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- Title
Idiopathic Pulmonary Fibrosis: The Association between the Adaptive Multiple Features Method and Fibrosis Outcomes.
- Authors
Salisbury, Margaret L.; Lynch, David A.; van Beek, Edwin J. R.; Kazerooni, Ella A.; Junfeng Guo; Meng Xia; Murray, Susan; Anstrom, Kevin J.; Yow, Eric; Martinez, Fernando J.; Hoffman, Eric A.; Flaherty, Kevin R.; Guo, Junfeng; Xia, Meng; IPFnet Investigators
- Abstract
<bold>Rationale: </bold>Adaptive multiple features method (AMFM) lung texture analysis software recognizes high-resolution computed tomography (HRCT) patterns.<bold>Objectives: </bold>To evaluate AMFM and visual quantification of HRCT patterns and their relationship with disease progression in idiopathic pulmonary fibrosis.<bold>Methods: </bold>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.<bold>Measurements and Main Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
COMPUTED tomography; DIGITAL image processing; LONGITUDINAL method; LUNGS; RESEARCH funding; PULMONARY function tests; DISEASE progression; IDIOPATHIC pulmonary fibrosis
- Publication
American Journal of Respiratory & Critical Care Medicine, 2017, Vol 195, Issue 7, p921
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201607-1385OC