, 52 and 106 weeks (median TLCOz<-2.2 at all visits). Ventilation defect percentage was <6% for all patients. There was no longitudinal change (n=8) in 129Xe gas transfer or TLCOz between 24 and 52 weeks. There was a significant decrease in FEV1/FVC Z-score and an increase in FVC Z-score (p=0.018; p=0.043). At 24 and 52 weeks, RBC:M correlated with TLCOz (r=0.661, p=0.038; r=0.709, p=0.015). Conclusion: Xenon gas transfer remains impaired two years post hospitalisation in this cohort. Fig 1: RBC:M alongside healthy control data (57(41-68)years, 67% male).
导语:部分患者在COVID-19住院后肺间质性改变持续存在。目的:利用129Xe和1H MRI表征COVID-19引起的纵向肺改变。方法:CT或1H MRI异常患者在住院后106周进行MRI和PFTs检查。MRI方案:129Xe气体转移(关键指标:红细胞到膜分数，RBC:M)， 129Xe通气，肺灌注和结构成像。纵向比较(24周vs 52周)和相关性采用Wilcoxon sign Rank和spearmans Rank进行评估。结果:23例患者(中位年龄:68(范围:53-78)岁，87%男性)在入院后23(6-33)周(n=13)、54(42-71)周(n=18)和106(98-117)周(n=7)行MRI检查。与老年对照组相比，患者在24周、52周和106周时RBC: M下降，转移因子z评分较低(每次就诊时tlcoz的中位数为-2.2)。所有患者的通气缺陷率为6%。在24周和52周之间，129Xe气体传递或TLCOz没有纵向变化(n=8)。FEV1/FVC z -评分显著降低，FVC z -评分显著升高(p=0.018;p = 0.043)。24周和52周时，RBC:M与TLCOz相关(r=0.661, p=0.038;r = 0.709, p = 0.015)。结论:在该队列中，氙气转移在住院两年后仍然受损。图1:RBC:M与健康对照数据(57(41-68)岁，67%为男性)。
{"title":"Impaired xenon gas transfer observed two years after COVID-19 hospitalisation in patients with signs of interstitial lung disease","authors":"Laura Saunders, Guilhem Collier, Ho-Fung Chan, Paul Hughes, Laurie Smith, Helen Marshall, Martin Brook, Alberto Biancardi, Madhwesha Rao, Graham Norquay, Neil Stewart, James Grist, Kher Lik Ng, Amanda Goodwin, Jonathan Brooke, Galina Pavlovskaya, Iain Stewart, Andrew Swift, Smitha Rajaram, Phil Molyneaux, Kevin Johnson, Joseph Jacob, Fergus Gleeson, Ian Hall, Thomas Meersmann, Ling-Pei Ho, A A Roger Thompson, Gisli Jenkins, Jim Wild","doi":"10.1183/13993003.congress-2023.oa4857","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.oa4857","url":null,"abstract":"<b>Introduction:</b> Interstitial lung changes persist in some patients after COVID-19 hospitalisation. <b>Aim:</b> To characterise longitudinal pulmonary changes due to COVID-19 using <sup>129</sup>Xe and <sup>1</sup>H MRI. <b>Methods:</b> Patients with abnormal CT or <sup>1</sup>H MRI underwent MRI and PFTs up to 106 weeks after hospitalisation. MRI protocol: <sup>129</sup>Xe gas transfer (key metric: red blood cell to membrane fraction, RBC:M), <sup>129</sup>Xe ventilation, lung perfusion and structural imaging. Longitudinal comparisons (24 vs 52 weeks) and correlations were assessed using Wilcoxon Signed Rank and Spearman9s rank. <b>Results:</b> 23 patients (median age: 68(range: 53-78) years, 87% male) underwent MRI at 23(6-33)(n=13), 54(42-71)(n=18) and 106(98-117)(n=7) weeks after hospital admission. <b>Patients had decreased RBC:</b> M compared to older controls and low transfer factor Z-score at 24, 52 and 106 weeks (median TLCOz<-2.2 at all visits). Ventilation defect percentage was <6% for all patients. There was no longitudinal change (n=8) in <sup>129</sup>Xe gas transfer or TLCOz between 24 and 52 weeks. There was a significant decrease in FEV1/FVC Z-score and an increase in FVC Z-score (p=0.018; p=0.043). At 24 and 52 weeks, RBC:M correlated with TLCOz (r=0.661, p=0.038; r=0.709, p=0.015). <b>Conclusion:</b> Xenon gas transfer remains impaired two years post hospitalisation in this cohort. <b>Fig 1:</b> RBC:M alongside healthy control data (57(41-68)years, 67% male).","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":"136201024","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.pa4002
Tim Jonas Hallenberger, Meropi Karakioulaki, Desiree Schumann, Michael Tamm, Daiana Stolz, Eleni Papakonstantinou
Introduction: Lung volume reduction (LVR) is a therapeutic option for patients with advanced heterogeneous lung emphysema in COPD. We compared the extent of emphysema as assessed by two current standard methods: high-resolution computed tomography (HRCT) analysed by StratX® software and single photon emission computed tomography (SPECT). Method: Patients evaluated for LVR were considered for inclusion. The primary endpoint was the qualitative and quantitative discordance on the extent of tissue destruction per lobe as assessed by perfusion (SPECT) and voxel density (StratX®). Secondary outcomes were the evaluation of fissure completeness by StratX® and an improvement in lung function test (LFT) after LVR. Results: We included 164 patients in this study. Qualitative discordance occurred in 29.3% patients, mainly in the RUL and was more severely rated by SPECT. Quantitative discordance was highest in the RUL (20.16±35.49%). The highest fissure completeness was measured between the LUL and LLL (91.61±12.46%). After LVR, there was a significant improvement in RV, TLC and FEV1 (all p<0.001) and in 50% of patients there was a significant improvement in at least one LFT parameter. However, seven patients showed no improvement in any LFT parameter. Conclusion: In this study we demonstrated that there is a discordance regarding the estimation of emphysema extent in at least one lobe in one third of patients evaluated for LVR with SPECT and HRCT/StratX®. Our results warrant direct comparison of SPECT and StratX® in terms of preoperative evaluation in a randomized controlled trial.
{"title":"Comparison of HRCT and SPECT in the estimation of emphysema heterogeneity for endoscopic lung volume reduction","authors":"Tim Jonas Hallenberger, Meropi Karakioulaki, Desiree Schumann, Michael Tamm, Daiana Stolz, Eleni Papakonstantinou","doi":"10.1183/13993003.congress-2023.pa4002","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4002","url":null,"abstract":"<b>Introduction:</b> Lung volume reduction (LVR) is a therapeutic option for patients with advanced heterogeneous lung emphysema in COPD. We compared the extent of emphysema as assessed by two current standard methods: high-resolution computed tomography (HRCT) analysed by StratX® software and single photon emission computed tomography (SPECT). Method: Patients evaluated for LVR were considered for inclusion. The primary endpoint was the qualitative and quantitative discordance on the extent of tissue destruction per lobe as assessed by perfusion (SPECT) and voxel density (StratX®). Secondary outcomes were the evaluation of fissure completeness by StratX® and an improvement in lung function test (LFT) after LVR. <b>Results:</b> We included 164 patients in this study. Qualitative discordance occurred in 29.3% patients, mainly in the RUL and was more severely rated by SPECT. Quantitative discordance was highest in the RUL (20.16±35.49%). The highest fissure completeness was measured between the LUL and LLL (91.61±12.46%). After LVR, there was a significant improvement in RV, TLC and FEV1 (all p<0.001) and in 50% of patients there was a significant improvement in at least one LFT parameter. However, seven patients showed no improvement in any LFT parameter. Conclusion: In this study we demonstrated that there is a discordance regarding the estimation of emphysema extent in at least one lobe in one third of patients evaluated for LVR with SPECT and HRCT/StratX®. Our results warrant direct comparison of SPECT and StratX® in terms of preoperative evaluation in a randomized controlled trial.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"38 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":"136201532","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.pa3540
Ignacio Fernández Ceballos, Julieta Gonzalez Anaya, Juan Martín Nuñez Silveira, Emilio Steinberg, Leiniker Navarro Rey, Gabriel Elias Vega, Ivan Huespe, Indalecio Carboni Bisso, Marcos Las Heras, Rodriogo Cornejo
Introduction: Bronchoalveolar lavage (BAL) is used in the diagnosis of pneumonia in patients with Mechanical Ventilation. Its performance involves the instillation of saline solution, which is associated with lung collapse and worsening hypoxemia. Positioning the patient9s head at 0° could increase the loss of lung volume and oxygenation. A therapeutic option to mitigate this effect could be to perform this procedure with head elevation at 30°. Aims and Objectives: The study aimed to assess changes in lung volumes in relation to the position of the patient9s head. Methods: Case series of 3 patients. End-expiratory Lung Impedance (EELI) measurements were performed (Pulmovista V500) in the following situations: Head at 30° before BAL, 0° before BAL, 0° post-BAL and 30° post-BAL. Results: In patients 1 and 2, the change of headrest from 30° to 0° before BAL resulted in an overall decrease in EELI (83.1% - 20.2%). Performing BAL increased the drop in EELI, with greater expression in the regions where BAL was performed. After BAL was completed, in both patients, the repositioning of the headrest to 30° produced an increase in global EELI without reaching the values obtained with the headrest at 30° before BAL (Patient 1 80.5% - Patiente 2 52.9%). In patient 3, the change of head position from 30° to 0° after BAL showed a 12.5% decrease in EELI. Performing BAL deepened the drop in overall EELI (-44.4%), as did repositioning the headrest to 30° (-70%) post-BAL. Conclusion: Changes in bedside positioning before BAL resulted in a reduction in EELI in all 3 patients. The repositioning of the head after BAL had a heterogeneous behavior increasing the EELI in patients 1 and 2, and decreasing it in patient 3
