Quantitative evaluation of disease severity in connective tissue disease-associated interstitial lung disease by dual-energy computed tomography

Abstract

Background High-resolution computed tomography (HRCT) is recommended diagnosing and monitoring connective tissue disease-associated interstitial lung disease (CTD-ILD). Quantitative computed tomography has the potential to precisely assess the radiological severity of CTD-ILD, but has still been under study. Objective To investigate whether dual-energy computed tomography (DECT), a novel quantitative technique, can be used for quantitative severity assessment in CTD-ILD. Methods This cross sectional study recruited adult CTD-ILD patients who underwent DECT scans from the ICE study between October 2019 and November 2021. DECT parameters, including effective atomic number (Zeff), lung (lobe) volume, and monochromatic CT number (MCTN) of each lung lobe, were evaluated. CTD-ILD was classified into extensive CTD-ILD and limited CTD-ILD by staging algorithm using combined forced vital capacity (FVC)%predicted and total extent of ILD (TEI) on CT. Dyspnea, cough, and life quality were scored by Borg dyspnea score, Leicester cough questionnaire (LCQ), and short-form 36 health survey questionnaire (SF-36), respectively. Results There was a total of 147 patients with DECT scans enrolled. Higher Zeff value (3.104 vs 2.256, p < 0.001), higher MCTN (− 722.87 HU vs − 802.20 HU, p < 0.001), and lower lung volume (2309.51cm3 vs 3475.21cm3, p < 0.001) were found in extensive CTD-ILD compared with limited CTD-ILD. DECT parameters had significant moderate correlations with FVC%predicted (|r|= 0.542–0.667, p < 0.01), DLCO%predicted (|r|= 0.371–0.427, p < 0.01), and TEI (|r|= 0.485–0.742, p < 0.01). Receiver operating characteristic (ROC) analysis indicated MCTN averaged over the whole lung had the best performance for extensive CTD-ILD discrimination (AUC = 0.901, cut-off: − 762.30 HU, p < 0.001), with a sensitivity of 82.1% and a specificity of 85.4%. The Zeff value was the independent risk factor for dyspnea (OR = 3.644, 95% CI: 1.846–7.192, p < 0.001) and cough (OR = 3.101, 95% CI: 1.528–6.294, p = 0.002), and lung volume significantly contributed to the mental component summary (MCS) in SF-36 (standardized β = 0.198, p < 0.05). Conclusions DECT can be applied to evaluate the severity of CTD-ILD.

High-Resolution Computed Tomography in Diagnosing and Monitoring Various Interstitial Lung Diseases

“…Our findings showed significant negative associations among the severity and extent of HRCT abnormalities and impaired pulmonary function in terms of severity and extent scores, with FVC%, VC%, and FEV 1 % being the three variables that were most strongly correlated. This is consistent with research by Li et al [14], Chen et al [16], Doshi et al [15], and Palalane et al [13], which found comparable relationships between pulmonary function measures and HRCT results. The consistency of these associations highlights how strong these connections are across various patient populations.…”

“…Our study's emphasis on the link between pulmonary function measures and HRCT results is supported by studies conducted by Li et al [14], Doshi et al [15], and Chen et al [16]. The stability of these interactions across several patient cohorts is shown by the constant negative correlations seen between spirometric measures (FVC%, VC%, and FEV 1 %) and HRCT severity and extent scores.…”

Thoracic Diseases: Technique and Applications of Dual-Energy CT

“…The Zeff value was the independent risk factor for dyspnoea and cough. Thus, DECT analysis could provide a further objective tool for use in the diagnosis and monitoring of these lung diseases, although caution must be exercised in extrapolating these results, and further prospective validations of such preliminary results should be followed, without a significant imbalance in the radiological patterns (usual interstitial pneumonitis and nonspecific interstitial pneumonia) among the patients included [54].…”