A study design for statistical learning technique to predict radiological progression with an application of idiopathic pulmonary fibrosis using chest CT images

Recent studies have suggested that in patients with an idiopathic interstitial pneumonia (IIP), a probable usual interstitial pneumonia (UIP) pattern on chest computed tomography (CT) is sufficient to diagnose idiopathic pulmonary fibrosis (IPF) without histopathology.We retrospectively compared the prognosis and time to first acute exacerbation (AE) in IIP patients with a UIP and a probable UIP pattern on initial chest CT.One hundred and sixty IIP patients with a UIP pattern and 242 with a probable UIP pattern were identified. Probable UIP pattern was independently associated with longer survival time (adjusted hazard ratio 0.713, 95% CI 0.536–0.950; p=0.021) and time to first AE (adjusted hazard ratio 0.580, 95% CI 0.389–0.866; p=0.008). In subjects with a probable UIP pattern who underwent surgical lung biopsy, the probability of a histopathological UIP pattern was 83%. After multidisciplinary discussion and the inclusion of longitudinal behaviour, a diagnosis of IPF was made in 66% of cases. In IPF patients, survival time and time to first AE were not associated with CT pattern. Among subjects with a probable UIP pattern, compared to non-IPF patients, survival time and time to first AE were shorter in IPF patients.In conclusion, IIP patients with a probable UIP pattern on initial chest CT had a better prognosis and longer time to first AE than those with a UIP pattern. However, when baseline data and longitudinal behaviour provided a final diagnosis of IPF, CT pattern was not associated with these outcomes. This suggests diagnostic heterogeneity among patients with a probable UIP pattern.

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Increased Pulmonary Artery to Aorta Diameter Ratio on Chest CT in Patients With Idiopathic Pulmonary Fibrosis is Associated With More Severe Pulmonary Fibrosis, Coronary Calcification, and Physiological and Hemodynamic Abnormalities

CHEST Journal ◽

10.1016/j.chest.2017.08.482 ◽

2017 ◽

Vol 152 (4) ◽

pp. A455

Author(s):

M. Faisal Siddiqi ◽

Adam Rothman ◽

Jason Filopei ◽

Madeline Ehrlich ◽

Mary Salvatore ◽

...

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Pulmonary Artery ◽

Coronary Calcification ◽

Chest Ct ◽

Diameter Ratio ◽

Aorta Diameter

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Hyperpolarized 129Xe MRI Features Identify Functional Differences That Do Not Correlate with Chest CT in Patients with Idiopathic Pulmonary Fibrosis

10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1116 ◽

2021 ◽

Author(s):

D. Mummy ◽

A. Swaminathan ◽

K. Yarnall ◽

J. Mammarappallil ◽

B. Driehuys ◽

...

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Chest Ct ◽

Functional Differences ◽

Mri Features ◽

Hyperpolarized 129Xe

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Fibrosis-Net: A Tailored Deep Convolutional Neural Network Design For Prediction of Pulmonary Fibrosis Progression From Chest CT Images

10.21203/rs.3.rs-610010/v1 ◽

2021 ◽

Author(s):

Alexander Wong ◽

Jack Lu ◽

Adam Dorfman ◽

Paul McInnis ◽

Mahmoud Famouri ◽

...

Keyword(s):

