Nicola Sverzellati1, Mario Silva2, Valeria Seletti2, Carlotta Galeone3, Stefano Palmucci4, Sara Piciucchi5, Carlo Vancheri6, Venerino Poletti7, Sara Tomassetti8, Ronald Karwoski9, Brian J Bartholmai10. 1. Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Padiglione Barbieri, V. Gramsci 14, Parma, Italy. nicola.sverzellati@unipr.it. 2. Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Padiglione Barbieri, V. Gramsci 14, Parma, Italy. 3. Department of Clinical Sciences and Community, University of Milan, Milan, Italy. 4. Department of Medical and Surgical Sciences and Advanced Technologies-Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy. 5. Department of Radiology, Azienda USL Romagna, Ospedale GB Morgagni, Forlì, Italy. 6. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy. 7. Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark. 8. Department of Diseases of the Thorax, Ospedale G.B. Morgagni, Forli, Italy. 9. Biomedical Imaging Resource, Mayo Clinic, Rochester, MN, USA. 10. Division of Radiology, Mayo Clinic, Rochester, MN, USA.
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.
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.
Authors: Minna E Mononen; Hannu-Pekka Kettunen; Sanna-Katja Suoranta; Miia S Kärkkäinen; Tuomas A Selander; Minna K Purokivi; Riitta L Kaarteenaho Journal: J Thorac Dis Date: 2021-04 Impact factor: 2.895