Internal and external responsiveness of computer-aided quantification of interstitial lung disease from high resolution computed tomography images in systemic sclerosis: a comparison with visual Reader-Based score

Fausto Salaffi, Paolo Fraticelli, Marina Carotti, Colomba Fischetti, Marco Di Carlo, Gian Marco Giuseppetti, Armando Gabrielli


 Background: The aim of this study was to evaluate and compare the internal and external responsiveness of a computer-aided method (CaM) with a conventional visual reader-based score (CoVR) for measuring interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) on high resolution computed tomography (HRCT). Methods: Thirty-one patients were included in this retrospective cohort. HRCTs were collected at baseline and after 1-year. The HRCT abnormalities were scored according to a CoVR (Warrick method) and a quantitative CaM. Internal responsiveness over 1-year was evaluated with standardized response mean (SRM). Receiver operating characteristic (ROC) curves analyses assessed the sensitivity and specificity of the two methods to discriminate between clinically relevant and no (relevant) progression, using judgement of the experts as gold standard (external responsiveness). Results: During 1-year, lung involvement was stable/improved in 17 of 31 patients (54.8%), and worsened in 14 patients (45.2%). The HRCT scores changed moderately over the follow-up period. Using SRM, the CaM was significantly more responsive to detect the changes due to treatment than the CoVR. Similarly, on ROC curve analysis, the CaM scores confirmed the highest performance (AUC ROC CaM vs. CoVR, 0.861 vs. 0.689; p = 0.011). Conclusion: The quantitative CaM analysis was more responsive than the CoVR method for accurately assessing and monitoring the SSc-ILD progression or response to therapy. 


Interstitial lung disease; Systemic sclerosis; Scoring methods

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ISSN: 2532-179X