Search

To determine the prevalence of pleural abnormalities and describe the computed tomography (CT) features observed in a well-characterised population of patients with pleural infection.A retrospective study of a subgroup of patients from the Second Multi-centre Intra-pleural Sepsis Trial (MIST 2) trial was carried out. Patients were diagnosed with pleural infection on robust clinical criteria. CT examinations were assessed by three observers independently for the presence of predefined features. Planned subgroup comparisons of patients with and without evidence of parenchymal infection were performed.Eighty-one patients were included. Parietal pleural thickening and enhancement were seen in 98.7% of patients. Visceral pleural changes were observed in most, including several previously undescribed features. Consolidation was observed in 61.7% of patients and there was a significant association of parenchymal consolidation with CT evidence of small airways infection (p0.001) and visceral pleural thickening and enhancement (p0.05). Features of parenchymal infection were absent in one third of patients.This study provides a comprehensive account of the parietal pleural, visceral pleural, and parenchymal changes of pleural infection on CT. Parenchymal infection is absent in a significant proportion of patients with pleural infection, suggesting that a pneumonic process may not be necessary for the development of pleural infection.

CT is of key diagnostic importance in interstitial lung disease and quantitative indices represent a potential tool to assess disease severity, but textural analysis may be a more suitable method than densitometric indices. We obtained CT imaging using a consistent protocol in a cohort of 28 patients with idiopathic pulmonary fibrosis (IPF) and applied a self-developed software tool to obtain measurements of the textural features of honeycombing (HC), reticulation (RT) and normal lung (NL), classified using Minkowski functionals.* CT indices were compared with static lung function and health status (St George9s Respiratory Questionnaire - SGRQ) by Pearson correlation. Correlations are shown in the table: Semi-automated textural analysis of CT imaging represents a potential tool for the diagnosis and objective quantification of idiopathic pulmonary fibrosis, and may be of use as a more sensitive and specific outcome measure in studies of disease modifying therapy than traditional outcomes.

Objective The aim of this study is to assess the performance of a computer-aided semi-automated algorithm we have adapted for the purpose of segmenting malignant pleural mesothelioma (MPM) on CT. Methods Forty-five CT scans were collected from 15 patients (M:F \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$=$$\end{document}= 10:5, mean age 62.8 years) in a multi-centre clinical drug trial. A computer-aided random walk-based algorithm was applied to segment the tumour; the results were then compared to radiologist-drawn contours and correlated with measurements made using the MPM-adapted Response Evaluation Criteria in Solid Tumour (modified RECIST). Results A mean accuracy (Sørensen–Dice index) of 0.825 (95% CI [0.758, 0.892]) was achieved. Compared to a median measurement time of 68.1 min (range [40.2, 102.4]) for manual delineation, the median running time of our algorithm was 23.1 min (range [10.9, 37.0]). A linear correlation (Pearson’s correlation coefficient: 0.6392, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p < 0.05$$\end{document}p

Background A major gap in the management of sarcoidosis is the lack of accessible and objective methods to measure disease activity. Since 90% of patients have pulmonary involvement, we explored if a disease activity score based on thoracic CT scans could address this clinical issue. Methods High resolution CT scans from 100 consecutive sarcoidosis patients at a regional sarcoidosis service were scored for extent of CT abnormalities known to relate to granuloma or lymphocytic infiltration from published CT-pathological studies. These individual abnormality scores were then correlated against serum ACE, sIL-2R and change in forced vital capacity (FVC) to identify CT abnormalities that reflect contemporaneous disease activity. The sum of these scores, or CT Activity Score (CTAS) was then validated against FVC response to treatment. Findings CT extent scores for nodularity, ground-glass opacification, inter-lobular septal thickening and consolidation correlated significantly with at least one of the disease activity parameters and were used to form CTAS. CTAS was found to predict FVC response to treatment at one year and was highly reproducible between radiologists. An abbreviated CTAS (aCTAS), constructed from presence or absence of the four CT abnormalities also showed significant correlation with FVC response to treatment. CTAS and aCTAS also correlated with response to treatment in the fibrotic subgroup. Interpretation CTAS provides a concept for an objective and reproducible CT scoring method to quantify disease activity in sarcoidosis. The score can potentially be used to stratify patients according to disease activity, determine response to treatment and establish if fibrotic sarcoidosis is active.

