Objective quantitative multidetector computed tomography assessments in patients with combined pulmonary fibrosis with emphysema: Relationship with pulmonary function and clinical events

PLoS One. 2020 Sep 17;15(9):e0239066. doi: 10.1371/journal.pone.0239066. eCollection 2020.

Abstract

Background: Combined pulmonary fibrosis with emphysema (CPFE) is a clinically meaningful syndrome characterized by coexisting upper-lobe emphysema and lower-lobe interstitial fibrosis. However, ambiguous diagnostic criteria and, particularly, the absence of objective methods to quantify emphysematous/fibrotic lesions in patients with CPFE confound the interpretation of the pathophysiology of this syndrome. We analyzed the relationship between objectively quantified computed tomography (CT) measurements and the results of pulmonary function testing (PFT) and clinical events in CPFE patients.

Materials and methods: We enrolled 46 CPFE patients who underwent CT and PFT. The extent of emphysematous lesions was obtained by calculating the percent of low attenuation area (%LAA). The extent of fibrotic lesions was calculated as the percent of high attenuation area (%HAA). %LAA and %HAA values were combined to yield the percent of abnormal area (%AA). We assessed the relationships between CT parameters and other clinical indices, including PFT results. Multivariate analysis was performed to examine the association between the CT parameters and clinical events.

Results: A greater negative correlation with percent predicted diffusing capacity of the lung for carbon monoxide (DLCO %predicted) existed for %AA (r = -0.73, p < 0.001) than for %LAA or %HAA alone. The %HAA value was inversely correlated with percent predicted forced vital capacity (r = -0.48, p < 0.001), percent predicted total lung capacity (r = -0.48, p < 0.01), and DLCO %predicted (r = -0.47, p < 0.01). Multivariate logistic regression analysis found that %AA showed the strongest association with hospitalization events (odds ratio = 1.20, 95% confidence interval = 1.01-1.54, p = 0.029).

Conclusion: Quantitative CT measurements reflected deterioration in pulmonary function and were associated with hospitalization in patients with CPFE. This approach could serve as a useful method to determine the extent of lung morphology, pathophysiology, and the clinical course of patients with CPFE.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Female
  • Humans
  • Lung / diagnostic imaging*
  • Lung / physiopathology
  • Middle Aged
  • Multidetector Computed Tomography
  • Pulmonary Emphysema / complications
  • Pulmonary Emphysema / diagnostic imaging*
  • Pulmonary Emphysema / physiopathology
  • Pulmonary Fibrosis / complications
  • Pulmonary Fibrosis / diagnostic imaging*
  • Pulmonary Fibrosis / physiopathology
  • Respiratory Function Tests

Grants and funding

NK recieved the grants from the Ministry of Education, Science, Sports and Culture, Grant-in-Aid for Scientific Research (C) (16K01407,19K12816), the Chiba Foundation for Health Promotion & Disease Prevention(No.1272). Koichiro T recieved the grants from the Respiratory Failure Research Group (H26-Intractable diseases-General-076) from the Ministry of Health, Labour and Welfare, Japan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.