CT findings associated with survival in chronic hypersensitivity pneumonitis

Jonathan H. Chung, Steven M. Montner, Ayodeji Adegunsoye, Justin Oldham, Aliya N. Husain, Rekha Vij, Imre Noth, Mary E. Strek

Research output: Contribution to journalArticle

11 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)5127-5135
Number of pages9
JournalEuropean Radiology
Volume27
Issue number12
DOIs
StatePublished - Dec 1 2017

Keywords

  • Chronic hypersensitivity pneumonitis
  • CT
  • Pulmonary hypertension
  • Survival
  • Usual interstitial pneumonitis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Chung, J. H., Montner, S. M., Adegunsoye, A., Oldham, J., Husain, A. N., Vij, R., Noth, I., & Strek, M. E. (2017). CT findings associated with survival in chronic hypersensitivity pneumonitis. European Radiology, 27(12), 5127-5135. https://doi.org/10.1007/s00330-017-4936-3