囊性纤维化 MRI 高信号体积 T2-权重定量: 初步研究。
- 作者列表："Benlala I","Hocke F","Macey J","Bui S","Berger P","Laurent F","Dournes G
:Background In patients with cystic fibrosis (CF), pulmonary structures with high MRI T2 signal intensity relate to inflammatory changes in the lung and bronchi. These areas of pathologic abnormalities can serve as imaging biomarkers. The feasibility of automated quantification is unknown. Purpose To quantify the MRI T2 high-signal-intensity lung volume and T2-weighted volume-intensity product (VIP) by using a black-blood T2-weighted radial fast spin-echo sequence in participants with CF. Materials and Methods Healthy individuals and study participants with CF were prospectively enrolled between January 2017 and November 2017. All participants underwent a lung MRI protocol including T2-weighted radial fast spin-echo sequence. Participants with CF also underwent pulmonary function tests the same day. Participants with CF exacerbation underwent repeat MRI after their treatment with antibiotics. Two observers supervised automated quantification of T2-weighted high-signal-intensity volume (HSV) and T2-weighted VIP independently, and the average score was chosen as consensus. Statistical analysis used the Mann-Whitney test for comparison of medians, correlations used the Spearman test, comparison of paired medians used the Wilcoxon signed rank test, and reproducibility was evaluated by using intraclass correlation coefficient. Results In 10 healthy study participants (median age, 21 years [age range, 18-27 years]; six men) and 12 participants with CF (median age, 18 years [age range, 9-40 years]; eight men), T2-weighted HSV was equal to 0% and 4.1% (range, 0.1%-17%), respectively, and T2-weighted VIP was equal to 0 msec and 303 msec (range, 39-1012 msec), respectively (P < .001). In participants with CF, T2-weighted HSV or T2-weighted VIP were associated with forced expiratory volume in 1 second percentage predicted (ρ = -0.88 and ρ = -0.94, respectively; P < .001). In six participants with CF exacerbation and follow-up after treatment, a decrease in both T2-weighted HSV and T2-weighted VIP was observed (P = .03). The intra- and interobserver reproducibility of MRI were good (intraclass correlation coefficients, >0.99 and >0.99, respectively). Conclusion In patients with cystic fibrosis (CF), automated quantification of lung MRI high-signal-intensity volume was reproducible and correlated with pulmonary function testing severity, and it improved after treatment for CF exacerbation. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Revel and Chassagnon in this issue.
背景: 在囊性纤维化 (CF) 患者中，具有高 MRI T2 信号强度的肺结构与肺和支气管的炎症改变有关。这些病理异常区域可作为影像学生物标志物。自动定量的可行性尚不清楚。目的: 在 CF 受试者中使用黑血 T2-权重径向快速自旋回波序列定量 MRI T2 高信号肺容积和 T2-权重 容积强度乘积 (VIP)。材料和方法: 在 2017年1月至 2017年11月期间前瞻性入组健康个体和 CF 研究参与者。所有受试者均接受肺部 MRI 检查，包括 T2-权重径向快速自旋回波序列。CF 的参与者也在同一天进行了肺功能检查。CF 恶化的参与者在接受抗生素治疗后接受重复 MRI 检查。两名观察者独立监督 T2-权重高信号强度体积 (HSV) 和 T2-权重 VIP 的自动定量，平均分被选为共识。统计学分析采用 Mann-Whitney 检验进行中位数比较，相关性采用 Spearman 检验，配对中位数比较采用 Wilcoxon 符号秩和检验，再现性采用组内相关系数进行评价。结果在 10 名健康研究参与者 (中位年龄，21 岁 [年龄范围，18-27 岁]; 6 名男性) 和 12 名 CF 参与者 (中位年龄，18 岁 [年龄范围,9-40 岁]; 8 名男性)，T2-权重 HSV 分别等于 0% 和 4.1% (范围，0.1%-17%),T2-权重 VIP 分别等于 0 msec 和 303 msec (范围为 39-1012 msec) (P <.001)。在 CF 的参与者中，T2-权重 HSV 或 T2-权重VIP 与 1 秒用力呼气容积预测百分比相关 (分别为 ρ = -0.88 和 ρ = -0.94; P <.001)。在 6 例 CF 恶化和治疗后随访的参与者中，观察到 HSV T2-权重 和 VIP T2-权重均降低 (P = .03)。MRI 的观察者内和观察者间再现性良好 (组内相关系数分别为> 0.99 和> 0.99)。结论在囊性纤维化 (CF) 患者中，肺 MRI 高信号容积的自动定量可重复，并与肺功能检测严重程度相关，CF 加重治疗后改善。©本文提供 RSNA，2019 在线补充材料。另见 Revel 和 Chassagnon 在本期的社论。
