October 2024
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21 Reads
Journal of Thoracic Oncology
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October 2024
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21 Reads
Journal of Thoracic Oncology
August 2024
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74 Reads
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1 Citation
Chest
April 2024
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24 Reads
April 2024
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23 Reads
February 2024
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101 Reads
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4 Citations
British Journal of Rheumatology
Objectives Interstitial lung disease (ILD) in connective tissue diseases (CTD) have highly variable morphology. We aimed to identify imaging features and their impact on ILD progression, mortality and immunosuppression response. Methods Patients with CTD-ILD had high-resolution chest computed tomography (HRCT) reviewed by expert radiologists blinded to clinical data for overall imaging pattern (usual interstitial pneumonia [UIP]; non-specific interstitial pneumonia [NSIP]; organizing pneumonia [OP]; fibrotic hypersensitivity pneumonitis [fHP]; and other). Transplant-free survival and change in percent-predicted forced vital capacity (FVC) were compared using Cox and linear mixed effects models adjusted for age, sex, smoking, and baseline FVC. FVC decline after immunosuppression was compared with pre-treatment. Results Of 645 CTD-ILD patients, the frequent CTDs were systemic sclerosis (n = 215), rheumatoid arthritis (n = 127), and inflammatory myopathies (n = 100). NSIP was the most common pattern (54%), followed by UIP (20%), fHP (9%), and OP (5%). Compared with UIP, FVC decline was slower for NSIP (1.1%/year, 95%CI 0.2, 1.9) and OP (3.5%/year, 95%CI 2.0, 4.9), and mortality was lower for NSIP (HR 0.65, 95%CI 0.45, 0.93) and OP (HR 0.18, 95%CI 0.05, 0.57), but higher in fHP (HR 1.58, 95%CI 1.01, 2.40). The extent of fibrosis also predicted FVC decline and mortality. After immunosuppression, FVC decline was slower compared with pre-treatment in NSIP (by 2.1%/year, 95%CI 1.4, 2.8), with no change for UIP or fHP. Conclusion Multiple radiologic patterns are possible in CTD-ILD, including a fHP pattern. NSIP and OP were associated with better outcomes and response to immunosuppression, while fHP had worse survival compared with UIP.
August 2023
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99 Reads
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14 Citations
Chest
Background: Clinical practice guidelines separately describe radiologic patterns of usual interstitial pneumonia (UIP) and fibrotic hypersensitivity pneumonitis (fHP), without direction on whether or how to apply these approaches concurrently within a single patient. Research question: How can we integrate guideline-defined radiologic patterns to diagnose interstitial lung disease (ILD) and what are the pitfalls associated with described patterns that require re-assessment in future guidelines? Study design and methods: Patients from the Canadian Registry for Pulmonary Fibrosis underwent detailed re-evaluation in standardized multidisciplinary discussion. Computed tomography features were quantified by chest radiologists blinded to clinical data and guideline-defined patterns were assigned. Clinical data were then provided to the radiologist and an ILD clinician, who jointly determined the leading diagnosis. Results: Clinical-radiological diagnosis of 1593 patients was idiopathic pulmonary fibrosis (IPF) in 26%, fHP in 12%, connective tissue disease-associated ILD (CTD-ILD) in 34%, idiopathic pneumonia with autoimmune features (IPAF) in 12%, and unclassifiable ILD in 10%. Typical and probable UIP patterns corresponded to a diagnosis of IPF in 66 and 57% of cases, respectively. Typical fHP pattern corresponded to a fHP clinical diagnosis in 65% of cases, while compatible fHP was non-specific and associated with CTD-ILD or IPAF in 48%. No pattern ruled out CTD-ILD. Gas trapping affecting >5% lung parenchyma on expiratory imaging was an important feature broadly separating compatible and typical fHP from other patterns (sensitivity 0.77, specificity 0.91). Interpretation: An integrated approach to guideline-defined UIP and fHP patterns is feasible and supports >5% gas trapping as an important branch point. Typical/probable UIP and typical fHP patterns have moderate predictive values for a corresponding diagnosis of IPF and fHP, although occasionally confounded by CTD-ILD; compatible fHP is non-specific.
