TY  - INPR
Y1  - 2023/07/28/
AV  - public
TI  - Automated airway quantification associates with mortality in idiopathic pulmonary fibrosis
N1  - This work is licensed under a Creative Commons Attribution 4.0 International License. The images
or other third-party material in this article are included in the Creative Commons license,
unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license,
users will need to obtain permission from the license holder to reproduce the material. To view a copy of this
license, visit http://creativecommons.org/licenses/by/4.0/
PB  - Springer Science and Business Media LLC
UR  - https://doi.org/10.1007/s00330-023-09914-4
ID  - discovery10174442
N2  - OBJECTIVES: The study examined whether quantified airway metrics associate with mortality in idiopathic pulmonary fibrosis (IPF). METHODS: In an observational cohort study (n?=?90) of IPF patients from Ege University Hospital, an airway analysis tool AirQuant calculated median airway intersegmental tapering and segmental tortuosity across the 2nd to 6th airway generations. Intersegmental tapering measures the difference in median diameter between adjacent airway segments. Tortuosity evaluates the ratio of measured segmental length against direct end-to-end segmental length. Univariable linear regression analyses examined relationships between AirQuant variables, clinical variables, and lung function tests. Univariable and multivariable Cox proportional hazards models estimated mortality risk with the latter adjusted for patient age, gender, smoking status, antifibrotic use, CT usual interstitial pneumonia (UIP) pattern, and either forced vital capacity (FVC) or diffusion capacity of carbon monoxide (DLco) if obtained within 3 months of the CT. RESULTS: No significant collinearity existed between AirQuant variables and clinical or functional variables. On univariable Cox analyses, male gender, smoking history, no antifibrotic use, reduced DLco, reduced intersegmental tapering, and increased segmental tortuosity associated with increased risk of death. On multivariable Cox analyses (adjusted using FVC), intersegmental tapering (hazard ratio (HR)?=?0.75, 95% CI?=?0.66-0.85, p?<?0.001) and segmental tortuosity (HR?=?1.74, 95% CI?=?1.22-2.47, p?=?0.002) independently associated with mortality. Results were maintained with adjustment using DLco. CONCLUSIONS: AirQuant generated measures of intersegmental tapering and segmental tortuosity independently associate with mortality in IPF patients. Abnormalities in proximal airway generations, which are not typically considered to be abnormal in IPF, have prognostic value. CLINICAL RELEVANCE STATEMENT: Quantitative measurements of intersegmental tapering and segmental tortuosity, in proximal (second to sixth) generation airway segments, independently associate with mortality in IPF. Automated airway analysis can estimate disease severity, which in IPF is not restricted to the distal airway tree. KEY POINTS: ? AirQuant generates measures of intersegmental tapering and segmental tortuosity. ? Automated airway quantification associates with mortality in IPF independent of established measures of disease severity. ? Automated airway analysis could be used to refine patient selection for therapeutic trials in IPF.
KW  - Idiopathic pulmonary fibrosis
KW  -  Lung
KW  -  Mortality
A1  - Cheung, Wing Keung
A1  - Pakzad, Ashkan
A1  - Mogulkoc, Nesrin
A1  - Needleman, Sarah
A1  - Rangelov, Bojidar
A1  - Gudmundsson, Eyjolfur
A1  - Zhao, An
A1  - Abbas, Mariam
A1  - McLaverty, Davina
A1  - Asimakopoulos, Dimitrios
A1  - Chapman, Robert
A1  - Savas, Recep
A1  - Janes, Sam M
A1  - Hu, Yipeng
A1  - Alexander, Daniel C
A1  - Hurst, John R
A1  - Jacob, Joseph
JF  - European Radiology
ER  -