Computer-Aided Tomographic Analysis of Interstitial Lung Disease (ILD) in Patients with Systemic Sclerosis (SSc). Correlation with Pulmonary Physiologic Tests and Patient-Centred Measures of Perceived Dyspnea and Functional Disability

• Published in: PloS one Vol. 11; no. 3; p. e0149240
• Main Authors: Salaffi, Fausto, Carotti, Marina, Di Donato, Eleonora, Di Carlo, Marco, Ceccarelli, Luca, Giuseppetti, Gianmarco
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01-03-2016; Public Library of Science (PLoS)
• Subjects: Abnormalities; Adult; Aged; Analysis; Antibodies; Arthritis; Biology and Life Sciences; Breathing; Carbon monoxide; Care and treatment; Complications and side effects; Computed tomography; Consent; Correlation; Correlation analysis; Cross-Sectional Studies; Diagnosis; Diagnostic imaging; Dyspnea; Dyspnea - diagnostic imaging; Dyspnea - psychology; Female; Fibrosis; Humans; Identification methods; Lung - diagnostic imaging; Lung - pathology; Lung - physiopathology; Lung diseases; Lung Diseases, Interstitial - diagnostic imaging; Lung Diseases, Interstitial - physiopathology; Lung Diseases, Interstitial - psychology; Lungs; Male; Measurement; Measurement methods; Medicine and Health Sciences; Methods; Middle Aged; Multivariate analysis; Patients; Perception; Physiology; Quality of life; Questionnaires; Radiography; Regression analysis; Regression models; Research and Analysis Methods; Respiration; Rheumatology; Risk factors; Scleroderma; Scleroderma (Disease); Scleroderma, Systemic - diagnostic imaging; Scleroderma, Systemic - physiopathology; Scleroderma, Systemic - psychology; Studies; Systemic sclerosis; Tomography, X-Ray Computed; Validity; Vital Capacity; Young Adult; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0149240

This study was designed (a) to evaluate an improved quantitative lung fibrosis score based on a computer-aided diagnosis (CaM) system in patients with systemic sclerosis (SSc),-related interstitial lung disease (SSc-ILD), (b) to investigate the relationship between physiologic parameters (forced vital capacity [FVC] and single-breath diffusing capacity for carbon monoxide [DLCO]), patient-centred measures of dyspnea and functional disability and CaM and visual reader-based (CoVR) methods, and (c) to identify potential surrogate measures from quantitative and visual HRCT measurement.
126 patients with SSc underwent chest radiography, HRCT and PFTs. The following patient-centred measures were obtained: modified Borg Dyspnea Index (Borg score), VAS for breathing, and Health Assessment Questionnaire-Disability Index (HAQ-DI). HRCT abnormalities were scored according to the conventional visual reader-based score (CoVR) and by a CaM. The relationships among the HRCT scores, physiologic parameters (FVC and DLCO, % predicted) results and patient-centred measures, were calculated using linear regression analysis and Pearson's correlation. Multivariate regression models were performed to identify the predictor variables on severity of pulmonary fibrosis.
Subjects with limited cutaneous SSc had lower HAQ-DI scores than subjects with diffuse cutaneous SSc (p <0.001). CaM and CoVR scores were similar in the 2 groups. In univariate analysis, a strong correlation between CaM and CoVR was observed (p <0.0001). In multivariate analysis the CaM and CoVR scores were predicted by DLco, FVC, Borg score and HAQ-DI. Age, sex, disease duration, anti-topoisomerase antibodies and mRSS were not significantly associated with severity of pulmonary fibrosis on CaM- and CoVR methods.
Although a close correlation between CaM score results and CoVR total score was found, CaM analysis showed a more significant correlation with DLco (more so than the FVC), patient-centred measures of perceived dyspnea and functional disability. Computer-aided tomographic analysis is computationally efficient, and in combination with physiologic and patient-centred measures, it could allow a means for accurately assessing and monitoring the disease progression or response to therapy.