CT findings associated with survival in chronic hypersensitivity pneumonitis

• Published in: European radiology Vol. 27; no. 12; pp. 5127 - 5135
• Main Authors: Chung, Jonathan H., Montner, Steven M., Adegunsoye, Ayodeji, Oldham, Justin M., Husain, Aliya N., Vij, Rekha, Noth, Imre, Strek, Mary E.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2017; Springer Nature B.V
• Subjects: Adult; Aged; Alveolitis; Alveolitis, Extrinsic Allergic - diagnostic imaging; Alveolitis, Extrinsic Allergic - pathology; Aorta; Bronchiectasis; Chest; Chronic Disease; Computed tomography; Coronary vessels; Diagnosis; Diagnostic Radiology; Female; Fibrosis; Fibrosis - pathology; Humans; Hypersensitivity; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - pathology; Idiopathic Pulmonary Fibrosis - pathology; Imaging; Internal Medicine; Interventional Radiology; Lung diseases; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Opacity; Pneumonitis; Prediction models; Prevalence; Pulmonary arteries; Pulmonary artery; Pulmonary Artery - diagnostic imaging; Pulmonary fibrosis; Radiology; Smoking; Survival; Survival Analysis; Thorax; Tomography, X-Ray Computed - methods; Ultrasound; CT; Chronic hypersensitivity pneumonitis; Survival; Pulmonary hypertension; Usual interstitial pneumonitis
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-017-4936-3

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.