Decision Making ◽

Pulmonary Fibrosis ◽

Network Design ◽

Ct Images ◽

Chest Ct ◽

Correct Decision ◽

Fibrosis Progression ◽

Likelihood Score ◽

Log Likelihood ◽

Performance Validation

Abstract Background: Pulmonary fibrosis is a devastating chronic lung disease that causes irreparable lung tissue scarring and damage, resulting in progressive loss in lung capacity and has no known cure. A critical step in the treatment and management of pulmonary fibrosis is the assessment of lung function decline, with computed tomography (CT) imaging being a particularly effective method for determining the extent of lung damage caused by pulmonary fibrosis. Motivated by this, we introduce Fibrosis-Net, a deep convolutional neural network design tailored for the prediction of pulmonary fibrosis progression from chest CT images. More specifically, machine-driven design exploration was leveraged to determine a strong architectural design for CT lung analysis, upon which we build a customized network design tailored for predicting forced vital capacity (FVC) based on a patient's CT scan, initial spirometry measurement, and clinical metadata. Finally, we leverage an explainability-driven performance validation strategy to study the decision-making behaviour of Fibrosis-Net as to verify that predictions are based on relevant visual indicators in CT images.Results: Experiments using a patient cohort from the OSIC Pulmonary Fibrosis Progression Challenge showed that the proposed Fibrosis-Net is able to achieve a significantly higher modified Laplace Log Likelihood score than the winning solutions on the challenge. Furthermore, explainability-driven performance validation demonstrated that the proposed Fibrosis-Net exhibits correct decision-making behaviour by leveraging clinically-relevant visual indicators in CT images when making predictions on pulmonary fibrosis progress. Conclusion: Fibrosis-Net is able to achieve a significantly higher modified Laplace Log Likelihood score than the winning solutions on the OSIC Pulmonary Fibrosis Progression Challenge, and has been shown to exhibit correct decision-making behaviour when making predictions. Fibrosis-Net is available to the general public in an open-source and open access manner as part of the OpenMedAI initiative. While Fibrosis-Net is not yet a production-ready clinical assessment solution, we hope that its release will encourage researchers, clinicians, and citizen data scientists alike to leverage and build upon it.

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Standardised 3D-CT Lung Volumes for Patients with Idiopathic Pulmonary Fibrosis

10.21203/rs.3.rs-1129054/v1 ◽

2021 ◽

Author(s):

Yuko Tanaka ◽

Yuzo Suzuki ◽

Hirotsugu Hasegawa ◽

Koshi Yokomura ◽

Atsuki Fukada ◽

...

Keyword(s):

Computed Tomography ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Pulmonary Function Tests ◽

Three Dimensional ◽

Ct Images ◽

3D Ct ◽

Pulmonary Physiology ◽

Lung Physiology ◽

Lower Lung

Abstract Background: The assessment of lung physiology via pulmonary function tests (PFTs) is essential for patients with idiopathic pulmonary fibrosis (IPF). However, PFTs require active participation, which can be challenging for patients with severe respiratory failure, such as during acute exacerbations (AE) of IPF. Recently advances enabled to re-construct of 3-dimensional computed-tomography (3D-CT) images. Methods: This is a retrospective multi-center cohort study. This study established a standardisation method and quantitative analysis of lung volume (LV) based on anthropometry using three-dimensional computed tomography (3D-CT) images. The standardised 3D-CT LV in patients with IPF at diagnosis (n=140) and during AE (cohort1; n=61 and cohort2; n=50) and those of controls (n=53) were measured. Results: The standardised 3D-CT LVs at IPF diagnosis were less than those of control patients, especially in the lower lung lobes. The standardised 3D-CT LVs were correlated with forced vital capacity (FVC) and validated using the modified Gender-Age-Physiology (GAP) index. The standardised 3D-CT LVs at IPF diagnosis were independently associated with prognosis. During AE, PFTs were difficult to perform, 3D-CT analyses revealed reduced lung capacity in both the upper and lower lobes compared to those obtained at diagnosis. Lower standardised 3D-CT LVs during AE were independently associated with worse outcomes in independent two cohorts. Particularly, volume loss in the upper lobe at AE had prognostic values.Conclusion: A novel image quantification method for assessing pulmonary physiology using standardised 3D-CT-derived LVs was developed. This method successfully predicts mortality in patients with IPF and AE of IPF, and may be a useful alternative to PFTs when PFTs cannot be performed.

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Clinical characteristics of imported and second-generation COVID-19 cases outside Wuhan, China: A multicenter retrospective study

10.1101/2020.04.19.20071472 ◽

2020 ◽

Cited By ~ 3

Author(s):

Puyu Shi ◽

Guoxia Ren ◽

Jun Yang ◽

Zhiqiang Li ◽

Shujiao Deng ◽

...

