Visual vs Fully Automatic Histogram-Based Assessment of Idiopathic Pulmonary Fibrosis (IPF) Progression Using Sequential Multidetector Computed Tomography (MDCT)

Objectives To describe changes over time in extent of idiopathic pulmonary fibrosis (IPF) at multidetector computed tomography (MDCT) assessed by semi-quantitative visual scores (VSs) and fully automatic histogram-based quantitative evaluation and to test the relationship between these two methods of quantification. Methods Forty IPF patients (median age: 70 y, interquartile: 62-75 years;M:F, 33: 7) that underwent 2 MDCT at different time points with a median interval of 13 months (interquartile: 10-17 months) were retrospectively evaluated. In-house software YACTA quantified automatically lung density histogram (10th-90th percentile in 5th percentile steps). Longitudinal changes in VSs and in the percentiles of attenuation histogram were obtained in 20 untreated patients and 20 patients treated with pirfenidone. Pearson correlation analysis was used to test the relationship between VSs and selected percentiles. Results In follow-up MDCT, visual overall extent of parenchymal abnormalities (OE) increased in median by 5 %/year (interquartile: 0 %/y;+11 %/y). Substantial difference was found between treated and untreated patients in HU changes of the 40th and of the 80th percentiles of density histogram. Correlation analysis between VSs and selected percentiles showed higher correlation between the changes (Delta) in OE and Delta 40th percentile (r=0.69;p<0.001) as compared to Delta 80th percentile (r=0.58;p<0.001);closer correlation was found between Delta ground-glass extent and Delta 40th percentile (r=0.66, p<0.001) as compared to Delta 80th percentile (r=0.47, p=0.002),while the Delta reticulations correlated better with the Delta 80th percentile (r=0.56, p<0.001) in comparison to Delta 40th percentile (r=0.43, p=0.003). Conclusions There is a relevant and fully automatically measurable difference at MDCT in VSs and in histogram analysis at one year follow-up of IPF patients, whether treated or untreated: Delta 40th percentile might reflect the change in overall extent of lung abnormalities, notably of ground-glass pattern;furthermore Delta 80th percentile might reveal the course of reticular opacities

Visual vs Fully Automatic Histogram-Based Assessment of Idiopathic Pulmonary Fibrosis (IPF) Progression Using Sequential Multidetector Computed Tomography (MDCT)

Objectives To describe changes over time in extent of idiopathic pulmonary fibrosis (IPF) at multidetector computed tomography (MDCT) assessed by semi-quantitative visual scores (VSs) and fully automatic histogram-based quantitative evaluation and to test the relationship between these two methods of quantification. Methods Forty IPF patients (median age: 70 y, interquartile: 62-75 years;M:F, 33: 7) that underwent 2 MDCT at different time points with a median interval of 13 months (interquartile: 10-17 months) were retrospectively evaluated. In-house software YACTA quantified automatically lung density histogram (10th-90th percentile in 5th percentile steps). Longitudinal changes in VSs and in the percentiles of attenuation histogram were obtained in 20 untreated patients and 20 patients treated with pirfenidone. Pearson correlation analysis was used to test the relationship between VSs and selected percentiles. Results In follow-up MDCT, visual overall extent of parenchymal abnormalities (OE) increased in median by 5 %/year (interquartile: 0 %/y;+11 %/y). Substantial difference was found between treated and untreated patients in HU changes of the 40th and of the 80th percentiles of density histogram. Correlation analysis between VSs and selected percentiles showed higher correlation between the changes (Delta) in OE and Delta 40th percentile (r=0.69;p<0.001) as compared to Delta 80th percentile (r=0.58;p<0.001);closer correlation was found between Delta ground-glass extent and Delta 40th percentile (r=0.66, p<0.001) as compared to Delta 80th percentile (r=0.47, p=0.002),while the Delta reticulations correlated better with the Delta 80th percentile (r=0.56, p<0.001) in comparison to Delta 40th percentile (r=0.43, p=0.003). Conclusions There is a relevant and fully automatically measurable difference at MDCT in VSs and in histogram analysis at one year follow-up of IPF patients, whether treated or untreated: Delta 40th percentile might reflect the change in overall extent of lung abnormalities, notably of ground-glass pattern;furthermore Delta 80th percentile might reveal the course of reticular opacities

