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Quantitative computed tomography assessment for systemic sclerosis–related interstitial lung disease: comparison of different methods

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Abstract

Objectives

To compare the previously defined six different histogram-based quantitative lung assessment (QLA) methods on high-resolution CT (HRCT) in patients with systemic sclerosis (SSc)–related interstitial lung disease (ILD).

Methods

The HRCT images of SSc patients with ILD were reviewed, and the visual ILD score (semiquantitative) and the severity of ILD (limited or extensive) were calculated. The QLA score of ILD was evaluated using the previously defined six different methods and parameters (different lung attenuation ranges, skewness, kurtosis, mean lung attenuation, and standard deviation [SD]). Pulmonary function tests (PFTs) were also performed on all patients. Relationships among variables were evaluated using Spearman’s correlation coefficient (r). Diagnostic performance of quantitative methods for the ability to differentiate the limited from extensive ILD was calculated using ROC analysis.

Results

Fifty-five patients were included in the study. There was a significant correlation between all quantitative and semiquantitative measurement results (p < 0.0001). The QLA scores revealed a significant correlation with PFT results. The kurtosis value of the voxels between − 200 and − 1024 Hounsfield unit (HU) (Method-5) showed the best correlation with semiquantitative evaluation (r = − 0.740, p < 0.0001). The ROC analysis demonstrated the best performance of SD of the voxels between − 400 and − 950 HU (Method-6) for histogram analysis method and Method-3 (voxels between − 260 and − 600 HU were calculated as ILD) for CT density cutoff methods.

Conclusions

All the QLA methods are applicable in assessing the ILD score in SSc patients and have potential importance to differentiate limited from extensive ILD.

Key Points

• Quantitative interstitial lung disease assessment helps clinicians to assess systemic sclerosis patients with interstitial lung disease.

• Quantitative lung assessment methods are applicable in assessing the interstitial lung disease score in systemic sclerosis patients.

• Quantitative lung assessment methods have potential importance in the management of patients.

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Abbreviations

AUC:

Area under the curve

CII:

Computerized integrated index

CII-5:

Computerized integrated index of Method-5

CII-6:

Computerized integrated index of Method-6

CT:

Computed tomography

CVDs:

Collagen vascular diseases

DLCO:

Single-breath diffusing capacity

DcSSc:

Diffuse forms of systemic sclerosis

FEV1:

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

HRCT:

High-resolution computed tomography

HU:

Hounsfield unit

ILD:

Interstitial lung disease

KURT-5:

Kurtosis value of Method-5

KURT-6:

Kurtosis value of Method-6

LcSSc:

Limited forms of systemic sclerosis

MLA:

Mean lung attenuation

MLA-5:

Mean lung attenuation value of Method-5

MLA-6:

Mean lung attenuation value of Method-6

PCA:

Principal component analysis

PFT:

Pulmonary function test

PRoTA:

Pattern recognition or texture analysis

QLA:

Quantitative lung assessment

QUANT-1:

Quantitative Method-1

QUANT-2:

Quantitative Method-2

QUANT-3:

Quantitative Method-3

QUANT-4:

Quantitative Method-4

ROC:

Receiver operating characteristic

SD:

Standard deviation

SD-5:

Standard deviation value of Method-5

SD-6:

Standard deviation value of Method-6

SKEW-5:

Skewness value of Method-5

SKEW-6:

Skewness value of Method-6

SSc:

Systemic sclerosis

TLC:

Total lung capacity

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Acknowledgments

The authors thank Dr. Hande Senol for help in statistical analyses.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, School of Medicine, University of Pamukkale, Kinikli, 20100, Denizli, Turkey

    Furkan Ufuk & Mahmut Demirci

  2. Department of Chest Diseases, School of Medicine, University of Pamukkale, Kinikli, 20100, Denizli, Turkey

    Goksel Altinisik

Authors
  1. Furkan Ufuk
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  2. Mahmut Demirci
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Corresponding author

Correspondence to Furkan Ufuk.

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Guarantor

The scientific guarantor of this publication is Furkan UFUK, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Hande Senol kindly provided statistical advice for this manuscript.

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Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Cross sectional study

• Performed at one institution

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Ufuk, F., Demirci, M. & Altinisik, G. Quantitative computed tomography assessment for systemic sclerosis–related interstitial lung disease: comparison of different methods. Eur Radiol 30, 4369–4380 (2020). https://doi.org/10.1007/s00330-020-06772-2

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