August 2023
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44 Reads
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6 Citations
Journal of Thoracic Oncology
Background: With global adoption of CT lung cancer screening, there is increasing interest to use artificial intelligence (AI) deep learning methods to improve the clinical management process. To enable AI research using an open source, cloud-based, globally distributed, screening CT imaging dataset and computational environment that are compliant with the most stringent international privacy regulations that also protects the intellectual properties of researchers, the International Association of the Study of Lung Cancer (IASLC) sponsored development of the Early Lung Imaging Confederation (ELIC) resource in 2018. The objective of this report is to describe the updated capabilities of ELIC and illustrate how this resource can be utilized for clinically relevant AI research. Methods: In this second Phase of the initiative, metadata and screening CT scans from two time points were collected from 100 screening participants in seven countries. An automated deep learning AI lung segmentation algorithm, automated quantitative emphysema metrics, and a quantitative lung nodule volume measurement algorithm were run on these scans. Results: A total of 1,394 CTs were collected from 697 participants. The LAV950 quantitative emphysema metric was found to be potentially useful in distinguishing lung cancer from benign cases using a combined slice thickness ≥ 2.5 mm. Lung nodule volume change measurements had better sensitivity and specificity for classifying malignant from benign lung nodules when applied to solid lung nodules from high quality CT scans. Conclusion: These initial experiments demonstrated that ELIC can support deep learning AI and quantitative imaging analyses on diverse and globally distributed cloud-based datasets.
May 2023
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17 Reads
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1 Citation
Annals of the Rheumatic Diseases
Background Lung imaging findings vary among subtypes of connective tissue disease-associated interstitial lung disease (CTD-ILD), leading to both diagnostic and therapeutic challenges. Objectives We performed a comprehensive assessment of ILD morphology across CTD-ILD subtypes by examining the presence of overall imaging patterns and specific morphological features. Methods High-resolution chest computed tomography (HRCT) of patients with CTD-ILD enrolled in the multicentre Canadian Registry for Pulmonary Fibrosis from their first ILD clinic visit were re-reviewed in standardized multidisciplinary discussion. All CTD diagnoses were rheumatologist-confirmed. An experienced chest radiologist blinded to clinical data quantified the percentage of lung parenchyma affected by honeycombing, reticulation, ground glass opacity (GGO), hypoattenuating lobules, consolidation, and emphysema. Gas trapping was evaluated on expiratory CT. Each case was categorized into an overall disease pattern including usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP), fibrotic hypersensitivity pneumonitis (fHP), lymphocytic interstitial pneumonia (LIP), and unclassifiable. Results 615 patients with CTD-ILD were assessed with 215 (33%) having systemic sclerosis (SSc), 127 (20%) rheumatoid arthritis (RA), 100 (16%) idiopathic inflammatory myopathy (IIM), 61 (9%) mixed connective tissue disease (MCTD), 40 (6%) Sjogren’s syndrome (SS), 19 (3%) lupus (SLE), and 83 (13%) undifferentiated connective tissue disease (UCTD). NISP was most predominant in SSc (76%), IIM (62%), and MCTD (66%), while UIP was most common in RA (47%) and SS (33%). A fHP pattern was most common in RA (15%), SLE (21%), and MCTD (12%) (Figure 1a). There was substantial variability in the extent of fibrotic (honeycombing, reticulations) and non-fibrotic (pure GGO, consolidation) parenchymal features within and across each CTD (Figure 1b). Conclusion There is considerable variation in imaging features across subtypes of CTD-ILD, with NSIP generally most common, UIP most frequent in RA and SS, and fHP less frequent but most common in RA, SLE, and MCTD. This variability highlights the need for additional data on management of CTD-ILD that considers the potential for variable treatment responses across major CTD-ILD subtypes and