Comparison of the Quantitative CT Imaging Biomarkers of Idiopathic Pulmonary Fibrosis at Baseline and Early Change with an Interval of 7 Months

Kim, Hee Jin; Brown, Matthew S.; Chong, Daniel; Gjertson, David W.; Lu, Peiyun; Kim, Soo Hyun; Coy, Heidi; Goldin, Jonathan G.

doi:10.1016/j.acra.2014.08.004

Cited by 108 publications

(83 citation statements)

References 36 publications

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“…We also note that several subjects in the IPF cohort had CT and MRI scans several months apart. However, other studies of quantitative CT biomarkers in IPF detected changes in CT score over a 7-month period of 2–3% 11 . Thus, we expect the average 5 month separation of scans to be an unlikely explanation for the lack of correlation with 129 Xe MRI.…”

Section: Discussionmentioning

confidence: 90%

“…To this end, high-resolution CT (HRCT) has become a mainstay in IPF, detecting fibrotic changes and structural abnormalities to establish the presence of a usual interstitial pneumonia (UIP) pattern without the need for surgical lung biopsies 1 . This has led to further interest in using quantitative CT to measure longitudinal change, assess disease severity, and predict mortality 11–13 . However, the structural alterations detected on CT often do not correlate well with patient symptoms 14 .…”

Section: Introductionmentioning

confidence: 99%

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Using hyperpolarized ¹²⁹Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis

Wang

Robertson

Wang³

et al. 2017

Thorax

130

136

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Background Assessing functional impairment, therapeutic response, and disease progression in patients with idiopathic pulmonary fibrosis (IPF) continues to be challenging. Hyperpolarized 129Xe MRI can address this gap through its unique capability to image gas transfer three-dimensionally from airspaces to interstitial barrier tissues to RBCs. This must be validated by testing the degree to which it correlates with pulmonary function tests (PFTs) and CT scores and its spatial distribution reflects known physiology and patterns of disease. Methods 13 healthy individuals (33.6±15.7 years) and 12 IPF patients (66.0±6.4 years) underwent 129Xe MRI to generate 3D quantitative maps depicting the 129Xe ventilation distribution, its uptake in interstitial barrier tissues, and its transfer to RBCs. For each map, mean values were correlated with PFTs and CT fibrosis scores and their patterns were tested for the ability to depict functional gravitational gradients in healthy lung, and to detect the known basal and peripheral predominance of disease in IPF. Results 129Xe MRI depicted functional impairment in IPF patients, whose mean barrier uptake increased by 188% compared to the healthy reference population. 129Xe MRI metrics correlated poorly and insignificantly with CT fibrosis scores, but strongly with pulmonary function tests. Barrier uptake and RBC transfer both correlated significantly with DLCO (r=−0.75, p<0.01 and r=0.72, p<0.01), while their ratio (RBC/barrier) correlated strongly (r=0.94, p<0.01). RBC transfer exhibited significant anterior-posterior gravitational gradients in healthy volunteers, but not in IPF, where it was significantly impaired in the basal (p=0.02) and sub-pleural (p<0.01) lung. Conclusions Hyperpolarized 129Xe MRI is a rapid and well-tolerated exam that provides region-specific quantification of interstitial barrier thickness and RBC transfer efficiency. With further development, it could become a robust tool for measuring disease progression and therapeutic response in IPF patients, sensitively and non-invasively.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Using hyperpolarized ¹²⁹Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis

Wang

Robertson

Wang³

et al. 2017

Thorax

130

136

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“…New computer algorithms utilising three-dimensional volumetric CT datasets, can quantify parenchymal pattern extents (27,28) and have been shown to better predict survival in various fibrosing lung diseases at baseline, than visual CT scores (29,30). Computer analysis also has the potential to uncover CT features hitherto under-recognised by visual CT analysis that predict mortality in IPF.…”

Section: Introductionmentioning

confidence: 99%

Predicting Outcomes in Idiopathic Pulmonary Fibrosis Using Automated Computed Tomographic Analysis