{"title":"Changes in lung volumes during bronchoalveolar lavage according to bedside position. Case Series","authors":"Ignacio Fernández Ceballos, Julieta Gonzalez Anaya, Juan Martín Nuñez Silveira, Emilio Steinberg, Leiniker Navarro Rey, Gabriel Elias Vega, Ivan Huespe, Indalecio Carboni Bisso, Marcos Las Heras, Rodriogo Cornejo","doi":"10.1183/13993003.congress-2023.pa3540","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa3540","url":null,"abstract":"<b>Introduction:</b> Bronchoalveolar lavage (BAL) is used in the diagnosis of pneumonia in patients with Mechanical Ventilation. Its performance involves the instillation of saline solution, which is associated with lung collapse and worsening hypoxemia. Positioning the patient9s head at 0° could increase the loss of lung volume and oxygenation. A therapeutic option to mitigate this effect could be to perform this procedure with head elevation at 30°. <b>Aims and Objectives:</b> The study aimed to assess changes in lung volumes in relation to the position of the patient9s head. <b>Methods:</b> Case series of 3 patients. End-expiratory Lung Impedance (EELI) measurements were performed (Pulmovista V500) in the following situations: Head at 30° before BAL, 0° before BAL, 0° post-BAL and 30° post-BAL. <b>Results:</b> In patients 1 and 2, the change of headrest from 30° to 0° before BAL resulted in an overall decrease in EELI (83.1% - 20.2%). Performing BAL increased the drop in EELI, with greater expression in the regions where BAL was performed. After BAL was completed, in both patients, the repositioning of the headrest to 30° produced an increase in global EELI without reaching the values obtained with the headrest at 30° before BAL (Patient 1 80.5% - Patiente 2 52.9%). In patient 3, the change of head position from 30° to 0° after BAL showed a 12.5% decrease in EELI. Performing BAL deepened the drop in overall EELI (-44.4%), as did repositioning the headrest to 30° (-70%) post-BAL. <b>Conclusion:</b> Changes in bedside positioning before BAL resulted in a reduction in EELI in all 3 patients. The repositioning of the head after BAL had a heterogeneous behavior increasing the EELI in patients 1 and 2, and decreasing it in patient 3","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":"136259130","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.pa3538
Kaouther Ben Amara, Imen Bouassida, wifek SAIDANI, Sarra Zairi, Hazem Zribi, Mehdi Abdennadher, Imen Sahnoun, Adel Marghli, Sarra Zairi
Introduction: A parenchyma-saving operation is the rule in the treatment of pulmonary hidatid cyst (PHC). However, pneumonectomy can be necessary in some situations. Material : Retrospective study over a period of 20 years including 5 patients who underwent pneumonectomy for pulmonary hydatidosis. Results: The average age was 45 years old with a female predominance of 80%. Three patients had a history of complicated PHC treated by cystectomy (1 case) and liver hydatid cyst operated on (2 cases). Two patients presented a pulmonary hydatid embolism treated medically (1 case) and surgically (1 case). The main symptoms were chest pain (5 cases), dry cough (5 cases). Chest computed tomography, performed in all patients, revealed voluminous fluid tone masses, homogeneous well limited, occupying one lobe (1 cases), two lobes (2 cases) and three lobes (2 cases) with pulmonary hydatid embolism in two cases. Four patients had pneumonectomy for a destroyed hepatized lung and one patient a totalisation pneumonectomy, through a posterolateral thoracotomy in all cases. The mean duration of postoperative drainage was 3 days. The histological study confirmed the diagnosis. The postoperative course was simple for 3 patients. Two postoperative complications were reported: Cardiac arrythmia and postoperative pneumonia. Conclusion : In pulmonary hydatidosis surgery, lung tissue should be preserved and resection should be avoided whenever it is possible. However, Pulmonary resection becomes unavoidable if irreversible changes have occurred throughout the lung and a large amount of parenchyma is attached to the cyst. This highlights the importance of rigourous prophylaxis and early diagnosis.
