Morphological Patterns of Sarcoidosis and Clinical Outcome: Retrospective Analysis through a Multidisciplinary Approach

The aim of this work was to verify the correlations between different pulmonary morphological patterns and functional outcomes in sarcoidosis patients, using a validated score for the comparison between the high-resolution computed tomography (HRCT) of patients belonging to different imaging patterns. From the electronic database of the reference center for interstitial lung diseases of our University Hospital, we retrospectively selected 55 patients with a diagnosis of sarcoidosis according to the American Thoracic Society (ATS) criteria; we evaluated the initial HRCT examination and pulmonary function tests collected at baseline and after a year. Patients were divided into typical (48% of patients) and atypical (52%) HRCT patterns, and a computer tomography activity score (CTAS) was associated with each HRCT appearance detected; clinical history, impact of therapy, and extra-thoracic locations were also considered. We found that worsening of diffusing capacity for carbon monoxide (DLCO) is related to the CTAS (r = −0.20, p = 0.01), and there was an inverse correlation between the variation of forced vital capacity (FVC) and the value of the CTAS (r = −0.30, p = 0.23) in the subgroup of patients with atypical patterns. CTAS were higher in patients with extra-pulmonary localizations (p = 0.05) and the subgroup of patients with extra-thoracic locations and atypical manifestations had a greater worsening in terms of variation of FVC (p = 0.03) and DLCO% (p = 0.04). No difference between treated and untreated patients was found.

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State of the art in the diagnosis and management of interstitial lung disease

Medicine and Pharmacy Reports ◽

10.15386/cjmed-457 ◽

2015 ◽

Vol 88 (2) ◽

pp. 116-123 ◽

Cited By ~ 2

Author(s):

Maria T. A. Buzan ◽

Carmen Monica Pop

Keyword(s):

Multidisciplinary Approach ◽

Pulmonary Function Tests ◽

Blood Gas Analysis ◽

Final Diagnosis ◽

Interstitial Lung Diseases ◽

Gas Analysis ◽

High Resolution Computed Tomography ◽

Pulmonary Parenchyma ◽

6 Minute Walk Test ◽

Minute Walk

The interstitial lung diseases (ILDs) are a diverse group of disorders characterized by a varying combination of inflammation and fibrosis of the pulmonary parenchyma. Treatment and prognosis of ILD typically depend on the underlying ILD subtype, highlighting the importance of accurate classification and diagnosis. Besides a thorough history and clinical examination, the protocol should include a 6-minute walk test, chest radiography, high-resolution computed tomography, biochemical analysis, pulmonary function tests, blood gas analysis, bronchoalveolar lavage, and, when necessary, a lung biopsy. The final diagnosis of ILD entities requires dynamic interaction between clinicians, radiologists and pathologists to reach a clinico-radiologic-pathologic diagnosis, the gold standard no longer being the histology but rather a multidisciplinary approach.

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Monitoring and management of fibrosing interstitial lung diseases: a narrative review for practicing clinicians

Therapeutic Advances in Respiratory Disease ◽

10.1177/17534666211039771 ◽

2021 ◽

Vol 15 ◽

pp. 175346662110397

Author(s):

Anoop M. Nambiar ◽

Christopher M. Walker ◽

Jeffrey A. Sparks

Keyword(s):

Lung Diseases ◽

Multidisciplinary Approach ◽

Progressive Disease ◽

Pulmonary Function Tests ◽

Interstitial Lung Diseases ◽

Narrative Review ◽

Disease Monitoring ◽

Close Monitoring ◽

High Resolution Computed Tomography ◽

Progression Risk

Close monitoring of patients with fibrosing interstitial lung diseases (ILDs) is important to enable prompt identification and management of progressive disease. Monitoring should involve regular assessment of physiology (including pulmonary function tests), symptoms, and, when appropriate, high-resolution computed tomography. The management of patients with fibrosing ILDs requires a multidisciplinary approach and should be individualized based on factors such as disease severity, evidence of progression, risk factors for progression, comorbidities, and the preferences of the patient. In this narrative review, we discuss how patients with fibrosing ILDs can be effectively monitored and managed in clinical practice.

