Presentation is loading. Please wait.

Presentation is loading. Please wait.

Diagnostic tools – imaging and lung function (humans) David A Lynch, MB.

Similar presentations


Presentation on theme: "Diagnostic tools – imaging and lung function (humans) David A Lynch, MB."— Presentation transcript:

1 Diagnostic tools – imaging and lung function (humans) David A Lynch, MB

2 Disclosures Consultant:Research support: Perceptive ImagingCentocor, Inc Boehringer IngelheimSiemens Inc GenentechNHLBI Gilead Intermune Veracyte Pfizer

3 Conflict of interest I ain’t going near no CT scanner Jack

4 CT in human fibrotic lung disease Technique Terminology Patterns of fibrosis Quantification

5 High Resolution CT technique Thin section (0.625-1.5 mm) Small field of view Edge-enhancing reconstruction Adequate inspiration Absent motion Prone and expiratory images very helpful Multiplanar images Standard window width (1500) and level (-700) Mayo JR. CT evaluation of diffuse infiltrative lung disease: dose considerations and optimal technique. Journal of thoracic imaging. 2009;24(4):252-9.

6

7

8 Features of lung fibrosis Reticular lines Honeycombing Ground glass attenuation or consolidation (uncommon) Traction bronchiectasis/architectural distortion Lobar volume loss Hansell DM, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697-722.

9 Reticular abnormality with traction bronchiectasis

10 Reticular abnormality with honeycombing

11 Ground glass abnormality

12 Consolidation with traction bronchiectasis

13 Architectural distortion

14 Lobar volume loss

15 CT distribution Craniocaudal Upper lung predominant Lower lung predominant Mid lung predominant Axial Peripheral/subpleural Peribronchovascular

16 Patterns of lung fibrosis in humans UIP NSIP Hypersensitivity pneumonitis Sarcoidosis Organizing pneumonia Idiopathic pleuroparenchymal fibroelastosis

17

18 UIP pattern Subpleural, basal predominance Reticular abnormality Honeycombing with or without traction bronchiectasis Absence of features inconsistent with UIP pattern ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management. AJRCCM, 2011 Mar 15;183(6):788-824

19 Possible UIP Subpleural, basal predominance Reticular abnormality Absence of features inconsistent with UIP pattern ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management. AJRCCM, 2011 Mar 15;183(6):788-824

20 IPFNET: Concordance between CT and pathologic diagnoses Pathology diagnosis CT diagnosisDefinite UIPProbable UIPPossible UIPNot UIPTotal UIP821712102 Possible UIP5194064 Inconsistent with UIP55 16 4075 Total1884292241 Yagihashi et al. Soc Thorac Radiol 2014

21 NSIP  Basal predominance  Peribronchovascular/ subpleural sparing  Confluent pattern  Volume loss  Ground glass  Reticular  Traction bronchiectasis  Consolidation +/-  Honeycombing rare Travis et al. Am J Respir Crit Care Med. 2008;177:1338

22 Fibrotic sarcoidosis

23 Fibrotic hypersensitivity pneumonitis Upper, mid or lower lung predominance Infiltrative Centrilobular nodules Irregular lines Ground glass Reticular opacity Honeycombing Obstructive Air trapping Cysts Emphysema

24 Organizing pneumonia

25 Idiopathic pleuropulmonary fibroelastosis (IPPFE) Rare entity Upper lobe predominant Dense pleural/subpleural fibrosis Traction bronchiectasis and volume loss Frankel SK. Chest 2004;126:2007-2013.

26 Bleomycin induced fibrosis in rabbits Hirose et al. Am Rev Respir Dis. 1993 Mar;147(3):730-8. Lynch et al. Acad Radiol. 1997 Feb;4(2):102-7

27 Bleomycin induced fibrosis in rabbits Lynch et al. Acad Radiol. 1997 Feb;4(2):102-7

28 Quantification of lung fibrosis Semiquantitative Densitometry/CT histogram Texture-based methods

29 Relationship between semiquantitative assessment and physiologic impairment Wells et al. Am J Respir Crit Care Med Vol 167. pp 962–969, 2003

30 Relationship between semiquantitative assessment and mortality: Multivariate Baseline Variable Hazard ratio 95% Confidence Interval p Value HRCT features Overall extent of fibrosis 2.711.61, 4.55< 0.0001 % predicted DLCO 0.940.90, 0.98 0.004 Treatment assignment to IFN-γ1b 0.530.28, 0.990.04 Lynch DA, et al. Am J Respir Crit Care Med2005;172:488-93.

31 Histogram-based parameters Courtesy: Stephen Humphries, National Jewish Health

32 Relationship between quantitative histogram assessment and physiologic impairment R 2 = 0.23 P<0.0001 R 2 = 0.30 P<0.0001 R 2 = 0.20 P<0.0001 Best et al., Radiology; 2003;208:407-414

33 Multivariate analysis of predictors of mortality in IPF (n=167, 35 deaths) Effect Odds Ratio Estimates 95% Confidence Limits Wald Chi- Square Pr > ChiSq Kurtosis at Baseline0.579 0.32 to 1.0493.2490.0715 Mean Visual Fibrosis at Baseline CT1.104 1.018 to 1.1985.71710.0168 Best et al., Radiology; 2008 Mar;246(3):935-40.

34 Normal lung Reticular Abnormality Textural analysis Courtesy: Stephen Humphries, National Jewish Health

35 Critical features of CT assessment of fibrosis High resolution technique, with minimal motion Standardized descriptive lexicon Systematic categorization of fibrotic patterns Quantification Visual Histogram based Textural Validation against physiology, pathology, outcome

36 THANKS!


Download ppt "Diagnostic tools – imaging and lung function (humans) David A Lynch, MB."

Similar presentations


Ads by Google