{"title":"Pneumonectomy in the surgery of pulmonary Hydatid cysts: A therapeutic option that is sometimes unavoidable","authors":"Kaouther Ben Amara, Imen Bouassida, wifek SAIDANI, Sarra Zairi, Hazem Zribi, Mehdi Abdennadher, Imen Sahnoun, Adel Marghli, Sarra Zairi","doi":"10.1183/13993003.congress-2023.pa3538","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa3538","url":null,"abstract":"<b>Introduction:</b> A parenchyma-saving operation is the rule in the treatment of pulmonary hidatid cyst (PHC). However, pneumonectomy can be necessary in some situations. <b>Material :</b> Retrospective study over a period of 20 years including 5 patients who underwent pneumonectomy for pulmonary hydatidosis. <b>Results:</b> The average age was 45 years old with a female predominance of 80%. Three patients had a history of complicated PHC treated by cystectomy (1 case) and liver hydatid cyst operated on (2 cases). Two patients presented a pulmonary hydatid embolism treated medically (1 case) and surgically (1 case). The main symptoms were chest pain (5 cases), dry cough (5 cases). Chest computed tomography, performed in all patients, revealed voluminous fluid tone masses, homogeneous well limited, occupying one lobe (1 cases), two lobes (2 cases) and three lobes (2 cases) with pulmonary hydatid embolism in two cases. Four patients had pneumonectomy for a destroyed hepatized lung and one patient a totalisation pneumonectomy, through a posterolateral thoracotomy in all cases. The mean duration of postoperative drainage was 3 days. The histological study confirmed the diagnosis. The postoperative course was simple for 3 patients. Two postoperative complications were reported: Cardiac arrythmia and postoperative pneumonia. <b>Conclusion :</b> In pulmonary hydatidosis surgery, lung tissue should be preserved and resection should be avoided whenever it is possible. However, Pulmonary resection becomes unavoidable if irreversible changes have occurred throughout the lung and a large amount of parenchyma is attached to the cyst. This highlights the importance of rigourous prophylaxis and early diagnosis.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"368 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":"136259437","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.pa4012
Rebecca Saray Marchesini Stival, Bruno Pedrazzani, Ariele Haagsma, Cristina Pellegrino Baena
Introduction: The density of radiologists per inhabitant is 7.5/100 thousand in the United Kingdom; in Brazil, it is 6.2, and in some areas, 1.5. Thoracic Radiologists are even scarcer. Pulmonologists frequently diagnose features associated with pulmonary fibrosis. Objective: To determine the interobserver agreement in diagnosing features associated with interstitial lung diseases. Methods: 63 chest CTs of covid-19 outpatients discharged from public hospitals of Curitiba/PR/Brazil from June 2020 to December 2021 were evaluated by an experienced pulmonologist and a thoracic radiologist. Each chest CT was assessed for the following characteristics: presence or absence of traction bronchiectasis and parenchymal bands in any lung lobe, independent of the severity, and qualitative visual evaluation was used to determine the extension of GGO, characterized: mild (1%–24%), moderate (25%–49%), severe (50–74%); very severe (≥ 75%). In addition, interobserver agreement for two observers in overall image quality or CT features was determined for a nonparametric Cohen´s Kappa test. Results: Traction bronchiectasis was identified for the thoracic radiologist in 14 (22.2%) and parenchymal bands in 38 (60.3%) CT, for the pulmonologist in 9 (14.3%), 32 (50.8%), respectively. The kappa agreement of traction bronchiectasis between professionals was 0,632 (p=<0.001), interpreted as substantial, for parenchymal bands was k=0.49 (p<0.001), with a moderate agreement. On the Other hand, extension GGO had no agreement (k=0.221; p= 0.001). Conclusions: Interobserver agreement in the diagnosis of traction bronchiectasis, the main feature associated with pulmonary fibrosis, was substantial.
{"title":"Observer agreement in the diagnosis of interstitial lung diseases","authors":"Rebecca Saray Marchesini Stival, Bruno Pedrazzani, Ariele Haagsma, Cristina Pellegrino Baena","doi":"10.1183/13993003.congress-2023.pa4012","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4012","url":null,"abstract":"<b>Introduction:</b> The density of radiologists per inhabitant is 7.5/100 thousand in the United Kingdom; in Brazil, it is 6.2, and in some areas, 1.5. Thoracic Radiologists are even scarcer. Pulmonologists frequently diagnose features associated with pulmonary fibrosis. <b>Objective:</b> To determine the interobserver agreement in diagnosing features associated with interstitial lung diseases. <b>Methods:</b> 63 chest CTs of covid-19 outpatients discharged from public hospitals of Curitiba/PR/Brazil from June 2020 to December 2021 were evaluated by an experienced pulmonologist and a thoracic radiologist. Each chest CT was assessed for the following characteristics: presence or absence of traction bronchiectasis and parenchymal bands in any lung lobe, independent of the severity, and qualitative visual evaluation was used to determine the extension of GGO, characterized: mild (1%–24%), moderate (25%–49%), severe (50–74%); very severe (≥ 75%). In addition, interobserver agreement for two observers in overall image quality or CT features was determined for a nonparametric Cohen´s Kappa test. Results: Traction bronchiectasis was identified for the thoracic radiologist in 14 (22.2%) and parenchymal bands in 38 (60.3%) CT, for the pulmonologist in 9 (14.3%), 32 (50.8%), respectively. The kappa agreement of traction bronchiectasis between professionals was 0,632 (p=<0.001), interpreted as substantial, for parenchymal bands was k=0.49 (p<0.001), with a moderate agreement. On the Other hand, extension GGO had no agreement (k=0.221; p= 0.001). <b>Conclusions:</b> Interobserver agreement in the diagnosis of traction bronchiectasis, the main feature associated with pulmonary fibrosis, was substantial.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"40 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":"136259572","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.oa4851