Visual vs fully automatic histogram-based assessment of Idiopathic Pulmonary Fibrosis (IPF) Progression Using Sequential Multidetector Computed Tomography (MDCT)

Objectives To describe changes over time in extent of idiopathic pulmonary fibrosis (IPF) at multidetector computed tomography (MDCT) assessed by semi-quantitative visual scores (VSs) and fully automatic histogram-based quantitative evaluation and to test the relationship between these two methods of quantification. Methods Forty IPF patients (median age: 70 y, interquartile: 62-75 years; M:F, 33:7) that underwent 2 MDCT at different time points with a median interval of 13 months (interquartile: 10-17 months) were retrospectively evaluated. In-house software YACTA quantified automatically lung density histogram (10th-90th percentile in 5th percentile steps). Longitudinal changes in VSs and in the percentiles of attenuation histogram were obtained in 20 untreated patients and 20 patients treated with pirfenidone. Pearson correlation analysis was used to test the relationship between VSs and selected percentiles. Results In follow-up MDCT, visual overall extent of parenchymal abnormalities (OE) increased in median by 5 %/year (interquartile: 0 %/y; +11 %/y). Substantial difference was found between treated and untreated patients in HU changes of the 40th and of the 80th percentiles of density histogram. Correlation analysis between VSs and selected percentiles showed higher correlation between the changes (δ) in OE and δ 40th percentile (r=0.69; p<0.001) as compared to δ 80th percentile (r=0.58; p<0.001); closer correlation was found between δ ground-glass extent and δ 40th percentile (r=0.66, p<0.001) as compared to δ 80th percentile (r=0.47, p=0.002), while the δ reticulations correlated better with the δ 80th percentile (r=0.56, p<0.001) in comparison to δ 40th percentile (r=0.43, p=0.003). Conclusions There is a relevant and fully automatically measurable difference at MDCT in VSs and in histogram analysis at one year follow-up of IPF patients, whether treated or untreated: δ 40th percentile might reflect the change in overall extent of lung abnormalities, notably of ground-glass pattern; furthermore δ 80th percentile might reveal the course of reticular opacities

Similar Weight Loss Induces Greater Improvements in Insulin Sensitivity and Liver Function among Individuals with NAFLD Compared to Individuals without NAFLD

Background: Preliminary evidence suggests that weight loss among obese has differential metabolic effects depending on the presence of non-alcoholic fatty liver disease (NAFLD). We assessed whether NAFLD predisposes to differential changes in liver fat content, liver function, and metabolic parameters upon diet-induced weight loss in a 50-week intervention trial. Methods: 143 overweight and obese non-smokers underwent a 12-week dietary intervention and a 38-week follow-up. Diet-induced changes in anthropometric measures, circulating biomarkers, and magnetic resonance (MR)-derived liver fat content and adipose tissue volumes were evaluated by mixed linear models stratifying by NAFLD at baseline. Results: The prevalence of NAFLD at baseline was 52%. Diet-induced weight loss after 12 (NAFLD: 4.8 &plusmn; 0.5%, No NAFLD: 5.1 &plusmn; 0.5%) and 50 weeks (NAFLD: 3.5 &plusmn; 0.7%, No NAFLD: 3.5 &plusmn; 0.9%) was similar in both groups, while the decrease in liver fat was significantly greater in the NAFLD group (week 12: 32.9 &plusmn; 9.5% vs. 6.3 &plusmn; 4.0%; week 50: 23.3 &plusmn; 4.4% vs. 5.0 &plusmn; 4.2%). Decreases in biomarkers of liver dysfunction (GGT, ALT, AST) and HOMA IR were also significantly greater in the NAFLD group. Other metabolic parameters showed no significant differences. Conclusion: Our data suggest that individuals with NAFLD show greater improvements of liver function and insulin sensitivity after moderate diet-induced weight loss than individuals without NAFLD

Visualization of the fully automatic lung parenchyma segmentation as obtained by in-house YACTA software.

<p>Sagittal reconstruction image of a non-enhanced MDCT scan obtained from a patient suffering from idiopathic pulmonary fibrosis (IPF) not included in the current trial. YACTA software automatically segmented lung parenchyma and trachea-bronchial tree, emphasized as green and orange overlay respectively (window width: 1600 HU; level: -600 HU). Note that the segmentation algorithm fails to segment portions of the lung parenchyma in the sub-pleural space of the recessus, due to its similar density to the chest wall. (MDCT = multidetector computed tomography).</p

Correlation analysis between selected percentiles of multidetector computed tomography (MDCT) attenuation histogram and visual scores (VSs).

