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Heterogenous lung inflammation CT patterns distinguish pneumonia and immune checkpoint inhibitor pneumonitis and complement blood biomarkers in acute myeloid leukemia: proof of concept

BACKGROUND: Immune checkpoint inhibitors (ICI) may cause pneumonitis, resulting in potentially fatal lung inflammation. However, distinguishing pneumonitis from pneumonia is time-consuming and challenging. To fill this gap, we build an image-based tool, and further evaluate it clinically alongside r...

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Autores principales: Aminu, Muhammad, Daver, Naval, Godoy, Myrna C. B., Shroff, Girish, Wu, Carol, Torre-Sada, Luis F., Goizueta, Alberto, Shannon, Vickie R., Faiz, Saadia A., Altan, Mehmet, Garcia-Manero, Guillermo, Kantarjian, Hagop, Ravandi-Kashani, Farhad, Kadia, Tapan, Konopleva, Marina, DiNardo, Courtney, Pierce, Sherry, Naing, Aung, Kim, Sang T., Kontoyiannis, Dimitrios P., Khawaja, Fareed, Chung, Caroline, Wu, Jia, Sheshadri, Ajay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10570510/
https://www.ncbi.nlm.nih.gov/pubmed/37841255
http://dx.doi.org/10.3389/fimmu.2023.1249511
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author Aminu, Muhammad
Daver, Naval
Godoy, Myrna C. B.
Shroff, Girish
Wu, Carol
Torre-Sada, Luis F.
Goizueta, Alberto
Shannon, Vickie R.
Faiz, Saadia A.
Altan, Mehmet
Garcia-Manero, Guillermo
Kantarjian, Hagop
Ravandi-Kashani, Farhad
Kadia, Tapan
Konopleva, Marina
DiNardo, Courtney
Pierce, Sherry
Naing, Aung
Kim, Sang T.
Kontoyiannis, Dimitrios P.
Khawaja, Fareed
Chung, Caroline
Wu, Jia
Sheshadri, Ajay
author_facet Aminu, Muhammad
Daver, Naval
Godoy, Myrna C. B.
Shroff, Girish
Wu, Carol
Torre-Sada, Luis F.
Goizueta, Alberto
Shannon, Vickie R.
Faiz, Saadia A.
Altan, Mehmet
Garcia-Manero, Guillermo
Kantarjian, Hagop
Ravandi-Kashani, Farhad
Kadia, Tapan
Konopleva, Marina
DiNardo, Courtney
Pierce, Sherry
Naing, Aung
Kim, Sang T.
Kontoyiannis, Dimitrios P.
Khawaja, Fareed
Chung, Caroline
Wu, Jia
Sheshadri, Ajay
author_sort Aminu, Muhammad
collection PubMed
description BACKGROUND: Immune checkpoint inhibitors (ICI) may cause pneumonitis, resulting in potentially fatal lung inflammation. However, distinguishing pneumonitis from pneumonia is time-consuming and challenging. To fill this gap, we build an image-based tool, and further evaluate it clinically alongside relevant blood biomarkers. MATERIALS AND METHODS: We studied CT images from 97 patients with pneumonia and 29 patients with pneumonitis from acute myeloid leukemia treated with ICIs. We developed a CT-derived signature using a habitat imaging algorithm, whereby infected lungs are segregated into clusters (“habitats”). We validated the model and compared it with a clinical-blood model to determine whether imaging can add diagnostic value. RESULTS: Habitat imaging revealed intrinsic lung inflammation patterns by identifying 5 distinct subregions, correlating to lung parenchyma, consolidation, heterogenous ground-glass opacity (GGO), and GGO-consolidation transition. Consequently, our proposed habitat model (accuracy of 79%, sensitivity of 48%, and specificity of 88%) outperformed the clinical-blood model (accuracy of 68%, sensitivity of 14%, and specificity of 85%) for classifying pneumonia versus pneumonitis. Integrating imaging and blood achieved the optimal performance (accuracy of 81%, sensitivity of 52% and specificity of 90%). Using this imaging-blood composite model, the post-test probability for detecting pneumonitis increased from 23% to 61%, significantly (p = 1.5E − 9) higher than the clinical and blood model (post-test probability of 22%). CONCLUSION: Habitat imaging represents a step forward in the image-based detection of pneumonia and pneumonitis, which can complement known blood biomarkers. Further work is needed to validate and fine tune this imaging-blood composite model and further improve its sensitivity to detect pneumonitis.
