What role does artificial intelligence-driven quantitative analysis of chest computed tomography play in providing pulmonary function for idiopathic pulmonary fibrosis patients undergoing pirfenidone treatment?

Background: In patients with idiopathic pulmonary fibrosis (IPF), computed tomography (CT) quantification using artificial intelligence (AI) has been explored as a method to assess the therapeutic response to antifibrotic agents; however, studies evaluating long-term follow-up outcomes remain scarce. We investigated AI-driven quantitative analysis for long-term follow-up chest CT of IPF patients undergoing pirfenidone treatment.

Methods: Among the 2,223 patients diagnosed with interstitial lung disease by chest CT at Jeonbuk National University Hospital, 36 patients with a multidisciplinary diagnosis of IPF were included in the study after excluding those who had not undergone surgical lung biopsy or did not have available pulmonary function tests (PFTs).

A Quantitative Imaging Measure of Progressive Pulmonary Fibrosis.

Rationale: Progressive pulmonary fibrosis (PPF) is common in patients with fibrotic interstitial lung disease (ILD) and leads to high mortality. While PPF guideline criteria include computed tomography (CT)-based progression, these measures are qualitative and prone to inter-reader variability. Quantitative CT (qCT) measurements have the potential to overcome this limitation.

Current State of Fibrotic Interstitial Lung Disease Imaging.

Interstitial lung disease (ILD) diagnosis is complex, continuously evolving, and increasingly reliant on thin-section chest CT. Multidisciplinary discussion aided by a thorough radiologic review can achieve a high-confidence diagnosis of ILD in the majority of patients and is currently the reference standard for ILD diagnosis. CT also allows the early recognition of interstitial lung abnormalities, possibly reflective of unsuspected ILD and progressive in a substantial proportion of patients.

ACR Appropriateness Criteria® Lung Cancer-Surveillance After Therapy.

This document reviews the evidence supporting different imaging modalities and techniques used to evaluate patients with a history of lung cancer. It focuses on the imaging evaluation of patients treated for stage I-III non-small-cell lung cancer and small-cell lung cancer, whether using individual modalities or combinations. Guidelines for both routine surveillance of stage I-III lung cancer and for the evaluation of suspected recurrence or disease progression are provided.

ACR Appropriateness Criteria® Chronic Dyspnea-Noncardiovascular Origin: 2024 Update.

For patients with chronic dyspnea of noncardiovascular origin, chest radiography is usually appropriate as the first-line imaging modality. Chest CT without contrast is either usually appropriate or may be appropriate as a second-line option for conditions of unclear etiology or suspected chronic obstructive pulmonary disease, small airways disease, and post-COVID-19 complications. Chest CT with contrast may have a role in patients with pleura/chest wall disease or diaphragm dysfunction.

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompetent Patients: 2024 Update.

Acute respiratory illness is one of the leading causes of morbidity and mortality amongst infectious diseases worldwide and a major public health issue. Even though most cases are due to self-limited viral infections, a significant number of cases are due to more serious respiratory infections where delay in diagnosis can lead to morbidity and mortality. Imaging plays a key role in the initial diagnosis and management of acute respiratory illness.

Quantitative Computed Tomography Measures of Lung Fibrosis and Outcomes in the National Lung Screening Trial.

Incidental features of interstitial lung disease (ILD) are commonly observed on chest computed tomography (CT) scans and are independently associated with poor outcomes. Although most studies to date have relied on qualitative assessments of ILD, quantitative imaging algorithms have the potential to effectively detect ILD and assist in risk stratification for population-based cohorts. To determine whether quantitative measures of ILD are associated with clinically relevant outcomes in the NLST (National Lung Screening Trial).

Human CD33 deficiency is associated with mild alteration of circulating white blood cell counts.

The single pass transmembrane protein CD33 is enriched in phagocytic and hematopoietic cell types, such as monocytes. CD33 is thought to be associated with immune cell function, susceptibility to Alzheimer's disease, and rare leukemias. Antagonism or genetic ablation of CD33 has been proposed to treat Alzheimer's disease, hematological cancers, and as a selection mechanism for enriching genetically altered blood cells.

Preoperative Chest CT Myosteatosis Indicates Worse Postoperative Survival in Stage 0-IIB Non-Small Cell Lung Cancer.

Background Skeletal muscle density (SMD) and intermuscular adipose tissue (IMAT) are myosteatosis markers. The prognostic value of myosteatosis markers in preoperative risk stratification of patients with early-stage non-small cell lung cancer (NSCLC) remains unknown. Purpose To assess whether increased myosteatosis markers at chest CT before lung resection of early-stage NSCLC are associated with and predictive of worse overall survival (OS).

