Quantitative interstitial lung disease scores in idiopathic inflammatory myopathies: longitudinal changes and clinical implications - PubMed (original) (raw)
Quantitative interstitial lung disease scores in idiopathic inflammatory myopathies: longitudinal changes and clinical implications
Jina Yeo et al. Rheumatology (Oxford). 2023.
Abstract
Objectives: To investigate computer-aided quantitative scores from high-resolution CT (HRCT) images and determine their longitudinal changes and clinical significance in patients with idiopathic inflammatory myopathies (IIMs)-related interstitial lung disease (IIMs-ILD).
Methods: The clinical data and HRCT images of 80 patients with IIMs who underwent serial HRCT scans at least twice were retrospectively analysed. Quantitative ILD (QILD) scores (%) were calculated as the sum of the extent of lung fibrosis, ground-glass opacity, and honeycombing. The individual time-estimated ΔQILD between two consecutive scans was derived using a linear approximation of yearly changes.
Results: The baseline median QILD (interquartile range) scores in the whole lung were 28.1% (19.1-43.8). The QILD was significantly correlated with forced vital capacity (r = -0.349, P = 0.002) and diffusing capacity for carbon monoxide (r = -0.381, P = 0.001). For ΔQILD between the first two scans, according to the visual ILD subtype, QILD aggravation was more frequent in patients with usual interstitial pneumonia (UIP) than non-UIP (80.0% vs 44.4%, P = 0.013). Multivariable logistic regression analyses identified UIP was significantly related to radiographic ILD progression (ΔQILD >2%, P = 0.015). Patients with higher baseline QILD scores (>28.1%) had a higher risk of lung transplantation or death (P = 0.015). In the analysis of three serial HRCT scans (n = 41), dynamic ΔQILD with four distinct patterns (improving, worsening, convex and concave) was observed.
Conclusion: QILD changes in IIMs-ILD were dynamic, and baseline UIP patterns seemed to be related to a longitudinal progression in QILD. These may be potential imaging biomarkers for lung function, changes in ILD severity and prognosis in IIMs-ILD.
Keywords: idiopathic inflammatory myopathy; interstitial lung disease; lung transplant-free survival; quantitative score.
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Figures
Graphical abstract
Figure 1.
Correlations between QILD scores and pulmonary function indices at baseline. Scatter plots of QILD scores of the whole lung (A) and the most severe zone (B) with %predicted FVC (left panel) and %predicted DLCO (right panel). Pearson’s correlation coefficients (r) with 95% CIs and _P_-values (P) are shown. DLCO: diffusing capacity of carbon monoxide; FVC: forced vital capacity; QILD: quantitative interstitial lung disease
Figure 2.
Individual time-estimated yearly ΔQILD scores between the first and second HRCT scans. Data are presented as Cleveland dot plots of ΔQILD scores in the whole lung (A) and most severe zone (B) and combined ΔQGG with ΔQLF scores (sorted by ΔQGG) in the whole lung (C) and most severe zone (D) for all patients (left panel) and in those sorted by ILD patterns (right panel). NSIP: non-specific interstitial pneumonia; OP: organizing pneumonia; QGG: quantitative ground-glass opacity; QILD: quantitative interstitial lung disease score; QLF: quantitative lung fibrosis; UIP: usual interstitial pneumonia
Figure 3.
Four distinct patterns of dynamic ΔQILD scores from three consecutive HRCT scans (n = 41). Whole lung-QILD scores (A) and yearly time-estimated ΔQILD scores between scans (B) are described as follows: improving (_n_=7), worsening (_n_=7), convex-like change (_n_=11), and concave-like change (_n_=16). HRCT: high-resolution CT; QILD: quantitative interstitial lung disease
Figure 4.
Representative serial images of a 57-year-old male patient with dermatomyositis showing concave-like dynamic QILD scores. Axial HRCT images are displayed consecutively at baseline, 6 months and 26 months (A–C). QILD scores are annotated on the axial images (D–F). Blue dots represent fibrosis, yellow dots represent ground-glass opacities and pink dots represent honeycombs. Coronal views of HRCT images (G–I) and QILD-annotated images (J–L) are also shown. Each QILD score is indicated in the box below. HRCT: high-resolution computed tomography; QGG: quantitative ground-glass opacity; QHC: quantitative honeycombing; QILD: quantitative interstitial lung disease score; QLF: quantitative lung fibrosis
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