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. 2020 Aug;25(8):855-862.
doi: 10.1111/resp.13783. Epub 2020 Feb 17.

Reference values for high attenuation areas on chest CT in a healthy, never-smoker, multi-ethnic sample: The MESA study

Imaani Easthausen  1   2 , Anna Podolanczuk  2 , Eric Hoffman  3 , Steven Kawut  4 , Elizabeth Oelsner  2 , John S Kim  5 , Ganesh Raghu  6 , Karen Hinckley Stukovsky  7 , Susan Redline  8 , Robyn L McClelland  7 , R Graham Barr  2   9 , David J Lederer  2   10
Affiliations

Reference values for high attenuation areas on chest CT in a healthy, never-smoker, multi-ethnic sample: The MESA study

Imaani Easthausen et al. Respirology. 2020 Aug.

Erratum in

  • CORRIGENDUM.
    [No authors listed] [No authors listed] Respirology. 2021 Mar;26(3):281. doi: 10.1111/resp.14010. Epub 2021 Jan 17. Respirology. 2021. PMID: 33601476 No abstract available.

Abstract

Background and objective: Normative values for HAA-a quantitative, CT-based measure of subclinical ILD-in healthy adults are needed to improve interpretability in clinical and research settings.

Methods: HAA was measured on full-lung CT in 3110 participants in the MESA study. Clinical prediction models were developed using a healthy never-smoker subset with normal spirometry (n = 696). RMSE on cross-validation was used as the primary criterion for model selection. Parametric and non-parametric methods were considered. z-Scores were calculated for the entire study sample. Associations between z-scores and several ILD features were estimated.

Results: In the healthy never-smoker subset, the mean age was 69 years with a range of 54-93 years. The median HAA was 4.3% with a range of 2.7-17.8%. Linear regression had better predictive performance than other methods. The final model included race, height, weight, age and sex. The standard error of the estimate was 1.62 with a cross-validated RMSE of 1.64 and an adjusted R2 of 0.139. z-Scores were associated with several ILD outcomes in adjusted models, including ILA (OR: 1.40 per z-unit; 95% CI: 1.30, 1.52), exertional dyspnoea (OR: 1.08 per z-unit; 95% CI: 1.02, 1.15) and FVC (expected increase per z-unit: -2.49; 95% CI: -2.95, - 2.03).

Conclusion: We present a reference equation and z-scores to define expected values of HAA on full-lung CT to aid HAA interpretation in middle-aged and older adults.

Keywords: high attenuation area; pulmonary fibrosis; quantitative computed tomography; reference equations; subclinical interstitial lung disease.

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Figures

Figure 1
Figure 1
Flow diagram of MESA participants included in the healthy never-smoker subset. BMI, body mass index; CT, computed tomography; MESA, Multi-Ethnic Study of Atherosclerosis.
Figure 2
Figure 2
Density plots showing the distribution of: (A) observed HAA values, (B) predicted HAA values (solid) and ULN (dashed) and (C) z-scores (solid) and ULN (z-score = 1.634). Blue denotes the healthy never-smoker subset and orange denotes the complete study sample. (D) ROC curve showing sensitivity versus false positive rate (1 − specificity) for ILA detection for varying elevated HAA threshold values. AUC, area under the curve; HAA, high attenuation area; ILA, interstitial lung abnormality; ROC, receiver operating curve; ULN, upper limit of normal.
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Comment in

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