Pleural interventions are commonly performed in both elective and emergency settings. They include simple thoracocentesis, closed pleural biopsy (with or without image guidance), intercostal drain (ICD) insertion, in-dwelling pleural catheter insertion and medical thoracoscopy. Complications of pleural procedures are common but their incidence is often under-recognised. Higher operator experience and the use of image guidance are key factors demonstrated to significantly reduce the frequency of complications.1 Injury to the intercostal artery (ICA) is an infrequent but potentially life-threatening complication of all pleural interventions. Pleural haemorrhage is reported to occur in up to 2% of thoracocenteses, up to 13% of ICD insertions and up to 4% of thoracoscopies.2 The true incidence of ICA laceration and consequent pleural haemorrhage is likely to be higher due to under-reporting of complications seen in retrospective case series. The British Thoracic Society has published guidelines for the insertion of ICDs,1 aiming to reduce the potential harm of ICD insertion. Although these recommendations are likely to reduce certain complications such as drain insertion into abdominal or thoracic viscera, they do not specifically address the possibility of ICA injury. Proper site selection for pleural interventions is important as this minimises the likelihood of ICA laceration. In a recent large study, Helm et al 3 identified that ICA is exposed within the intercostal space in the first 6 cm lateral to the spine using CT pulmonary angiograph and mapping of the ICA course. The variability of ICA is greater in older people and in more cephalad rib spaces and decreases with lateral distance from the spinous process. Additionally, another important parameter is the management protocol for intrapleural haemorrhage. This should be in place prior to any pleural interventions to avoid life-threatening delays. We present three cases of iatrogenic ICA injury in different clinical circumstances, from three different …

Pleural procedures are commonly performed by physicians from a range of specialities. These procedures vary in complexity, from relatively straightforward pleural aspiration to more challenging procedures such as pleuroscopy. After appropriate training, even complex pleural procedures have a low risk of complications. Nevertheless, an appreciation of procedural risks is essential for physician training and forms the crux of a valid patient consent process. This review presents a systematic evaluation of the potential complications of common pleural procedures.

Appearance representation and feature extraction of anatomy or anatomical features is a key step for segmentation and classification tasks. We focus on an advanced appearance model in which an object is decomposed into pyramidal complementary channels, and each channel is represented by a part-based model. We apply it to landmark detection and pathology classification on the problem of lumbar spinal stenosis. The performance is evaluated on 200 routine clinical data with varied pathologies. Experimental results show an improvement on both tasks in comparison with other appearance models. We achieve a robust landmark detection performance with average point to boundary distances lower than 2 pixels, and image-level anatomical classification with accuracies around \(85\,\%\).

Negative pressure ventilation via an external device (‘iron lung’) has the potential to provide better oxygenation with reduced barotrauma in patients with ARDS. This study was designed to see if oxygenation differences between positive and negative ventilation could be explained by CT. Six anaesthetized rabbits had ARDS induced by repeated saline lavage. Rabbits were ventilated with positive pressure ventilation (PPV) and negative pressure ventilation (NPV) in turn. Dynamic CT images were acquired over the respiratory cycle. A computer-aided method was used to segment the lung and calculate the range of CT densities within each slice. Volumes of ventilated lung and atelectatic lung were measured over the respiratory cycle. NPV was associated with an increased percentage of ventilated lung and decreased percentage of atelectatic lung. The most significant differences in ventilation and atelectasis were seen at mid-inspiration and mid-expiration (ventilated lung NPV = 61%, ventilated lung PPV = 47%, p < 0.001; atelectatic lung NPV = 10%, atelectatic lung PPV 19%, p < 0.001). Aeration differences were not significant at end-inspiration. Dynamic CT can show differences in lung aeration between positive and negative ventilation in ARDS. These differences would not be appreciated if only static breath-hold CT was used.

We focus on optimising the Active Shape Model (ASM) with several extensions. The modification is threefold. First, we tackle the over-constraint problem and obtain an optimal shape with minimum energy considering both the shape prior and the salience of local features, based on statistical theory: a compact closed form solution to the optimal shape is deduced. Second, we enhance the ASM searching method by modelling and removing the variations of local appearance presented in the training data. Third, we speed up the convergence of shape fitting by integrating information from multi-scale local features simultaneously. Experiments show significant improvement brought by these modifications, i.e., optimal shape against standard relaxation methods dealing with inadequate training samples; enhanced searching method against standard gradient descent methods in searching accuracy; multi-scale local features against popular coarse-to-fine strategies in convergence speed.

