A Volumetric Computed Tomography Analysis of the Normal Lung in Idiopathic Pulmonary Fibrosis: The Relationship with the Survival
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- Ohkubo Hirotsugu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
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- Taniguchi Hiroyuki
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Japan
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- Kondoh Yasuhiro
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Japan
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- Yagi Mitsuaki
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Japan
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- Furukawa Taiki
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Japan
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- Johkoh Takeshi
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Japan
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- Arakawa Hiroaki
- Department of Radiology, Dokkyo University School of Medicine, Japan
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- Fukuoka Junya
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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- Niimi Akio
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
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<p>Objective An image analysis of high-resolution computed tomography (HRCT) can provide objective quantitation of the disease status in idiopathic pulmonary fibrosis (IPF). However, to our knowledge, no reports have investigated the utility of the normal lung volume for evaluating mortality from IPF. This study aimed to evaluate the relationship between the normally attenuated lung volume on HRCT as a percentage of whole-lung volume (NL%) and IPF mortality. </p><p>Methods The NL% was determined by HRCT (between -950 and -701 Hounsfield units) using a density mask technique and volumetric software. The NL%, visual assessments of the normal lung by two radiologists, pulmonary function variables, and the gender, age, and physiology (GAP) index were retrospectively evaluated for 175 patients with IPF. Uni- and multivariate Cox proportional hazards analyses and C statistics for mortality were performed. </p><p>Results The univariate Cox proportional hazards analysis identified the NL% as a prognostic factor [hazard ratio, 0.949; 95% confidence interval (CI), 0.936-0.964; p<0.0001]. In the multivariate analysis, the NL% was a prognostic factor, but the radiologists' visual assessment scores of normal lung were not. The C index increased when the NL% was included in the models of the pulmonary function variables. Furthermore, the C index for a combined model of GAP stage and categorized NL% (0.758; 95% CI, 0.751-0.762) was higher than for the model with the GAP stage alone (0.689; 95% CI, 0.672-0.709). </p><p>Conclusion The NL% was a prognostic factor in our study population. Quantification of the normal lung using our method may help improve the IPF staging systems. </p>
収録刊行物
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- Internal Medicine
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Internal Medicine 57 (7), 929-937, 2018
一般社団法人 日本内科学会