特发性肺纤维化疾病进展：动态定量胸部计算机断层扫描随访分析

Idiopathic pulmonary fibrosis disease progression: a dynamic quantitative chest computed tomography follow-up analysis.

作者信息

Sun Haishuang, Liu Min, Kang Han, Yang Xiaoyan, Zhang Peiyao, Zhang Rongguo, Dai Huaping, Wang Chen

机构信息

Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China.

National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.

出版信息

Quant Imaging Med Surg. 2023 Mar 1;13(3):1488-1498. doi: 10.21037/qims-22-843. Epub 2023 Jan 9.

DOI:10.21037/qims-22-843

PMID:36915349

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10006139/

Abstract

BACKGROUND

To clarify whether dynamic quantification of variables derived from chest high-resolution computed tomography (HRCT) can assess the progression of idiopathic pulmonary fibrosis (IPF).

METHODS

Patients with IPF who underwent serial computed tomography (CT) imaging were retrospectively enrolled. Several structural abnormalities seen on HRCT in IPF were segmented and quantified. Patients were divided into 2 groups according to their pulmonary function test (PFT) results: those with disease stabilization and those with disease progression, and differences between the groups were analyzed.

RESULTS

There were no statistically significant differences between the 2 patient groups for the following parameters: baseline PFTs, total lesion extent, lesion extent at different sites in the lungs, and pulmonary vessel-related parameters (with P values ranging from 0.057 to 0.894). Median changes in total lung volume, total lesion volume, and total lesion ratio were significantly higher in patients with worsening disease compared with those with stable disease (P<0.001). There was a significant increase in total lesion volume of 214.73 mL [interquartile range (IQR), 68.26 to 501.46 mL] compared with 3.67 mL (IQR, -71.70 to 85.33 mL) in the disease progression group compared with the disease stability group (P=0.001). The decline in pulmonary vessel volume and number of pulmonary vessel branches was more pronounced in the group with functional worsening compared with the group with functional stability. Moreover, changes in lesion volume ratio were negatively correlated with changes in diffusing capacity of the lungs for carbon monoxide (DLco) during follow-up (R=-0.57, P<0.001), and changes in pulmonary vessel-related parameters demonstrated positive correlation with DLco (with R ranging from 0.27 to 0.53, P<0.001) and forced vital capacity (FVC) (with R ranging from 0.44 to 0.61, P<0.001).

CONCLUSIONS

Changes in CT-related parameters during follow-up may have better predictive performance compared with baseline imaging parameters and PFTs for disease progression in IPF.

摘要

背景

为了阐明源自胸部高分辨率计算机断层扫描（HRCT）的变量的动态量化是否可以评估特发性肺纤维化（IPF）的进展。

方法

回顾性纳入接受系列计算机断层扫描（CT）成像的IPF患者。对IPF患者HRCT上可见的几种结构异常进行分割和量化。根据肺功能测试（PFT）结果将患者分为两组：疾病稳定组和疾病进展组，并分析两组之间的差异。

结果

两组患者在以下参数方面无统计学显著差异：基线PFT、总病变范围、肺部不同部位的病变范围以及肺血管相关参数（P值范围为0.057至0.894）。与疾病稳定的患者相比，疾病恶化的患者全肺容积、总病变容积和总病变比率的中位数变化显著更高（P<0.001）。与疾病稳定组相比，疾病进展组的总病变容积显著增加，为214.73 mL[四分位数间距（IQR），68.26至501.46 mL]，而疾病稳定组为3.67 mL（IQR，-71.70至85.33 mL）（P=0.001）。与功能稳定组相比，功能恶化组肺血管容积和肺血管分支数量的下降更为明显。此外，病变容积比率的变化与随访期间肺一氧化碳弥散量（DLco）的变化呈负相关（R=-0.57，P<0.001），肺血管相关参数的变化与DLco（R范围为0.27至0.53，P<0.001）和用力肺活量（FVC）（R范围为0.44至0.61，P<0.001）呈正相关。