BACKGROUND: It is conventionally taught that the intercostal artery is shielded in the intercostal groove of the superior rib. The continuous course and variability of the intercostal artery, and factors that may influence them, have not been described in a large number of arteries in vivo. METHODS: Maximal intensity projection reformats in the coronal plane were produced from CT scan pulmonary angiograms to identify the posterolateral course of the intercostal artery (seventh to 11th rib spaces). A novel semiautomated computer segmentation algorithm was used to measure distances between the lower border of the superior rib, the upper border of the inferior rib, and the position of the intercostal artery when exposed in the intercostal space. The position and variability of the artery were analyzed for association with clinical factors. RESULTS: Two hundred ninety-eight arteries from 47 patients were analyzed. The mean lateral distance from the spine over which the artery was exposed within the intercostal space was 39 mm, with wide variability (SD, 10 mm; 10th-90th centile, 28-51 mm). At 3 cm lateral distance from the spine, 17% of arteries were shielded by the superior rib, compared with 97% at 6 cm. Exposed artery length was not associated with age, sex, rib space, or side. The variability of arterial position was significantly associated with age (coefficient, 0.91; P < .001) and rib space number (coefficient, - 2.60; P < .001). CONCLUSIONS: The intercostal artery is exposed within the intercostal space in the first 6 cm lateral to the spine. The variability of its vertical position is greater in older patients and in more cephalad rib spaces.

Expanded abstract Citation Rahman NM, Maskell NA, West A, Teoh R, Arnold A, Mackinlay C, Peckham D, Davies CW, Ali N, Kinnear W, Bentley A, Kahan BC, Wrightson JM, Davies HE, Hooper CE, Lee YC, Hedley EL, Crosthwaite N, Choo L, Helm EJ, Gleeson FV, Nunn AJ, Davies RJ: N Engl J Med 2011, 365:518-26. PMID: 21830966, available on www.pubmed. gov Background More than 30% of patients with pleural infection either die or require surgery. Drainage of infected fluid is the key to successful treatment, but intrapleural fibrinolytic therapy did not improve outcomes in an earlier, large, randomized trial therapy (Multicenter Intrapleural Sepsis Trial [MIST1]). Methods Objective: To evaluate the efficacy and safety of intrapleural DNase alone, alteplase alone, or the combination of both, to improve pleural drainage. Design: Multicenter, double-blind, double-dummy, 2 × 2 factorial randomized trial. Setting: Eleven centers in the United Kingdom (UK). Subjects: Adult patients (mean age 59 years, 72% men), who had clinical evidence of infection, and pleural fluid that had macroscopic purulence, a positive culture or Gram stain for bacteria, or a pH < 7.2. Intervention: Patients were assigned to 1 of the 4 study interventions for 3 days: double placebo, intrapleural tissue plasminogen activator (t-PA) and DNase, t-PA and placebo, or DNase and placebo. Outcomes: The primary outcome was the change in pleural opacity, measured as the percentage of the hemithorax occupied by effusion, on chest radiography on day 7 as compared with day 1. Secondary outcomes included referral for surgery, duration of hospital stay, and adverse events. Results The mean (± SD) change in pleural opacity was greater in the t-PA-DNase group than in the placebo group (-29.5 ± 23.3% vs. -17.2 ± 19.6%; difference, -7.9%; 95% confidence interval [CI], -13.4 to -2.4; P = 0.005). The change observed with t-PA alone and with DNase alone (-17.2 ± 24.3 and -14.7 ± 16.4%, respectively) was not significantly different from that observed with placebo. The frequency of surgical referral at 3 months was lower in the t-PA-DNase group than in the placebo group (2 of 48 patients [4%] vs. 8 of 51 patients [16%]; odds ratio for surgical referral, 0.17; 95% CI, 0.03 to 0.87; P = 0.03) but was greater in the DNase group (18 of 46 patients [39%]) than in the placebo group (odds ratio, 3.56; 95% CI, 1.30 to 9.75; P = 0.01). Combined t-PA-DNase therapy was associated with a reduction in the hospital stay, as compared with placebo (difference, -6.7 days; 95% CI, -12.0 to -1.9; P = 0.006). Hospital stay with either agent alone was not significantly different from that with placebo. The frequency of adverse events did not differ significantly among the groups. Conclusions Intrapleural t-PA-DNase therapy improved fluid drainage in patients with pleural infection and reduced the frequency of surgical referral and the duration of hospital stay. Treatment with DNase alone or t-PA alone was ineffective.