Neha Anegondi, Yixuan Zou, Xuefeng Hou, Mohammadreza Negahdar, Dorothy Cheung, Paula Belloni, Alex De Crespigny, Alexandre Fernandez Coimbra
Introduction: Idiopathic pulmonary fibrosis (IPF) results in lung function decline. Prognostic models that accurately predict IPF progression could inform research studies and clinical care. Objectives: To develop deep learning (DL) models to predict IPF progression using baseline high-resolution computed tomography (HRCT). Methods: Retrospective analysis was performed on IPF patients enrolled in clinical trials (NCT01872689, NCT00287729, NCT01366209). Only baseline visit HRCT (non-contrast, supine position, full inspiration) were included in the analysis. The image dataset was split into training (n = 274) and holdout (n = 117). The training dataset was then split into 5 folds for cross-validation (CV). Two multi-task DL models [HRCT-only and multi-modal (HRCT and baseline clinical features)] were trained to simultaneously predict 3 endpoints: FVC at 1 year (mL), FVC change at 1 year (mL) and FVC slope (mL/year). The performance of the DL models were benchmarked with a linear model using baseline clinical features and evaluated using squared Pearson correlation coefficient (r2). Results: The multi-modal model had the best CV performance on training set with mean r2 of 0.87, 0.13, and 0.14 for FVC at 1 year, FVC change at 1 year, and FVC slope. On the holdout set, the same model showed r2 of 0.88, 0.11, and 0.12. In comparison, the benchmark model had a mean r2 of 0.85, 0.05, and 0.05 on the training set and 0.89, 0.04, and 0.04 on the holdout set, respectively, for the 3 endpoints. Conclusion: HRCT scans add marginal value to baseline clinical features in predicting IPF progression. Further work is required to improve the performance of the current models for potential use in research studies and clinical care.
{"title":"Prognostic modeling in idiopathic pulmonary fibrosis using deep learning","authors":"Neha Anegondi, Yixuan Zou, Xuefeng Hou, Mohammadreza Negahdar, Dorothy Cheung, Paula Belloni, Alex De Crespigny, Alexandre Fernandez Coimbra","doi":"10.1183/13993003.congress-2023.oa4851","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.oa4851","url":null,"abstract":"<b>Introduction:</b> Idiopathic pulmonary fibrosis (IPF) results in lung function decline. Prognostic models that accurately predict IPF progression could inform research studies and clinical care. <b>Objectives:</b> To develop deep learning (DL) models to predict IPF progression using baseline high-resolution computed tomography (HRCT). <b>Methods:</b> Retrospective analysis was performed on IPF patients enrolled in clinical trials (NCT01872689, NCT00287729, NCT01366209). Only baseline visit HRCT (non-contrast, supine position, full inspiration) were included in the analysis. The image dataset was split into training (n = 274) and holdout (n = 117). The training dataset was then split into 5 folds for cross-validation (CV). Two multi-task DL models [HRCT-only and multi-modal (HRCT and baseline clinical features)] were trained to simultaneously predict 3 endpoints: FVC at 1 year (mL), FVC change at 1 year (mL) and FVC slope (mL/year). The performance of the DL models were benchmarked with a linear model using baseline clinical features and evaluated using squared Pearson correlation coefficient (r<sup>2</sup>). <b>Results:</b> The multi-modal model had the best CV performance on training set with mean r<sup>2</sup> of 0.87, 0.13, and 0.14 for FVC at 1 year, FVC change at 1 year, and FVC slope. On the holdout set, the same model showed r<sup>2</sup> of 0.88, 0.11, and 0.12. In comparison, the benchmark model had a mean r<sup>2</sup> of 0.85, 0.05, and 0.05 on the training set and 0.89, 0.04, and 0.04 on the holdout set, respectively, for the 3 endpoints. <b>Conclusion:</b> HRCT scans add marginal value to baseline clinical features in predicting IPF progression. Further work is required to improve the performance of the current models for potential use in research studies and clinical care.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"37 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":"136193695","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: Although fixed airway obstruction on spirometry is crucial for COPD diagnosis, it might be insufficient to identify subjects with pre-COPD. Quantitative computerized tomography (CT) measurements might be helpful to distinguish the subjects with pre-COPD. Thus, we aimed to compare quantitative CT findings of subjects with pre-COPD and COPD. Methods: Subjects who were admitted to our clinic with chronic respiratory symptoms and were evaluated for COPD as a pre-diagnosis were included in the study. Subjects were categorized as COPD and pre-COPD groups according to the FEV1/FVC ratio. Thorax CT voxel-based attenuation analysis was performed by Myrian® Expert software(Intrasense SA-1231, Montpellier, France). Attenuation values lower than -950 Hounsfield Units (HU) were defined as emphysema. Results: Of 163, 106 COPD and 57 pre-COPD cases were included. COPD group had significantly higher lung volume (5683 ml vs 4921 ml, p=0.001) and lower mean attenuation value (-830.0 HU vs -808.2 HU, p<0.001) than the pre-COPD group. Moreover, the COPD group had a higher emphysema percentage than the pre-COPD group (3.87% vs 0.28%, p<0.001). Conclusion: Quantitative CT of pre-COPD demonstrated radiologic findings that might help to corroborate COPD diagnosis, which was also associated with the severity of the airflow obstruction and be an alternative method for COPD diagnosis when it is difficult to reach spirometry.
