Research Presentation Session

RPS 604a - Evaluation of interstitial lung disease: recent advances and new techniques

Lectures

1
RPS 604a - Advanced visualisation of peroneal artery perforators prior to autologous transplantation in head and neck surgery by dual-energy CTA and semiautomatic vessel unfolding

RPS 604a - Advanced visualisation of peroneal artery perforators prior to autologous transplantation in head and neck surgery by dual-energy CTA and semiautomatic vessel unfolding

05:17G. Milanese, Erlangen/ DE

2
RPS 604a - Cross-border knowledge sharing in the diagnostic workup of a rare disease: experiences with a Trans-European teleradiology project on idiopathic pulmonary fibrosis

RPS 604a - Cross-border knowledge sharing in the diagnostic workup of a rare disease: experiences with a Trans-European teleradiology project on idiopathic pulmonary fibrosis

07:30T. Weikert, Basel / CH

Purpose:

To share experience from a large, ongoing expert reading teleradiology program in Europe and Asia aiming at supporting referring centres to interpret high-resolution computed tomography (HRCT) with respect to the presence of usual interstitial pneumonia (UIP)-pattern in patients with suspected idiopathic pulmonary fibrosis (IPF).

Methods and materials:

We analysed data from 01/2014 to 05/2019, including HRCTs from 239 medical centres in 12 European and Asian countries that were transmitted to our picture archiving and communication system (PACS) via a secured internet connection. Structured reports were generated in consensus by a radiologist with over 20 years experience in thoracic imaging and a pulmonologist with specific expertise in interstitial lung disease according to current guidelines on IPF. Reports were sent to referring physicians. We evaluated patient characteristics, technical issues, report turnaround times, and frequency of diagnoses. We also conducted a survey to collect feedback from referring physicians.

Results:

HRCT image data from 703 patients was transmitted (53.5% male). The mean age was 63.7 years (SD:17). In 35.1% of all cases, the diagnosis was “UIP”/”Typical UIP”. The mean report turnaround time was 1.7 days (SD:2.9). Data transmission errors occurred in 7.1%. The overall satisfaction rate among referring physicians was high (8.4 out of 10; SD:3.2).

Conclusion:

This Eurasian teleradiology program demonstrates the feasibility of cross-border teleradiology for the provision of state-of-the-art structured reporting to centres with limited expertise in chest radiology.

Limitations:

A low response rate of the survey. No cost-effectiveness analysis was conducted.

Ethics committee approval

Informed conset was waived by the local ethics committee (Project ID: Req-2019-00403).

Funding:

No funding was received for this work. The teleradiology program is financially supported by Boehringer Ingelheim.

3
RPS 604a - Evaluation of the relationship between pulmonary manifestations and laboratory findings in rheumatoid arthritis patients

RPS 604a - Evaluation of the relationship between pulmonary manifestations and laboratory findings in rheumatoid arthritis patients

05:54H. Çelik, Izmir / TR

Purpose:

The relationship between radiological and laboratory findings in rheumatoid arthritis (RA) patients is not fully documented in the literature. We aimed to show the correlation between chest computed tomography (CT) findings and laboratory tests used in the diagnosis and follow-up of patients with RA.

Methods and materials:

Chest CT scans of 263 patients with RA were evaluated for a rheumatoid nodule, serositis, bronchiectasis, constrictive bronchiolitis, follicular bronchiolitis, and interstitial fibrosis pattern (Figure 1-3). Anti-nuclear antibody (ANA), rheumatoid factor (RF), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) values synchronous with CT scans were recorded. The relationship between the radiological findings and laboratory data was analysed.

Results:

70% of patients were female. CT scans revealed rheumatoid nodules in 25% and cavitation in at least one rheumatoid nodule in 21% of patients with rheumatoid nodules. Nonspecific interstitial pneumonia (NSIP) was the most common fibrosis pattern (% 65). Serositis, bronchiectasis, and constrictive bronchiolitis were defined in 18%, 36%, and 22% of the patients, respectively. A statistically significant relationship was found between constrictive bronchiolitis and ESR (p: 0.001), between serositis, ESR, and CRP (p=0.003 ve p<0001 respectively), and between bronchiectasis and CRP (p=0.005) (Table 1). There was no statistically significant relationship between ANA values ​​and any radiological findings.

Conclusion:

This study suggests that some specific laboratory tests used in the diagnosis and follow-up of RA may predict lung involvement patterns that may develop due to rheumatoid arthritis such as constructive bronchiolitis, serositis, and bronchiectasis.

Limitations:

There were differences in some of the chest CT protocols such as the use of high-resolution CT or contrast media. Also, some laboratory tests were not performed in all patients.

Ethics committee approval

Ethics committee approval is available.

Funding:

No funding was received for this work.

4
RPS 604a - The evaluation of lung CT densitometry in interstitial lung diseases

RPS 604a - The evaluation of lung CT densitometry in interstitial lung diseases

05:46Y. Şengül, Istanbul / TR

Purpose:

To evaluate the relationship between changes in the density in lung parenchyma with pulmonary function test (PFT) and visual CT features, regardless of the pattern differences in ILD, and also to investigate the threshold values of densitometric parameters in predicting the severity of pulmonary fibrosis.

Methods and materials:

69 patients with idiopathic pulmonary fibrosis (IPF), systemic sclerosis (SSc), and rheumatoid arthritis (RA) were evaluated who had no more than a 1-month interval between thorax CT and PFT measurements. CT scans were scored visually then processed to obtain mean lung density (MLD), the percentage of high attenuation area (HAA%), and the HU value in 85th percentile. The relationships between the densitometry with PFT and semiquantitative scoring were evaluated.