Jacob

Bartholmai²,

Rajagopalan³

et al. 2018

Am J Respir Crit Care Med

163

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Short running head: IPF baseline outcome prediction Word count: 4310 wordsThis article has an online data supplement, which is accessible from this issue's table of content online at www.atsjournals.org At a Glance: Quantification of CT parenchymal patterns in idiopathic pulmonary fibrosis using computer tools has been suggested as a method that can improve on mortality prediction using visual CT scoring. As computer technology advances, it has now become possible to study CT parenchymal features that have no visual correlate. Our study demonstrates that computer-derived vessel-related structure scores can outperform current gold-standard measures of outcome in idiopathic pulmonary fibrosis such as forced vital capacity decline. Specifically, we demonstrate that using thresholds of computer-derived vessel-related structure scores for cohort enrichment can identify idiopathic pulmonary fibrosis patients that respond to antifibrotic medication with reduced FVC decline and improved survival.Importantly, the vessel-related structure thresholds would be able to reduce idiopathic pulmonary fibrosis drug-trial population sizes by 26% thereby dramatically reducing study costs. JJ and AUW were also involved in the conception and design of the study.BJB, RK and SR invented and developed CALIPER. They were involved in processing the raw CT scans and in generation of figures but were not involved with the analysis or interpretation of the data in the study. When used as a cohort enrichment tool, a CALIPER VRS score >4.4% of the lung was able to reduce the requisite sample size of an IPF drug trial by 26%. Conclusions:Our study has validated a new quantitative CT measure in IPF patients fulfilling drug trial entry criteria, the VRS scores, that outperformed current goldstandard measures of outcome. When used for cohort enrichment in an IPF drugtrial setting, VRS threshold scores can reduce a required IPF drug trial population size by 25%, thereby limiting prohibitive trial costs. Importantly VRS scores identify patients in whom antifibrotic medication prolongs life and reduces forced vital capacity decline. 6

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“…To date, computerised quantitative computed tomography has been validated primarily using visual analysis and PFTs for comparison. For instance, KIM et al [58] demonstrated that quantitative lung fibrosis was a sensitive marker for early changes (∼7 months) in the severity of lung disease in IPF patients when compared with FVC and DLCO. Further investigation is needed to determine the specific advantages of quantitative computed tomography over traditional methods of evaluating lung disease severity such as clinical symptoms and PFTs.…”

Section: Detection Of Disease Progression In Patients With Worsening mentioning

confidence: 99%

The role of high-resolution computed tomography in the follow-up of diffuse lung disease

2017

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High-resolution computed tomography (HRCT) of the lung is a key component of the multidisciplinary approach to diagnosis in diffuse lung disease (DLD). HRCT also plays an important role in the follow-up of patients with established DLD. In this respect, serial HRCT examinations may provide valuable information that cannot be determined from clinical history and other diagnostic tests, such as pulmonary function tests. Important roles of HRCT in this context include assisting in determining prognosis, monitoring for the efficacy of treatment, detecting progression of disease or complications, and evaluating patients with worsening or acute symptoms. Both clinicians and radiologists should be aware of the expected evolution of HRCT changes in a variety of DLDs. The goals of this paper are to discuss: 1) the expected evolution of HRCT findings over time in common DLDs; 2) the role of serial HRCT examinations in formulating an initial diagnosis; and 3) the role of HRCT in the follow-up of patients with known DLD.

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Comparison of the Quantitative CT Imaging Biomarkers of Idiopathic Pulmonary Fibrosis at Baseline and Early Change with an Interval of 7 Months

Cited by 108 publications

References 36 publications

Using hyperpolarized ¹²⁹Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis

Using hyperpolarized ¹²⁹Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis

Predicting Outcomes in Idiopathic Pulmonary Fibrosis Using Automated Computed Tomographic Analysis

The role of high-resolution computed tomography in the follow-up of diffuse lung disease

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Comparison of the Quantitative CT Imaging Biomarkers of Idiopathic Pulmonary Fibrosis at Baseline and Early Change with an Interval of 7 Months

Cited by 108 publications

References 36 publications

Using hyperpolarized 129Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis

Using hyperpolarized 129Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis

Predicting Outcomes in Idiopathic Pulmonary Fibrosis Using Automated Computed Tomographic Analysis

The role of high-resolution computed tomography in the follow-up of diffuse lung disease

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Using hyperpolarized ¹²⁹Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis

Using hyperpolarized ¹²⁹Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis