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2.
Eur Radiol ; 27(9): 3635-3646, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28130610

RESUMO

BACKGROUND: Hypersensitivity pneumonitis (HP) has a variable clinical course. Modelling of quantitative CALIPER-derived CT data can identify distinct disease phenotypes. Mortality prediction using CALIPER analysis was compared to the interstitial lung disease gender, age, physiology (ILD-GAP) outcome model. METHODS: CALIPER CT analysis of parenchymal patterns in 98 consecutive HP patients was compared to visual CT scoring by two radiologists. Functional indices including forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLco) in univariate and multivariate Cox mortality models. Automated stratification of CALIPER scores was evaluated against outcome models. RESULTS: Univariate predictors of mortality included visual and CALIPER CT fibrotic patterns, and all functional indices. Multivariate analyses identified only two independent predictors of mortality: CALIPER reticular pattern (p = 0.001) and DLco (p < 0.0001). Automated stratification distinguished three distinct HP groups (log-rank test p < 0.0001). Substitution of automated stratified groups for FVC and DLco in the ILD-GAP model demonstrated no loss of model strength (C-Index = 0.73 for both models). Model strength improved when automated stratified groups were combined with the ILD-GAP model (C-Index = 0.77). CONCLUSIONS: CALIPER-derived variables are the strongest CT predictors of mortality in HP. Automated CT stratification is equivalent to functional indices in the ILD-GAP model for predicting outcome in HP. KEY POINTS: • Computer CT analysis better predicts mortality than visual CT analysis in HP. • Quantitative CT analysis is equivalent to functional indices for prognostication in HP. • Prognostication using the ILD-GAP model improves when combined with quantitative CT analysis.


Assuntos
Alveolite Alérgica Extrínseca/diagnóstico por imagem , Idoso , Alveolite Alérgica Extrínseca/mortalidade , Alveolite Alérgica Extrínseca/fisiopatologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Londres/epidemiologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/mortalidade , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Capacidade de Difusão Pulmonar/fisiologia , Testes de Função Respiratória , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital/fisiologia
3.
Clin Radiol ; 68(5): 433-48, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23351776

RESUMO

The rapid evolution of multidetector computed tomography (MDCT) and the introduction of dual-energy CT (DECT) have been paralleled by an unprecedented advancement in post-processing techniques. This has provided complementary methods of two- and three-dimensional visualization of the airways and lung parenchyma, many of which are easily available and not too time-consuming. In addition, advanced imaging has paved the way for methods of quantification of disease that may have a role to play in monitoring chronic obstructive pulmonary disease (COPD) and interstitial lung disease. Computer-aided detection also continues to be explored in lung cancer and pulmonary embolism detection. However, many of these techniques have not yet found widespread adoption in clinical practice. In this article, we review the imaging techniques (used in both single-energy and DECT) that can benefit from post-processing, describe the various post-processing tools available, and consider their clinical application with specific reference to COPD, diffuse lung disease, lung cancer, and pulmonary embolism.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Pneumopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos , Imageamento Tridimensional/métodos , Pulmão/diagnóstico por imagem
4.
Br J Radiol ; 84(1003): 581-92, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21697412

RESUMO

Idiopathic pulmonary fibrosis (IPF) has a more variable clinical course than has been traditionally recognised. Many patients will remain stable over time while others experience relatively rapid deterioration. The prognosis and clinical course of patients with other fibrosing lung diseases is also variable. A number of conditions may complicate the clinical course of the idiopathic fibrosing lung diseases, which results in morbidity and mortality, but also represents potentially treatable causes of worsening symptoms. Infection and malignancy have a long-recognised association with IPF while other conditions, particularly pulmonary hypertension and acute exacerbation of IPF, are being increasingly recognised in this patient population. Many of these patients have serial high-resolution CT (HRCT) examinations that may demonstrate one or more of these supervening conditions. In this article we review the more common conditions that may complicate the course of idiopathic fibrosing lung disease with an emphasis on the HRCT appearance, which the reporting radiologist should be aware of.


Assuntos
Infecções Bacterianas/diagnóstico por imagem , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Infecções Bacterianas/microbiologia , Feminino , Humanos , Fibrose Pulmonar Idiopática/complicações , Pneumopatias/microbiologia , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Tomografia Computadorizada por Raios X/instrumentação
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