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Computed tomography findings as determinants of pulmonary function tests in fibrotic interstitial lung diseases—Network-analyses and multivariate models

Chronic Respiratory Disease ◽

10.1177/1479973120967025 ◽

2020 ◽

Vol 17 ◽

pp. 147997312096702

Author(s):

David Lang ◽

Kaveh Akbari ◽

Stefan Walcherberger ◽

Benedikt Hergan ◽

Andreas Horner ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Function ◽

Pulmonary Function Tests ◽

Information Criterion ◽

Forced Expiratory Volume ◽

Interstitial Lung Diseases ◽

High Resolution Computed Tomography ◽

Diffusion Capacity ◽

Network Analyses ◽

The Impact

The aim was to evaluate the impact of multiple high-resolution computed tomography (HRCT) features on pulmonary function test (PFT) biomarkers in fibrotic interstitial lung disease (FILD) patients. HRCT of subsequently ILD-board-discussed FILD patients were semi-quantitatively evaluated in a standardized approach: 18 distinct lung regions were scored for noduli, reticulation, honeycombing, consolidations, ground glass opacities (GGO), traction bronchiectasis (BRK) and emphysema. Total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, diffusion capacity for carbon monoxide (DLCO) and transfer coefficient (KCO) were assessed. Interactions between each PFT biomarker and all HRCT scores were visualized by network analyses, modeled according to the Schwarz Bayesian Information Criterion and incorporated in uni- and multivariate stepwise regression analyses. Among 108 FILD patients (mean age 67 years, 77% male), BRK extent was a major significant uni- or multivariate determinant of all PFT analyzed. Besides that, diffusion-based variables DLCO and KCO showed a larger dependency on reticulation, emphysema and GGO, while forced expiratory volume-based measures FEV1, FVC and FEV1/FVC were more closely associated with consolidations. For TLC, the only significant multivariate determinant was reticulation. In conclusion, PFT biomarkers derived from spirometry, body plethysmography and diffusion capacity in FILD patients are differentially influenced by semi-quantified HRCT findings.

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Computed Tomography Findings as Determinants of Local and Systemic Inflammation Biomarkers in Interstitial Lung Diseases: A Retrospective Registry-based Descriptive Study

10.21203/rs.3.rs-246233/v1 ◽

2021 ◽

Author(s):

David Lang ◽

Kaveh Akbari ◽

Andreas Horner ◽

Magdalena Hepp ◽

Bernhard Kaiser ◽

...

Keyword(s):

Computed Tomography ◽

Blood Lymphocyte ◽

Lung Diseases ◽

Interstitial Lung Diseases ◽

University Hospital ◽

Federal State ◽

High Resolution Computed Tomography ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Fraction ◽

Hrct Finding

Abstract Purpose: To evaluate the association of peripheral blood (PBL) and broncho-alveolar lavage (BAL) biomarkers with inflammatory versus fibrotic high-resolution computed tomography (HRCT) findings in interstitial lung diseases (ILD). Methods: HRCT of 127 subsequent ILD-board patients were semi-quantitatively evaluated in a standardized way: Reticulation/honeycombing (RET), traction bronchiectasis (TBR) and emphysema (EMP) were classified as non-inflammatory/fibrotic; consolidations (CON), ground glass opacities (GGO), noduli (NDL) and mosaic attenuation (MOS) as active inflammatory findings. Presence or absence of each HRCT finding was counted in 6 distinct lung regions, resulting scores were graded as minimal (0–1 regions involved), medium (2–4) or extensive (5–6). Associations of routinely assessed PBL/BAL biomarkers with these radiological scores were evaluated using Spearman correlation coefficients and graphical presentation; significance of the graded HRCT scores was tested by applying Kruskal-Wallis tests. Results: Blood neutrophil, lymphocyte and eosinophil fraction, neutrophil-lymphocyte ratio (NLR) and BAL lymphocyte fraction consistently showed opposite correlations for inflammatory versus non-inflammatory/fibrotic HRCT finding scores. Blood lymphocyte fraction significantly differed by graded GGO (p = 0.032) and CON (p = 0.027) extent, eosinophil fraction by TBR (p = 0.006) and NLR by CON (p = 0.009). C-reactive protein was significantly related to GGO (p = 0.023) and CON (p = 0.004), BAL lymphocyte fraction to GGO (p = 0.017). Conclusion: Blood lymphocyte and eosinophil fraction, NLR, CRP and BAL lymphocyte fraction may aid to differentiate inflammatory from non-inflammatory/fibrotic ILD patterns. Trial registration: This evaluation was based on data from the ILD registry of Kepler University Hospital Linz, as approved by the ethics committee of the federal state of Upper-Austria (EK Nr. I-26-17).