Imaging of Chronic Thromboembolic Pulmonary Hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary hypertension secondary to chronic obstruction of pulmonary arteries by organized thromboemboli. Echocardiography and Echocardiography and ventilation/perfusion (V/Q) scan are the initial screening examinations for CTEPH; the diagnosis is often missed on computed tomography (CT). Imaging findings of chronic thromboembolic pulmonary disease overlap with those of acute pulmonary embolism, and radiologists should evaluate for the presence of concurrent chronic disease in all cases of acute pulmonary embolism detected on CT pulmonary angiography.

Optimizing prone CT use for suspected interstitial lung abnormalities.

Objectives: We investigated whether supine chest CT alone suffices for diagnosing ILAs, thereby reducing the need for prone chest CT.

Materials And Methods: Patients who underwent prone chest CT for suspected ILAs from January 2021 to July 2023, with matching supine CT within 1 year, were retrospectively evaluated. Five multinational thoracic radiologists independently rated ILA suspicion and fibrosis scores (1 to 5-point) and ILA extent (1-100%) using supine CT first, then combined supine-prone CT after a 1-month washout.

Quantitative CT Scan Analysis in Rheumatoid Arthritis-Related Interstitial Lung Disease.

Background: Quantitative CT imaging may be a useful predictor of outcome in rheumatoid arthritis-related interstitial lung disease (RA-ILD).

Research Question: What is the utility of deep learning-based lung fibrosis quantitation on CT imaging in assessing disease severity, predicting mortality, and identifying progression in RA-ILD?

Study Design And Methods: CT scans on a primary cohort of 289 patients and a validation cohort of 50 individuals with RA-ILD were assessed quantitatively by using the data-driven texture analysis (DTA) method. We examined associations between quantitative scores for extent of lung fibrosis and pulmonary function and survival.

ACR Appropriateness Criteria® Tracheobronchial Disease.

A variety of thoracic imaging modalities and techniques have been used to evaluate diseases of the trachea and central bronchi. This document evaluates evidence for the use of thoracic imaging in the evaluation of tracheobronchial disease, including clinically suspected tracheal or bronchial stenosis, tracheomalacia or bronchomalacia, and bronchiectasis. Appropriateness guidelines for initial imaging evaluation of tracheobronchial disease and for pretreatment planning or posttreatment evaluation are included.

Hypersensitivity Pneumonitis on Thin-Section Chest CT Scans: Diagnostic Performance of the ATS/JRS/ALAT versus ACCP Imaging Guidelines.

Purpose To compare the diagnostic performance of the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax (ATS/JRS/ALAT) versus the American College of Chest Physicians (ACCP) imaging classifications for hypersensitivity pneumonitis (HP). Materials and Methods Patients in the institutional review board-approved Interstitial Lung Disease (ILD) registry referred for multidisciplinary discussion (MDD) at the authors' institution (January 1, 2006-April 1, 2021) were included in this retrospective study when ILD was diagnosed at MDD. MDD diagnoses included HP, connective tissue disease-ILD, and idiopathic pulmonary fibrosis.

2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Treatment of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases.

Objective: We provide evidence-based recommendations regarding the treatment of interstitial lung disease (ILD) in adults with systemic autoimmune rheumatic diseases (SARDs).

Methods: We developed clinically relevant population, intervention, comparator, and outcomes questions. A systematic literature review was then performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology.

Assessing Patient Values and Preferences to Inform the 2023 American College of Rheumatology/American College of Chest Physicians Interstitial Lung Disease Guidelines.

Objective: Patient engagement is critical to clinical practice guideline (CPG) development. This work presents our approach to ascertaining patients' values and preferences to inform the American College of Rheumatology guidelines for screening, monitoring, and treatment of interstitial lung disease (ILD) in people with systemic autoimmune rheumatic diseases (SARDs).

Methods: We conducted a cross-sectional qualitative study of a purposefully sampled Patient Panel using a modified content analytic approach.

2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Treatment of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases.

Objective: We provide evidence-based recommendations regarding the treatment of interstitial lung disease (ILD) in adults with systemic autoimmune rheumatic diseases (SARDs).

Methods: We developed clinically relevant population, intervention, comparator, and outcomes questions. A systematic literature review was then performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology.

2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases.

Objective: We provide evidence-based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease.

Methods: We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology.

2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases.

Objective: We provide evidence-based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease.

Methods: We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology.

ACR Appropriateness Criteria® Sepsis.

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. A search for the underlying cause of infection typically includes radiological imaging as part of this investigation. This document focuses on thoracic and abdominopelvic causes of sepsis.

Myocardial Blood Flow Quantified Using Stress Cardiac Magnetic Resonance After Mild COVID-19 Infection.

Background: Severe COVID-19 infection is known to alter myocardial perfusion through its effects on the endothelium and microvasculature. However, the majority of patients with COVID-19 infection experience only mild symptoms, and it is unknown if their myocardial perfusion is altered after infection.

Objectives: The authors aimed to determine if there are abnormalities in myocardial blood flow (MBF), as measured by stress cardiac magnetic resonance (CMR), in individuals after a mild COVID-19 infection.