Mediastinal lymph node enlargement on CT scans in idiopathic pulmonary fibrosis

Abstract Background and objectives Evidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients. Methods This retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models. Results The study population consisted of 152 IPF patients, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86–13.62, p ≤ 0.001) and significant disease progression (HR 2.99, 95% CI 1.22–7.33, p = 0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time. Conclusions Diffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.

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Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends.

10.21203/rs.3.rs-46826/v2 ◽

2020 ◽

Author(s):

Giacomo Sgalla ◽

Anna Rita Larici ◽

Nicoletta Golfi ◽

Mariarosaria Calvello ◽

Alessandra Farchione ◽

...

Keyword(s):

Lymph Node ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Lymph Nodes ◽

Ct Scan ◽

Disease Progression ◽

Mediastinal Lymph Node ◽

Mediastinal Lymph Nodes ◽

Lymph Node Enlargement

Abstract Background and objectivesEvidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients.MethodsThis retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models.Results152 IPF patients were included in the analysis, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86-13.62, p≤0.001) and significant disease progression (HR 2.99, 95% CI 1.22-7.33, p=0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time.ConclusionsDiffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.

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Impact of mediastinal lymph node enlargement on the prognosis of idiopathic pulmonary fibrosis

PLoS ONE ◽

10.1371/journal.pone.0201154 ◽

2018 ◽

Vol 13 (7) ◽

pp. e0201154 ◽

Cited By ~ 3

Author(s):

Sooim Sin ◽

Kyung Hee Lee ◽

Jee Hye Hur ◽

Sang-hoon Lee ◽

Yeon Joo Lee ◽

...

Keyword(s):

Lymph Node ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Mediastinal Lymph Node ◽

Lymph Node Enlargement

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Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends

10.21203/rs.3.rs-46826/v1 ◽

2020 ◽

Author(s):

Giacomo Sgalla ◽

Anna Rita Larici ◽

Nicoletta Golfi ◽

Mariarosaria Calvello ◽

Alessandra Farchione ◽

...

Keyword(s):

Lymph Node ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Lymph Nodes ◽

Ct Scan ◽

Disease Progression ◽

Mediastinal Lymph Node ◽

Mediastinal Lymph Nodes ◽

Lymph Node Enlargement

Abstract Background and objectives: Evidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients. Methods: This retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models. Results: 152 IPF patients were included in the analysis, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86-13.62, p≤0.001) and significant disease progression (HR 2.99, 95% CI 1.22-7.33, p=0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time. Conclusions: Diffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.

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Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends

10.21203/rs.3.rs-46826/v3 ◽

2020 ◽

Author(s):

Giacomo Sgalla ◽

Anna Rita Larici ◽

Nicoletta Golfi ◽

Mariarosaria Calvello ◽

Alessandra Farchione ◽

...

Keyword(s):

Lymph Node ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Lymph Nodes ◽

Ct Scan ◽

Disease Progression ◽

Mediastinal Lymph Node ◽

Mediastinal Lymph Nodes ◽

Lymph Node Enlargement

Abstract Background and objectives Evidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients. Methods This retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models. Results 152 IPF patients were included in the analysis, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86-13.62, p≤0.001) and significant disease progression (HR 2.99, 95% CI 1.22-7.33, p=0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time. Conclusions Diffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.

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Mediastinal lymph node enlargement on CT scans in patients with usual interstitial pneumonitis.

American Journal of Roentgenology ◽

10.2214/ajr.154.2.2105008 ◽

1990 ◽

Vol 154 (2) ◽

pp. 251-254 ◽

Cited By ~ 30

Author(s):

C Bergin ◽

R A Castellino

Keyword(s):

Lymph Node ◽

Interstitial Pneumonitis ◽

Mediastinal Lymph Node ◽

Ct Scans ◽

Lymph Node Enlargement ◽

Usual Interstitial Pneumonitis

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Diagnostic Yield of eXcelon, a New Transbronchial Histology Aspiration Needle in Patients With Mediastinal Lymph Node Enlargement

Journal of Bronchology ◽

10.1097/lbr.0b013e31803815c5 ◽

2007 ◽

Vol 14 (2) ◽

pp. 86-89 ◽

Cited By ~ 3

Author(s):

Frank H. W. Hermens ◽

Frederik B. J. M. Thunnissen ◽

Julius P. Janssen

Keyword(s):

Lymph Node ◽

Diagnostic Yield ◽

Mediastinal Lymph Node ◽

Lymph Node Enlargement

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Prognostic value of mediastinal lymph node enlargement in chronic interstitial lung disease

Diagnostic and Interventional Radiology ◽

10.5152/dir.2021.19585 ◽

2021 ◽

Author(s):

Stefano Grecuccio ◽

◽

Nicola Sverzellati ◽

Elisabetta Uslenghi ◽

Antonella Caminati ◽

...

Keyword(s):

Lymph Node ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Prognostic Value ◽

Mediastinal Lymph Node ◽

Lymph Node Enlargement

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Comparative analysis of density histograms and visual scores in incremental and volumetric high-resolution computed tomography of the chest in idiopathic pulmonary fibrosis patients

La radiologia medica ◽

10.1007/s11547-020-01307-7 ◽

2020 ◽

Author(s):

Gaetano Rea ◽

Marina De Martino ◽

Annalisa Capaccio ◽

Pasquale Dolce ◽

Tullio Valente ◽

...

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Lung Function ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Ct Scans ◽

High Resolution Computed Tomography ◽

Disease Extent ◽

Single Breath ◽

Volumetric Ct

Abstract Background Volumetric high-resolution computed tomography (HRCT) of the chest has recently replaced incremental CT in the diagnostic workup of idiopathic pulmonary fibrosis (IPF). Concomitantly, visual and quantitative scores have been proposed for disease extent assessment to ameliorate disease management. Purpose To compare the performance of density histograms (mean lung attenuation, skewness, and kurtosis) and visual scores, along with lung function correlations, in IPF patients submitted to incremental or volumetric thorax HRCT. Material and methods Clinical data and CT scans of 89 newly diagnosed and therapy-naive IPF patients were retrospectively evaluated. Results Forty-six incremental and 43 volumetric CT scans were reviewed. No differences of density histograms and visual scores estimates were found by comparing two HRCT techniques, with an optimal inter-operator agreement (concordance correlation coefficient >0.90 in all instances). Single-breath diffusing lung capacity for carbon monoxide (DLCOsb) was inversely related with the Best score (r = −00.416; p = 0.014), the Kazerooni fibrosis extent (r = −0.481; p = 0.004) and the mean lung attenuation (r = −0.382; p = 0.026), while a positive correlation was observed with skewness (r = 0.583; p = 0.001) and kurtosis (r = 0.543; p = 0.001) in the incremental HRCT sub-group. Similarly, in the volumetric CT sub-cohort, DLCOsb was significantly associated with skewness (r = 0.581; p = 0.007) and kurtosis (r = 0.549; p = 0.018). Correlations with visual scores were not confirmed. Forced vital capacity significantly related to all density indices independently on HRCT technique. Conclusions Density histograms and visual scores similarly perform in incremental and volumetric HRCT. Density quantification displays an optimal reproducibility and proves to be superior to visual scoring as more strongly correlated with lung function.

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