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Lung Ultrasound as a First-Line Test in the Evaluation of Post-COVID-19 Pulmonary Sequelae

Frontiers in Medicine ◽

10.3389/fmed.2021.815732 ◽

2022 ◽

Vol 8 ◽

Author(s):

David Clofent ◽

Eva Polverino ◽

Almudena Felipe ◽

Galo Granados ◽

Marta Arjona-Peris ◽

...

Keyword(s):

Lung Ultrasound ◽

Pulmonary Function Tests ◽

Inverse Correlation ◽

Strongly Correlated ◽

First Line ◽

Roc Curve Analysis ◽

High Resolution Computed Tomography ◽

Line Test ◽

Moderate Inverse Correlation

Background: Interstitial lung sequelae are increasingly being reported in survivors of COVID-19 pneumonia. An early detection of these lesions may help prevent the development of irreversible lung fibrosis. Lung ultrasound (LUS) has shown high diagnostic accuracy in interstitial lung disease (ILD) and could likely be used as a first-line test for post-COVID-19 lung sequelae.Methods: Single-center observational prospective study. Follow-up assessments of consecutive patients hospitalized for COVID-19 pneumonia were conducted 2–5 months after the hospitalization. All patients underwent pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and LUS. Radiological alterations in HRCT were quantified using the Warrick score. The LUS score was obtained by evaluating the presence of pathological B-lines in 12 thoracic areas (range, 0–12). The correlation between the LUS and Warrick scores was analyzed.Results: Three hundred and fifty-two patients who recovered from COVID-19 pneumonia were recruited between July and September 2020. At follow-up, dyspnea was the most frequent symptom (69.3%). FVC and DLCO alterations were present in 79 (22.4%) and 234 (66.5%) patients, respectively. HRCT showed relevant interstitial lung sequelae (RILS) in 154 (43.8%) patients (Warrick score ≥ 7). The LUS score was strongly correlated with the HRCT Warrick score (r = 0.77) and showed a moderate inverse correlation with DLCO (r = −0.55). The ROC curve analysis revealed that a LUS score ≥ 3 indicated an excellent ability to discriminate patients with RILS (sensitivity, 94.2%; specificity, 81.8%; negative predictive value, 94.7%).Conclusions: LUS could be implemented as a first-line procedure in the evaluation of Post-COVID-19 interstitial lung sequelae. A normal LUS examination rules out the presence of these sequelae in COVID-19 survivors, avoiding the need for additional diagnostic tests such as HRCT.

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Computed Tomography Findings as Determinants of Local and Systemic Inflammation Biomarkers in Interstitial Lung Diseases: A Retrospective Cohort Study

10.21203/rs.3.rs-64867/v1 ◽

2020 ◽

Author(s):

David Lang ◽

Kaveh Akbari ◽

Andreas Horner ◽

Magdalena Hepp ◽

Bernhard Kaiser ◽

...

Keyword(s):