phenotypes. • Download figure • Open in new tab • Download powerpoint REFERENCES NIL. Acknowledgements NIL. Disclosure of Interests Boyang Zheng: None declared, Daniel-Costin Marinescu: None declared, cameron hague: None declared, Nestor Muller: None declared, darra murphy: None declared, Andrew Churg: None declared, Joanne Wright: None declared, Amna Al-Arnawoot: None declared, Gerald Cox: None declared, Zachary Guenther: None declared, Amanda Grant-Orser: None declared, James Huynh: None declared, Tracy Elliot: None declared, Derek Fladeland: None declared, Jen Ellis: None declared, geoff karjala: None declared, Gillian Goobie Grant/research support from: Boehringer Ingelheim.Pulmonary Fibrosis Foundation, Kerri Johannson Paid instructor for: Boehringer-Ingelheim, Hoffman-La Roche Ltd, Consultant of: Boehringer-Ingelheim, Hoffman-La Roche Ltd, Pliant Therapeutics, Stacey Lok Speakers bureau: Boehringer Ingelheim, Tony Sedlic: None declared, Nasreen Khalil: None declared, Veronica Marcoux Grant/research support from: Astra Zeneca, Roche, Boehringer Ingelheim, Martin Kolb Speakers bureau: Roche, Novartis, Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim, Pieris, Roche, Ciaran Scallan: None declared, Nathan Hambly Speakers bureau: Boehringer Ingelheim, Janssen, Roche, Grant/research support from: Boehringer Ingelheim, Janssen, Roche, sarah macisaac: None declared, Jonathon Leipsic Speakers bureau: GE Healthcare, Philips Healthcare, victoria tan: None declared, celine durand: None declared, Helene Manganas Grant/research support from: Boehringer Ingelheim Canada, Hoffmann La Roche, Galapagos, BMS, Ehsan Haider Speakers bureau: Boerhinger Ingelheim, Jolene Fisher Speakers bureau: Boehringer-Ingelheim, Consultant of: Boehringer-Ingelheim, AstraZeneca, micheal mcinnis: None declared, shane shapera Consultant of: AstraZeneca, Boehringer Ingelheim, Hoffman LaRoche, Ana-Maria Bilawich: None declared, John Mayo: None declared, patrick bourgouin: None declared, julie morisset Speakers bureau: Roche, Boehringer Ingelheim, Kelly Sun: None declared, Alyson Wong: None declared, Christopher Ryerson Speakers bureau: Boehringer Ingelheim, Hoffmann-La Roche, Astra Zeneca, Consultant of: Boehringer Ingelheim, Hoffmann-La Roche, Astra Zeneca.
May 2023
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47 Reads
Annals of the Rheumatic Diseases
Background Prognosis in connective tissue disease associated interstitial lung disease (CTD-ILD) is influenced by the underlying diagnosis and chest imaging pattern. Usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP), and fibrotic hypersensitivity pneumonitis (fHP) patterns can be found across all CTD-ILD subtypes although their impact on disease evolution and treatment response is unclear. Objectives Our goal was to examine the association of lung imaging pattern with CTD-ILD progression, mortality, and immunosuppression response. Methods 615 patients with CTD-ILD enrolled in the Canadian Registry for Pulmonary Fibrosis had high-resolution chest computed tomography (HRCT) from their first ILD clinic visit reviewed in standardized multidisciplinary discussion. All CTD diagnoses were rheumatologist-confirmed. Experienced chest radiologists blinded to clinical data categorized each case into five groups: UIP, NSIP, organizing pneumonia (OP), fHP, and other patterns. Longitudinal percent-predicted forced vital capacity (FVC) and transplant-free survival were compared between imaging groups using linear mixed effects and Cox proportional hazards models adjusted for age, sex, smoking pack-years, and baseline FVC. Linear mixed effects models were used to compare pre- and post-treatment rate of FVC decline in patients with ≥6 months follow-up before and after treatment with mycophenolate, azathioprine, rituximab, cyclophosphamide, and/or tocilizumab. UIP was the reference group for all comparisons. Results The most frequent CTD subtypes were systemic sclerosis (SSc) (33%), rheumatoid arthritis (RA) (20%), and idiopathic inflammatory myopathy (IIM) (16%) with NSIP pattern present in 54% of all CTD-ILD (Table 1). On multivariable analyses among all CTD-ILD patients, NSIP was associated with a slower rate of FVC decline by 1.1%/year (0.2, 1.9) and a lower mortality HR (95%CI) of 0.65 (0.45, 0.93) compared to UIP. OP was also associated with a slower rate of FVC decline by 3.5%/year (2.0, 4.9) and a lower