Putman Rachel K, Rose Jonathan A, San José Estepar Ruben, Tukpah Ann-Marcia C, Cutting Claire C, Hino Takuya, Hata Akinori, Nishino Mizuki, Humphries Stephen M, Lynch David A, Silverman Edwin K, Cho Michael H, Rosas Ivan O, Washko George R, Hatabu Hiroto, San José Estepar Raúl, Hunninghake Gary M
Brigham and Women's Hospital, Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States;
Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States.
Am J Respir Crit Care Med. 2025 Jul 28. doi: 10.1164/rccm.202501-0247OC.
Interstitial lung abnormalities (ILA) are visually identified changes on chest computed tomography (CT) scans that may represent early/mild pulmonary fibrosis. Quantitative interstitial abnormalities (QIA) measure potential parenchymal lung injury on chest CT scans using an automated algorithm. It is not known if combining these visual and quantitative assessments improves prediction of imaging progression.
To assess the utility of quantitative imaging to predict imaging progression of ILA and adverse clinical outcomes in a cohort of smokers.
ILA presence, subtypes, and progression, as well as QIA were assessed on chest CT scans from participants ~5 years apart in COPDGene. Multivariable logistic regression assessed associations with ILA progression, Cox proportional hazards assessed the relationship between ILA progression and mortality.
4373 participants had serial CT scans, 544 (12%) had ILA on at least one; of those 391 (72%) had imaging visual progression and 153 (28%) did not. Specific imaging features were associated progression, (e.g. traction bronchiectasis, OR=3.1, 95% CI 1.3-7.3, P=0.003). Among those with ILA, baseline quantitative measures (QIA and forced vital capacity [FVC]) were not associated with progression, however, visual imaging progression was associated with increased longitudinal change of QIA (mean difference 6.5%, 95% CI 4.9%-8.1%, P<0.0001). In ILA, QIA increase was associated with an increased rate of mortality independent of FVC decline, (HR=1.05, 95% CI 1.01-1.09, P=0.009).
Baseline quantitative measures (QIA and FVC) were not associated with visual ILA progression, however longitudinal change in QIA was correlated with imaging progression and adverse clinical outcomes.
间质性肺异常（ILA）是胸部计算机断层扫描（CT）上肉眼可见的变化，可能代表早期/轻度肺纤维化。定量间质异常（QIA）使用自动算法测量胸部CT扫描上潜在的肺实质损伤。尚不清楚将这些视觉和定量评估相结合是否能改善对影像学进展的预测。
评估定量成像在预测一组吸烟者ILA影像学进展和不良临床结局中的作用。
在COPDGene研究中，对间隔约5年的参与者的胸部CT扫描评估ILA的存在、亚型和进展以及QIA。多变量逻辑回归评估与ILA进展的关联，Cox比例风险评估ILA进展与死亡率之间的关系。
4373名参与者进行了系列CT扫描，其中544名（12%）至少有一次ILA；其中391名（72%）有影像学视觉进展，153名（28%）没有。特定的影像学特征与进展相关（例如，牵拉性支气管扩张，OR=3.1，95%CI 1.3-7.3，P=0.003）。在有ILA的患者中，基线定量指标（QIA和用力肺活量[FVC]）与进展无关，然而，视觉影像学进展与QIA的纵向变化增加相关（平均差异6.5%，95%CI 4.9%-8.1%，P<0.0001）。在ILA患者中，QIA增加与死亡率增加相关，且独立于FVC下降（HR=1.05，95%CI 1.01-1.09，P=0.009）。
基线定量指标（QIA和FVC）与ILA视觉进展无关，然而QIA的纵向变化与影像学进展和不良临床结局相关。
