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. 2024 Nov;85(6):1141-1156.
doi: 10.3348/jksr.2024.0032. Epub 2024 Nov 21.

Long-Term Follow-Up of Interstitial Lung Abnormalities in Low-Dose Chest CT in Health Screening: Exploring the Predictors of Clinically Significant Interstitial Lung Diseases Using Artificial Intelligence-Based Quantitative CT Analysis

Won Jong Jeong, Bo Da Nam, Jung Hwa Hwang, Chang Hyun Lee, Hee-Young Yoon, Eun Ji Lee, Eunsun Oh, Jewon Jeong, Sung Hwan Bae

Long-Term Follow-Up of Interstitial Lung Abnormalities in Low-Dose Chest CT in Health Screening: Exploring the Predictors of Clinically Significant Interstitial Lung Diseases Using Artificial Intelligence-Based Quantitative CT Analysis

Won Jong Jeong et al. J Korean Soc Radiol. 2024 Nov.

Abstract
in English, Korean

Purpose: This study examined longitudinal changes in interstitial lung abnormalities (ILAs) and predictors of clinically significant interstitial lung diseases (ILDs) in a screening population with ILAs.

Materials and methods: We retrieved 36891 low-dose chest CT records from screenings between January 2003 and May 2021. After identifying 101 patients with ILAs, the clinical findings, spirometry results, and initial and follow-up CT findings, including visual and artificial intelligence-based quantitative analyses, were compared between patients diagnosed with ILD (n = 23, 23%) and those who were not (n = 78, 77%). Logistic regression analysis was used to identify significant parameters for the clinical diagnosis of ILD.

Results: Twenty-three patients (n = 23, 23%) were subsequently diagnosed with clinically significant ILDs at follow-up (mean, 8.7 years). Subpleural fibrotic ILAs on initial CT and signs of progression on follow-up CT were common in the ILD group (both p < 0.05). Logistic regression analysis revealed that emerging respiratory symptoms (odds ratio [OR], 5.56; 95% confidence interval [CI], 1.28-24.21; p = 0.022) and progression of ILAs at follow-up chest CT (OR, 4.07; 95% CI, 1.00-16.54; p = 0.050) were significant parameters for clinical diagnosis of ILD.

Conclusion: Clinically significant ILD was subsequently diagnosed in approximately one-quarter of the screened population with ILAs. Emerging respiratory symptoms and progression of ILAs at follow-up chest CT can be predictors of clinically significant ILDs.

목적: 본 연구는 일반검진 집단에서 간질성 폐 이상(interstitial lung abnormality; 이하 ILA)의 장기적 변화를 확인하고 임상적으로 유의미한 간질성 폐질환(interstitial lung disease; 이하 ILD)으로 진행하는 예측 인자를 탐색하였다.

대상과 방법: 2003년 1월부터 2021년 5월까지 검진 CT 검사에서 36891개의 저선량 흉부 CT 기록을 검색하였다. ILA 환자 101명을 선정하여, 추적검사에서 ILD를 진단받은 환자(23명, 23%)와 진단받지 않은 환자(78명, 77%)를 대상으로 임상 자료, 폐활량측정검사(spirometry), 시각 및 인공지능 기반 정량 분석을 포함한 최초 및 추적 CT 결과를 비교하였고, 로지스틱 회귀 분석을 통해 ILD의 임상 진단에 중요한 인자를 확인하였다.

결과: 23명의 환자(23%)가 추적기간(평균 추적 기간, 8.7년) 동안 임상적으로 의미 있는 ILD로 진단되었다. 초기 CT의 흉막하 섬유성 ILA와 추적 CT에서의 진행이 ILD 환자에서 자주 관찰되었다(p < 0.05). 로지스틱 회귀 분석 결과, 새로운 호흡기 증상 발현(odds ratio [이하 OR] 5.56, 95% confidence interval [이하 CI] 1.28–24.21, p = 0.022)과 추적 흉부 CT 검사에서 간질성 폐 이상의 진행 소견(OR 4.07, 95% CI 1.00–16.54, p = 0.050)이 ILD의 임상 진단에 유의미한 예측 인자였다.

