Ultra-low-dose chest computed tomography for interstitial lung disease using model-based iterative reconstruction with or without the lung setting

Hata, Akinori; Yanagawa, Masahiro; Honda, Osamu; Miyata, Tomo; Tomiyama, Noriyuki

doi:10.1097/md.0000000000015936

Cited by 12 publications

(7 citation statements)

References 29 publications

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“…ILA is ideally evaluated using a thin-section chest CT protocol reconstructed with thin sections (≤1.5 mm) and a high-spatial-frequency algorithm. Thin-section CT should be performed if the initial CT examination was performed without thin sections, using an ultra-low-dose protocol or using nonoptimal reconstruction methods such as soft-tissue setting and some iterative reconstructions that affect the image texture (72,73), that is, if the scan did not include all of the lungs (eg, abdominal CT) or if the identified abnormalities are equivocal for ILA. Prone CT scanning is often helpful in distinguishing dependent lung atelectasis from true ILA (74,75).…”

Section: Guidance For Radiologistsmentioning

confidence: 99%

Interstitial Lung Abnormalities: State of the Art

et al. 2021

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T he recognition of the importance of interstitial lung abnormality (ILA) at CT emerged from the systematic evaluation of large cohorts, showing a prevalence of 4%-9% in cigarette smokers and a prevalence of 2%-7% in never-smokers (Table 1) (1-9). Individuals with ILA have an increase in symptoms such as chronic cough and shortness of breath, decreased total lung capacity, reduced exercise capacity, and increased all-cause mortality. ILA may progress and may represent subclinical or early pulmonary fibrosis (Table 2) (10-16).A recent Fleischner position paper provided an updated definition of ILA, with descriptive terms, a summary of risk factors and clinical outcomes, and a proposed schema for management (2). Our purpose is to provide a practical guide for radiologists regarding ILA that includes the definition of and terms for ILA, outcomes, possible strategies for clinical management, and future directions. Entities Not Considered ILAPotential chest CT pitfalls and overlaps in ILA are summarized in Table 3. Although centrilobular nodularity (Fig 5) was included in initial descriptions of ILA The clinical importance of interstitial lung abnormality (ILA) is increasingly recognized. In July 2020, the Fleischner Society published a position paper about ILA. The purposes of this article are to summarize the definition, existing evidence, clinical management, and unresolved issues for ILA from a radiologic standpoint and to provide a practical guide for radiologists. ILA is a common incidental finding at CT and is often progressive and associated with worsened clinical outcomes. The hazard ratios for mortality range from 1.3 to 2.7 in large cohorts. Risk factors for ILA include age, smoking status, other inhalational exposures, and genetic factors (eg, gene encoding mucin 5B variant). Radiologists should systematically record the presence, morphologic characteristics, distribution, and subcategories of ILA (ie, nonsubpleural, subpleural nonfibrotic, and subpleural fibrotic), as these are informative for predicting progression and mortality. Clinically significant interstitial lung disease should not be considered ILA. Individuals with ILA are triaged into higher-and lower-risk groups depending on their risk factors for progression, and systematic follow-up, including CT, should be considered for the higher-risk group. Artificial intelligence-based automated analysis for ILA may be helpful, but further validation and improvement are needed. Radiologists have a central role in clinical management and research on ILA.

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Section: Guidance For Radiologistsmentioning

confidence: 99%

Interstitial Lung Abnormalities: State of the Art

et al. 2021

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“…It is important to highlight that, in our study, only 5 of the 65 emphysema CT cases had been recorded on the radiographs. Currently, new technology has been developed allowing better visualisation of the interstitium using low-dose CT,38–40 which may facilitate using CT for the early diagnosis of pneumoconiosis with less concern about radiation exposure. However, the use of CT as a surveillance tool requires further studies to better assess its application, such as: what is the appropriate screening interval for the target population, risk–benefit analyses related to cumulative radiation doses, standardisation of image readings, availability of scanners and costs involved.…”

Section: Discussionmentioning

confidence: 99%

Volume-based tomography for the diagnosis of incipient silicosis in former gold miners

