nach oben

Erschienen in:

04.06.2018 | Chest

An automated computed tomography score for the cystic fibrosis lung

verfasst von: Guillaume Chassagnon, Clémence Martin, Pierre-Régis Burgel, Dominique Hubert, Isabelle Fajac, Nikos Paragios, Evangelia I. Zacharaki, Paul Legmann, Joel Coste, Marie-Pierre Revel

Erschienen in: European Radiology | Ausgabe 12/2018

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To develop an automated density-based computed tomography (CT) score evaluating high-attenuating lung structural abnormalities in patients with cystic fibrosis (CF).

Methods

Seventy adult CF patients were evaluated. The development cohort comprised 17 patients treated with ivacaftor, with 45 pre-therapeutic and follow-up chest CT scans. Another cohort of 53 patients not treated with ivacaftor was used for validation. CT-density scores were calculated using fixed and adapted thresholds based on histogram characteristics, such as the mode and standard deviation. Visual CF-CT score was also calculated. Correlations between the CT scores and forced expiratory volume in 1 s (FEV₁% pred), and between their changes over time were assessed.

Results

On cross-sectional evaluation, the correlation coefficients between FEV₁%pred and the automated scores were slightly lower to that of the visual score in the development and validation cohorts (R = up to -0.68 and -0.61, versus R = -0.72 and R = -0.64, respectively). Conversely, the correlation to FEV₁%pred tended to be higher for automated scores (R = up to -0.61) than for visual score (R = -0.49) on longitudinal follow-up. Automated scores based on Mode + 3 SD and Mode +300 HU showed the highest cross-sectional (R = -0.59 to -0.68) and longitudinal (R = -0.51 to -0.61) correlation coefficients to FEV₁%pred.

Conclusions

The developed CT-density score reliably quantifies high-attenuating lung structural abnormalities in CF.

Key Points

• Automated CT score shows moderate to good cross-sectional correlations with FEV ₁ %pred _.

• CT score has potential to be integrated into the standard reporting workflow

Nur mit Berechtigung zugänglich

Tepper LA, Caudri D, Utens EMWJ et al (2014) Tracking CF disease progression with CT and respiratory symptoms in a cohort of children aged 6-19 years. Pediatr Pulmonol 49:1182–1189. https://doi.org/10.1002/ppul.22991 CrossRefPubMed

O’Connor OJ, Vandeleur M, McGarrigle AM et al (2010) Development of low-dose protocols for thin-section CT assessment of cystic fibrosis in pediatric patients. Radiology 257:820–829. https://doi.org/10.1148/radiol.10100278 CrossRefPubMed

Miéville FA, Berteloot L, Grandjean A et al (2013) Model-based iterative reconstruction in pediatric chest CT: assessment of image quality in a prospective study of children with cystic fibrosis. Pediatr Radiol 43:558–567. https://doi.org/10.1007/s00247-012-2554-4 CrossRefPubMed

Ernst CW, Basten IA, Ilsen B et al (2014) Pulmonary disease in cystic fibrosis: assessment with chest CT at chest radiography dose levels. Radiology 273:597–605. https://doi.org/10.1148/radiol.14132201 CrossRefPubMed

Wainwright CE, Vidmar S, Armstrong DS et al (2011) Effect of bronchoalveolar lavage-directed therapy on Pseudomonas aeruginosa infection and structural lung injury in children with cystic fibrosis: a randomized trial. JAMA 306:163–171. https://doi.org/10.1001/jama.2011.954 CrossRefPubMed

Brody AS, Klein JS, Molina PL et al (2004) High-resolution computed tomography in young patients with cystic fibrosis: distribution of abnormalities and correlation with pulmonary function tests. J Pediatr 145:32–38. https://doi.org/10.1016/j.jpeds.2004.02.038 CrossRefPubMed

Cademartiri F, Luccichenti G, Palumbo AA et al (2008) Predictive value of chest CT in patients with cystic fibrosis: a single-center 10-year experience. AJR Am J Roentgenol 190:1475–1480. https://doi.org/10.2214/AJR.07.3000 CrossRefPubMed

Brody AS, Sucharew H, Campbell JD et al (2005) Computed tomography correlates with pulmonary exacerbations in children with cystic fibrosis. Am J Respir Crit Care Med 172:1128–1132. https://doi.org/10.1164/rccm.200407-989OC CrossRefPubMed

Loeve M, Hop WCJ, de Bruijne M et al (2012) Chest computed tomography scores are predictive of survival in patients with cystic fibrosis awaiting lung transplantation. Am J Respir Crit Care Med 185:1096–1103. https://doi.org/10.1164/rccm.201111-2065OC CrossRefPubMed

10.

