학술논문
Objective quantitative multidetector computed tomography assessments in patients with combined pulmonary fibrosis with emphysema: Relationship with pulmonary function and clinical events.
Document Type
Academic Journal
Author
Suzuki M; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.; Kawata N; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.; Abe M; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.; Yokota H; Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University Hospital, Chiba-city, Chiba, Japan.; Anazawa R; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.; Matsuura Y; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.; Ikari J; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.; Matsuoka S; Department of Radiology, St. Marianna University School of Medicine, Kawasaki-city, Kanagawa, Japan.; Tsushima K; Department of Pulmonary Medicine, International University of Health and Welfare, School of Medicine, Kozunomori, Narita-city, Chiba, Japan.; Tatsumi K; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.
Source
Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Combined pulmonary fibrosis with emphysema (CPFE) is a clinically meaningful syndrome characterized by coexisting upper-lobe emphysema and lower-lobe interstitial fibrosis. However, ambiguous diagnostic criteria and, particularly, the absence of objective methods to quantify emphysematous/fibrotic lesions in patients with CPFE confound the interpretation of the pathophysiology of this syndrome. We analyzed the relationship between objectively quantified computed tomography (CT) measurements and the results of pulmonary function testing (PFT) and clinical events in CPFE patients.
Materials and Methods: We enrolled 46 CPFE patients who underwent CT and PFT. The extent of emphysematous lesions was obtained by calculating the percent of low attenuation area (%LAA). The extent of fibrotic lesions was calculated as the percent of high attenuation area (%HAA). %LAA and %HAA values were combined to yield the percent of abnormal area (%AA). We assessed the relationships between CT parameters and other clinical indices, including PFT results. Multivariate analysis was performed to examine the association between the CT parameters and clinical events.
Results: A greater negative correlation with percent predicted diffusing capacity of the lung for carbon monoxide (DLCO %predicted) existed for %AA (r = -0.73, p < 0.001) than for %LAA or %HAA alone. The %HAA value was inversely correlated with percent predicted forced vital capacity (r = -0.48, p < 0.001), percent predicted total lung capacity (r = -0.48, p < 0.01), and DLCO %predicted (r = -0.47, p < 0.01). Multivariate logistic regression analysis found that %AA showed the strongest association with hospitalization events (odds ratio = 1.20, 95% confidence interval = 1.01-1.54, p = 0.029).
Conclusion: Quantitative CT measurements reflected deterioration in pulmonary function and were associated with hospitalization in patients with CPFE. This approach could serve as a useful method to determine the extent of lung morphology, pathophysiology, and the clinical course of patients with CPFE.
Competing Interests: The authors have declared that no competing interests exist.
Materials and Methods: We enrolled 46 CPFE patients who underwent CT and PFT. The extent of emphysematous lesions was obtained by calculating the percent of low attenuation area (%LAA). The extent of fibrotic lesions was calculated as the percent of high attenuation area (%HAA). %LAA and %HAA values were combined to yield the percent of abnormal area (%AA). We assessed the relationships between CT parameters and other clinical indices, including PFT results. Multivariate analysis was performed to examine the association between the CT parameters and clinical events.
Results: A greater negative correlation with percent predicted diffusing capacity of the lung for carbon monoxide (DLCO %predicted) existed for %AA (r = -0.73, p < 0.001) than for %LAA or %HAA alone. The %HAA value was inversely correlated with percent predicted forced vital capacity (r = -0.48, p < 0.001), percent predicted total lung capacity (r = -0.48, p < 0.01), and DLCO %predicted (r = -0.47, p < 0.01). Multivariate logistic regression analysis found that %AA showed the strongest association with hospitalization events (odds ratio = 1.20, 95% confidence interval = 1.01-1.54, p = 0.029).
Conclusion: Quantitative CT measurements reflected deterioration in pulmonary function and were associated with hospitalization in patients with CPFE. This approach could serve as a useful method to determine the extent of lung morphology, pathophysiology, and the clinical course of patients with CPFE.
Competing Interests: The authors have declared that no competing interests exist.