Pulmonary Blood Mass and Quantitative Lung Function Imaging in Idiopathic Pulmonary Fibrosis.
Pulmonary Blood Mass and Quantitative Lung Function Imaging in Idiopathic Pulmonary Fibrosis.
复制标题
特发性肺纤维化的肺血质量和定量肺功能成像。
DOI：
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
E. Castillo
中科院分区：
文献类型：
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作者：
G. Nair;S. Al;E. Castillo
1例有阻塞性睡眠呼吸暂停病史的63岁男性在2013年接受手术肺活检后被诊断为特发性肺纤维化（IPF）。吡非尼酮治疗始于2014年。在接下来的3年里，他的症状进行性增加，呼吸困难和咳嗽加重。他入组了一项评估疾病进展的临床研究（经我们的机构审查委员会批准[IRB编号2017-240]）。通过使用最先进的成像技术，计算定义的肺部感兴趣区域内每个体素的定量肺功能（QLF）和肺血质量（PBM）变化（1，2）（图）。由呼吸运动引起的容量和PBM的变化被认为分别是肺通气和灌注的替代物。使用应用于吸气和呼气CT图像对的图像处理（配准和分割）提供的信息，我们计算肺内每个体素的体积和血液质量变化。所得到的QLF体积变化图像和PBM变化图像分别代表通气和灌注成像的三维定量替代。如图所示，纤维化下肺区的通气减少，而中肺区和上肺区的通气保持不变。然而，与纤维化下肺区相比，上肺区具有相对减少的血液质量。在6个月时，尽管薄层CT特征或通气没有变化，但下肺区PBM轻度降低。已证明肺血流量减少与IPF患者的肺容量减少和CT视觉评分增加显著相关（3）。在这里，我们展示了接受抗纤维化药物治疗的IPF患者在保留通气参数的情况下灌注信号的纵向变化。
A 63-year-old man with history of obstructive sleep apnea was diagnosed with idiopathic pulmonary fibrosis (IPF) following a surgical lung biopsy in 2013. Pirfenidone treatment was started in 2014. Over the next 3 years, he had a progressive increase in symptoms with worsening dyspnea and cough. He was enrolled in a clinical study (approved by our institutional review board committee [IRB number 2017-240]) assessing disease progression. By using a stateof-the-art imaging technique, quantitative lung function (QLF) and pulmonary blood mass (PBM) changes are computed for each voxel within a defined lung region of interest (1,2) (Figure). Changes in volume and PBM, induced by respiratory motion, are considered to be surrogates for pulmonary ventilation and perfusion, respectively. Using the information provided by image processing (registration and segmentation) applied to an inhalation and exhalation CT image pair, we compute the volume and blood mass changes for each voxel within the lung. The resulting QLFvolume change image and PBM change image, respectively, represent a three-dimensional quantitative surrogate for ventilation and perfusion imaging. As shown in the Figure, ventilation is diminished in the fibrotic lower lung zones and preserved in the mid and upper lung zones. However, the upper lung zones have relatively diminished blood mass compared with the fibrotic lower lung zones. At 6 months, there is a mild decrease in the lower lung zone PBM despite no change in the thin-section CT features or ventilation. Diminished pulmonary blood flow has been shown to significantly correlate with decreased lung volume and increased CT visual score in patients with IPF (3). Here, we demonstrate longitudinal changes in the perfusion signal with preserved ventilation parameters in a patient with IPF receiving antifibrotic medication.