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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Pulmonary Medicine 1/2015

Clinical impact of high-attenuation and cystic areas on computed tomography in fibrotic idiopathic interstitial pneumonias

Zeitschrift:
BMC Pulmonary Medicine > Ausgabe 1/2015
Autoren:
Kiminobu Tanizawa, Tomohiro Handa, Sonoko Nagai, Toyohiro Hirai, Takeshi Kubo, Tsuyoshi Oguma, Isao Ito, Yutaka Ito, Kizuku Watanabe, Kensaku Aihara, Kohei Ikezoe, Toru Oga, Kazuo Chin, Takateru Izumi, Michiaki Mishima
Wichtige Hinweise

Competing interests

The Department of Respiratory Care and Sleep Control Medicine at Kyoto University is funded by endowments from Philips Respironics, Teijin Pharma Ltd, Fukuda Denshi Inc. and Fukuda Lifetec Keiji. The authors themselves have no conflicts of interest to disclose.

Authors’ contributions

KT collected, analyzed, and interpreted the data, and drafted the article. TH was fully responsible for data integrity and accuracy of data analysis, developing the concept and design of the study, collecting, analyzing, and interpreting the data, and critically revising the draft article. SN collected, analyzed, and interpreted data, revised the draft article critically, and gave final approval for the revised article. TH developed the in-house computer software, analyzed and interpreted data, and revised the draft article critically. KT collected, analyzed, and interpreted data, and revised the draft article critically. TO and II revised the draft article critically. YI collected, analyzed, and interpreted data and critically revised the draft article. KW, KA, KI, and TO critically revised the draft article. KC, MI, and MM also revised the draft article, approving final revisions.

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, rs = −0.59; % carbon monoxide diffusion capacity, rs = −0.43; fibrosis score, rs = 0.23). Densitometric parameters (MLD, SD-LD, kurtosis, and skewness) correlated significantly with physiologic measures and fibrosis score (|rs| = 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.
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