Pleural disease is a problem of global significance which causes significant morbidity and mortality. Pleural disease is usually first suspected on chest x-ray but further imaging, often ultrasound, is usually required as part of the diagnostic work-up. Complex imaging with computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT are less often performed but are routinely required in patients with mesothelioma and occasionally required in patients with pleural infection and other pleural diseases. Cross-sectional imaging may be used to suggest the diagnosis of pleural disease, quantify disease severity, guide biopsy, and even predict prognosis. This review will focus on the contributions of CT, MRI, and PET to the management of pleural disease with discussion of their relative strengths and weaknesses.

Cystic fibrosis (CF) is an inherited condition that causes progressive respiratory failure and is the third most common indication for adult bilateral lung transplantation. Post-transplant hyperlipidemia commonly affects lung transplant recipients, but the impact of lung transplantation on serum lipids in the adult CF population is not well studied. The aim of this study was to examine the impact of lung transplantation on the prevalence of hyperlipidemia in CF adults.We retrospectively analyzed prospectively collected data in 108 CF adults undergoing bilateral sequential lung transplantation from 1996 to 2007 at our institution.The prevalence of hypercholesterolemia (5.2 mmol/liter) and hypertriglyceridemia (2.2 mmol/liter) increased significantly after lung transplant (14.8% vs 32.4%, p = 0.002; 8.3% vs 41.7%, p0.0001, respectively). Cyclosporine A (CsA) use was associated with significantly higher post-transplant total and LDL cholesterol compared with tacrolimus use. Post-transplant calculated Framingham risk score was10% in all but 1 subject.Hyperlipidemia was common in our cohort of post-lung transplant CF adults, with a higher prevalence in those receiving CsA. Despite these findings, calculated cardiovascular risk remained low and none of these subjects developed clinically evident cardiovascular disease.

Computer-aided detection (CAD) has been shown to increase the sensitivity for detection of pulmonary nodules in adults. This study reports initial findings utilizing a CAD system for the detection of pediatric pulmonary nodules. To assess the performance of CAD and pediatric radiologists in the detection of pediatric pulmonary nodules. CT scans from a series of pediatric patients with known primary tumors and lung nodules were analyzed by four radiologists and a commercially available CAD system. IRB approval was obtained. Sensitivities were calculated for detection according to nodule size and location. In 24 children (age 3–18 years) 173 nodules were identified. Overall the sensitivity of CAD was 34%, but the sensitivity of CAD for detection of nodules 4.0 mm or larger was 80%. Overall radiologist sensitivity ranged from 68% to 79%. There were 0.9 CAD false-positives and 0.3–2.4 radiologist false-positives per study. CAD in our pediatric oncology patients had good sensitivity for detection of lung nodules 4 mm and larger with a low number of false-positives. However, the sensitivity was considerably less for nodules smaller than 4 mm.

Conventional positive-pressure ventilation delivers pressure to the airways; in contrast, negative pressure is delivered globally to the chest and abdomen.To test the hypothesis that ventilation with negative pressure results in better oxygenation and less injury than with positive pressure.Anesthetized, surfactant-depleted rabbits were ventilated for 2.5 hours in pairs (positive or negative). Tidal volume was 12 ml . kg(-1), normocapnia was maintained by adjusting respiratory rate, and Fi(O(2)) was 1.0.Lung injury was assessed with histologic scoring, perfusion using thermodilution (global perfusion), and injected intravascular microspheres (regional perfusion); and dynamic computed tomography was used to determine inflation patterns. Negative pressure was associated with a higher Pa(O(2)), a lower Pa-Pet(CO(2)) gradient (despite identical minute ventilation), and less lung injury. Lung perfusion (global and regional) was similar with positive and negative pressure. Positive end-expiratory pressure applied to the airway was more efficiently transmitted to the pleural space than comparable levels of negative end-expiratory pressure applied to the chest wall; however, the oxygenation associated with any level of end-expiratory lung volume was greater when achieved by negative versus positive pressure. Dynamic computed tomography suggested that lung distension achieved with negative pressure is characterized by greater proportions of normally aerated lung (with less atelectasis) during inspiration and at end-expiration.Negative-pressure ventilation results in superior oxygenation that is unrelated to lung perfusion and may be explained by more effective inflation of lung volume during both inspiration and expiration.