mortality HR (95%CI) of 0.18 (0.05, 0.57) compared to UIP. In contrast, fHP had a higher mortality HR (95%CI) of 1.58 (1.01, 2.40). The rate of FVC decline after treatment was not significantly different compared to pre-treatment in the UIP group but was slower in the NSIP group by 2.1%/year (1.4, 2.8). Subgroup analyses in RA-ILD and SSc-ILD showed the persistence of fHP having a higher mortality compared to UIP in RA-ILD. Conclusion The presence of an NSIP pattern was associated with improved outcomes and immunosuppression response compared to UIP in the overall CTD-ILD group. The findings of fHP associated with worse survival compared to UIP in CTD-ILD and in the RA-ILD are novel. These findings need to be further confirmed in disease specific cohorts and randomized trials of immunosuppression in patients with CTD-ILD. Table 1. Association between imaging patterns with FVC decline, mortality, and immunosupression response in CTD-ILD Imaging pattern Difference in the annualized rate of FVC change between imaging patterns (95%CI) Mortality Hazard ratio (95%CI) Difference in the annualized rate of FVC change Pre- vs Post-Treatment (95%CI) UIP Reference group Reference group 0.1 (-1.4,1.7) NSIP 1.1 (0.2, 1.9) 0.65 (0.45, 0.93) 2.1 (1.4, 2.8) OP 3.5 (2.0, 4.9) 0.18 (0.05, 0.57 NA fHP -0.7 (-2.0, 0.6) 1.58 (1.01, 2.48) NA Other 0.2 (-1.0, 1.4) 0.63 (0.36, 1.08) NA All models were adjusted for age, sex, smoking pack years, and baseline FVC 95%CI = 95% confidence interval, UIP = Usual interstitial pneumonia, NSIP = Nonspecific interstitial pneumonia, OP = organizing pneumonia, fHP = fibrotic hypersensitivity pneumonitis, Other = other imaging patterns including lymphocytic interstitial pneumonia, desquamative interstitial pneumonia, pleuralparenchymal fibroelastosis, unclassifiable REFERENCES NIL. Acknowledgements NIL. Disclosure of Interests Boyang Zheng: None declared, Daniel-Costin Marinescu: None declared, cameron hague: None declared, Nestor Muller: None declared, darra murphy: None declared, Andrew Churg: None declared, Joanne Wright: None declared, Amna Al-Arnawoot: None declared, Ana-Maria Bilawich: None declared, patrick bourgouin: None declared, Gerald Cox: None declared, celine durand: None declared, Tracy Elliot: None declared, Jen Ellis: None declared, Jolene Fisher Consultant of: Boehringer-Ingelheim, AstraZeneca, Derek Fladeland: None declared, Amanda Grant-Orser: None declared, Gillian Goobie Grant/research support from: Boehringer Ingelheim, Zachary Guenther: None declared, Ehsan Haider: None declared, Nathan Hambly Speakers bureau: Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim, Janssen, Roche, James Huynh: None declared, Kerri Johannson Consultant of: Boehringer-Ingelheim, Hoffman-La Roche Ltd, geoff karjala: None declared, Nasreen Khalil: None declared, Martin Kolb Speakers bureau: Roche, Novartis, Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim, Pieris, Roche, Jonathon Leipsic Speakers bureau: GE Healthcare, Philips Healthcare, Stacey Lok Speakers bureau: Boehringer Ingelheim, sarah macisaac: None declared, micheal mcinnis: None declared, Helene Manganas Grant/research support from: Boehringer Ingelheim Canada, Hoffmann La Roche, Galapagos, BMS, Veronica Marcoux Grant/research support from: Astra Zeneca,Roche,Boehringer Ingelheim, John Mayo: None declared, julie morisset Speakers bureau: Roche, Boehringer Ingelheim, Ciaran Scallan: None declared, Tony Sedlic: None declared, shane shapera Consultant of: AstraZeneca, Boehringer Ingelheim, Hoffman LaRoche, Kelly Sun: None declared, victoria tan: None declared, Alyson Wong: None declared, Christopher Ryerson Speakers bureau: Boehringer Ingelheim, Hoffmann-La Roche, Astra Zeneca, Consultant of: Boehringer Ingelheim, Hoffmann-La Roche, Astra Zeneca.
May 2023
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18 Reads
... High Resolution Computed Tomography (HRCT) is currently considered the gold standard diagnostic technique for the screening of ILD in pSS patients [6,7]. It also provides valuable information on ILD pattern, extension and severity, therefore playing a key role for the prognostic assessment and management [6, 8,9]. Histologic examination is not routinely required in pSS patients, and whether a more precise histologic characterization of ILD pattern improves the prognostic stratification and treatment strategies is still debated. ...
