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Stratification of long-term outcome in stable idiopathic pulmonary fibrosis by combining longitudinal computed tomography and forced vital capacity

  • Chest
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Abstract

Objectives

To test HRCT with either visual or quantitative analysis in both short-term and long-term follow-up of stable IPF against long-term (transplant-free) survival, beyond 2 years of disease stability.

Methods

Fifty-eight IPF patients had FVC measurements and HRCTs at baseline (HRCT0), 10–14 months (HRCT1) and 22–26 months (HRCT2). Visual scoring, CALIPER quantitative analysis of HRCT measures, and their deltas were evaluated against combined all-cause mortality and lung transplantation by adjusted Cox proportional hazard models at each time interval.

Results

At HRCT1, a ≥ 20% relative increase in CALIPER-total lung fibrosis yielded the highest radiological association with outcome (C-statistic 0.62). Moreover, the model combining FVC% drop ≥ 10% and ≥ 20% relative increase of CALIPER-total lung fibrosis improved the stratification of outcome (C-statistic 0.69, high-risk category HR 12.1; landmark analysis at HRCT1 C-statistic 0.66, HR 14.9 and at HRCT2 C-statistic 0.61, HR 21.8). Likewise, at HRCT2, the model combining FVC% decrease trend and ≥ 20% relative increase of CALIPER-pulmonary vessel–related volume (VRS) improved the stratification of outcome (C-statistic 0.65, HR 11.0; landmark analysis at HRCT1 C-statistic 0.62, HR 13.8 and at HRCT2 C-statistic 0.58, HR 12.6). A less robust stratification of outcome distinction was also demonstrated with the categorical visual scoring of disease change.

Conclusions

Annual combined CALIPER -FVC changes showed the greatest stratification of long-term outcome in stable IPF patients, beyond 2 years.

Key Points

• Longitudinal high-resolution computed tomography (HRCT) data is more helpful than baseline HRCT alone for stratification of long-term outcome in IPF.

• HRCT changes by visual or quantitative analysis can be added with benefit to the current spirometric reference standard to improve stratification of long-term outcome in IPF.

• HRCT follow-up at 12–14 months is more helpful than HRCT follow-up at 23–26 months in clinically stable subjects with IPF.

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Abbreviations

CALIPER:

Computer-Aided Lung Informatics for Pathology Evaluation and Rating

CI:

Confidence interval

CT:

Computed tomography

DLco:

Diffusing capacity for carbon monoxide

FEV1:

Forced expiratory volume in one second

FVC:

Forced vital capacity

GAP:

Gender-age-physiology

HR:

Hazard ratio

HRCT:

High-resolution computed tomography

ILD:

Interstitial lung disease

IPF:

Idiopathic pulmonary fibrosis

PFT:

Pulmonary function test

VRS:

Pulmonary vessel–related volume

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Funding

This study has received funding by the European Society of Thoracic Imaging.

Author information

Authors and Affiliations

  1. Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Padiglione Barbieri, V. Gramsci 14, Parma, Italy

    Nicola Sverzellati, Mario Silva & Valeria Seletti

  2. Department of Clinical Sciences and Community, University of Milan, Milan, Italy

    Carlotta Galeone

  3. Department of Medical and Surgical Sciences and Advanced Technologies-Radiodiagnostic and Radiotherapy Unit, University Hospital “Policlinico-Vittorio Emanuele”, Catania, Italy

    Stefano Palmucci

  4. Department of Radiology, Azienda USL Romagna, Ospedale GB Morgagni, Forlì, Italy

    Sara Piciucchi

  5. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

    Carlo Vancheri

  6. Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark

    Venerino Poletti

  7. Department of Diseases of the Thorax, Ospedale G.B. Morgagni, Forli, Italy

    Sara Tomassetti

  8. Biomedical Imaging Resource, Mayo Clinic, Rochester, MN, USA

    Ronald Karwoski

  9. Division of Radiology, Mayo Clinic, Rochester, MN, USA

    Brian J. Bartholmai

Authors
  1. Nicola Sverzellati
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  2. Mario Silva
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Corresponding author

Correspondence to Nicola Sverzellati.

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Guarantor

The scientific guarantor of this publication is Nicola Sverzellati.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Dr. Sverzellati reports grants and personal fees from Roche, personal fees from Boehringer-Ingelheim, outside the submitted work.

Dr. Tomassetti reports grants and personal fees from Roche, personal fees from Boehringer-Ingelheim, outside the submitted work.

Dr. Palmucci reports personal fees as speaker (Roche and Boehringer Ingelheim); as writer (Boehringer Ingelheim).

Dr. Silva reports grants from European Society of Thoracic Imaging, during the conduct of the study.

Dr. Bartholmai reports personal fees from Promedior, LLC, and from Imbio, LLC, outside the submitted work. Mayo Clinic has received grants from NIH/NHLBI, fees from Imbio, LLC, and Boehringer Ingelheim outside the submitted work. In addition, Dr. Bartholmai has a patent SYSTEMS AND METHODS FOR ANALYZING IN VIVO TISSUE VOLUMES USING MEDICAL IMAGING pending to Mayo Clinic.

Mr. Karwoski reports other from Imbio Inc., outside the submitted work.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• prognostic study/observational

• multicenter study

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Sverzellati, N., Silva, M., Seletti, V. et al. Stratification of long-term outcome in stable idiopathic pulmonary fibrosis by combining longitudinal computed tomography and forced vital capacity. Eur Radiol 30, 2669–2679 (2020). https://doi.org/10.1007/s00330-019-06619-5

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  • DOI: https://doi.org/10.1007/s00330-019-06619-5

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