Kilcoyne A, Lavelle LP, McCarthy CJ et al (2016) Chest CT abnormalities and quality of life: relationship in adult cystic fibrosis. Ann Transl Med 4:87. https://doi.org/10.21037/atm.2016.03.08 CrossRefPubMedPubMedCentral

11.

Loeve M, Gerbrands K, Hop WC et al (2011) Bronchiectasis and pulmonary exacerbations in children and young adults with cystic fibrosis. Chest 140:178–185. https://doi.org/10.1378/chest.10-1152 CrossRefPubMed

12.

Calder AD, Bush A, Brody AS, Owens CM (2014) Scoring of chest CT in children with cystic fibrosis: state of the art. Pediatr Radiol 44:1496–1506. https://doi.org/10.1007/s00247-013-2867-y CrossRefPubMed

13.

Ramsey BW, Davies J, McElvaney NG et al (2011) A CFTR potentiator in patients with cystic fibrosis and the G551D mutation. N Engl J Med 365:1663–1672. https://doi.org/10.1056/NEJMoa1105185 CrossRefPubMedPubMedCentral

14.

Wainwright CE, Elborn JS, Ramsey BW et al (2015) Lumacaftor–Ivacaftor in patients with cystic fibrosis homozygous for Phe508del CFTR. N Engl J Med 373:220–231. https://doi.org/10.1056/NEJMoa1409547 CrossRefPubMedPubMedCentral

15.

Chassagnon G, Hubert D, Fajac I et al (2016) Long-term computed tomographic changes in cystic fibrosis patients treated with ivacaftor. Eur Respir J 48:248–252. https://doi.org/10.1183/13993003.01918-2015 CrossRef

16.

Gevenois PA, De Vuyst P, de Maertelaer V et al (1996) Comparison of computed density and microscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 154:187–192. https://doi.org/10.1164/ajrccm.154.1.8680679 CrossRefPubMed

17.

Goris ML, Zhu HJ, Blankenberg F et al (2003) An automated approach to quantitative air trapping measurements in mild cystic fibrosis. Chest 123:1655–1663CrossRef

18.

Goris ML, Zhu HJ, Robinson TE (2007) A critical discussion of computer analysis in medical imaging. Proc Am Thorac Soc 4:347–349. https://doi.org/10.1513/pats.200701-014HT CrossRefPubMed

19.

Bonnel A-S, Song SM-H, Kesavarju K et al (2004) Quantitative air-trapping analysis in children with mild cystic fibrosis lung disease. Pediatr Pulmonol 38:396–405. https://doi.org/10.1002/ppul.20091 CrossRefPubMed

20.

DeBoer EM, Swiercz W, Heltshe SL et al (2014) Automated CT scan scores of bronchiectasis and air trapping in cystic fibrosis. Chest 145:593–603. https://doi.org/10.1378/chest.13-0588 CrossRefPubMed

21.

Loeve M, Rosenow T, Gorbunova V et al (2015) Reversibility of trapped air on chest computed tomography in cystic fibrosis patients. Eur J Radiol 84:1184–1190. https://doi.org/10.1016/j.ejrad.2015.02.011 CrossRefPubMed

22.

O’Connell OJ, McWilliams S, McGarrigle A et al (2012) Radiologic imaging in cystic fibrosis: cumulative effective dose and changing trends over 2 decades. Chest 141:1575–1583. https://doi.org/10.1378/chest.11-1972 CrossRefPubMed

23.

Palumbo AA, Luccichenti G, Belgrano M et al (2007) Three-dimensional quantitative assessment of lung parenchyma in cystic fibrosis: preliminary results. Radiol Med 112:21–30. https://doi.org/10.1007/s11547-007-0117-9 CrossRefPubMed

24.

Wielpütz MO, Eichinger M, Weinheimer O et al (2013) Automatic airway analysis on multidetector computed tomography in cystic fibrosis: correlation with pulmonary function testing. J Thorac Imaging 28:104–113. https://doi.org/10.1097/RTI.0b013e3182765785 CrossRefPubMed

25.