<p>Summary of correlation analysis between visual scores (VSs) and selected percentiles obtained from multidetector computed tomography (MDCT) attenuation histogram at initial MDCT and at 1-year follow-up. Pearson r coefficients were calculated for overall extent of abnormalities (OE), ground-glass opacities extent (GGO), reticulations extent (RET), and honeycombing extent (HC), expressed as percent of parenchyma involved (%), with the density, expressed as Hounsfield Unit (HU), of both the 40^th and the 80^th percentiles obtained from the MDCT attenuation histogram at baseline. The same coefficients were obtained for longitudinal changes at 1-year (Δ) in VSs, expressed as percent per year (%/y), with the variation in density, expressed as Hounsfield Unit per year (HU/y), of both the 40^th and the 80^th percentiles obtained from the MDCT attenuation histogram. In bold <i>p</i> values statistically significant (<i>p</i><0.05).</p><p>Correlation analysis between selected percentiles of multidetector computed tomography (MDCT) attenuation histogram and visual scores (VSs).</p

Study population (n = 40) characteristics.

<p>Summary of gender, age, body mass index (BMI), smoking history, comorbidities, diagnostic procedures, pulmonary function tests [including vital capacity (VC), total lung capacity (TLC), diffusing capacity of the lung for carbon monoxide (DLCO), and arterial pressure of oxygen (PaO₂)], therapy prior and after initial multidetector computed tomography (MDCT), and interval between initial and follow-up MDCT data of the idiopathic pulmonary fibrosis (IPF) patients that constituted the study population. Data are presented as absolute number of patients (n) or median and interquartile range (in brackets).</p><p>^aWas considered the presence or absence of emphysema additionally to fibrosis.</p><p>^bOne value is missing due to patient inability to perform pulmonary function tests.</p><p>^cSeven values are missing due to patient inability to perform the DLCO test.</p><p>^dImmunomodulator indicates azathioprine and\or cyclophosphamide at a dosage clinically indicated.</p><p>Study population (n = 40) characteristics.</p

Visual scores obtained at multidetector computed tomography (MDCT).

<p>Summary of the visual scores, expressed as percent of parenchyma involved (%), obtained at initial multidetector computed tomography (MDCT) and their longitudinal changes at 1-year (Δ), expressed as percent per year (%/y). Ground-glass opacities, reticular opacities, honeycombing, consolidations, and emphysema were defined according to the recommendations suggested by the Fleischner Society nomenclature committee [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0130653#pone.0130653.ref010" target="_blank">10</a>]. Data are expressed as median and interquartile ranges (in brackets).</p><p>Visual scores obtained at multidetector computed tomography (MDCT).</p

Correlation analysis of pulmonary function tests (PFTs) with visual scores (VSs) and selected percentiles obtained from multidetector computed tomography (MDCT) attenuation histogram.

<p>Summary of correlation analysis between pulmonary function tests (PFTs), visual scores (VSs), and selected percentiles (PERC) obtained from multidetector computed tomography (MDCT) attenuation histogram at initial MDCT and at 1-year follow-up. Pearson r coefficients were calculated for overall extent of abnormalities (OE), ground-glass opacities extent (GGO), reticulations extent (RET), honeycombing extent (HC) [all expressed as percentage of parenchyma involved (%)], and the density, expressed as Hounsfield Unit (HU), of selected percentiles obtained from the MDCT attenuation histogram with the percent predicted (%) of vital capacity (VC) and of diffusing capacity of the lung for carbon monoxide (DLCO) at baseline. The same coefficients were obtained for both longitudinal changes at 1-year (Δ) in VSs, expressed as percent per year (%/y), and in the density, expressed as Hounsfield Unit per year (HU/y), of selected percentiles obtained from the MDCT attenuation histogram with the variation, expressed as percent predicted per year (%/y), of VC% and of DLCO%. In bold <i>p</i> values statistically significant (<i>p</i><0.05).</p><p>Correlation analysis of pulmonary function tests (PFTs) with visual scores (VSs) and selected percentiles obtained from multidetector computed tomography (MDCT) attenuation histogram.</p