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. 2017 May 16;12(5):e0177689.
doi: 10.1371/journal.pone.0177689. eCollection 2017.

Texture analysis using proton density and T2 relaxation in patients with histological usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP)

Maria T A Buzan  1   2   3   4 , Andreas Wetscherek  5 , Claus Peter Heussel  2   3   4 , Michael Kreuter  4   6 , Felix J Herth  4   6 , Arne Warth  4   7 , Hans-Ulrich Kauczor  3   4 , Carmen Monica Pop  1 , Julien Dinkel  4   8
Affiliations

Texture analysis using proton density and T2 relaxation in patients with histological usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP)

Maria T A Buzan et al. PLoS One. .

Abstract

Objectives: The purpose of our study was to assess proton density (PD) and T2 relaxation time of usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) and to evaluate their utility in differentiating the two patterns. Furthermore, we aim to investigate whether these two parameters could help differentiate active-inflammatory and stable-fibrotic lesions in NSIP.

Methods: 32 patients (mean age: 69 years; M:F, 1:1) with pathologically proven disease (UIP:NSIP, 1:1), underwent thoracic thin-section multislice CT scan and 1.5T MRI. A total of 437 regions-of-interest (ROIs) were classified at CT as advanced, moderate or mild alterations. Based on multi-echo single-shot TSE sequence acquired at five echo times, with breath-holding at end-expiration and ECG-triggering, entire lung T2 and PD maps were generated from each subject. The T2 relaxation time and the respective signal intensity were quantified by performing a ROI measurement on the T2 and PD maps in the corresponding CT selected areas of the lung.

Results: UIP and NSIP regional patterns could not be differentiated by T2 relaxation times or PD values alone. Overall, a strong positive correlation was found between T2 relaxation and PD in NSIP, r = 0.64, p<0.001; however, this correlation was weak in UIP, r = 0.20, p = 0.01. T2 relaxation showed significant statistical difference between active-inflammatory and stable-fibrotic NSIP regions at all levels, p<0.05, while for the analysis of ventral lesions PD proved no statistical difference, p>0.05.

Conclusions: T2 relaxation times and PD values may provide helpful quantitative information for differentiating NSIP from UIP pattern. These parameters have the potential to differentiate active-inflammatory and stable-fibrotic lesions in NSIP.

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Conflict of interest statement

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Heussel CP is a consultant for Pfizer, Boehringer Ingelheim, Gilead, Intermune, Fresenius, Astellas and Olympus; he also received research funding from Siemens, Pfizer, and Boheringer Ingelheim as well as fees for lectures from Gilead, MSD, Pfizer, Intermune, Basilea, Bayer and Novartis. Kreuter M received a grant from Dietmar Hopp Stiftung; he is also a consultant for Intermune/Roche and Boehringer and he received fees for lectures and educational presentations from Boehringer and Intermune/Roche. Herth F is board member of Novartis, Astra Zeneca, Grifols, Berlin Chemie, Chiesi, Pulmonx, and PneumRx; he also received fees for lectures from the same companies. Kauczor HU is board member of Siemens; he also received fees for lectures and educational presentations from Bracco, Novartis, Siemens, Boehringer, and Bayer. Dinkel J received fees for lecturesnfrom MSD, Roche and Boehringer Ingelheim. The other authors have declared that no competing interests exist. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1
A 59 year old male patient with stable NSIP: image A is the sagittal reformat CT reference image, with the arrow indicating the region of interest, followed by the T2 map, image B and PD intensity map, image C. Below is the case of a 65 year old male patient with NSIP and suspected inflammatory activity and his corresponding images, D to F. Both cases show similar CT morphology and inhomogeneous T2 relaxation and PD of the lung; there is higher T2 relaxation and PD intensity on both type of maps in the active disease case. Exemplary ROI placement in relevant pathological areas is demonstrated.
See this image and copyright information in PMC

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