背景:虽然肺量测定的固定气道阻塞对COPD诊断至关重要，但它可能不足以识别COPD前期受试者。定量计算机断层扫描(CT)测量可能有助于区分copd前期受试者。因此，我们的目的是比较COPD前期和COPD受试者的定量CT表现。方法:以慢性呼吸系统症状入院并被评估为COPD作为预诊断的受试者纳入研究。根据FEV1/FVC比率将受试者分为COPD组和COPD前期组。胸腔CT体素衰减分析采用Myrian®Expert软件(Intrasense SA-1231，法国蒙彼利埃)。衰减值低于-950 Hounsfield单位(HU)定义为肺气肿。结果:163例患者中，COPD患者106例，COPD前期患者57例。COPD组肺容量显著高于COPD前组(5683 ml vs 4921 ml, p=0.001)，平均衰减值显著低于COPD前组(-830.0 HU vs -808.2 HU, p=0.001)。COPD组肺气肿发生率高于COPD前组(3.87% vs 0.28%， p<0.001)。结论:COPD前期CT定量显示的影像学表现可能有助于COPD的诊断，且与气流阻塞的严重程度相关，在肺活量测定难以达到时可作为COPD诊断的替代方法。
{"title":"The comparison of quantitative CT features of COPD and pre-COPD: results from a real-life study","authors":"Selin Ercan, Aylin Ozgen Alpaydin, Ali Canturk, Emre Ruhat Avci, Saliha Selin Ozuygur Ermis, Gozde Tokatli, Gökçen Ömeroglu Simsek, Pinar Balci, Naciye Sinem Gezer","doi":"10.1183/13993003.congress-2023.pa2282","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa2282","url":null,"abstract":"<b>Background:</b> Although fixed airway obstruction on spirometry is crucial for COPD diagnosis, it might be insufficient to identify subjects with pre-COPD. Quantitative computerized tomography (CT) measurements might be helpful to distinguish the subjects with pre-COPD. Thus, we aimed to compare quantitative CT findings of subjects with pre-COPD and COPD. <b>Methods:</b> Subjects who were admitted to our clinic with chronic respiratory symptoms and were evaluated for COPD as a pre-diagnosis were included in the study. Subjects were categorized as COPD and pre-COPD groups according to the FEV1/FVC ratio. Thorax CT voxel-based attenuation analysis was performed by Myrian® Expert software(Intrasense SA-1231, Montpellier, France). Attenuation values lower than -950 Hounsfield Units (HU) were defined as emphysema. <b>Results:</b> Of 163, 106 COPD and 57 pre-COPD cases were included. COPD group had significantly higher lung volume (5683 ml vs 4921 ml, <i>p</i>=0.001) and lower mean attenuation value (-830.0 HU vs -808.2 HU, <i>p</i><0.001) than the pre-COPD group. Moreover, the COPD group had a higher emphysema percentage than the pre-COPD group (3.87% vs 0.28%, <i>p</i><0.001). <b>Conclusion:</b> Quantitative CT of pre-COPD demonstrated radiologic findings that might help to corroborate COPD diagnosis, which was also associated with the severity of the airflow obstruction and be an alternative method for COPD diagnosis when it is difficult to reach spirometry.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"31 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":"136194493","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.pa2280
Tjeerd van der Veer, Anastasia Kimberley Ay-Lan Kwee, Leticia Gallardo Estrella, Elrozy R. Andrinopoulou, Jean Paul Charbonnier, Stephen M. Humphries, Pim A. De Jong, David A. Lynch, Harm A. W. M. Tiddens, Esther Pompe
Aims: Subclinical heart failure may lead to congestion in the pulmonary veins and increased mortality. Aim: To determine the association of pulmonary vein volume with all-cause mortality in smokers with and without COPD. Methods: The artery-vein phenotyping analysis (AVX) was performed using the AI-based lung quantification platform LungQ (Thirona, The Netherlands). AVX quantified total volume of small (diameter <2mm; AVXSV) and large (≥2mm; AVXLV) pulmonary veins on CT in 7903 participants of the COPDGene study, normalized for body height. Cox regression analysis was used to analyze associations between AVXSV and AVXLV scores and mortality. Corrections were made for age, sex, BMI, FEV1%predicted, mMRC, 6MWT, smoking status, emphysema, airway wall thickness, coronary artery calcium score, severe exacerbations, and scanner model. Results: Mean age was 60.1±9.0 years; 3594 (45.5%) subjects had COPD. AVXSV was 82.3±13.3 mm3/cm; AVXLV 178.2±53.1 mm3/cm. Higher AVXSV and AVXLV were both associated with higher mortality, HR 1.57 (CI 1.31-1.88) and HR 1.07 (CI 1.01-1.13) per 50 mm3/cm, respectively. Conclusions: Increased pulmonary venous volume is associated with a higher mortality in smokers with and without COPD, independent of emphysema and coronary artery calcium score, and may be a marker of volume redistribution as a result of heart failure.
