Quantitative evaluation of disease severity in connective tissue disease-associated interstitial lung disease by dual-energy computed tomography

Ling Chen; Min Zhu; Haiyan Lu; Ting Yang; Wanjiang Li; Yali Zhang; Qibing Xie; Zhenlin Li; Huajing Wan; Fengming Luo

doi:10.1186/s12931-022-01972-4

Quantitative evaluation of disease severity in connective tissue disease-associated interstitial lung disease by dual-energy computed tomography

Respir Res. 2022 Mar 5;23(1):47. doi: 10.1186/s12931-022-01972-4.

Authors

Ling Chen^#^{1

2}, Min Zhu^#^{1

2}, Haiyan Lu^#¹, Ting Yang¹, Wanjiang Li³, Yali Zhang^{1

2}, Qibing Xie⁴, Zhenlin Li³, Huajing Wan^{5

6}, Fengming Luo^{7

8}

Affiliations

¹ Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
² Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, No.2222 Xin Chuan Road, Chengdu, 610041, Sichuan, China.
³ Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
⁴ Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, 610041, China.
⁵ Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China. wanhuajing1974@wchscu.cn.
⁶ Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, No.2222 Xin Chuan Road, Chengdu, 610041, Sichuan, China. wanhuajing1974@wchscu.cn.
⁷ Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China. fengmingluo@outlook.com.
⁸ Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, No.2222 Xin Chuan Road, Chengdu, 610041, Sichuan, China. fengmingluo@outlook.com.

^# Contributed equally.

Abstract

Background: High-resolution computed tomography (HRCT) is recommended diagnosing and monitoring connective tissue disease-associated interstitial lung disease (CTD-ILD). Quantitative computed tomography has the potential to precisely assess the radiological severity of CTD-ILD, but has still been under study.

Objective: To investigate whether dual-energy computed tomography (DECT), a novel quantitative technique, can be used for quantitative severity assessment in CTD-ILD.

Methods: This cross sectional study recruited adult CTD-ILD patients who underwent DECT scans from the ICE study between October 2019 and November 2021. DECT parameters, including effective atomic number (Z_eff), lung (lobe) volume, and monochromatic CT number (MCTN) of each lung lobe, were evaluated. CTD-ILD was classified into extensive CTD-ILD and limited CTD-ILD by staging algorithm using combined forced vital capacity (FVC)%predicted and total extent of ILD (TEI) on CT. Dyspnea, cough, and life quality were scored by Borg dyspnea score, Leicester cough questionnaire (LCQ), and short-form 36 health survey questionnaire (SF-36), respectively.

Results: There was a total of 147 patients with DECT scans enrolled. Higher Z_eff value (3.104 vs 2.256, p < 0.001), higher MCTN (- 722.87 HU vs - 802.20 HU, p < 0.001), and lower lung volume (2309.51cm³ vs 3475.21cm³, p < 0.001) were found in extensive CTD-ILD compared with limited CTD-ILD. DECT parameters had significant moderate correlations with FVC%predicted (|r|= 0.542-0.667, p < 0.01), DLCO%predicted (|r|= 0.371-0.427, p < 0.01), and TEI (|r|= 0.485-0.742, p < 0.01). Receiver operating characteristic (ROC) analysis indicated MCTN averaged over the whole lung had the best performance for extensive CTD-ILD discrimination (AUC = 0.901, cut-off: - 762.30 HU, p < 0.001), with a sensitivity of 82.1% and a specificity of 85.4%. The Z_eff value was the independent risk factor for dyspnea (OR = 3.644, 95% CI: 1.846-7.192, p < 0.001) and cough (OR = 3.101, 95% CI: 1.528-6.294, p = 0.002), and lung volume significantly contributed to the mental component summary (MCS) in SF-36 (standardized β = 0.198, p < 0.05).

Conclusions: DECT can be applied to evaluate the severity of CTD-ILD.

Keywords: Connective tissue disease-associated interstitial lung disease (CTD-ILD); Dual-energy computed tomography (DECT); Effective atomic number (Zeff); Lung volume (LV); Monochromatic CT number (MCTN).

Publication types

Evaluation Study

MeSH terms

Cross-Sectional Studies
Female
Humans
Lung / diagnostic imaging*
Lung / physiopathology
Lung Diseases, Interstitial / diagnosis*
Lung Diseases, Interstitial / physiopathology
Male
Middle Aged
Quality of Life*
ROC Curve
Radiography, Dual-Energy Scanned Projection / methods*
Severity of Illness Index
Tomography, X-Ray Computed / methods*
Vital Capacity / physiology*

Abstract

Publication types

MeSH terms

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