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spelling pubmed-105705102023-10-14 Heterogenous lung inflammation CT patterns distinguish pneumonia and immune checkpoint inhibitor pneumonitis and complement blood biomarkers in acute myeloid leukemia: proof of concept Aminu, Muhammad Daver, Naval Godoy, Myrna C. B. Shroff, Girish Wu, Carol Torre-Sada, Luis F. Goizueta, Alberto Shannon, Vickie R. Faiz, Saadia A. Altan, Mehmet Garcia-Manero, Guillermo Kantarjian, Hagop Ravandi-Kashani, Farhad Kadia, Tapan Konopleva, Marina DiNardo, Courtney Pierce, Sherry Naing, Aung Kim, Sang T. Kontoyiannis, Dimitrios P. Khawaja, Fareed Chung, Caroline Wu, Jia Sheshadri, Ajay Front Immunol Immunology BACKGROUND: Immune checkpoint inhibitors (ICI) may cause pneumonitis, resulting in potentially fatal lung inflammation. However, distinguishing pneumonitis from pneumonia is time-consuming and challenging. To fill this gap, we build an image-based tool, and further evaluate it clinically alongside relevant blood biomarkers. MATERIALS AND METHODS: We studied CT images from 97 patients with pneumonia and 29 patients with pneumonitis from acute myeloid leukemia treated with ICIs. We developed a CT-derived signature using a habitat imaging algorithm, whereby infected lungs are segregated into clusters (“habitats”). We validated the model and compared it with a clinical-blood model to determine whether imaging can add diagnostic value. RESULTS: Habitat imaging revealed intrinsic lung inflammation patterns by identifying 5 distinct subregions, correlating to lung parenchyma, consolidation, heterogenous ground-glass opacity (GGO), and GGO-consolidation transition. Consequently, our proposed habitat model (accuracy of 79%, sensitivity of 48%, and specificity of 88%) outperformed the clinical-blood model (accuracy of 68%, sensitivity of 14%, and specificity of 85%) for classifying pneumonia versus pneumonitis. Integrating imaging and blood achieved the optimal performance (accuracy of 81%, sensitivity of 52% and specificity of 90%). Using this imaging-blood composite model, the post-test probability for detecting pneumonitis increased from 23% to 61%, significantly (p = 1.5E − 9) higher than the clinical and blood model (post-test probability of 22%). CONCLUSION: Habitat imaging represents a step forward in the image-based detection of pneumonia and pneumonitis, which can complement known blood biomarkers. Further work is needed to validate and fine tune this imaging-blood composite model and further improve its sensitivity to detect pneumonitis. Frontiers Media S.A. 2023-09-29 /pmc/articles/PMC10570510/ /pubmed/37841255 http://dx.doi.org/10.3389/fimmu.2023.1249511 Text en Copyright © 2023 Aminu, Daver, Godoy, Shroff, Wu, Torre-Sada, Goizueta, Shannon, Faiz, Altan, Garcia-Manero, Kantarjian, Ravandi-Kashani, Kadia, Konopleva, DiNardo, Pierce, Naing, Kim, Kontoyiannis, Khawaja, Chung, Wu and Sheshadri https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Aminu, Muhammad
Daver, Naval
Godoy, Myrna C. B.
Shroff, Girish
Wu, Carol
Torre-Sada, Luis F.
Goizueta, Alberto
Shannon, Vickie R.
Faiz, Saadia A.
Altan, Mehmet
Garcia-Manero, Guillermo
Kantarjian, Hagop
Ravandi-Kashani, Farhad
Kadia, Tapan
Konopleva, Marina
DiNardo, Courtney
Pierce, Sherry
Naing, Aung
Kim, Sang T.
Kontoyiannis, Dimitrios P.
Khawaja, Fareed
Chung, Caroline
Wu, Jia
Sheshadri, Ajay
Heterogenous lung inflammation CT patterns distinguish pneumonia and immune checkpoint inhibitor pneumonitis and complement blood biomarkers in acute myeloid leukemia: proof of concept
title Heterogenous lung inflammation CT patterns distinguish pneumonia and immune checkpoint inhibitor pneumonitis and complement blood biomarkers in acute myeloid leukemia: proof of concept
title_full Heterogenous lung inflammation CT patterns distinguish pneumonia and immune checkpoint inhibitor pneumonitis and complement blood biomarkers in acute myeloid leukemia: proof of concept
title_fullStr Heterogenous lung inflammation CT patterns distinguish pneumonia and immune checkpoint inhibitor pneumonitis and complement blood biomarkers in acute myeloid leukemia: proof of concept
title_full_unstemmed Heterogenous lung inflammation CT patterns distinguish pneumonia and immune checkpoint inhibitor pneumonitis and complement blood biomarkers in acute myeloid leukemia: proof of concept
title_short Heterogenous lung inflammation CT patterns distinguish pneumonia and immune checkpoint inhibitor pneumonitis and complement blood biomarkers in acute myeloid leukemia: proof of concept
title_sort heterogenous lung inflammation ct patterns distinguish pneumonia and immune checkpoint inhibitor pneumonitis and complement blood biomarkers in acute myeloid leukemia: proof of concept
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10570510/
https://www.ncbi.nlm.nih.gov/pubmed/37841255
http://dx.doi.org/10.3389/fimmu.2023.1249511
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