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Idiopathic Pulmonary Fibrosis: The Association between the Adaptive Multiple Features Method and Fibrosis Outcomes

2016; American Thoracic Society; Volume: 195; Issue: 7 Linguagem: Inglês

10.1164/rccm.201607-1385oc

1535-4970

Margaret L. Salisbury, David A. Lynch, Edwin J.R. van Beek, Ella A. Kazerooni, Junfeng Guo, Meng Xia, Susan Murray, Kevin J. Anstrom, Eric Yow, Fernando J. Martínez, Eric A. Hoffman, Kevin R. Flaherty,

Sarcoidosis and Beryllium Toxicity Research

Rationale: Adaptive multiple features method (AMFM) lung texture analysis software recognizes high-resolution computed tomography (HRCT) patterns.Objectives: To evaluate AMFM and visual quantification of HRCT patterns and their relationship with disease progression in idiopathic pulmonary fibrosis.Methods: Patients with idiopathic pulmonary fibrosis in a clinical trial of prednisone, azathioprine, and N-acetylcysteine underwent HRCT at study start and finish. Proportion of lung occupied by ground glass, ground glass–reticular (GGR), honeycombing, emphysema, and normal lung densities were measured by AMFM and three radiologists, documenting baseline disease extent and postbaseline change. Disease progression includes composite mortality, hospitalization, and 10% FVC decline.Measurements and Main Results: Agreement between visual and AMFM measurements was moderate for GGR (Pearson’s correlation r = 0.60, P < 0.0001; mean difference = −0.03 with 95% limits of agreement of −0.19 to 0.14). Baseline extent of GGR was independently associated with disease progression when adjusting for baseline Gender-Age-Physiology stage and smoking status (hazard ratio per 10% visual GGR increase = 1.98, 95% confidence interval [CI] = 1.20–3.28, P = 0.008; and hazard ratio per 10% AMFM GGR increase = 1.36, 95% CI = 1.01–1.84, P = 0.04). Postbaseline visual and AMFM GGR trajectories were correlated with postbaseline FVC trajectory (r = −0.30, 95% CI = −0.46 to −0.11, P = 0.002; and r = −0.25, 95% CI = −0.42 to −0.06, P = 0.01, respectively).Conclusions: More extensive baseline visual and AMFM fibrosis (as measured by GGR densities) is independently associated with elevated hazard for disease progression. Postbaseline change in AMFM-measured and visually measured GGR densities are modestly correlated with change in FVC. AMFM-measured fibrosis is an automated adjunct to existing prognostic markers and may allow for study enrichment with subjects at increased disease progression risk.