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Automatic Quantification of Interstitial Lung Disease From Chest Computed Tomography in Systemic Sclerosis

Background: Interstitial lung disease (ILD) is a common complication in patients with systemic sclerosis (SSc), and its diagnosis contributes to early treatment decisions. Purposes: To quantify ILD associated with SSc (SSc-ILD) from chest CT images using an automatic quantification method based on t...

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Autores principales: Carvalho, Alysson Roncally S., Guimarães, Alan R., Sztajnbok, Flávio R., Rodrigues, Rosana Souza, Silva, Bruno Rangel Antunes, Lopes, Agnaldo José, Zin, Walter Araujo, Almeida, Isabel, França, Manuela Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546366/
https://www.ncbi.nlm.nih.gov/pubmed/33102508
http://dx.doi.org/10.3389/fmed.2020.577739
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author Carvalho, Alysson Roncally S.
Guimarães, Alan R.
Sztajnbok, Flávio R.
Rodrigues, Rosana Souza
Silva, Bruno Rangel Antunes
Lopes, Agnaldo José
Zin, Walter Araujo
Almeida, Isabel
França, Manuela Maria
author_facet Carvalho, Alysson Roncally S.
Guimarães, Alan R.
Sztajnbok, Flávio R.
Rodrigues, Rosana Souza
Silva, Bruno Rangel Antunes
Lopes, Agnaldo José
Zin, Walter Araujo
Almeida, Isabel
França, Manuela Maria
author_sort Carvalho, Alysson Roncally S.
collection PubMed
description Background: Interstitial lung disease (ILD) is a common complication in patients with systemic sclerosis (SSc), and its diagnosis contributes to early treatment decisions. Purposes: To quantify ILD associated with SSc (SSc-ILD) from chest CT images using an automatic quantification method based on the computation of the weight of interstitial lung opacities. Methods: Ninety-four patients with SSc underwent CT, forced vital capacity (FVC), and carbon monoxide diffusion capacity (DL(CO)) tests. Seventy-three healthy individuals without radiological evidence of lung disease served as controls. After lung and airway segmentation, the ratio between the weight of interstitial opacities [densities between −500 and +50 Hounsfield units (HU)] and the total lung weight (densities between −1,000 and +50 HU) was used as an ILD indicator (ILD[%] = 100 × [LW((−500 to +50HU))/LW((−1, 000 to +50HU))]). The cutoff of normality between controls and SSc was determined with a receiver operator characteristic curve. The severity of pulmonary involvement in SSc patients was also assessed by calculating Z scores of ILD relative to the average interstitial opacities in controls. Accordingly, SSc-ILD was classified as SSc Limited-ILD (Z score < 3) and SSc Extensive-ILD (Z score ≥ 3 or FVC < 70%). Results: Seventy-eight (83%) SSc patients were classified as presenting SSc-ILD (optimal ILD threshold of 23.4%, 0.83 sensitivity, 0.92 specificity, and 0.94 area under the receiver operator characteristic curve, 95% CI from 0.89 to 0.96, 0.93 positive predictive value, and 0.81 negative predictive value, p < 0.001) and exhibited radiological attenuations compatible with interstitial pneumonia dispersed in the lung parenchyma. Thirty-six (38%) patients were classified as SSc Extensive-ILD (ILD threshold ≥ 29.6% equivalent to a Z score ≥ 3) and 42 (45%) as SSc Limited-ILD. Eighteen (50%) patients with SSc Extensive-ILD presented FVC < 70%, being only five patients classified exclusively based on FVC. SSc Extensive-ILD also presented lower DL(CO) (57.9 ± 17.9% vs. 73.7 ± 19.8%; p < 0.001) and total lung volume (2,916 ± 674 vs. 4,286 ± 1,136, p < 0.001) compared with SSc Limited-ILD. Conclusion: The proposed method seems to provide an alternative to identify and quantify the extension of ILD in patients with SSc, mitigating the subjectivity of semiquantitative analyzes based on visual scores.