Carneiro¹,

Silva

et al. 2022

Occup Environ Med

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ObjectiveTo evaluate silicosis diagnosed through CT, with integration of clinical-occupational data, in silica-exposed workers presenting chest X-rays within International Labor Organization (ILO) category 0.MethodsCross-sectional study with 339 former gold miners, with comparable exposures and X-rays classified as ILO subcategory 0/0 (n=285) and 0/1 (n=54) were submitted to volume-based CT. The findings were classified according to the International Classification of HRCT CT for Occupational and Environmental Respiratory Diseases.ResultsA profusion degree of round opacities (RO)>1 was found in 22.4% (76/339) of the CT exams. After integrating the CT findings with clinical and occupational data, silicosis was diagnosed as follows: 43/285 (15.1%) and 14/54 (25.9%) in workers whose X-rays had been classified as 0/0 and 0/1, respectively. There was an upward trend towards longer exposures, reaching 38.9% when working more than 10 years underground and classified as 0/1 (p=0019). Those with presence of RO whose final diagnosis was not silicosis were mainly cases of tuberculosis or ‘indeterminate nodules’. Emphysema was found in 65/339 (19.1%), only 5 being detected in the X-ray.ConclusionVolume-based CT proved to be useful in the investigation of silicosis among individuals with a relevant exposure to silica, capturing diagnoses that had not been identified on X-rays. A response gradient of silicosis was showed by CT even in this population with ILO category 0 radiographs. It can be indicated based on quantitative and/or qualitative criteria of occupational exposure, especially considering the possibilities of low CT dosage.

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“…Thus, low-dose CT for screening has been developed and validated in CTD-ILD [ 31 ]. Ultra-low dose CTs have been used for other lung diseases and with the advent of artificial intelligence (AI) in radiology, it may become viable for CTD-ILD too [ 32 ]. Current quantitative CT (qCT) parameters can quantify lung involvement in SSc and differentiate it from IPF [ 33 ].…”

Section: Screening Monitoring and Diagnosismentioning

confidence: 99%

Management of Connective Tissue Disease–related Interstitial Lung Disease

Ahmed

Handa

2022

Curr Pulmonol Rep

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Purpose of Review This review aims to collate current evidence on the screening, diagnosis, and treatment of various connective tissue disease (CTD)–associated interstitial lung diseases (CTD-ILD) and present a contemporary framework for the management of such patients. It also seeks to summarize treatment outcomes including efficacy and safety of immunosuppressants, anti-fibrotics, and stem cell transplantation in CTD-ILD. Recent Findings Screening for ILD has been augmented by the use of artificial intelligence, ultra-low dose computerized tomography (CT) of the chest, and the use of chest ultrasound. Serum biomarkers have not found their way into clinical practice as yet. Identifying patients who need treatment and choosing the appropriate therapy is important to minimize the risk of therapy-related toxicity. The first-line drugs for systemic sclerosis (SSc) ILD include mycophenolate and cyclophosphamide. Nintedanib, an anti-fibrotic tyrosine kinase inhibitor, is approved for use in SSc-ILD. The US Food and Drug Administration (FDA) has recently approved tocilizumab subcutaneous injection for slowing the rate of decline in pulmonary function in adult patients with SSc-ILD. Autologous stem cell transplantation may have a role in select cases of SSc-ILD. Summary CTD-ILD is a challenging area with diverse entities and variable outcomes. High-resolution CT is the investigative modality of choice. Treatment decisions need to be individualized and are based on patient symptoms, lung function, radiologic abnormalities, and the risk of disease progression. Precision medicine may play an important role in determining the optimal therapy for an individual patient in the future.

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Ultra-low-dose chest computed tomography for interstitial lung disease using model-based iterative reconstruction with or without the lung setting

Cited by 12 publications

References 29 publications

Interstitial Lung Abnormalities: State of the Art

Interstitial Lung Abnormalities: State of the Art

Volume-based tomography for the diagnosis of incipient silicosis in former gold miners

Management of Connective Tissue Disease–related Interstitial Lung Disease

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