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.pa2289
Lennart Conemans, Mieke Crutsen, Wendel Dierckx, Sami Simons, Martijn Spruit, Bita Hajian
Introduction: Severe eosinophilic asthma (SEA) is known to respond favorably to benralizumab. Small airway dysfunction (SAD) is present across GINA stages and correlates with asthma severity. To date, effects of benralizumab on SAD in patients with SEA are unknown. This study aimed to detect changes in SAD after initiation of benralizumab in patients with SEA using Functional Respiratory Imaging (FRI). Methods: An open-label, single-arm trial in adult patients with SEA eligible for treatment with benralizumab was designed. Spirometry guided HRCT scans at FRC and TLC were evaluated before and after benralizumab and analyzed using computational fluid dynamics (FLUIDDA NV). Primary outcome was FRI based SAD, defined as change in specific image-based airway volume (SIVAW). Wilcoxon signed ranks test was used. Preliminary data are reported. Results: 18 patients were included, 6 of which completed the study to date. SIVAW (mL/L) at FRC increased from baseline (T0; 5.54; 4.73-7.09; median, IQR) to week 4 (6.34; 5,86-7.21 p=0.046) and week 12 (6.66; 4.89-7.94 p=0.028). SIVAW at TLC increased (T0 8.11; 6.75-8.65) to week 4 (8.39, 6.86-8.94 p=0.028). Specific image-based airway resistance (SIRAW in kPa*s) at T0 at FRC (1.26; 0.58-9.22) and TLC (0.64; 0.40-0.78) decreased at week 4 (FRC 0.54; 0.41-1.36, TLC 0.46; 0.34-0.58 p=0.028) and 12 (FRC 0.42; 0.19-4.25, TLC 0.46; 0.34-0.58 p=0.028). ACQ-6 (3.17 to 2.33) and SGRQ (67 to 55) improved (p<0.05) from T0 to week 12 as did FEV1 (1.40L (58%) to 1.72L (74%) p=0.028). Conclusion: FRI is feasible in patients with SEA and can detect improvements in SAD as early as 4 weeks after treatment initiation with benralizumab.
{"title":"Effect of benralizumab on small airway dysfunction using functional respiratory imaging in patients with severe eosinophilic asthma","authors":"Lennart Conemans, Mieke Crutsen, Wendel Dierckx, Sami Simons, Martijn Spruit, Bita Hajian","doi":"10.1183/13993003.congress-2023.pa2289","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa2289","url":null,"abstract":"<b>Introduction:</b> Severe eosinophilic asthma (SEA) is known to respond favorably to benralizumab. Small airway dysfunction (SAD) is present across GINA stages and correlates with asthma severity. To date, effects of benralizumab on SAD in patients with SEA are unknown. This study aimed to detect changes in SAD after initiation of benralizumab in patients with SEA using Functional Respiratory Imaging (FRI). <b>Methods:</b> An open-label, single-arm trial in adult patients with SEA eligible for treatment with benralizumab was designed. Spirometry guided HRCT scans at FRC and TLC were evaluated before and after benralizumab and analyzed using computational fluid dynamics (FLUIDDA NV). Primary outcome was FRI based SAD, defined as change in specific image-based airway volume (SIV<sub>AW</sub>). Wilcoxon signed ranks test was used. Preliminary data are reported. <b>Results:</b> 18 patients were included, 6 of which completed the study to date. SIV<sub>AW</sub> (mL/L) at FRC increased from baseline (T0; 5.54; 4.73-7.09; median, IQR) to week 4 (6.34; 5,86-7.21 p=0.046) and week 12 (6.66; 4.89-7.94 p=0.028). SIV<sub>AW</sub> at TLC increased (T0 8.11; 6.75-8.65) to week 4 (8.39, 6.86-8.94 p=0.028). Specific image-based airway resistance (SIR<sub>AW</sub> in kPa*s) at T0 at FRC (1.26; 0.58-9.22) and TLC (0.64; 0.40-0.78) decreased at week 4 (FRC 0.54; 0.41-1.36, TLC 0.46; 0.34-0.58 p=0.028) and 12 (FRC 0.42; 0.19-4.25, TLC 0.46; 0.34-0.58 p=0.028). ACQ-6 (3.17 to 2.33) and SGRQ (67 to 55) improved (p<0.05) from T0 to week 12 as did FEV1 (1.40L (58%) to 1.72L (74%) p=0.028). <b>Conclusion:</b> FRI is feasible in patients with SEA and can detect improvements in SAD as early as 4 weeks after treatment initiation with benralizumab.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"36 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":"136194397","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.pa3535