결론: ILA 환자의 약 4분의 1에서 이후 임상적으로 의미 있는 ILD로 진단되었다. 새로운 호흡기 증상의 발현과 추적 흉부 CT 검사에서 간질성 폐 이상의 진행 소견은 임상적으로 중요한 ILD의 예측 인자가 될 수 있다.

Keywords: Fibrosis; Interstitial Lung Abnormalities; Interstitial Lung Disease; Lung; Tomography, X-Ray Computed.

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Conflict of interest statement

Conflicts of Interest: The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. The flowchart presents the selection of the study population.
*The search terms suggesting the presence of ILAs were “interstitial,” “ILD,” “DILD,” “IPF,” “UIP,” “NSIP,” “reticul-,” and “dependent+fibrosis.” ILA = interstitial lung abnormality, ILD = interstitial lung disease
Fig. 2
Fig. 2. These are CT images of a 59-year-old man with a subpleural fibrotic ILA. Idiopathic pulmonary fibrosis was diagnosed in this patient with a usual interstitial pneumonia pattern on lung biopsy performed 1 year after the initial low-dose CT scan.
A, B. Axial low-dose chest CT scan (A) shows subpleural reticulation with traction bronchiolectasis in both basal lungs, which is classified as a subpleural fibrotic ILA by visual analysis. On QCT analysis (B), the extent of the disease is 5.6% of the total lungs (yellow, fibrotic ILA; green, nonfibrotic ILA). C, D. Axial high-resolution CT scan with prone positioning (C) performed at the 11-year follow-up shows an increased progression of the lung fibrosis with increased honeycombing. Traction bronchiectasis is also progressing with decreased lung volume. On QCT analysis (D), the extent of disease has increased to 25.0% of the total lungs (yellow, ground-glass opacity; orange, reticulation; red, honeycombing or traction bronchiectasis/bronchiolectasis). ILA = interstitial lung abnormality, QCT = quantitative CT
Fig. 3
Fig. 3. These are CT images of a 63-year-old man with subpleural nonfibrotic ILA and subsequent clinicoradiologic diagnosis of interstitial lung disease with a radiologic pattern of fibrotic nonspecific interstitial pneumonia.
A, B. Axial low-dose chest CT scan (A) shows mild ground-glass opacities with subtle reticulation (arrows) in the subpleural and nonsubpleural areas of both basal lungs. No evidence of honeycombing or architectural distortion is noted. This case is classified as a subpleural nonfibrotic ILA by visual analysis. On QCT analysis (B), the extent of disease is 0.6% of the total lungs (yellow, fibrotic ILA; green, nonfibrotic ILA). C, D. Axial high-resolution CT with prone positioning (C) taken after 5 years reveals increased fibrosis with subpleural reticulation and traction bronchiolectasis in both basal lungs (arrows). On QCT analysis (D) the extent of disease has increased to 7.0% of the total lungs (yellow, ground-glass opacity; orange, reticulation; red, honeycombing or traction bronchiectasis/bronchiolectasis). ILA = interstitial lung abnormality, QCT = quantitative CT
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References

    1. Hatabu H, Hunninghake GM, Richeldi L, Brown KK, Wells AU, Remy-Jardin M, et al. Interstitial lung abnormalities detected incidentally on CT: a position paper from the Fleischner Society. Lancet Respir Med. 2020;8:726–737. - PMC - PubMed
    1. Araki T, Putman RK, Hatabu H, Gao W, Dupuis J, Latourelle JC, et al. Development and progression of interstitial lung abnormalities in the Framingham Heart Study. Am J Respir Crit Care Med. 2016;194:1514–1522. - PMC - PubMed
    1. Putman RK, Gudmundsson G, Axelsson GT, Hida T, Honda O, Araki T, et al. Imaging patterns are associated with interstitial lung abnormality progression and mortality. Am J Respir Crit Care Med. 2019;200:175–183. - PMC - PubMed
    1. Hoyer N, Wille MMW, Thomsen LH, Wilcke T, Dirksen A, Pedersen JH, et al. Interstitial lung abnormalities are associated with increased mortality in smokers. Respir Med. 2018;136:77–82. - PubMed
    1. Putman RK, Hatabu H, Araki T, Gudmundsson G, Gao W, Nishino M, et al. Association between interstitial lung abnormalities and all-cause mortality. JAMA. 2016;315:672–681. - PMC - PubMed

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