Article Text
Abstract
Introduction There is currently no readily accessible measure to specifically quantify the amount of fibrosis in idiopathic pulmonary fibrosis (IPF). Such a measure could isolate contribution of fibrosis from other comorbidities to lung function abnormality and deterioration of disease, and potentially help determine if there has been response to antifibrotic treatment.
Methods In a pilot study of 39 IPF patients, we used a CT-based visual scoring method to examine the correlation between the sum of all fibrotic features (all traction bronchiectasis, ground glass with traction bronchiectasis, honeycombing and reticulation; referred to as Total Fibrosis Score, TFS) or the individual fibrotic features, with lung function, Composite Physiologic Index (CPI) and time to death in the 5 years following CT measurement.
Results TFS measurements were highly reproducible (r=0.982; p<0.001) and correlated significantly with TLCO, FVC and CPI. Traction bronchiectasis score was superior to others in its correlation to lung function and CPI, and as good as TFS. TFS and traction bronchiectasis score were also the best correlates (individually) to time to death (r=0.60 for both, and p=0.002 and p=0.004, respectively).
Conclusion We suggest that TFS and our 6-slices method of quantifying traction bronchiectasis on CT scans could be readily accessible and simple methods of quantifying lung fibrosis in IPF. These scores could assist in determining if clinical deterioration is due to worsening fibrosis, for correlation of research findings to amount of lung fibrosis, and to stratify patients for established drug treatment and clinical trials. Our findings also provide a basis for larger studies to validate these findings and determine if the scores could measure change in fibrosis.
- imaging/CT MRI etc
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Footnotes
Contributors EF and L-PH conceived the study, RB and VSN performed the scoring and contributed to score design, RKH identified patient and contributed to discussions, EF and L-PH wrote the manuscript.
Funding The study was funded by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). L-PH is supported in part by the MRC UK (MC_UU_00008/1). Correspondence to L-PH (ling-pei.ho@imm.ox.ac.uk).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval The study was approved by the South-Central Oxford Research Ethics Committee (14/SC/1060).
Provenance and peer review Not commissioned; internally peer reviewed.
Data availability statement Data are available on reasonable request.