Computed Tomography ◽

Blood Lymphocyte ◽

Correlation Coefficients ◽

Interstitial Lung Diseases ◽

University Hospital ◽

Federal State ◽

High Resolution Computed Tomography ◽

Neutrophil Lymphocyte Ratio ◽

Upper Austria ◽

Lymphocyte Fraction

Abstract Background: Additional to high-resolution computed tomography (HRCT), peripheral blood (PBL) and broncho-alveolar lavage (BAL) could provide biomarkers to distinguish predominantly inflammatory from non-inflammatory/fibrotic interstitial lung disease (ILD) phenotypes. Methods:HRCT of 127 subsequent ILD-board patients were semi-quantitatively evaluated in a standardized way: Reticulation/honeycombing (RET), traction bronchiectasis (TBR) and emphysema (EMP) were classified as non-inflammatory/fibrotic; consolidations (CON), ground glass opacities (GGO), noduli (NDL) and mosaic attenuation (MOS) as active inflammatory findings. These HRCT findings were counted as present or absent in 6 distinct lung regions, resulting scores were graded as minimal (0-1 regions involved), medium (2-4) or extensive (5-6). Associations between routinely assessed PBL/BAL biomarkers with these radiological scores were evaluated using Spearman correlation coefficients; significance of the graded HRCT scores by applying Kruskal-Wallis tests.Results: Blood neutrophil, lymphocyte and eosinophil fraction, neutrophil-lymphocyte ratio (NLR) and BAL lymphocyte fraction consistently showed opposite correlations for inflammatory versus non-inflammatory/fibrotic HRCT finding scores. Blood lymphocyte fraction significantly differed by graded GGO (p=0.032) and CON (p=0.027) extent, eosinophil fraction by TBR (p=0.006) and NLR by CON (p=0.009). C-reactive protein was significantly related to GGO (p=0.023) and CON (p=0.004), BAL lymphocyte fraction to GGO (p=0.017). Conclusions:Blood lymphocyte and eosinophil fraction, NLR, CRP and BAL lymphocyte fraction may aid to differentiate inflammatory from non-inflammatory/fibrotic ILD patterns. Trial registration:This evaluation was based on data from the ILD registry of Kepler University Hospital Linz, as approved by the ethics committee of the federal state of Upper-Austria (EK Nr. I-26-17).

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SYSTEMIC LUPUS ERYTHEMATOSUS;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.01.479 ◽

2017 ◽

Vol 24 (01) ◽

pp. 14-20

Author(s):

Muhammad Afzal Hamdani ◽

Khalid Parvez ◽

Faisal Naseeb ◽

Umair Afzal ◽

Bashiruddin - ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Pulmonary Function Tests ◽

University Hospital ◽

Systemic Lupus ◽

High Resolution Computed Tomography ◽

Cross Sectional ◽

Pleural Thickening ◽

Organ Systems ◽

Pulmonary Manifestations

Systemic lupus erythematosus (SLE), is a multifactorial, complex etiologicaldisorder, characterized by inflammation and involvement of multiple organ systems includinglungs. Objective: 1-To evaluate whether high resolution computed tomography (HRCT) helpsin the diagnosis of pulmonary manifestations of SLE. 2-To study the pattern and extent of lunginvolvement using HRCT. Design: A Prospective cross - sectional clinical study. Period: Fouryears, July 2012 to June 2016. Setting: King Khalid University Hospital (KKUH) King SaudUniversity (KSU), Rheumatology division Department of Medicine. Methods: This study included113 patients attending outpatients or admitted as inpatients having respiratory symptomsand diagnosed as SLE according to American College of Rheumatology (ACR) classificationcriteria. Chest X- ray, pulmonary function tests, and HRCT chest were done. Investigationsto detect other organ involvement were done. Pregnant females and patients having otherconnective tissue or occupational diseases were excluded. Results: Of the total 113 patients102 were female and 11 males. Age of patients was 37.1 ±13.0 years. The HRCT abnormalitieswere pleural effusion, pleural thickening, atelectasis, ground glass opacities including nonspecificinterstitial pneumonitis (NSIP) and usual interstitial pneumonitis (UIP), pulmonaryarterial hypertension, pulmonary embolism and hilar lymphadenopathy. Conclusion: Variouspulmonary manifestations are present in a significant number of symptomatic SLE patients anda variety of HRCT patterns can be seen to diagnose and treat them.

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Identification of interstitial lung diseases using deep learning

International Journal of Electrical and Computer Engineering (IJECE) ◽

10.11591/ijece.v10i6.pp6283-6291 ◽

2020 ◽

Vol 10 (6) ◽

pp. 6283

Author(s):

Nidhin Raju ◽

Anita H. B. ◽

Peter Augustine

Keyword(s):

Deep Learning ◽

Medical Imaging ◽

Lung Diseases ◽

Medical Image Analysis ◽

Healthcare Providers ◽

Clinical History ◽

Interstitial Lung Diseases ◽

High Resolution Computed Tomography ◽

Advanced Technique ◽

Open Chest

The advanced medical imaging provides various advantages to both the patients and the healthcare providers. Medical Imaging truly helps the doctor to determine the inconveniences in a human body and empowers them to make better choices. Deep learning has an important role in the medical field especially for medical image analysis today. It is an advanced technique in the machine learning concept which can be used to get efficient output than using any other previous techniques. In the anticipated work deep learning is used to find the presence of interstitial lung diseases (ILD) by analyzing high-resolution computed tomography (HRCT) images and identifying the ILD category. The efficiency of the diagnosis of ILD through clinical history is less than 20%. Currently, an open chest biopsy is the best way of confirming the presence of ILD. HRCT images can be used effectively to avoid open chest biopsy and improve accuracy. In this proposed work multi-label classification is done for 17 different categories of ILD. The average accuracy of 95% is obtained by extracting features with the help of a convolutional neural network (CNN) architecture called SmallerVGGNet.