{"title":"Increased volume of pulmonary veins on CT associates independently with higher mortality in smokers with and without COPD","authors":"Tjeerd van der Veer, Anastasia Kimberley Ay-Lan Kwee, Leticia Gallardo Estrella, Elrozy R. Andrinopoulou, Jean Paul Charbonnier, Stephen M. Humphries, Pim A. De Jong, David A. Lynch, Harm A. W. M. Tiddens, Esther Pompe","doi":"10.1183/13993003.congress-2023.pa2280","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa2280","url":null,"abstract":"<b>Aims:</b> Subclinical heart failure may lead to congestion in the pulmonary veins and increased mortality. <b>Aim:</b> To determine the association of pulmonary vein volume with all-cause mortality in smokers with and without COPD. <b>Methods:</b> The artery-vein phenotyping analysis (AVX) was performed using the AI-based lung quantification platform LungQ (Thirona, The Netherlands). AVX quantified total volume of small (diameter <2mm; AVX<sub>SV</sub>) and large (≥2mm; AVX<sub>LV</sub>) pulmonary veins on CT in 7903 participants of the COPDGene study, normalized for body height. Cox regression analysis was used to analyze associations between AVX<sub>SV</sub> and AVX<sub>LV</sub> scores and mortality. Corrections were made for age, sex, BMI, FEV1%predicted, mMRC, 6MWT, smoking status, emphysema, airway wall thickness, coronary artery calcium score, severe exacerbations, and scanner model. <b>Results:</b> Mean age was 60.1±9.0 years; 3594 (45.5%) subjects had COPD. AVX<sub>SV</sub> was 82.3±13.3 mm3/cm; AVX<sub>LV</sub> 178.2±53.1 mm3/cm. Higher AVX<sub>SV</sub> and AVX<sub>LV</sub> were both associated with higher mortality, HR 1.57 (CI 1.31-1.88) and HR 1.07 (CI 1.01-1.13) per 50 mm3/cm, respectively. <b>Conclusions:</b> Increased pulmonary venous volume is associated with a higher mortality in smokers with and without COPD, independent of emphysema and coronary artery calcium score, and may be a marker of volume redistribution as a result of heart failure.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"21 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":"136195207","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.pa2294
Benjamin Welham, Michael Bennett, Kristoffer Ostridge, Matthew Guy, Clint Zvavamwe, Francis Sundram, Tom Wilkinson
Introduction: COPD is a heterogenous disease. Molecular imaging of inflammation could define endotypes, but heterogeneity of lung structure complicates this process. We aimed to develop methods to quantify inflammatory cytokines in heterogenous lung tissue as potential targets for therapy. Methods: Using SPECT-CT imaging, we developed techniques to quantify cytokine activity. Five patients with COPD and 5 healthy volunteers were recruited under ethically approved informed consent. They underwent SPECT-CT of the lungs at 6 (+/- 1) and 24 (+/- 4) hours after infusion of 99mTc-anti-TNF-α to quantify TNF-α activity in the lungs. Quantification was normalised to aortic arch signal to account for biological clearance. Results: Median normalised SPECT counts (CN) were higher in the healthy group at both time points. Strong correlations were seen between CN and both blood vessel density and emphysema quantification (figure 1). A regression model to correct for emphysema revealed higher CN at both time points in the COPD group, but differences were not statistically significant. Conclusions: Molecular imaging of inflammatory cytokines is affected by key confounding factors, and analysis techniques should account for structural heterogeneity.