February 2024
British Journal of Rheumatology
... Schniering et al. suggested that ground-glass opacities, reticular patterns, and honeycombing are relatively common, which differs from the results of this study. This difference may be related to three-dimensional recognition by AI and the relatively small sample size [7,[29][30][31]. ...
May 2023
Annals of the Rheumatic Diseases
... In the last 5 years a scr eening pr ogram is proposed to all smokers, ex-smokers and pa tien ts with chronic obstructive pulmonary disease (COPD) [ 1 ]. We are expecting new proposals on lung cancer screening based on newly published studies [ 2 ] and artificial int elligenc e software [3][4][5]. Mor eov er, the next and most important st ep t o achieve a c omplet e methodology for lung canc er screening has been recen tly elucida ted by combining serum biomarkers to radiological findings [ 6 , 7 ]. The screening program assisted in the diagnosis of pulmonary nodules, based on a radiological finding. ...
August 2023
Journal of Thoracic Oncology
... Der Nachweis eines Mosaik/Air Trappings in mehr als drei Lappen außerhalb von fibrotischen Arealen sprach hier gegen eine UIP und für eine fibrotische EAA oder eine CTD-ILD (61 % bei Non-UIP vs. 20 % bei UIP) [181]. In einer kanadischen Studie ließ exspiratorisches Air Trapping > 5 % des Lungenparenchyms die Differenzierung einer fibrotischen EAA von anderen fibrotischen ILD mit einer Sensitivität von 91 % und Spezifität von 77 % zu [189]. ...
August 2023
Chest
... A total of sixteen studies were included following the search and review processes (Fig. 1), comprising six modeling studies [9][10][11][12][13][14], nine retrospective cohort studies [15][16][17][18][19][20][21][22][23], and one prospective cohort study [24] (Table 1). ...
December 2022
Lung Cancer
... A total of sixteen studies were included following the search and review processes (Fig. 1), comprising six modeling studies [9][10][11][12][13][14], nine retrospective cohort studies [15][16][17][18][19][20][21][22][23], and one prospective cohort study [24] (Table 1). ...
January 2022
... 36 When two or more LDCTs are available, a deep learning algorithm 37 using age at the most recent scan, sex, smoking duration, pack-years, age quit smoking, family history of lung cancer, emphysema, days between the last two scans, and nodule parameters (new or preexisting, location, attenuation, spiculation), average diameter, growth defined as volume doubling time less than or equal to 400 days and increase in density, may optimize the screening intervals better than volume doubling time alone, by identifying biologically more aggressive lung cancers earlier among high-risk individuals and reducing the frequency of LDCTs in lowrisk individuals. 38 Prediction algorithms developed using data from the NLST also suggest that optimization of screening intervals for participants with and without baseline nodules could increase the efficiency of screening programs without compromising early detection, 39,40 and that this optimization may be further improved by integrating scores from artificial intelligence (AI) analysis of LDCT images. 41 The duration of benefit from a single screening LDCT should be explored further. ...
September 2022
Journal of Thoracic Oncology
... All discrete lung lesions on the baseline CT were annotated by the same reviewing radiologist using soft tissue windows. Then, an in-house Otsu-based segmentation pipeline was developed to segment the entire lung parenchyma, lung tumors from CT volumes [43]. We first re-windowed and normalized the whole lung CT volumes to minimize any technical differences between images acquired with different scanners and/or scanning parameters. ...
September 2022
Journal of Thoracic Oncology
... Original research Open access trial (comparing PLCO m2012 ≥1.58% to NELSON criteria) support the hypothesis that the PLCO m2012 risk model outperforms categorical eligibility criteria in terms of sensitivity and predictive value, although discrimination and calibration measures have not yet been reported. 14 15 A number of uncertainties about model performance remain including how to select the optimal model and screening threshold for a given population. As screening implementation expands, it is important to validate the models in real-world clinical programmes to enable selection of the best-performing model and optimal thresholds. ...
December 2021
The Lancet Oncology
... Therefore, they play an important role in the early detection of lung cancer. The National Lung Screening Trial [8][9][10] showed that screening with low-dose computed tomography (LDCT) will result in a 20% reduction in lung cancer mortality. However, due to the complex background factors of CT images and the small characteristics of pulmonary nodules themselves, existing human factors and computer models cannot accurately distinguish benign and malignant nodules [11]. ...
October 2021
Journal of Thoracic Oncology