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spelling pubmed-75463662020-10-22 Automatic Quantification of Interstitial Lung Disease From Chest Computed Tomography in Systemic Sclerosis Carvalho, Alysson Roncally S. Guimarães, Alan R. Sztajnbok, Flávio R. Rodrigues, Rosana Souza Silva, Bruno Rangel Antunes Lopes, Agnaldo José Zin, Walter Araujo Almeida, Isabel França, Manuela Maria Front Med (Lausanne) Medicine Background: Interstitial lung disease (ILD) is a common complication in patients with systemic sclerosis (SSc), and its diagnosis contributes to early treatment decisions. Purposes: To quantify ILD associated with SSc (SSc-ILD) from chest CT images using an automatic quantification method based on the computation of the weight of interstitial lung opacities. Methods: Ninety-four patients with SSc underwent CT, forced vital capacity (FVC), and carbon monoxide diffusion capacity (DL(CO)) tests. Seventy-three healthy individuals without radiological evidence of lung disease served as controls. After lung and airway segmentation, the ratio between the weight of interstitial opacities [densities between −500 and +50 Hounsfield units (HU)] and the total lung weight (densities between −1,000 and +50 HU) was used as an ILD indicator (ILD[%] = 100 × [LW((−500 to +50HU))/LW((−1, 000 to +50HU))]). The cutoff of normality between controls and SSc was determined with a receiver operator characteristic curve. The severity of pulmonary involvement in SSc patients was also assessed by calculating Z scores of ILD relative to the average interstitial opacities in controls. Accordingly, SSc-ILD was classified as SSc Limited-ILD (Z score < 3) and SSc Extensive-ILD (Z score ≥ 3 or FVC < 70%). Results: Seventy-eight (83%) SSc patients were classified as presenting SSc-ILD (optimal ILD threshold of 23.4%, 0.83 sensitivity, 0.92 specificity, and 0.94 area under the receiver operator characteristic curve, 95% CI from 0.89 to 0.96, 0.93 positive predictive value, and 0.81 negative predictive value, p < 0.001) and exhibited radiological attenuations compatible with interstitial pneumonia dispersed in the lung parenchyma. Thirty-six (38%) patients were classified as SSc Extensive-ILD (ILD threshold ≥ 29.6% equivalent to a Z score ≥ 3) and 42 (45%) as SSc Limited-ILD. Eighteen (50%) patients with SSc Extensive-ILD presented FVC < 70%, being only five patients classified exclusively based on FVC. SSc Extensive-ILD also presented lower DL(CO) (57.9 ± 17.9% vs. 73.7 ± 19.8%; p < 0.001) and total lung volume (2,916 ± 674 vs. 4,286 ± 1,136, p < 0.001) compared with SSc Limited-ILD. Conclusion: The proposed method seems to provide an alternative to identify and quantify the extension of ILD in patients with SSc, mitigating the subjectivity of semiquantitative analyzes based on visual scores. Frontiers Media S.A. 2020-09-25 /pmc/articles/PMC7546366/ /pubmed/33102508 http://dx.doi.org/10.3389/fmed.2020.577739 Text en Copyright © 2020 Carvalho, Guimarães, Sztajnbok, Rodrigues, Silva, Lopes, Zin, Almeida and França. http://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 Medicine
Carvalho, Alysson Roncally S.
Guimarães, Alan R.
Sztajnbok, Flávio R.
Rodrigues, Rosana Souza
Silva, Bruno Rangel Antunes
Lopes, Agnaldo José
Zin, Walter Araujo
Almeida, Isabel
França, Manuela Maria
Automatic Quantification of Interstitial Lung Disease From Chest Computed Tomography in Systemic Sclerosis
title Automatic Quantification of Interstitial Lung Disease From Chest Computed Tomography in Systemic Sclerosis
title_full Automatic Quantification of Interstitial Lung Disease From Chest Computed Tomography in Systemic Sclerosis
title_fullStr Automatic Quantification of Interstitial Lung Disease From Chest Computed Tomography in Systemic Sclerosis
title_full_unstemmed Automatic Quantification of Interstitial Lung Disease From Chest Computed Tomography in Systemic Sclerosis
title_short Automatic Quantification of Interstitial Lung Disease From Chest Computed Tomography in Systemic Sclerosis
title_sort automatic quantification of interstitial lung disease from chest computed tomography in systemic sclerosis
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546366/
https://www.ncbi.nlm.nih.gov/pubmed/33102508
http://dx.doi.org/10.3389/fmed.2020.577739
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