Results:

All densitometry values in patients with ILD were significantly higher than the control group. MLD threshold value was -760 (sensitivity 50%, specificity 81%), the HAA% 7.3 (sensitivity 65%, specificity 81%), 85th perc -660 (sensitivity 62%, specificity 81%) based on DLCO% predicted value of 70 in determining the severity of pulmonary fibrosis.

Densitometric parameters showed a statistically significant correlation with physiologic quantities and fibrosis score (r: -0.40 to -0.50) and (r:0.52 to 0.66), respectively.

The fibrosis score and densitometry parameters were high in patients with a pulmonary artery diameter greater than 29 mm.

Conclusion:

Quantitative densitometric CT parameters correlate with pulmonary function test results and visual scoring. This objective method may be useful for determining the extent and severity of fibrosis in ILD.

Limitations:

A retrospective study and the low number of samples.

Ethics committee approval

The local Medical Ethical Committee permission (09.2018.782) was obtained.

Funding:

No funding was received for this work.

5
RPS 604a - A comparison between the ATS/ERS/JRS/ALAT criteria of 2011 and 2018 for usual interstitial pneumonia on HRCT: a cross-sectional study

RPS 604a - A comparison between the ATS/ERS/JRS/ALAT criteria of 2011 and 2018 for usual interstitial pneumonia on HRCT: a cross-sectional study

04:24L. Wuyts, Edegem / BE

Purpose:

To determine whether the revised 2018 ATS/ERS/JRS/ALAT radiological criteria for usual interstitial pneumonia (UIP) provide better diagnostic agreement compared to those published in 2011.

Methods and materials:

The cohort for this cross-sectional study (single-centre, nonacademic) was recruited from a multidisciplinary ILD team discussion (MDD) from July 2010 to December 2018, with clinical suspicion of idiopathic pulmonary fibrosis (n= 325). Exclusion criteria were technical HRCT issues, images not acquired within reference centre, the presence of lung neoplasm, the patient suffering from known connective tissue disease, drug exposure to pulmonary toxins, or a lack of a working diagnosis after MDD (Figure 1). Four readers with varying degrees of experience in the interpretation of HRCT independently assessed 192 HRCT scans for the presence of fibrotic lung disease characteristics. A diagnostic category was assigned to each HRCT according to both the previous (2011) and current (2018) radiological criteria based on the ATS/ERS/JRS/ALAT statements on IPF (Figures 2 and 3). An inter-rater variability analysis (Gwet’s second-order agreement coefficient) was performed.

Results:

The resulting estimate of Gwet's AC1 coefficient for the use of the ATS/ERS/JRS/ALAT radiological criteria for 2011 and 2018 is 0.62 (± 0.06) and 0.65 (± 0.06), respectively (Table 1). The inter-rater variability improved for every pair of readers, except for one. Considering the varying degree of experience of these 4 radiologists, we report only minor differences in the agreement level.

Conclusion:

No statistically significantly higher degree of diagnostic agreement is observed when applying the revised ATS/ERS/JRS/ALAT radiological criteria for UIP of 2018 compared to those of 2011. The estimated inter-rater variability for assigning the diagnostic categories is moderate for both classification systems, although it improves consistently, independent from the degree of experience in HRCT interpretation.

Limitations:

n/a

Ethics committee approval

Ethics committee approval was obtained.

Funding:

No funding was received for this work.

6
RPS 604a - Can we improve the prediction of survival in fibrotic interstitial lung diseases? Texture-based quantitative CT model outperforms expert diagnosis

RPS 604a - Can we improve the prediction of survival in fibrotic interstitial lung diseases? Texture-based quantitative CT model outperforms expert diagnosis

05:33E. Barbosa Jr., Philadelphia / US

Purpose:

Usual interstitial pneumonia (UIP) is generally associated with a worse prognosis than other types of non-UIP fibrotic interstitial lung diseases (ILD). We hypothesised that a texture-based model utilising high-resolution quantitative HRCT (qCT) imaging features can better predict survival in ILD patients when compared to the clinical standard of UIP versus non-UIP expert diagnostic labels.

Methods and materials:

40 ILD patients (20 UIP, 20 non-UIP ILD) were classified by expert consensus of 2 radiologists and followed for 7 years. Clinical variables (CVs) such as age, gender, smoking status, and co-morbidities, as well as the outcomes such as time to death or lung transplantation, were recorded. A survival analysis (Kaplan-Meier with Cox regression) was performed, comparing expert diagnostic labels (UIP vs non-UIP) versus a texture-based model utilising 26 higher-order 3D imaging metrics derived from quantitative HRCT, with varying region of interest (ROI) sizes, controlling for age and co-morbidities.

Results:

Survival curves of UIP vs non-UIP ILD patients (using expert diagnostic labels) were not statistically different (p=0.59). In contrast, our texture-based qCT model with CVs achieved statistically significant partition of the cohort (p=0.029, c-statistic = 0.73) into distinct survival sub-groups.

Conclusion:

Our texture-based qCT model substantially outperformed expert diagnostic labels (UIP vs non-UIP expert) to predict survival in ILD patients. These models, by capturing latent HRCT derived lung parenchymal texture biomarkers that are not explicitly accounted for in clinical standard diagnostic labels, may provide more accurate prognostication, ultimately contributing to more effective patient management, treatment planning, and possibly improving long-term outcomes.

Limitations:

The retrospective nature and sample size of the study.

Ethics committee approval

Approved by the local IRB (#821679) with HIPAA waiver of informed consent.

Funding:

This research was supported by a Radiological Society of North America (RSNA) Research Seed Grant to the lead author (EB).

PEP Subscription Required

This course is only accessible for ESR Premium Education Package subscribers.