Purpose Peripherally inserted central catheters (PICCs) are commonly used in patients with cystic fibrosis (CF) to administer intravenous antibiotics for pulmonary exacerbations. The aim of this study was to determine the incidence of PICC-related deep vein thrombosis (DVT) in a large group of adults with CF with and without Burkholderia cepacia complex (BCC) infection, and to investigate the association between PICC-related DVT and preinsertion serum erythrocyte sedimentation rate (ESR). Materials and methods This was a retrospective cohort study of all patients with PICCs inserted at a single institution during a 6-year period. A total of 524 adults with CF were treated in the clinic over this time period, with 147 (28.1%) having one or more PICCs inserted. Symptomatic venous thromboses were confirmed by Doppler ultrasound. Patients were classified as BCC-positive or BCC-negative, and preinsertion blood test results were analyzed. Results A total of 376 PICCs were inserted in 147 patients, with 12 patients (8.2%) developing symptomatic PICC-related DVT. Five additional subjects (3.4%) were diagnosed with asymptomatic PICC-related DVT. BCC-positive patients had a higher overall incidence of PICC-related DVT (20.9%) than BCC-negative patients (7.7%; P = .02). Preinsertion serum ESRs were higher in patients who subsequently developed PICC-related DVT (mean +/- SE, 54.4 mm/h +/- 7.2) compared with those without DVT (38.4 mm/h +/- 2.5; P Conclusions The incidence of symptomatic PICC-related DVT was 3.7% per PICC. BCC-positive patients had a higher overall incidence of DVT than BCC-negative patients. Higher preinsertion ESRs in patients who developed PICC-related DVT suggest that systemic inflammation may be a risk factor for subsequent PICC-related DVT.

Potter et al highlight the failure of the two week wait initiative to discriminate between patients with breast cancer and those with benign disease.1 However, what is more important is whether earlier diagnosis provided by a fast track system improves outcomes for patients. Evidence for this is lacking. This is likely to be due …

Acute respiratory distress syndrome (ARDS) can occur in people with or without previous lung disease. Analysis of aeration in artificial ventilation for ARDS is one of the major applications of computed tomography (CT) lung density examination. A movie of an affected rabbit lung over the respiratory cycle was produced by dynamic CT with a cine loop technique. This technique can produce thousands of CT images for analysis with a single experiment. A fully automated algorithm based on the capability of wavelet transformation to detect edges in the image is proposed. This method accurately and consistently segments the lung in pulmonary CT images. The speed and accuracy of this technique allows it to outperform other methods when dealing with the large number of images created by dynamic computed tomography

Introduction and Objectives Several studies have described the typical imaging features of empyema on CT, including pleural thickening, pleural enhancement, septation and loculation. However, there are further CT features of empyema which are less well described, or have only been reported in small groups of patients. The aim of this study was to establish the prevalence of the different CT imaging features of empyema in a large, well-characterised cohort of empyema patients. Methods This was a retrospective cohort study comprising a subgroup of patients from the MIST 2 trial, who underwent a pre-treatment thoracic CT at a single institution. Patients in this trial had confirmed empyema using consistent diagnostic criteria. To ensure consistent and reliable image interpretation, each CT examination was assessed for predefined imaging features by three independent Thoracic Radiologists using a proforma. These features are listed in Abstract S62 table 1. We explored the sensitivity of the presence of five “classic” features of empyema described by Kearney et al (2000): loculation, parietal pleural thickening and enhancement and increased extrapleural fat thickness and attenuation. Results 97 patients were included in the study. Imaging features are summarised in Abstract S62 table 1. 98.5% (95% CI 90.9% to 99.9%) of patients had at least two of five classic CT features of empyema. Additionally, we noted a significant number of patients with visceral pleural enhancement (66%), with indrawing/tenting of the visceral pleural (30%) and with subvisceral oedema (34%). Parenchymal changes were seen in the majority of patients. Associated consolidation was seen in the ipsilateral lung in 63% of patients; which was adjacent to the empyema in 87% of cases. Conclusion This study describes the prevalence of multiple CT features of empyema and highlights the frequency of associated visceral changes. Many of the typical features of empyema were highly prevalent in this population but we also noted a high frequency of several other, less well-reported features. Subvisceral oedema is a previously unreported feature of empyema. These features may have implications for both diagnosis and prognosis.

