Evaluation of computer-based computer tomography stratification against outcome models in connective tissue disease-related interstitial lung disease: A patient outcome study

Joseph Jacob, Brian Jack Bartholmai, Srinivasan Rajagopalan, Anne Laure Brun, Ryoko Egashira, Ronald Karwoski, Maria Kokosi, Athol U. Wells, David M. Hansell

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Abstract

Background: To evaluate computer-based computer tomography (CT) analysis (CALIPER) against visual CT scoring and pulmonary function tests (PFTs) when predicting mortality in patients with connective tissue disease-related interstitial lung disease (CTD-ILD). To identify outcome differences between distinct CTD-ILD groups derived following automated stratification of CALIPER variables. Methods: A total of 203 consecutive patients with assorted CTD-ILDs had CT parenchymal patterns evaluated by CALIPER and visual CT scoring: honeycombing, reticular pattern, ground glass opacities, pulmonary vessel volume, emphysema, and traction bronchiectasis. CT scores were evaluated against pulmonary function tests: forced vital capacity, diffusing capacity for carbon monoxide, carbon monoxide transfer coefficient, and composite physiologic index for mortality analysis. Automated stratification of CALIPER-CT variables was evaluated in place of and alongside forced vital capacity and diffusing capacity for carbon monoxide in the ILD gender, age physiology (ILD-GAP) model using receiver operating characteristic curve analysis. Results: Cox regression analyses identified four independent predictors of mortality: patient age (P < 0.0001), smoking history (P = 0.0003), carbon monoxide transfer coefficient (P = 0.003), and pulmonary vessel volume (P < 0.0001). Automated stratification of CALIPER variables identified three morphologically distinct groups which were stronger predictors of mortality than all CT and functional indices. The Stratified-CT model substituted automated stratified groups for functional indices in the ILD-GAP model and maintained model strength (area under curve (AUC) = 0.74, P < 0.0001), ILD-GAP (AUC = 0.72, P < 0.0001). Combining automated stratified groups with the ILD-GAP model (stratified CT-GAP model) strengthened predictions of 1- and 2-year mortality: ILD-GAP (AUC = 0.87 and 0.86, respectively); stratified CT-GAP (AUC = 0.89 and 0.88, respectively). Conclusions: CALIPER-derived pulmonary vessel volume is an independent predictor of mortality across all CTD-ILD patients. Furthermore, automated stratification of CALIPER CT variables represents a novel method of prognostication at least as robust as PFTs in CTD-ILD patients.

Original languageEnglish (US)
Article number190
JournalBMC Medicine
Volume14
Issue number1
DOIs
StatePublished - Nov 23 2016

Fingerprint

Connective Tissue Diseases
Interstitial Lung Diseases
Tomography
Outcome Assessment (Health Care)
Carbon Monoxide
Area Under Curve
Mortality
Respiratory Function Tests
Vital Capacity
Computer Simulation
Lung
Bronchiectasis
Emphysema
Traction
ROC Curve
Glass
Smoking
History
Regression Analysis

Keywords

  • Computer tomography
  • Connective tissue disease
  • Interstitial lung disease
  • Pulmonary fibrosis
  • Quantitative CT

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Evaluation of computer-based computer tomography stratification against outcome models in connective tissue disease-related interstitial lung disease : A patient outcome study. / Jacob, Joseph; Bartholmai, Brian Jack; Rajagopalan, Srinivasan; Brun, Anne Laure; Egashira, Ryoko; Karwoski, Ronald; Kokosi, Maria; Wells, Athol U.; Hansell, David M.

In: BMC Medicine, Vol. 14, No. 1, 190, 23.11.2016.

Research output: Contribution to journalArticle

Jacob, Joseph ; Bartholmai, Brian Jack ; Rajagopalan, Srinivasan ; Brun, Anne Laure ; Egashira, Ryoko ; Karwoski, Ronald ; Kokosi, Maria ; Wells, Athol U. ; Hansell, David M. / Evaluation of computer-based computer tomography stratification against outcome models in connective tissue disease-related interstitial lung disease : A patient outcome study. In: BMC Medicine. 2016 ; Vol. 14, No. 1.
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T2 - A patient outcome study

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AU - Brun, Anne Laure

AU - Egashira, Ryoko

AU - Karwoski, Ronald

AU - Kokosi, Maria

AU - Wells, Athol U.

AU - Hansell, David M.

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N2 - Background: To evaluate computer-based computer tomography (CT) analysis (CALIPER) against visual CT scoring and pulmonary function tests (PFTs) when predicting mortality in patients with connective tissue disease-related interstitial lung disease (CTD-ILD). To identify outcome differences between distinct CTD-ILD groups derived following automated stratification of CALIPER variables. Methods: A total of 203 consecutive patients with assorted CTD-ILDs had CT parenchymal patterns evaluated by CALIPER and visual CT scoring: honeycombing, reticular pattern, ground glass opacities, pulmonary vessel volume, emphysema, and traction bronchiectasis. CT scores were evaluated against pulmonary function tests: forced vital capacity, diffusing capacity for carbon monoxide, carbon monoxide transfer coefficient, and composite physiologic index for mortality analysis. Automated stratification of CALIPER-CT variables was evaluated in place of and alongside forced vital capacity and diffusing capacity for carbon monoxide in the ILD gender, age physiology (ILD-GAP) model using receiver operating characteristic curve analysis. Results: Cox regression analyses identified four independent predictors of mortality: patient age (P < 0.0001), smoking history (P = 0.0003), carbon monoxide transfer coefficient (P = 0.003), and pulmonary vessel volume (P < 0.0001). Automated stratification of CALIPER variables identified three morphologically distinct groups which were stronger predictors of mortality than all CT and functional indices. The Stratified-CT model substituted automated stratified groups for functional indices in the ILD-GAP model and maintained model strength (area under curve (AUC) = 0.74, P < 0.0001), ILD-GAP (AUC = 0.72, P < 0.0001). Combining automated stratified groups with the ILD-GAP model (stratified CT-GAP model) strengthened predictions of 1- and 2-year mortality: ILD-GAP (AUC = 0.87 and 0.86, respectively); stratified CT-GAP (AUC = 0.89 and 0.88, respectively). Conclusions: CALIPER-derived pulmonary vessel volume is an independent predictor of mortality across all CTD-ILD patients. Furthermore, automated stratification of CALIPER CT variables represents a novel method of prognostication at least as robust as PFTs in CTD-ILD patients.

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KW - Computer tomography

KW - Connective tissue disease

KW - Interstitial lung disease

KW - Pulmonary fibrosis

KW - Quantitative CT

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