Kliment Corrine R, Araki Tetsuro, Doyle Tracy J, Gao Wei, Dupuis Josée, Latourelle Jeanne C, Zazueta Oscar E, Fernandez Isis E, Nishino Mizuki, Okajima Yuka, Ross James C, Estépar Raúl San José, Diaz Alejandro A, Lederer David J, Schwartz David A, Silverman Edwin K, Rosas Ivan O, Washko George R, O'Connor George T, Hatabu Hiroto, Hunninghake Gary M
From the Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
BMC Pulm Med. 2015 Oct 29;15:134. doi: 10.1186/s12890-015-0124-x.
Evidence suggests that individuals with interstitial lung abnormalities (ILA) on a chest computed tomogram (CT) may have an increased risk to develop a clinically significant interstitial lung disease (ILD). Although methods used to identify individuals with ILA on chest CT have included both automated quantitative and qualitative visual inspection methods, there has been not direct comparison between these two methods. To investigate this relationship, we created lung density metrics and compared these to visual assessments of ILA.
To provide a comparison between ILA detection methods based on visual assessment we generated measures of high attenuation areas (HAAs, defined by attenuation values between -600 and -250 Hounsfield Units) in >4500 participants from both the COPDGene and Framingham Heart studies (FHS). Linear and logistic regressions were used for analyses.
Increased measures of HAAs (in ≥ 10 % of the lung) were significantly associated with ILA defined by visual inspection in both cohorts (P < 0.0001); however, the positive predictive values were not very high (19 % in COPDGene and 13 % in the FHS). In COPDGene, the association between HAAs and ILA defined by visual assessment were modified by the percentage of emphysema and body mass index. Although increased HAAs were associated with reductions in total lung capacity in both cohorts, there was no evidence for an association between measurement of HAAs and MUC5B promoter genotype in the FHS.
Our findings demonstrate that increased measures of lung density may be helpful in determining the severity of lung volume reduction, but alone, are not strongly predictive of ILA defined by visual assessment. Moreover, HAAs were not associated with MUC5B promoter genotype.
有证据表明，胸部计算机断层扫描（CT）显示存在间质性肺异常（ILA）的个体发生具有临床意义的间质性肺疾病（ILD）的风险可能增加。虽然用于在胸部CT上识别ILA个体的方法包括自动定量和定性视觉检查方法，但这两种方法之间尚未进行直接比较。为了研究这种关系，我们创建了肺密度指标，并将其与ILA的视觉评估结果进行比较。
为了比较基于视觉评估的ILA检测方法，我们在慢性阻塞性肺疾病基因（COPDGene）研究和弗雷明汉心脏研究（FHS）的4500多名参与者中生成了高衰减区域（HAA，由-600至-250亨氏单位之间的衰减值定义）的测量值。采用线性和逻辑回归进行分析。
两个队列中，HAA测量值增加（占肺组织的≥10%）均与视觉检查定义的ILA显著相关（P<0.0001）；然而，阳性预测值不是很高（COPDGene研究中为19%，FHS研究中为13%）。在COPDGene研究中，HAA与视觉评估定义的ILA之间的关联因肺气肿百分比和体重指数而有所改变。虽然两个队列中HAA增加均与肺总量降低相关，但在FHS研究中，没有证据表明HAA测量值与MUC5B启动子基因型之间存在关联。
我们的研究结果表明，肺密度测量值增加可能有助于确定肺容积减少的严重程度，但仅凭这一点并不能强烈预测视觉评估定义的ILA。此外，HAA与MUC5B启动子基因型无关。
