Multidisciplinary discussion (MDD) requiring close communication between specialists (clinicians, radiologists and pathologists) is the gold standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). However, MDD by specialists is not always feasible because they are often separated by time and location. An online database would facilitate data sharing and MDD. Our aims were to develop a nationwide cloud-based integrated database containing clinical, radiological and pathological data of patients with IIPs along with a web-based MDD system, and to validate the diagnostic utility of web-based MDD in IIPs.Clinical data, high-resolution computed tomography images and lung biopsy slides from patients with IIPs were digitised and uploaded to separate servers to develop a cloud-based integrated database. Web-based MDD was performed using the database and video-conferencing to reach a diagnosis.Clinical, radiological and pathological data of 524 patients in 39 institutions were collected, uploaded and incorporated into the cloud-based integrated database. Subsequently, web-based MDDs with a pulmonologist, radiologist and pathologist using the database and video-conferencing were successfully performed for the 465 cases with adequate data. Overall, the web-based MDD changed the institutional diagnosis in 219 cases (47%). Notably, the MDD diagnosis yielded better prognostic separation among the IIPs than did the institutional diagnosis.This is the first study of developing a nationwide cloud-based integrated database containing clinical, radiological and pathological data for web-based MDD in patients with IIPs. The database and the web-based MDD system that we built made MDD more feasible in practice, potentially increasing accurate diagnosis of IIPs.

here is increasing awareness of the clinical importance of incidentally detected interstitial lung abnormalities (ILAs) on non-contrast-enhanced chest CT images (1). Large cohort studies (2-5) of lung cancer screening have reported that ILAs are present in 8%-10% of participants. ILAs have been associated with a greater risk of all-cause mortality (l,2). Miller et al ( 6) recently reported that some subclinical ILAs at CT represent an early stage or a mild form of pulmonary fibrosis. Moreover, ILAs influence survival in patients with advanced lung cancer (7). Outcomes are reported to be poorer in patients with lung cancer with idiopathic pulmonary fibrosis (IPF) than in patients without IPF (8-10). However, quantitative evaluation of ILAs in patients with lung cancer and their influence on survival have not yet been fully investigated.Many computer-aided detection (CAD) systems have been developed to quantify diffuse lung abnormalities at . Subpleural abnormalities at CT, as measured by using the Gaussian histogram normalized correlation (GHNC) system, correspond to a histologic usual interstitial pneumonia (UIP) pattern of fibrosis in patients with interstitial lung diseases (ILDs) (15).Thus, we hypothesized that the volume of ILAs at CT measured using a GHNC-CAD system would be associated with the UIP CT pattern and worse prognosis in patients with lung cancer. The purpose of this study was to quantify ILAs at preoperative CT by using a GHNC-CAD system and to evaluate the extent of ILAs as a predictor of disease-free survival (DFS) in patients with lung cancer. We also evaluated the

No abstract

Although clinical applications of pulmonary MRI face technical limitations, currently available MRI methods have contributed to morphologic and functional evaluations of pulmonary nodules.

BackgroundRecent advances in multidetector computed tomography (MDCT) facilitate acquiring important clinical information for managing patients with COPD. MDCT can detect the loss of lung tissue associated with emphysema as a low-attenuation area (LAA) and the thickness of airways as the wall area percentage (WA%). The percentage of small pulmonary vessels <5 mm2 (% cross-sectional area [CSA] <5) has been recently recognized as a parameter for expressing pulmonary perfusion. We aimed to analyze the longitudinal changes in structural abnormalities using these CT parameters and analyze the effect of exacerbation and smoking cessation on structural changes in COPD patients.MethodsWe performed pulmonary function tests (PFTs), an MDCT, and a COPD assessment test (CAT) in 58 patients with COPD at the time of their enrollment at the hospital and 2 years later. We analyzed the change in clinical parameters including CT indices and examined the effect of exacerbations and smoking cessation on the structural changes.ResultsThe CAT score and forced expiratory volume in 1 second (FEV1) did not significantly change during the follow-up period. The parameters of emphysematous changes significantly increased. On the other hand, the WA% at the distal airways significantly decreased or tended to decrease, and the %CSA <5 slightly but significantly increased over the same period, especially in ex-smokers. The parameters of emphysematous change were greater in patients with exacerbations and continued to progress even after smoking cessation. In contrast, the WA% and %CSA <5 did not change in proportion to emphysema progression.ConclusionThe WA% at the distal bronchi and the %CSA <5 did not change in parallel with parameters of LAA over the same period. We propose that airway disease and vascular remodeling may be reversible to some extent by smoking cessation and appropriate treatment. Optimal management may have a greater effect on pulmonary vascularity and airway disease than parenchymal deconstruction in the early stage of COPD.