Infection and Inflammation

Interstitial Lung Disease Project

Interstitial Lung Disease (ILD) covers many different lung conditions and is characterised by the progressive destruction of the interstitium (the tissue that surrounds the air sacs in the lung). Idiopathic Pulmonary Fibrosis (IPF) is the most severe form of the disease and has a poorer prognosis than many cancers with an average survival of just 3 years after diagnosis.

Although CT scans are essential for diagnosing Interstitial Lung Disease and can be used to produce several promising measures of the disease, such techniques only map the structural abnormalities of the lungs, with no consideration to the underlying inflammatory processes which are believed to be the dominant element of the disease.

We have run a research project since 2006 aimed at correlating the severity of interstitial lung disease with the metabolic activity of lung cells (which reflects the degree of inflammation). While we don’t know the exact cellular mechanisms underlying the observed increase in FDG-PET signal (FDG is a radioactive tracer that is taken up by metabolically active cells), there is evidence that it is at least in part caused by metabolically active cells in the lungs of ILD patients.

In this way, FDG-PET has been shown to be a useful tool in improving our understanding of the pathogenesis and prognosis of Interstitial Lung Disease. We are currently exploring its potential to detect metabolic changes in the lungs before the damage becomes apparent on CT, which would be helpful in mild or early disease.

Furthermore, we recently completed a prospective clinical trial involving IPF patients that revealed an important prognostic role for FDG/PET to track the progression of disease, and which may provide a useful measure of disease burden for use in future clinical studies looking to test new treatments.

The top row images show an example of our pathway for patients with idiopathic pulmonary fibrosis. We scan all patients with a combined protocol HRCT/PET-CT. This approach is twofold, so we obtain anatomical (HRCT) and functional (FDG PET) images. The bottom images show an example of multiparametric imaging in lung cancer. From left to right: perfusion map, PET/MRI, FDG PET/CT following dynamic injection of contrast media in CT.

Our centre has several collaborators both within the campus and externally within industry including GSK, The Mayo Clinic and Imbio (with whom we are working with to develop a platform for CT quantification of ILD).

To date and to the best of our knowledge we are the first in world to combine a protocol of High-Resolution CT and FDG-PET in a single exam and apply a computed algorithm for the CT quantification of Interstitial Lung Disease.

Image Analysis Project with Imbio

We introduced one of the few UK models of artificial Intelligence and quantitative CT to precisely quantify (in clinical and research) patients suffering by fibrotic lung disorders.

Lung Texture Analysis (LTA) application is designed to help radiologists and pulmonologists identify, visualize, and quantify parenchymal abnormalities and categorize them into common radiological reporting categories (normal, ground glass, reticular, honeycomb and hyperlucent).

The LTA software is a set of imaging post-processing algorithms that perform segmentation, volume analysis (VOI) and classification on CT images of human lungs. LTA works on CT series with no user input or intervention, and results are directly routed to PACS for review.

With this system, we hope to pave the era for a simplified assessment of fibrotic conditions in the clinical pathway.