Mortality prediction in idiopathic pulmonary fibrosis: evaluation of computer-based CT analysis with conventional severity measures

Joseph Jacob, Brian Jack Bartholmai, Srinivasan Rajagopalan, Maria Kokosi, Arjun Nair, Ronald Karwoski, Simon L.F. Walsh, Athol U. Wells, David M. Hansell

Research output: Contribution to journalArticle

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Abstract

Computer-based computed tomography (CT) analysis can provide objective quantitation of disease in idiopathic pulmonary fibrosis (IPF). A computer algorithm, CALIPER, was compared with conventional CT and pulmonary function measures of disease severity for mortality prediction. CT and pulmonary function variables (forced expiratory volume in 1 s, forced vital capacity, diffusion capacity of the lung for carbon monoxide, transfer coefficient of the lung for carbon monoxide and composite physiologic index (CPI)) of 283 consecutive patients with a multidisciplinary diagnosis of IPF were evaluated against mortality. Visual and CALIPER CT features included total extent of interstitial lung disease, honeycombing, reticular pattern, ground glass opacities and emphysema. In addition, CALIPER scored pulmonary vessel volume (PVV) while traction bronchiectasis and consolidation were only scored visually. A combination of mortality predictors was compared with the Gender, Age, Physiology model. On univariate analyses, all visual and CALIPER-derived interstitial features and functional indices were predictive of mortality to a 0.01 level of significance. On multivariate analysis, visual CT parameters were discarded. Independent predictors of mortality were CPI (hazard ratio (95% CI) 1.05 (1.02–1.07), p<0.001) and two CALIPER parameters: PVV (1.23 (1.08–1.40), p=0.001) and honeycombing (1.18 (1.06–1.32), p=0.002). A three-group staging system derived from this model was powerfully predictive of mortality (2.23 (1.85–2.69), p<0.0001). CALIPER-derived parameters, in particular PVV, are more accurate prognostically than traditional visual CT scores. Quantitative tools such as CALIPER have the potential to improve staging systems in IPF.

Original languageEnglish (US)
Article number1601011
JournalEuropean Respiratory Journal
Volume49
Issue number1
DOIs
StatePublished - Jan 1 2017

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Idiopathic Pulmonary Fibrosis
Tomography
Lung
Mortality
Carbon Monoxide
Lung Volume Measurements
Bronchiectasis
Interstitial Lung Diseases
Vital Capacity
Emphysema
Forced Expiratory Volume
Traction
Glass
Multivariate Analysis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Mortality prediction in idiopathic pulmonary fibrosis : evaluation of computer-based CT analysis with conventional severity measures. / Jacob, Joseph; Bartholmai, Brian Jack; Rajagopalan, Srinivasan; Kokosi, Maria; Nair, Arjun; Karwoski, Ronald; Walsh, Simon L.F.; Wells, Athol U.; Hansell, David M.

In: European Respiratory Journal, Vol. 49, No. 1, 1601011, 01.01.2017.

Research output: Contribution to journalArticle

Jacob, Joseph ; Bartholmai, Brian Jack ; Rajagopalan, Srinivasan ; Kokosi, Maria ; Nair, Arjun ; Karwoski, Ronald ; Walsh, Simon L.F. ; Wells, Athol U. ; Hansell, David M. / Mortality prediction in idiopathic pulmonary fibrosis : evaluation of computer-based CT analysis with conventional severity measures. In: European Respiratory Journal. 2017 ; Vol. 49, No. 1.
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