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Title: Clinical impact of high-attenuation and cystic areas on computed tomography in fibrotic idiopathic interstitial pneumonias
Authors: Tanizawa, Kiminobu  kyouindb  KAKEN_id
Handa, Tomohiro  kyouindb  KAKEN_id
Nagai, Sonoko
Hirai, Toyohiro
Kubo, Takeshi  kyouindb  KAKEN_id
Oguma, Tsuyoshi  kyouindb  KAKEN_id
Ito, Isao  kyouindb  KAKEN_id
Ito, Yutaka
Watanabe, Kizuku
Aihara, Kensaku
Ikezoe, Kohei
Oga, Toru
Chin, Kazuo
Izumi, Takateru
Mishima, Michiaki
Author's alias: 谷澤, 公伸
半田, 知宏
平井, 豊博
久保, 武
伊藤, 功朗
小賀, 徹
陳, 和夫
三嶋, 理晃
Keywords: Quantitative computed tomography
Idiopathic interstitial pneumonias
Issue Date: 24-Jul-2015
Publisher: BioMed Central Ltd.
Journal title: BMC Pulmonary Medicine
Volume: 15
Thesis number: 74
Abstract: 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<inf>s</inf> = -0.59; % carbon monoxide diffusion capacity, r<inf>s</inf> = -0.43; fibrosis score, r<inf>s</inf> = 0.23). Densitometric parameters (MLD, SD-LD, kurtosis, and skewness) correlated significantly with physiologic measures and fibrosis score (|r<inf>s</inf>| = 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.
Rights: © 2015 Tanizawa et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License(, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
DOI(Published Version): 10.1186/s12890-015-0069-0
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