Stevan Ivković, Dušan Ivković, Aleksandar Ivković
Purpose: To explore the CT findings and pneumonia progression pattern of the Alpha, Delta, Omicron variants and subtypes of SARS-CoV-2 in asymptomatic patients. Method: In this retrospective comparative study, a total of 15874 patients with COVID-19 were included: 1281 patients with wild type (748 men, 52.6 years), 7945 with Alpha variant (4972 men, 46.2), 4233 with Delta variant (2548 men) and 2415 with Omicron and subtypes (1301 man, 44.2). Chest CT evaluation included opacities and repairing changes as well as lesion distribution and laterality. Chest CT severity score was also calculated. These parameters were statistically compared across the variants. Results: Total of 15874 patients with confirmed covid 19. Ground glass opacity (GGO), crazy paving, subpleural fibrosis with consolidation and repairing changes were calculated. Chest CT severity score was also calculated. There were 162 patients without symptoms, wild strain 12, Alpha strain 37, Delta strain 62, Omicron strain 51. Delta variant showed GGO and crazy paving with consolidation more noticeable than did the others. Wild strain had more unclear CT presentation. Alfa strain was the first strain with sharp CT presentation. Delta strain was with fast development of subpleural fibrosis. Omicron strain had smaller areas of CGO. Total lung CT severity scores were 0-5 (131), 6-10 (21), 11-15 (7), and 16 to 23 (3). There were 3 lethal cases. Post covid complication were found in 35 patients. 38 patients without symptoms were vaccinated. Conclusions: Asymptomatic patients can have severe forms, even lethal. Post covid can be found in asymptomatic patients.
{"title":"CT findings in asymptomatic patients with covid 19","authors":"Stevan Ivković, Dušan Ivković, Aleksandar Ivković","doi":"10.1183/13993003.congress-2023.pa3535","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa3535","url":null,"abstract":"<b>Purpose:</b> To explore the CT findings and pneumonia progression pattern of the Alpha, Delta, Omicron variants and subtypes of SARS-CoV-2 in asymptomatic patients. Method: In this retrospective comparative study, a total of 15874 patients with COVID-19 were included: 1281 patients with wild type (748 men, 52.6 years), 7945 with Alpha variant (4972 men, 46.2), 4233 with Delta variant (2548 men) and 2415 with Omicron and subtypes (1301 man, 44.2). Chest CT evaluation included opacities and repairing changes as well as lesion distribution and laterality. Chest CT severity score was also calculated. These parameters were statistically compared across the variants. <b>Results:</b> Total of 15874 patients with confirmed covid 19. Ground glass opacity (GGO), crazy paving, subpleural fibrosis with consolidation and repairing changes were calculated. Chest CT severity score was also calculated. There were 162 patients without symptoms, wild strain 12, Alpha strain 37, Delta strain 62, Omicron strain 51. Delta variant showed GGO and crazy paving with consolidation more noticeable than did the others. Wild strain had more unclear CT presentation. Alfa strain was the first strain with sharp CT presentation. Delta strain was with fast development of subpleural fibrosis. Omicron strain had smaller areas of CGO. Total lung CT severity scores were 0-5 (131), 6-10 (21), 11-15 (7), and 16 to 23 (3). There were 3 lethal cases. Post covid complication were found in 35 patients. 38 patients without symptoms were vaccinated. <b>Conclusions:</b> Asymptomatic patients can have severe forms, even lethal. Post covid can be found in asymptomatic patients.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"10 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":"136260552","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}