METHODS:OBJECTIVES:To asses the clinical course in RA-related interstitial lung disease (RA-ILD) patients with and without rituximab (RTX). The influence of other variables was also evaluated. METHODS:A longitudinal multicentre study was conducted in RA diagnosed with ILD from 2007 until 2018 in Madrid. Patients were included in a registry [pNEumology RhEumatology Autoinmune diseases (NEREA)] from the time of ILD diagnosis. The main endpoint was functional respiratory impairment (FI), when there was a decline ≥5% in the predicted forced vital capacity compared with the previous one. Pulmonary function was measured at baseline and in follow-up visits every 6-12 months. The independent variable was therapy with RTX. Covariables included sociodemographic, clinical, radiological and other therapies. Survival techniques were used to estimate the incidence rate (IR) and 95% CI of functional impairment, expressed per 100 patient-semesters. Cox multivariate regression models were run to examine the influence of RTX and other covariates on FI. Results were expressed as the hazard ratio (HR) and CI. RESULTS:A total of 68 patients were included. FI occurred in 42 patients [IR 23.5 (95% CI 19, 29.1)] and 50% of them had FI within 1.75 years of an ILD diagnosis. A multivariate analysis showed that RTX exposure resulted in a lower risk of FI compared with non-exposure [HR 0.51 (95% CI 0.31, 0.85)]. Interstitial pneumonia, glucocorticoids, disease activity and duration also influenced FI. CONCLUSION:RA-ILD patients deteriorate over time, with the median time free of impairment being <2 years. Patients exposed to RTX had a higher probability of remaining free of FI compared with other therapies. Other factors have also been identified. Key words: rheumatoid arthritis, interstitial lung disease, observational study, rituximab and prognosis
METHODS:The safety of anti-programmed cell death 1 (PD-1) antibody for patients with preexisting interstitial lung disease (ILD) remains unknown. The aim of this study was to evaluate the dependence of preexisting ILD on anti-PD-1 antibody-induced pneumonitis in non-small cell lung cancer (NSCLC) patients. We retrospectively reviewed the association of preexisting ILD with the incidence, radiographic pattern, and outcome of pneumonitis in NSCLC patients receiving anti-PD-1 antibody. A total of 331 patients were included in this study. Of these patients, 17 had preexisting ILD. The incidence of pneumonitis was higher among the patients with preexisting ILD than among those without preexisting ILD (29% vs. 10%, P = 0.027). The distributions of the CT appearances at the onset of anti-PD-1 antibody-induced pneumonitis were as follows: for the patients with preexisting ILD, two patients (40%) had diffuse alveolar damage (DAD), one patient each with organizing pneumonia-like (OP), hypersensitivity pneumonitis (HP), and other patterns (20% each); for the patients without preexisting ILD, 19 patients (61%) had OP, 8 (26%) had HP, 3 (10%) had DAD, and 1 (3.2%) had other patterns. The median onset time from the initiation of anti-PD-1 antibody treatment until the development of pneumonitis was 1.3 months (range 0.3–2.1 months) for the patients with preexisting ILD and 2.3 months (range 0.2–14.6 months) for the patients without preexisting ILD. Careful attention to the development of pneumonitis is needed, especially within the first 3 months after the start of anti-PD-1 antibody treatment, when using anti-PD-1 antibody to treat patients with preexisting ILD.
METHODS::Bacteria of the Burkholderia cepacia complex (Bcc) are ubiquitous multidrug resistant organisms and opportunistic pathogens capable of causing life threatening lung infections among cystic fibrosis (CF) patients. No effective therapies are currently available to eradicate Bcc bacteria from CF patients, as these organisms are inherently resistant to the majority of clinically available antimicrobials. An immunoproteomics approach was used to identify Bcc proteins that stimulate the humoral immune response of the CF host, using bacterial cells grown under conditions mimicking the CF lung environment and serum samples from CF patients with a clinical record of Bcc infection. 24 proteins of the Bcc strain B. cenocepacia J2315 were identified as immunoreactive, 19 here reported as immunogenic for the first time. Ten proteins were predicted as extracytoplasmic, 9 of them being conserved in Bcc genomes. The immunogenic Bcc extracytoplasmic proteins are potential targets for development of novel therapeutic strategies and diagnostic tools to protect patients against the onset of chronic Bcc lung infections.