title: Computer-Aided Tomographic Analysis of Interstitial Lung Disease (ILD) in Patients with Systemic Sclerosis (SSc). Correlation with Pulmonary Physiologic Tests and Patient-Centred Measures of Perceived Dyspnea and Functional Disability.
abstract: OBJECTIVE
  This study was designed (a) to evaluate an improved quantitative lung fibrosis score based on a computer-aided diagnosis (CaM) system in patients with systemic sclerosis (SSc),-related interstitial lung disease (SSc-ILD), (b) to investigate the relationship between physiologic parameters (forced vital capacity [FVC] and single-breath diffusing capacity for carbon monoxide [DLCO]), patient-centred measures of dyspnea and functional disability and CaM and visual reader-based (CoVR) methods, and (c) to identify potential surrogate measures from quantitative and visual HRCT measurement.
  
  
  METHODS
  126 patients with SSc underwent chest radiography, HRCT and PFTs. The following patient-centred measures were obtained: modified Borg Dyspnea Index (Borg score), VAS for breathing, and Health Assessment Questionnaire-Disability Index (HAQ-DI). HRCT abnormalities were scored according to the conventional visual reader-based score (CoVR) and by a CaM. The relationships among the HRCT scores, physiologic parameters (FVC and DLCO, % predicted) results and patient-centred measures, were calculated using linear regression analysis and Pearson's correlation. Multivariate regression models were performed to identify the predictor variables on severity of pulmonary fibrosis.
  
  
  RESULTS
  Subjects with limited cutaneous SSc had lower HAQ-DI scores than subjects with diffuse cutaneous SSc (p <0.001). CaM and CoVR scores were similar in the 2 groups. In univariate analysis, a strong correlation between CaM and CoVR was observed (p <0.0001). In multivariate analysis the CaM and CoVR scores were predicted by DLco, FVC, Borg score and HAQ-DI. Age, sex, disease duration, anti-topoisomerase antibodies and mRSS were not significantly associated with severity of pulmonary fibrosis on CaM- and CoVR methods.
  
  
  CONCLUSIONS
  Although a close correlation between CaM score results and CoVR total score was found, CaM analysis showed a more significant correlation with DLco (more so than the FVC), patient-centred measures of perceived dyspnea and functional disability. Computer-aided tomographic analysis is computationally efficient, and in combination with physiologic and patient-centred measures, it could allow a means for accurately assessing and monitoring the disease progression or response to therapy.
authors.affiliation: Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Salaffi
authors.affiliation: Department of Radiology, Polythecnic University of Marche, Ancona, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Carotti
authors.affiliation: Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Di Donato
authors.affiliation: Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Carlo
authors.affiliation: Department of Radiology, Polythecnic University of Marche, Ancona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ceccarelli
authors.affiliation: Department of Radiology, Polythecnic University of Marche, Ancona, Italy.
authors.forename: Gianmarco
authors.initials: G
authors.lastname: Giuseppetti
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000523:psychology; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010465:Perception; D012595:Scleroderma, Systemic / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000523:psychology; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity; D055815:Young Adult