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

BMC Pulmonary Medicine

Michiaki Mishima⁶  Takateru Izumi⁴  Kazuo Chin⁶  Toru Oga⁶  Kohei Ikezoe³  Kensaku Aihara⁵  Kizuku Watanabe²  Yutaka Ito⁷  Isao Ito³  Tsuyoshi Oguma³  Takeshi Kubo¹  Toyohiro Hirai⁴  Sonoko Nagai⁴  Tomohiro Handa³  Kiminobu Tanizawa⁶ 

[1] Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan;Department of Respiratory Medicine, Fukui Red-Cross Hospital, Fukui, Japan;Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan;Kyoto Central Clinic, Clinical Research Center, Kyoto, Japan;Department of Respiratory Medicine, Saiseikai-Noe Hospital, Osaka, Japan;Department of Respiratory Care and Sleep Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan;Department of Respiratory Medicine, Allergy and Clinical Immunology, School of Medical Sciences, Nagoya City University, Nagoya, Japan

关键词: Prognosis;    Idiopathic interstitial pneumonias;    Densitometry;    Quantitative computed tomography;   

Others  :  1222578
DOI  :  10.1186/s12890-015-0069-0

 received in 2015-02-16, accepted in 2015-07-06,  发布年份 2015

【 摘 要 】

Background

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

Methods

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

Results

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

Conclusion

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

【 授权许可】

   
2015 Tanizawa et al.

【 图 表 】

Fig. 1.

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