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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
Densitometry
Idiopathic interstitial pneumonias
Prognosis
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(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
URI: http://hdl.handle.net/2433/212527
DOI(Published Version): 10.1186/s12890-015-0069-0
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