{"title":"Bioradiomic SPECT-CT quantification of active lung inflammation is influenced by heterogeneity of lung tissue","authors":"Benjamin Welham, Michael Bennett, Kristoffer Ostridge, Matthew Guy, Clint Zvavamwe, Francis Sundram, Tom Wilkinson","doi":"10.1183/13993003.congress-2023.pa2294","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa2294","url":null,"abstract":"<b>Introduction:</b> COPD is a heterogenous disease. Molecular imaging of inflammation could define endotypes, but heterogeneity of lung structure complicates this process. We aimed to develop methods to quantify inflammatory cytokines in heterogenous lung tissue as potential targets for therapy. <b>Methods:</b> Using SPECT-CT imaging, we developed techniques to quantify cytokine activity. Five patients with COPD and 5 healthy volunteers were recruited under ethically approved informed consent. They underwent SPECT-CT of the lungs at 6 (+/- 1) and 24 (+/- 4) hours after infusion of <sup>99m</sup>Tc-anti-TNF-α to quantify TNF-α activity in the lungs. Quantification was normalised to aortic arch signal to account for biological clearance. <b>Results:</b> Median normalised SPECT counts (C<sub>N</sub>) were higher in the healthy group at both time points. Strong correlations were seen between C<sub>N</sub> and both blood vessel density and emphysema quantification (<i>figure 1</i>). A regression model to correct for emphysema revealed higher C<sub>N</sub> at both time points in the COPD group, but differences were not statistically significant. <b>Conclusions:</b> Molecular imaging of inflammatory cytokines is affected by key confounding factors, and analysis techniques should account for structural heterogeneity.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"46 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":"136200706","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.pa4008
Jagdeep Sahota, Balaji Ganeshan, Thida Win, Francesco Fraioli, Raymondo Endozo, Robert Shortman, Ashley M Groves, Joanna C Porter
Introduction: Mediastinal lymphadenopathy is a common feature in patients with IPF. We investigated the relationship between node avidity and survival. Aim: To assess the significance of FDG uptake in nodes of IPF patients undergoing PET imaging. Materials and Methods: 92 IPF patients were recruited prospectively. Mediastinal nodal FDG uptake was measured as SUVmax, SUVmin, and TBR (SUVmax/SUVmin). Kaplan Meier survival analysis was used to investigate overall survival between avid and non-avid node cohorts. Correlation between nodal uptake and Neutrophil lymphocyte ratio (NLR) was assessed using Pearson non-parametric Spearman’s rank correlation. Results: Of 92 IPF patients, 83 had enlarged lymph nodes and 65 were avid. Patients with avid lymphadenopathy had poorer survival compared to the rest at 50 months (p=0.454). Using a median value as a cut-off, TBR ≥1.72 was significantly associated with poorer outcome (p=0.05). Using an optimal value as a cut-off, SUVmax ≥3.68 were significantly associated with poorer outcome (p=0.033). FDG avidity (SUVmax and TBR) in the nodes correlated with NLR (p=0.033 and 0.041 respectively). Conclusion: Increased FDG avidity in the mediastinal nodes of IPF patients is associated with poorer outcome. Nodal activity correlated with NLR.
{"title":"Significance of FDG uptake in nodes of IPF patients undergoing PET imaging","authors":"Jagdeep Sahota, Balaji Ganeshan, Thida Win, Francesco Fraioli, Raymondo Endozo, Robert Shortman, Ashley M Groves, Joanna C Porter","doi":"10.1183/13993003.congress-2023.pa4008","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4008","url":null,"abstract":"<b>Introduction:</b> Mediastinal lymphadenopathy is a common feature in patients with IPF. We investigated the relationship between node avidity and survival. <b>Aim:</b> To assess the significance of FDG uptake in nodes of IPF patients undergoing PET imaging. <b>Materials and Methods:</b> 92 IPF patients were recruited prospectively. Mediastinal nodal FDG uptake was measured as SUV<sub>max</sub>, SUV<sub>min</sub>, and TBR (SUV<sub>max</sub>/SUV<sub>min</sub>). Kaplan Meier survival analysis was used to investigate overall survival between avid and non-avid node cohorts. Correlation between nodal uptake and Neutrophil lymphocyte ratio (NLR) was assessed using Pearson non-parametric Spearman’s rank correlation. <b>Results:</b> Of 92 IPF patients, 83 had enlarged lymph nodes and 65 were avid. Patients with avid lymphadenopathy had poorer survival compared to the rest at 50 months (p=0.454). Using a median value as a cut-off, TBR ≥1.72 was significantly associated with poorer outcome (p=0.05). Using an optimal value as a cut-off, SUV<sub>max</sub> ≥3.68 were significantly associated with poorer outcome (p=0.033). FDG avidity (SUV<sub>max</sub> and TBR) in the nodes correlated with NLR (p=0.033 and 0.041 respectively). <b>Conclusion:</b> Increased FDG avidity in the mediastinal nodes of IPF patients is associated with poorer outcome. Nodal activity correlated with NLR.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"23 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":"136259140","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：