title: Idiopathic Pulmonary Fibrosis: The Association between the Adaptive Multiple Features Method and Fibrosis Outcomes.
abstract: Adaptive multiple features method (AMFM) lung texture analysis software recognizes high-resolution computed tomography (HRCT) patterns.
  
  
  
  To evaluate AMFM and visual quantification of HRCT patterns and their relationship with disease progression in idiopathic pulmonary fibrosis.
  
  
  
  Patients with idiopathic pulmonary fibrosis in a clinical trial of prednisone, azathioprine, and N-acetylcysteine underwent HRCT at study start and finish. Proportion of lung occupied by ground glass, ground glass-reticular (GGR), honeycombing, emphysema, and normal lung densities were measured by AMFM and three radiologists, documenting baseline disease extent and postbaseline change. Disease progression includes composite mortality, hospitalization, and 10% FVC decline.
  
  
  
  Agreement between visual and AMFM measurements was moderate for GGR (Pearson's correlation r = 0.60, P < 0.0001; mean difference = -0.03 with 95% limits of agreement of -0.19 to 0.14). Baseline extent of GGR was independently associated with disease progression when adjusting for baseline Gender-Age-Physiology stage and smoking status (hazard ratio per 10% visual GGR increase = 1.98, 95% confidence interval [CI] = 1.20-3.28, P = 0.008; and hazard ratio per 10% AMFM GGR increase = 1.36, 95% CI = 1.01-1.84, P = 0.04). Postbaseline visual and AMFM GGR trajectories were correlated with postbaseline FVC trajectory (r = -0.30, 95% CI = -0.46 to -0.11, P = 0.002; and r = -0.25, 95% CI = -0.42 to -0.06, P = 0.01, respectively).
  
  
  
  More extensive baseline visual and AMFM fibrosis (as measured by GGR densities) is independently associated with elevated hazard for disease progression. Postbaseline change in AMFM-measured and visually measured GGR densities are modestly correlated with change in FVC. AMFM-measured fibrosis is an automated adjunct to existing prognostic markers and may allow for study enrichment with subjects at increased disease progression risk.
authors: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.
authors: Margaret L
authors: 0000-0001-8217-6955
authors: ML
authors: Salisbury
authors: 2 Department of Radiology, National Jewish Health, Denver, Colorado.
authors: David A
authors: DA
authors: Lynch
authors: 3 Centre for Inflammation Research, Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, United Kingdom.
authors: Edwin J R
authors: EJ
authors: van Beek
authors: 4 Department of Radiology, and.
authors: Ella A
authors: EA
authors: Kazerooni
authors: 5 Department of Radiology, University of Iowa, Iowa City, Iowa.
authors: Junfeng
authors: J
authors: Guo
authors: 6 Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
authors: Meng
authors: M
authors: Xia
authors: 6 Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
authors: Susan
authors: S
authors: Murray
authors: 7 Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.|8 Duke Clinical Research Institute, Duke Medical Center, Durham, North Carolina; and.
authors: Kevin J
authors: KJ
authors: Anstrom
authors: 8 Duke Clinical Research Institute, Duke Medical Center, Durham, North Carolina; and.
authors: Eric
authors: E
authors: Yow
authors: 9 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cornell Medical College, New York, New York.
authors: Fernando J
authors: FJ
authors: Martinez
authors: 5 Department of Radiology, University of Iowa, Iowa City, Iowa.
authors: Eric A
authors: EA
authors: Hoffman
authors: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.
authors: Kevin R
authors: KR
authors: Flaherty
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D012129:Respiratory Function Tests / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: idiopathic pulmonary fibrosis; multidetector computed tomography; prognosis