Assessment of survival in patients with idiopathic pulmonary fibrosis using quantitative HRCT indexes

被引：25

作者：

Torrisi, Sebastiano Emanuele ^{[1
]}

Palmucci, Stefano ^{[2
]}

Stefano, Alessandro ^{[3
]}

Russo, Giorgio ^{[3
]}

Torcitto, Alfredo Gaetano ^{[2
]}

Falsaperla, Daniele ^{[2
]}

Gioe, Mauro ^{[4
]}

Pavone, Mauro ^{[1
]}

Vancheri, Ada ^{[1
]}

Sambataro, Gianluca ^{[1
,5
]}

Sambataro, Domenico ^{[5
]}

Mauro, Letizia Antonella ^{[2
]}

Grassedonio, Emanuele ^{[6
]}

Basile, Antonio ^{[2
]}

Vancheri, Carlo ^{[1
]}

机构：

[1] Univ Catania, Reg Referral Ctr Rare Lung Dis, AOU Policlin Vittorio Emanuele, Dept Clin & Expt Med, Via Santa Sofia 78, Catania, Italy

[2] Univ Hosp Policlin Vittorio Emanuele, Dept Med Surg Sci & Adv Technol, Radiol Unit 1, Catania, Italy

[3] Inst Mol Bioimaging & Physiol, Contrada Pietropollastra Pisciotta, Natl Res Council IBFM CNR, I-90015 Cefalu, Italy

[4] Univ Pavia, Dept Brain & Behav Sci, Pavia, Italy

[5] Artroreuma Srl, Outpatient Rheumatol Accredited Natl Hlth Syst, Corso San Vito 53, I-95030 Mascalucia, CT, Italy

[6] Univ Palermo, Univ Hosp Paolo Giaccone, Sect Radiol Sci, DIBIMEF, Palermo, Italy

来源：

MULTIDISCIPLINARY RESPIRATORY MEDICINE | 2018年 / 13卷

关键词：

Idiopathic pulmonary fibrosis; HRCT; Kurtosis; Usual interstitial pneumonia; Survival; Mortality;

D O I：

10.1186/s40248-018-0155-2

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

BackgroundThe assessment of Idiopathic Pulmonary Fibrosis (IPF) using HRCT requires great experience and is limited by a significant inter-observer variability, even between trained radiologists. The evaluation of HRCT through automated quantitative analysis may hopefully solve this problem. The accuracy of CT-histogram derived indexes in the assessment of survival in IPF patients has been poorly studied.MethodsForty-two patients with a diagnosis of IPF and a follow up time of 3years were retrospectively collected; HRCT and Pulmonary Function Tests (PFTs) performed at diagnosis time were analysed; the extent of fibrotic disease was quantified on HRCT using kurtosis, skewness, Mean Lung Density (MLD), High attenuation areas (HAA%) and Fibrotic Areas (FA%). Univariate Cox regression was performed to assess hazard ratios for the explored variables and a multivariate model considering skewness, FVC, DLCO and age was created to test their prognostic value in assessing survival. Through ROC analysis, threshold values demonstrating the best sensitivity and specificity in predicting mortality were identified. They were used as cut-off points to graph Kaplan-Meier curves specific for the CT-indexes.ResultsKurtosis, skewness, MLD, HAA% and FA% were good predictors of mortality (HR 0.44, 0.74, 1.01, 1.12, 1.06; p=0.03, p=0.01, p=0.02, p=0.02 and p=0.017 respectively). Skewness demonstrated the lowest Akaike's information criterion value (55.52), proving to be the best CT variable for prediction of mortality. Significant survival differences considering proposed cut-off points were also demonstrated according to kurtosis (p=0.02), skewness (p=0.005), MLD (p=0.003), HAA% (p=0.009) and FA% (p=0.02) - obtained from quantitative HRCT analysis at diagnosis time.ConclusionsCT-histogram derived indexes may provide an accurate estimation of survival in IPF patients. They demonstrate a correlation with PFTs, highlighting their possible use in clinical practice.

引用

页数：8