RT Journal Article
SR Electronic
T1 Serial CT analysis in idiopathic pulmonary fibrosis: comparison of visual features that determine patient outcome
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 648
OP 654
DO 10.1136/thoraxjnl-2019-213865
VO 75
IS 8
A1 Jacob, Joseph
A1 Aksman, Leon
A1 Mogulkoc, Nesrin
A1 Procter, Alex J
A1 Gholipour, Bahareh
A1 Cross, Gary
A1 Barnett, Joseph
A1 Brereton, Christopher J
A1 Jones, Mark G
A1 van Moorsel, Coline H
A1 van Es, Wouter
A1 van Beek, Frouke
A1 Veltkamp, Marcel
A1 Desai, Sujal R
A1 Judge, Eoin
A1 Burd, Teresa
A1 Kokosi, Maria
A1 Savas, Recep
A1 Bayraktaroglu, Selen
A1 Altmann, Andre
A1 Wells, Athol U
YR 2020
UL http://thorax.bmj.com/content/75/8/648.abstract
AB Aims Patients with idiopathic pulmonary fibrosis (IPF) receiving antifibrotic medication and patients with non-IPF fibrosing lung disease often demonstrate rates of annualised forced vital capacity (FVC) decline within the range of measurement variation (5.0%–9.9%). We examined whether change in visual CT variables could help confirm whether marginal FVC declines represented genuine clinical deterioration rather than measurement noise.Methods In two IPF cohorts (cohort 1: n=103, cohort 2: n=108), separate pairs of radiologists scored paired volumetric CTs (acquired between 6 and 24 months from baseline). Change in interstitial lung disease, honeycombing, reticulation, ground-glass opacity extents and traction bronchiectasis severity was evaluated using a 5-point scale, with mortality prediction analysed using univariable and multivariable Cox regression analyses. Both IPF populations were then combined to determine whether change in CT variables could predict mortality in patients with marginal FVC declines.Results On univariate analysis, change in all CT variables except ground-glass opacity predicted mortality in both cohorts. On multivariate analysis adjusted for patient age, gender, antifibrotic use and baseline disease severity (diffusing capacity for carbon monoxide), change in traction bronchiectasis severity predicted mortality independent of FVC decline. Change in traction bronchiectasis severity demonstrated good interobserver agreement among both scorer pairs. Across all study patients with marginal FVC declines, change in traction bronchiectasis severity independently predicted mortality and identified more patients with deterioration than change in honeycombing extent.Conclusions Change in traction bronchiectasis severity is a measure of disease progression that could be used to help resolve the clinical importance of marginal FVC declines.