Salisbury Margaret L, Lynch David A, van Beek Edwin J R, Kazerooni Ella A, Guo Junfeng, Xia Meng, Murray Susan, Anstrom Kevin J, Yow Eric, Martinez Fernando J, Hoffman Eric A, Flaherty Kevin R
1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.
2 Department of Radiology, National Jewish Health, Denver, Colorado.
Am J Respir Crit Care Med. 2017 Apr 1;195(7):921-929. doi: 10.1164/rccm.201607-1385OC.
Adaptive multiple features method (AMFM) lung texture analysis software recognizes high-resolution computed tomography (HRCT) patterns.
To evaluate AMFM and visual quantification of HRCT patterns and their relationship with disease progression in idiopathic pulmonary fibrosis.
Patients with idiopathic pulmonary fibrosis in a clinical trial of prednisone, azathioprine, and N-acetylcysteine underwent HRCT at study start and finish. Proportion of lung occupied by ground glass, ground glass-reticular (GGR), honeycombing, emphysema, and normal lung densities were measured by AMFM and three radiologists, documenting baseline disease extent and postbaseline change. Disease progression includes composite mortality, hospitalization, and 10% FVC decline.
Agreement between visual and AMFM measurements was moderate for GGR (Pearson's correlation r = 0.60, P < 0.0001; mean difference = -0.03 with 95% limits of agreement of -0.19 to 0.14). Baseline extent of GGR was independently associated with disease progression when adjusting for baseline Gender-Age-Physiology stage and smoking status (hazard ratio per 10% visual GGR increase = 1.98, 95% confidence interval [CI] = 1.20-3.28, P = 0.008; and hazard ratio per 10% AMFM GGR increase = 1.36, 95% CI = 1.01-1.84, P = 0.04). Postbaseline visual and AMFM GGR trajectories were correlated with postbaseline FVC trajectory (r = -0.30, 95% CI = -0.46 to -0.11, P = 0.002; and r = -0.25, 95% CI = -0.42 to -0.06, P = 0.01, respectively).
More extensive baseline visual and AMFM fibrosis (as measured by GGR densities) is independently associated with elevated hazard for disease progression. Postbaseline change in AMFM-measured and visually measured GGR densities are modestly correlated with change in FVC. AMFM-measured fibrosis is an automated adjunct to existing prognostic markers and may allow for study enrichment with subjects at increased disease progression risk.
自适应多特征方法（AMFM）肺纹理分析软件可识别高分辨率计算机断层扫描（HRCT）模式。
评估AMFM以及HRCT模式的视觉量化，及其与特发性肺纤维化疾病进展的关系。
在一项关于泼尼松、硫唑嘌呤和N-乙酰半胱氨酸的临床试验中，特发性肺纤维化患者在研究开始和结束时接受了HRCT检查。通过AMFM和三位放射科医生测量磨玻璃影、磨玻璃-网状影（GGR）、蜂窝状影、肺气肿和正常肺密度所占据的肺比例，记录基线疾病范围和基线后变化。疾病进展包括综合死亡率、住院率和用力肺活量（FVC）下降10%。
视觉测量与AMFM测量在GGR方面的一致性为中等（Pearson相关系数r = 0.60，P < 0.0001；平均差异 = -0.03，95%一致性界限为-0.19至0.14）。在调整基线性别-年龄-生理阶段和吸烟状态后，GGR的基线范围与疾病进展独立相关（视觉GGR每增加10%的风险比 = 1.98，95%置信区间[CI] = 1.20 - 3.28，P = 0.008；AMFM GGR每增加10%的风险比 = 1.36，95% CI = 1.01 - 1.84，P = 0.04）。基线后视觉和AMFM的GGR轨迹与基线后FVC轨迹相关（r = -0.30，95% CI = -0.46至-0.11，P = 0.002；以及r = -0.25，95% CI = -0.42至-0.06，P = 0.01）。
更广泛的基线视觉和AMFM纤维化（以GGR密度衡量）与疾病进展风险升高独立相关。AMFM测量和视觉测量的GGR密度在基线后的变化与FVC的变化适度相关。AMFM测量的纤维化是现有预后标志物的一种自动辅助手段，可能有助于纳入疾病进展风险增加的受试者进行研究。
