Quantitative and semi-quantitative computed tomography analysis of interstitial lung disease associated with systemic sclerosis: A longitudinal evaluation of pulmonary parenchyma and vessels

Mariaelena Occhipinti, Silvia Bosello, Leuconoe Grazia Sisti, Giuseppe Cicchetti, Chiara de Waure, Tommaso Pirronti, Gianfranco Ferraccioli, Elisa Gremese, Anna Rita Larici

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: To evaluate interstitial lung disease associated with systemic sclerosis (SSc-ILD) and its changes during treatment by using quantitative analysis (QA) compared to semi-quantitative analysis (semiQA) of chest computed tomography (CT) scans. To assess the prognostic value of QA in predicting functional changes.

MATERIALS AND METHODS: We retrospectively selected 35 consecutive patients with SSc-ILD with complete pulmonary functional evaluation, Doppler-echocardiography, immunological tests, and chest CT scan at both baseline and follow-up after immunosuppressive therapy. CT images were analyzed by two chest radiologists for semiQA and by a computational platform for texture analysis of ILD patterns (CALIPER) for QA. Concordance between semiQA and QA was tested. Traction bronchiectasis severity was scored. Analysis of ROC curves was performed.

RESULTS: Seventy CT scans were analyzed and QA failed in 4/70 scans. Thus, the final population included 31/35 patients (51.3±12.1 years). QA had a weak-to-good concordance with semiQA (ICC reticular:0.275; ICC ground-glass:0.667) and QA correlated better than semiQA (r = -0.3 to -0.74 vs r = -0.3 to -0.4) with functional parameters. Both methods correlated with traction bronchiectases score and pulmonary artery diameter at CT. A pulmonary artery diameter ≥29mm distinguished patients with lower lung volumes and ILD extent greater than 39% (p<0.001). Changes in QA patterns during treatment were not accurate (AUC: 0.50 to 0.70; p>0.05) in predicting disease progression as assessed by functional parameters, whereas variation in total lung volume at QA accurately predicted changes in the composite functional respiratory endpoint with FVC% and DLco% (AUC = 0.74; 95%CI: 0.54 to 0.93; p = 0.03).

CONCLUSIONS: Pulmonary QA of CT images can objectively quantify specific patterns of ILD changes during treatment in patients with SSc-ILD. Changes in QA patterns do not correlate with functional changes, but variation in total lung volume at QA accurately predicted changes in the composite functional respiratory endpoint with FVC% and DLco%. Pulmonary artery diameter at CT reflects the interstitial involvement, identifying patients with more severe prognosis.

Original languageEnglish
Pages (from-to)e0213444
JournalPLoS One
Volume14
Issue number3
DOIs
Publication statusPublished - 2019

Keywords

  • Adult
  • Bronchiectasis/diagnostic imaging
  • Female
  • Humans
  • Longitudinal Studies
  • Lung Diseases, Interstitial/diagnostic imaging
  • Male
  • Middle Aged
  • Prognosis
  • Pulmonary Artery/diagnostic imaging
  • Radiographic Image Interpretation, Computer-Assisted
  • Respiratory Function Tests
  • Retrospective Studies
  • Rituximab/therapeutic use
  • Scleroderma, Systemic/diagnostic imaging
  • Tomography, X-Ray Computed/statistics & numerical data

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