Histogram-based analysis in progressive pulmonary fibrosis: relationships between pulmonary functional tests and HRCT indexes

Author:

Palmucci Stefano1,Tiralongo Francesco2,Galioto Federica1,Toscano Stefano1,Reali Linda1,Scavone Carlotta1,Fazio Giulia1,Ferlito Agata1,Sambataro Gianluca34,Vancheri Ada5,Sciacca Enrico3,Vignigni Giovanna3,Spadaro Carla3,Mauro Letizia Antonella2,Foti Pietro Valerio1,Vancheri Carlo3,Basile Antonio1

Affiliation:

1. Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy

2. Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy

3. Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

4. Rheumatology Outpatient Clinic Associated with the National Health System, Mascalucia (Catania), Italy

5. Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy

Abstract

Objectives: To investigate relationships between histogram-based high-resolution CT (HRCT) indexes and pulmonary function tests (PFTs) in interstitial lung diseases. Methods: Forty-nine patients having baseline and 1-year HRCT examinations and PFTs were investigated. Histogram-based HRCT indexes were calculated; strength of associations with PFTs was investigated using Pearson correlation. Patients were divided into progressive and non-progressive groups. HRCT indexes were compared between the two groups using the U-test; within each group, baseline and follow-up Wilcoxon analysis was performed. Receiver operating characteristic analysis was used for predicting disease progression. Results: At baseline, moderate correlations were observed considering kurtosis and diffusion capacity of the lungs for carbon monoxide (DLCO) (r = 0.54) and skewness and DLCO (r = 0.559), whereas weak but significant correlations were observed between forced vital capacity and kurtosis (r = 0.368, p = 0.009) and forced vital capacity and skewness (r = 0.391, p = 0.005). Negative correlations were reported between HAA% and PFTs (from r = −0.418 up to r = −0.507). At follow-up correlations between quantitative indexes and PFTs were also moderate, except for high attenuation area (HAA)% −700 and DLCO (r = −0.397). In progressive subgroup, moderate and strong correlations were found between DLCO and HRCT indexes (r = 0.595 kurtosis, r = 0.672 skewness, r=-0. 598 HAA% −600 and r = −0.626 HAA% −700). At follow-up, we observed significant differences between the two groups for kurtosis (p = 0.029), HAA% −600 (p = 0.04) and HAA% −700 (p = 0.02). To predict progression, ROC analysis reported sensitivity of 90.9% and specificity of 51.9% using a threshold value of δ kurtosis <0.03. Conclusion: At one year, moderate correlations suggest that progression could be assessed through HRCT quantification. Advances in knowledge: This study promotes histogram-based HRCT indexes in the assessment of progressive pulmonary fibrosis.

Publisher

Oxford University Press (OUP)

Subject

Radiology, Nuclear Medicine and imaging,General Medicine

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