Respiratory investigation · 2026
Association of the lower-lobe volume ratio on three-dimensional computed tomography with disease progression in idiopathic pulmonary fibrosis.
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Zaizen Midori, Zaizen Yoshiaki, Tsumura Kenji, Chikasue Tomonori, Nagata Shuji, Watanabe Masayuki, Okamoto Masaki, Tominaga Masaki, Tabata Kazuhiro, Tanoue Shuichi, Hoshino Tomoaki, Fujimoto Kiminori
Аннотация
BACKGROUND: Three-dimensional computed tomography (3D-CT)-based lung volume analysis has been reported to correlate with pulmonary function in idiopathic pulmonary fibrosis (IPF); however, its clinical relevance for predicting disease progression remains unclear.
METHODS: This retrospective study included 69 patients with IPF receiving nintedanib. The bilateral lower lobe volume to total lung volume (b-LLV/TLV) ratio was evaluated using 3D-CT. Clinical events were defined as an absolute decline in forced vital capacity (FVC) of ≥5% within 1 year, hospitalization due to worsening respiratory symptoms, or all-cause mortality. Associations between clinical events and clinical parameters, pulmonary function test results, and 3D-CT-derived measurements were assessed. Receiver operating characteristic analysis was conducted to identify optimal cutoff values, and a weighted risk score incorporating the b-LLV/TLV ratio was constructed.
RESULT: s: TLV measured by 3D-CT showed strong positive correlations with FVC and total lung capacity. Clinical events occurred in 41 patients (59%). In multivariate logistic regression analysis, male sex, lower percent predicted FVC (%FVC), and a reduced b-LLV/TLV ratio were independently associated with clinical events. The optimal cutoff value for the b-LLV/TLV ratio was 0.33 (area under the curve [AUC], 0.651). A risk score combining sex, %FVC, and the b-LLV/TLV ratio demonstrated moderate discriminative ability for predicting 1-year clinical events (AUC, 0.782).
CONCLUSION: s: The 3D-CT-derived b-LLV/TLV ratio was independently associated with clinical events in patients with IPF receiving nintedanib. A risk score incorporating the b-LLV/TLV ratio may enhance prediction of short-term clinical outcomes beyond conventional prognostic factors.
METHODS: This retrospective study included 69 patients with IPF receiving nintedanib. The bilateral lower lobe volume to total lung volume (b-LLV/TLV) ratio was evaluated using 3D-CT. Clinical events were defined as an absolute decline in forced vital capacity (FVC) of ≥5% within 1 year, hospitalization due to worsening respiratory symptoms, or all-cause mortality. Associations between clinical events and clinical parameters, pulmonary function test results, and 3D-CT-derived measurements were assessed. Receiver operating characteristic analysis was conducted to identify optimal cutoff values, and a weighted risk score incorporating the b-LLV/TLV ratio was constructed.
RESULT: s: TLV measured by 3D-CT showed strong positive correlations with FVC and total lung capacity. Clinical events occurred in 41 patients (59%). In multivariate logistic regression analysis, male sex, lower percent predicted FVC (%FVC), and a reduced b-LLV/TLV ratio were independently associated with clinical events. The optimal cutoff value for the b-LLV/TLV ratio was 0.33 (area under the curve [AUC], 0.651). A risk score combining sex, %FVC, and the b-LLV/TLV ratio demonstrated moderate discriminative ability for predicting 1-year clinical events (AUC, 0.782).
CONCLUSION: s: The 3D-CT-derived b-LLV/TLV ratio was independently associated with clinical events in patients with IPF receiving nintedanib. A risk score incorporating the b-LLV/TLV ratio may enhance prediction of short-term clinical outcomes beyond conventional prognostic factors.