Introduction: Physical inactivity and cognitive impairment in patients with chronic obstructive pulmonary disease (COPD) leads to frailty which is associated with poor prognosis. However, little is known on the impact of the pathophysiology on the human brain. Aims and objectives: We hypothesized that brain structure could change according to frailty in COPD. We aimed to clarify the relationship between frailty and cortical thickness. Methods: Cortical thickness measured MRI and the frailty score assessed using the Kihon Checklist (KCL) which is a self-reporting questionnaire were assessed in 40 stable COPD patients and 20 healthy controls. Results: In 34 cortical regions on each side, 12 on the right and 13 on the left were found to be significantly thinner in the COPD than in the healthy (p＜0.05, respectively). We examined the association between these regions and frailty score. We found 7 regions with significant negative correlations in COPD, but no in the healthy. Even when adjusted by age, one region on the left and 5 regions on the right showed significant correlations. The correlation coefficient between the bilateral superior frontal gyrus and frailty score were the largest (left: ρ = -0.5308, right: ρ = -0.5361) (p＜0.05). Interestingly, among the KCL, question domain including daily activities showed strongest correlation, with a sensitivity of 90% and a specificity of 73% to capture bottom quartile of thinning of the superior frontal gyrus if 2 of the 5 questions were applicable (left: AUC=0.85, right: AUC=0.88). Conclusion: Frailty in COPD is associated with decreased thickness of specific brain cortical regions, and most pronounced in the superior frontal gyrus. Moreover, KCL could be a useful tool to capture brain frailty.
{"title":"Correlation between frailty and reduced cortical thickness in Chronic Obstructive Pulmonary Disease.","authors":"Ayumi Fukatsu-Chikumoto, Tsunahiko Hirano, Shun Takahashi, Takuya Ishida, Tomihiro Donishi, Kazuyoshi Suga, Keiko Doi, Keiji Oishi, Shuichiro Ohata, Yoriyuki Murata, Yoshikazu Yamaji, Maki Asami-Noyama, Nobutaka Edakuni, Tomoyuki Kakugawa, Kazuto Matsunaga","doi":"10.1183/13993003.congress-2023.pa4000","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4000","url":null,"abstract":"<b>Introduction:</b> Physical inactivity and cognitive impairment in patients with chronic obstructive pulmonary disease (COPD) leads to frailty which is associated with poor prognosis. However, little is known on the impact of the pathophysiology on the human brain. <b>Aims and objectives:</b> We hypothesized that brain structure could change according to frailty in COPD. We aimed to clarify the relationship between frailty and cortical thickness. <b>Methods:</b> Cortical thickness measured MRI and the frailty score assessed using the Kihon Checklist (KCL) which is a self-reporting questionnaire were assessed in 40 stable COPD patients and 20 healthy controls. <b>Results:</b> In 34 cortical regions on each side, 12 on the right and 13 on the left were found to be significantly thinner in the COPD than in the healthy (p＜0.05, respectively). We examined the association between these regions and frailty score. We found 7 regions with significant negative correlations in COPD, but no in the healthy. Even when adjusted by age, one region on the left and 5 regions on the right showed significant correlations. The correlation coefficient between the bilateral superior frontal gyrus and frailty score were the largest (left: ρ = -0.5308, right: ρ = -0.5361) (p＜0.05). Interestingly, among the KCL, question domain including daily activities showed strongest correlation, with a sensitivity of 90% and a specificity of 73% to capture bottom quartile of thinning of the superior frontal gyrus if 2 of the 5 questions were applicable (left: AUC=0.85, right: AUC=0.88). <b>Conclusion:</b> Frailty in COPD is associated with decreased thickness of specific brain cortical regions, and most pronounced in the superior frontal gyrus. Moreover, KCL could be a useful tool to capture brain frailty.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"5 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":"136259314","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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