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by Paul J.C. Hughes, James A. Eaden, Marta Tibiletti, Nazia Chaudhuri, Sarah Skeoch, Ian N. Bruce, John C. Waterton, Stephen Bianchi, Geoff J. Parker, Jim M. Wild on behalf of the TRISTAN Consortium

EMIM 2024

Abstract

Interstitial lung disease (ILD) encompasses a diverse spectrum of pulmonary pathologies, characterized by a combination of clinical, radiographic, and physiological or pathological features. In ILDs, inflammatory and/or fibrotic alterations affect not only the interstitial space but also extend to involve the alveolar structures, alveolar ducts, and bronchioles1.
The TRISTAN study enrolled patients diagnosed with various ILDs including idiopathic pulmonary fibrosis (IPF), connective tissue disease-related ILD (CTD-ILD), hypersensitivity pneumonitis (HP), idiopathic nonspecific interstitial pneumonia (iNSIP), and drug-induced ILD (DI-ILD) and conducted etrospective research into patients with DI-ILD and Hodgkin’s lymphoma. This comprehensive selection of ILDs was made due to the ongoing diagnostic challenges associated with these conditions, necessitating multidisciplinary evaluations incorporating clinical history, pulmonary function tests, immune profiling, computed tomography (CT), and, where feasible, histological examination of lung tissue.
While computed tomography (CT) offers superior resolution compared to alternative imaging modalities such as nuclear medicine or magnetic resonance imaging (MRI), it remains challenging to differentiate between subtypes of ILD in approximately 50% of patients2, and extracting functional data from standard CT imaging poses difficulties. Pulmonary function tests (PFTs), notably assessing forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO), provide global measures of lung function but fail to offer detailed functional information3, highlighting the necessity for enhanced imaging biomarkers.
The TRISTAN study employed various imaging biomarkers derived from CALIPER4 analysis of CT images in conjunction with hyperpolarized xenon-129 (129Xe) and oxygen-enhanced MRI parameters for lung function evaluation, as well as dynamic contrast-enhanced (DCE) proton MRI metrics for lung perfusion assessment. This study aimed to investigate the correlations between these novel imaging biomarkers and PFT results, aiming to ascertain whether superior diagnostic and prognostic capabilities could be achieved compared to current ILD assessment methods. Building upon insights gained from the primary study, a new MR imaging protocol was developed to evaluate patients undergoing bleomycin treatment.
In my presentation, I will delve into the clinical aspects of the TRISTAN project, detailing the imaging methodologies employed and presenting preliminary results from the initial analysis of the data collected and analysed by the clinical members of the consortium.