Montaudon M, Berger P, Cangini-Sacher A et al (2007) Bronchial measurement with three-dimensional quantitative thin-section CT in patients with cystic fibrosis. Radiology 242:573–581. https://doi.org/10.1148/radiol.2422060030 CrossRefPubMed

26.

de Jong PA, Nakano Y, Hop WC et al (2005) Changes in airway dimensions on computed tomography scans of children with cystic fibrosis. Am J Respir Crit Care Med 172:218–224. https://doi.org/10.1164/rccm.200410-1311OC CrossRefPubMed

27.

Robinson PJ, Kreel L (1979) Pulmonary tissue attenuation with computed tomography: comparison of inspiration and expiration scans. J Comput Assist Tomogr 3:740–748CrossRef

28.

Levi C, Gray JE, McCullough EC, Hattery RR (1982) The unreliability of CT numbers as absolute values. AJR Am J Roentgenol 139:443–447. https://doi.org/10.2214/ajr.139.3.443 CrossRefPubMed

29.

Yuan R, Mayo JR, Hogg JC et al (2007) The effects of radiation dose and CT manufacturer on measurements of lung densitometry. Chest 132:617–623. https://doi.org/10.1378/chest.06-2325 CrossRefPubMed

30.

Kemerink GJ, Lamers RJ, Thelissen GR, van Engelshoven JM (1995) Scanner conformity in CT densitometry of the lungs. Radiology 197:749–752. https://doi.org/10.1148/radiology.197.3.7480750 CrossRefPubMed

31.

Perhomaa M, Jauhiainen J, Lähde S et al (2000) CT lung densitometry in assessing intralobular air content. An experimental and clinical study. Acta Radiol 41:242–248CrossRef

32.

Parr DG, Stoel BC, Stolk J et al (2004) Influence of calibration on densitometric studies of emphysema progression using computed tomography. Am J Respir Crit Care Med 170:883–890. https://doi.org/10.1164/rccm.200403-326OC CrossRefPubMed

33.

de Lavernhe I, Le Blanche A, Dégrugilliers L et al (2015) CT density distribution analysis in patients with cystic fibrosis: correlation with pulmonary function and radiologic scores. Acad Radiol 22:179–185. https://doi.org/10.1016/j.acra.2014.09.003 CrossRefPubMed

34.

Shah RM, Sexauer W, Ostrum BJ et al (1997) High-resolution CT in the acute exacerbation of cystic fibrosis: evaluation of acute findings, reversibility of those findings, and clinical correlation. AJR Am J Roentgenol 169:375–380. https://doi.org/10.2214/ajr.169.2.9242738 CrossRefPubMed

35.

Dorlöchter L, Nes H, Fluge G, Rosendahl K (2003) High resolution CT in cystic fibrosis—the contribution of expiratory scans. Eur J Radiol 47:193–198CrossRef

36.

de Jong PA, Ottink MD, Robben SGF et al (2004) Pulmonary disease assessment in cystic fibrosis: comparison of CT scoring systems and value of bronchial and arterial dimension measurements. Radiology 231:434–439. https://doi.org/10.1148/radiol.2312021393 CrossRefPubMed

37.

de Jong PA, Lindblad A, Rubin L et al (2006) Progression of lung disease on computed tomography and pulmonary function tests in children and adults with cystic fibrosis. Thorax 61:80–85. https://doi.org/10.1136/thx.2005.045146 CrossRefPubMed

38.

Mueller KS, Long FR, Flucke RL, Castile RG (2010) Volume-monitored chest CT: a simplified method for obtaining motion-free images near full inspiratory and end expiratory lung volumes. Pediatr Radiol 40:1663–1669. https://doi.org/10.1007/s00247-010-1671-1 CrossRefPubMed

39.

Loeve M, Krestin GP, Rosenfeld M et al (2013) Chest computed tomography: a validated surrogate endpoint of cystic fibrosis lung disease? Eur Respir J 42:844–857. https://doi.org/10.1183/09031936.00051512 CrossRefPubMed

40.

Committee for Medicinal Products for Human Use (2009) Guideline on the clinical development of medicinal products for the treatment of cystic fibrosis. European Medicines Agency, London

Titel: An automated computed tomography score for the cystic fibrosis lung
verfasst von: Guillaume Chassagnon
Clémence Martin
Pierre-Régis Burgel
Dominique Hubert
Isabelle Fajac
Nikos Paragios
Evangelia I. Zacharaki
Paul Legmann
Joel Coste
Marie-Pierre Revel
Publikationsdatum: 04.06.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 12/2018
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5516-x

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

An automated computed tomography score for the cystic fibrosis lung