Serial changes of CT findings in patients with chronic hypersensitivity pneumonitis: imaging trajectories and predictors
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Serial changes of CT findings in patients with chronic hypersensitivity pneumonitis: imaging trajectories and predictors of fibrotic progression and acute exacerbation Jooae Choe 1 & Eun Jin Chae 1
&
Yeon Joo Kim 2 & Kyung-Hyun Do 1 & Joon Seon Song 3 & Jin Woo Song 2
Received: 25 May 2020 / Revised: 4 September 2020 / Accepted: 4 November 2020 # European Society of Radiology 2020
Abstract Objectives To evaluate the longitudinal changes of chest CT findings in patients with chronic hypersensitivity pneumonitis (HP) and identify risk factors for fibrotic progression and acute exacerbation (AE). Methods This retrospective study included patients with chronic HP with follow-up CT. Baseline and serial follow-up CT were evaluated semi-quantitatively. Fibrosis score was defined as the sum of the area with reticulation and honeycombing. The modified CT pattern of Fleischner Society idiopathic pulmonary fibrosis diagnostic guidelines was evaluated. Cox proportional hazards regression was performed to determine significant variables associated with fibrotic progression and AEs. Results Of 91 patients, mean age was 59.1 years and 61.5% were women. The median follow-up period was 4.9 years. Seventy-nine patients (86.8%) showed fibrotic progression with persistent areas of mosaic attenuation, finally replaced by fibrosis, and 20 (22.0%) developed AE. Baseline fibrosis score and CT pattern of usual interstitial pneumonia (UIP)/ probable UIP were independent risk factors for predicting fibrotic progression (hazard ratio [HR] = 1.05, 95% confidence interval [CI] = 1.02–1.09, p < 0.001, for fibrosis score; HR = 2.50, CI = 1.50–4.16, p < 0.001, for CT pattern) and AEs (HR = 1.07, CI = 1.01–1.13, p = 0.019, for fibrosis score; HR = 5.47, CI = 1.23–24.45, p = 0.026, for CT pattern) after adjusting clinical covariables. Conclusion Fibrotic progression and AE were identified in 86.8% and 22.0% of patients with chronic HP. Fibrosis score and CT pattern of UIP/probable UIP on baseline chest CT may predict fibrotic progression and AE. Key Points • Most patients (87%) showed fibrotic progression on long-term follow-up with persistent areas of mosaic attenuation that were finally replaced by fibrosis at a later stage. • One-fifth of patients (22%) experienced acute exacerbation associated with worse prognosis. • Fibrosis score (sum of reticulation and honeycombing) and CT pattern of UIP/probable UIP on baseline CT were independent predictors for predicting fibrotic progression and acute exacerbation. Keywords Lung diseases, interstitial . Alveolitis, extrinsic allergic . Tomography, X-ray computed . Fibrosis . Proportional hazards models
Eun Jin Chae and Jin Woo Song equally contributed as corresponding authors * Eun Jin Chae [email protected] * Jin Woo Song [email protected] 1
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, 138-736 Seoul, South Korea
2
Department of Pulmonary and Critical Care Medicine, University
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