Background The intercostal artery is thought to be shielded in the groove of the superior rib; however, the course and variability of the intercostal artery, and factors which may influence these, have not been described in vivo. Describing these variables in vivo has potentially important implications for avoiding complications during common pleural procedures. Methods Maximum intensity projection (MIP) reformats in the coronal plane were produced from CT pulmonary angiograms, to identify the posterolateral course of the contrast opacified intercostal artery. A novel semi-automated computer segmentation algorithm was used to identify and measure distances between the lower border of the superior rib, the upper border of the inferior rib and the position of the intercostal artery when exposed in the intercostal space, and manually verified by a radiologist. Position and variability of the artery were described and then analysed for association with clinical factors using a random effects regression model. Results 298 arteries were analysed from 48 patients (mean age 60 years). The mean lateral distance from the spine over which the artery was exposed within the intercostal space (‘unsafe artery length’) was 39 mm with wide variability (SD=10 mm, 10th to 90th centile 28 mm to 51 mm, Abstract P64 Figure 1A). At 3 cm lateral distance from the spine 16.6% of arteries were shielded by the superior rib, compared to 96.6% at 6 cm. Unsafe artery length was not associated with age, sex, rib space or side. Using regression modelling, variability of arterial position (as SD and coefficient of variation) was significantly associated with age (coeff 0.91, p Conclusions The intercostal artery is exposed within the intercostal space in the first 6 cm lateral to the spine; variability of its vertical position is greater in older patients and more cephalad rib spaces. This implies that pleural interventions within 6 cm lateral to the spine should be conducted with caution and that the risk of intercostal artery laceration is potentially higher in older patients and more cephalad rib spaces.

Introduction Clinical decisions about treatment in pulmonary sarcoidosis, and phenotyping research studies are hampered by inability to objectively measure disease activity. We reviewed 120 consecutive patients from our Sarcoidosis Clinic and observed that raised sACE, immunoglobulin and/or presence of lymphopenia were associated with clinical decisions to change treatment. We question if these markers could be combined to form an objective measure of disease activity in pulmonary sarcoidosis. Methods As there is no ‘gold standard’ for disease activity in sarcoidosis, we used thoracic CT scan to reflect disease activity on the basis that ground glass opacity, nodularity, consolidation, interlobular septal thickening and conglomeration reflect T cell alveolit is, cellular infiltrate and granulomatous deposits1–2. Using Fleischner Society definition of terms3, we designed a scoring system (“CT activity score; CTAS”) to quantify this, and examined if a composite clinical score (“clinical activity score; CAS”; IgG>13 g/l= 1, Lymphocytes 100 U/l = 2) correlated with changes in CTAS. An enhanced CAS incorporating extent of defined CXR abnormalities was also examined. We collected data from 100 consecutive patients diagnosed according to WASOG/ATS criteria (with histological confirmation), who had thoracic CT scan, CXR and blood parameters within three months of each other. Two radiologists scored the CT scans blindly. We present results for the first 20 cases. Results CTAS score (maximum possible 81) in our patients ranged from 0 to 40; CAS from 0–4 (maximum 5); when including CXR score - from 1–12 (maximum 12). We found a strong correlation between CAS and CTAS (Figure 1). No correlation was observed between the CTAS and FVC, TLCO or KCO, supporting the premise that severe irreversible functional loss can be inactive. Conclusions A combination score incorporating lymphopenia, sACE levels, and hypergammaglobulinemia is strongly correlated with CT quantification of disease activity in pulmonary sarcoidosis. Addition of CXR scoring improved the correlation. This score could be used as an indicator of disease activity to aid clinical decisions on treatment, and paves the way for collation of larger numbers and longitudinal studies to further validate the tool. References Nishimura K et al. Radiology 1993. Oberstein A et al. Sarc Vasc Diffuse Lung Dis 1997. Hansell DM et al. Radiology 2008.