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CT findings associated with survival in chronic hypersensitivity pneumonitis.

CT findings associated with survival in chronic hypersensitivity pneumonitis.
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Chung JH, Montner SM, Adegunsoye A, Oldham JM, Husain AN, Vij R, Noth I, Strek ME,


Chung JH, Montner SM, Adegunsoye A, Oldham JM, Husain AN, Vij R, Noth I, Strek ME, (click to view)

Chung JH, Montner SM, Adegunsoye A, Oldham JM, Husain AN, Vij R, Noth I, Strek ME,

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European radiology 2017 07 07() doi 10.1007/s00330-017-4936-3
Abstract
OBJECTIVES
To identify CT findings in chronic hypersensitivity pneumonitis (cHP) associated with survival.

MATERIAL AND METHODS
Two thoracic radiologists assessed CT scans for specific imaging findings and patterns in 132 subjects with cHP. Survival analyses were performed.

RESULTS
The majority of subjects had an inconsistent with usual interstitial pneumonitis pattern on CT (55.3%,73/132). Hypersensitivity pneumonitis (HP) diagnosis on CT was less common in those with fibrosis (66.1%, 74/112) than those without fibrosis (85%,17/20). Smoking was associated with a lower prevalence of HP on CT (p=0.04). CT features of pulmonary fibrosis, especially traction bronchiectasis (HR 8.34, 95% CI 1.98-35.21) and increased pulmonary artery (PA)/aorta ratio (HR 2.49, 95% CI 1.27-4.89) were associated with worse survival, while ground-glass opacity (HR 0.31, 95% CI 0.12-0.79) was associated with improved survival. Survival association with imaging was less pronounced after adjustment for gender, age and physiology score.

CONCLUSIONS
A substantial proportion of cHP cases have a non-HP-like appearance. Ground-glass opacity, pulmonary fibrosis features and elevated PA/aorta ratio on CT likely reflect varying degrees of disease severity in cHP and may inform future clinical prediction models.

KEY POINTS
• A substantial proportion of subjects with chronic HP have a UIP-like pattern. • A UIP pattern in HP may be potentiated by smoking. • A diagnosis of HP should not be excluded based solely on CT appearance. • CT fibrosis and increased PA/aorta ratio signal worse survival.

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