Keyword(s):

Pulmonary Fibrosis ◽

Hospital Admission ◽

Symptom Onset ◽

Lymphocyte Count ◽

Clinical Characteristics ◽

Second Generation ◽

Discharge Rate ◽

Ct Images ◽

Chest Ct ◽

Multicenter Cohort Study

AbstractBackgroundThe mortality of COVID-19 differs between countries and regions. By now, reports on COVID-19 are largely focused on first-generation cases. This study aimed to clarify the clinical characteristics of imported and second-generation cases.MethodsThis retrospective, multicenter cohort study included 134 confirmed COVID-19 cases from 9 cities outside Wuhan. Epidemiological, clinical and outcome data were extracted from medical records and were compared between severe and non-severe cases. We further profiled the dynamic laboratory findings of some patients.Results34.3% of the 134 patients were severe cases, and 11.2% had complications. As of March 7, 2020, 91.8% patients were discharged and one patient (0.7%) died. The median age was 46 years. The median interval from symptom onset to hospital admission was 4.5 (IQR 3-7) days. The median lymphocyte count was 1.1×109/L. Age, lymphocyte count, CRP, ESR, DBIL, LDH, HBDH showed difference between severe and no-severe cases (all P<0.05). Baseline lymphocyte count was higher in the survived patients than in the non-survivor case, and it increased as the condition improved, but declined sharply when death occurred. The IL-6 level displayed a downtrend in survivors, but rose very high in the death case. Pulmonary fibrosis was found on later chest CT images in 51.5% of the pneumonia cases.ConclusionImported and second-generation cases outside Wuhan had a better prognosis than initial cases in Wuhan. Lymphocyte count and IL-6 level could be used for evaluating prognosis. Pulmonary fibrosis as the sequelae of COVID-19 should be taken into account.SummaryImported and second-generation cases manifested less complications, lower fatality, and higher discharge rate than initial cases, which may be related to the shorter interval from symptom onset to hospital admission, younger age, and higher lymphocyte count of the imported and second-generation patients. Lymphocyte count and IL-6 level could be used as indicators for evaluating prognosis. Pulmonary fibrosis was found in later chest CT images in more than half of the pneumonia cases and should be taken into account.

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Histologic factors associated with nintedanib efficacy in patients with idiopathic pulmonary fibrosis

PLoS ONE ◽

10.1371/journal.pone.0245147 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245147

Author(s):

Masahiro Nemoto ◽

Yoshiaki Zaizen ◽

Kensuke Kataoka ◽

Kishio Kuroda ◽

Kazuhiro Tabata ◽

...

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Progression Free Survival ◽

Available P ◽

Radiological Progression ◽

Free Survival ◽

Factors Associated ◽

Interlobular Septum ◽

Microscopic Features ◽

Histopathologic Evaluation

Background Histopathologic factors predictive of nintedanib efficacy in idiopathic pulmonary fibrosis have not been studied. We aimed to describe the characteristics, focusing on histopathology, of idiopathic pulmonary fibrosis patients who did and did not respond to nintedanib. Methods This study retrospectively examined the clinicoradiopathologic features of 40 consecutive patients with surgical lung biopsy-confirmed idiopathic pulmonary fibrosis treated with nintedanib. Additionally, we compared the histopathologic scoring of 21 microscopic features between patients with functional or radiological progression and those with non-progression during 12 months of treatment. Results The histopathologic evaluation showed edematous changes in the interlobular septum as the only histologic finding observed more frequently in patients with both functional and radiological progression than in those without (58% vs. 14%, P = 0.007 and 50% vs. 0%, P = 0.003, respectively). Regarding per-year change, patients with edematous changes in the interlobular septum showed greater progression in median changes in spared area (-12%, interquartile range: [-25%–-5%], vs. -3% [-7%–0%], P = 0.004) and reticular shadow (7% [3%–13%], vs. 0% [0%–5%], P = 0.041) on computed tomography. Functional and radiological progression-free survival were shorter in patients with edematous changes in the interlobular septum than in those without (6.6 months, 95% confidence interval: [5.9–25.3], vs. event <50%, [12.1–Not available], P = 0.0009, and 6.1 months, [5.2–6.6] vs. 14.5 months [7.8–not available], P<0.0001). Conclusions Edematous changes in the interlobular septum may indicate poor nintedanib efficacy in idiopathic pulmonary fibrosis. Further studies are needed to validate these findings and address the mechanism behind ECIS.

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