Chest CT Imaging Provides More Information Than Chest Radiography Alone in Determining Extent of Physiologic Impairment in Pulmonary Sarcoidosis
- PMID: 38830401
- DOI: 10.1016/j.chest.2024.04.031
Chest CT Imaging Provides More Information Than Chest Radiography Alone in Determining Extent of Physiologic Impairment in Pulmonary Sarcoidosis
Abstract
Background: Sarcoidosis staging primarily has relied on the Scadding chest radiographic system, although chest CT imaging is finding increased clinical use.
Research question: Whether standardized chest CT scan assessment provides additional understanding of lung function beyond Scadding stage and demographics is unknown and the focus of this study.
Study design and methods: We used the National Heart, Lung, and Blood Institute study Genomics Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis cases of sarcoidosis (n = 351) with Scadding stage and chest CT scans obtained in a standardized manner. One chest radiologist scored all CT scans with a visual scoring system, with a subset read by another chest radiologist. We compared demographic features, Scadding stage, and CT scan findings and the correlation between these measures. Associations between spirometry results and Dlco, CT scan findings, and Scadding stage were determined using regression analysis (n = 318). Agreement between readers was evaluated using Cohen's κ value.
Results: CT scan features were inconsistent with Scadding stage in approximately 40% of cases. Most CT scan features assessed on visual scoring were associated negatively with lung function. Associations persisted for FEV1 and Dlco when adjusting for Scadding stage, although some CT scan feature associations with FVC became insignificant. Scadding stage was associated primarily with FEV1, and inclusion of CT scan features reduced significance in association between Scadding stage and lung function. Multivariable regression modeling to identify radiologic measures explaining lung function included Scadding stage for FEV1 and FEV1 to FVC ratio (P < .05) and marginally for Dlco (P < .15). Combinations of CT scan measures accounted for Scadding stage for FVC. Correlations among Scadding stage and CT scan features were noted. Agreement between readers was poor to moderate for presence or absence of CT scan features and poor for degree and location of abnormality.
Interpretation: CT scan features explained additional variability in lung function beyond Scadding stage, with some CT scan features obviating the associations between lung function and Scadding stage. Whether CT scan features, phenotypes, or endotypes could be useful for managing patients with sarcoidosis needs more study.
Keywords: Genomic Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis (GRADS); Scadding stage; chest CT imaging; chest radiography; lung function; phenotypes; sarcoidosis.
Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: L. A. M. has received grants Mallinckrodt Pharmaceuticals and serves on the Scientific Advisory Board for the Foundation for Sarcoidosis Research and Boehringer Ingelheim. B. S. B. has received a grant from Mallinckrodt Pharmaceuticals. E. S. C. serves on the Scientific Advisory Board for the Foundation for Sarcoidosis Research and has participated in clinical trials sponsored by aTyr Pharma and LabCorp Drug. L. L. K. has received grants from Mallinckrodt Pharmaceuticals. D. A. L. served on a Scientific Advisory Board for Boehringer Ingelheim, Inc. N. K. is a scientific founder at Thyron; served as a consultant to Boehringer Ingelheim, Pliant, Astra Zeneca, RohBar, Veracyte, Augmanity, CSL Behring, Splisense, Galapagos, Fibrogen, GSK, Merck, and Thyron over the last 3 years; reports equity in Pliant and Thyron; reports grants from Veracyte, Boehringer Ingelheim, and BMS; and reports nonfinancial support from Astra Zeneca. None declared (W. L., I. C., G. K. B., E. M. B., W. P. D., E. H., K. G., S. R. W., C. F.).
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