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The role of high-resolution computed tomography in the follow-up of diffuse lung disease

European Respiratory Review ◽

10.1183/16000617.0008-2017 ◽

2017 ◽

Vol 26 (144) ◽

pp. 170008 ◽

Cited By ~ 8

Author(s):

Brett M. Elicker ◽

Kimberly G. Kallianos ◽

Travis S. Henry

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Lung Disease ◽

Pulmonary Function Tests ◽

Clinical History ◽

High Resolution Computed Tomography ◽

Diffuse Lung Disease ◽

Diffuse Lung

High-resolution computed tomography (HRCT) of the lung is a key component of the multidisciplinary approach to diagnosis in diffuse lung disease (DLD). HRCT also plays an important role in the follow-up of patients with established DLD. In this respect, serial HRCT examinations may provide valuable information that cannot be determined from clinical history and other diagnostic tests, such as pulmonary function tests. Important roles of HRCT in this context include assisting in determining prognosis, monitoring for the efficacy of treatment, detecting progression of disease or complications, and evaluating patients with worsening or acute symptoms. Both clinicians and radiologists should be aware of the expected evolution of HRCT changes in a variety of DLDs. The goals of this paper are to discuss: 1) the expected evolution of HRCT findings over time in common DLDs; 2) the role of serial HRCT examinations in formulating an initial diagnosis; and 3) the role of HRCT in the follow-up of patients with known DLD.

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Real-life prevalence of progressive fibrosing interstitial lung diseases

Scientific Reports ◽

10.1038/s41598-021-03481-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Maureen Gagliardi ◽

Damienne Vande Berg ◽

Charles-Edouard Heylen ◽

Sandra Koenig ◽

Delphine Hoton ◽

...

Keyword(s):

Lung Diseases ◽

Hypersensitivity Pneumonitis ◽

Vital Capacity ◽

Interobserver Agreement ◽

Pulmonary Function Tests ◽

Real Life ◽

Interstitial Lung Diseases ◽

Main Diagnosis ◽

High Resolution Computed Tomography ◽

Traction Bronchiectasis

AbstractThe concept of progressive fibrosing interstitial lung disease (PF-ILD) has recently emerged. However, real-life proportion of PF-ILDs outside IPF is still hard to evaluate. Therefore, we sought to estimate the proportion of PF-ILD in our ILD cohort. We also determined the proportion of ILD subtypes within PF-ILD and investigated factors associated with PF-ILDs. Finally, we quantified interobserver agreement between radiologists for the assessment of fibrosis. We reviewed the files of ILD patients discussed in multidisciplinary discussion between January 1st 2017 and December 31st 2019. Clinical data, pulmonary function tests (PFTs) and high-resolution computed tomography (HRCTs) were centrally reviewed. Fibrosis was defined as the presence of traction bronchiectasis, reticulations with/out honeycombing. Progression was defined as a relative forced vital capacity (FVC) decline of ≥ 10% in ≤ 24 months or 5% < FVC decline < 10% and progression of fibrosis on HRCT in ≤ 24 months. 464 consecutive ILD patients were included. 105 had a diagnosis of IPF (23%). Most frequent non-IPF ILD were connective tissue disease (CTD)-associated ILD (22%), hypersensitivity pneumonitis (13%), unclassifiable ILD (10%) and sarcoidosis (8%). Features of fibrosis were common (82% of CTD-ILD, 81% of HP, 95% of uILD). After review of HRCTs and PFTs, 68 patients (19% of non-IPF ILD) had a PF-ILD according to our criteria. Interobserver agreement for fibrosis between radiologists was excellent (Cohen’s kappa 0.86). The main diagnosis among PF-ILD were CTD-ILD (36%), HP (22%) and uILD (20%). PF-ILD patients were significantly older than non-F-ILD (P = 0.0005). PF-ILDs represent about 20% of ILDs outside IPF. This provides an estimation of the proportion of patients who might benefit from antifibrotics. Interobserver agreement between radiologists for the diagnosis of fibrotic ILD is excellent.

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