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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

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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.
Author(s)
김연주도경현송준선송진우채은진최주애
Issued Date
2021
Type
Article
Keyword
Bacterial pneumoniaCare and treatmentChestCT imagingDiagnostic RadiologyHypersensitivity pneumonitisImagingInternal MedicineInterventional RadiologyMedical researchMedicineMedicine &amp; Public HealthExperimentalNeuroradiologyPneumoniaRadiologyRisk factorsUltrasound
DOI
10.1007/s00330-020-07469-2
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7325
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2464605141&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Serial%20changes%20of%20CT%20findings%20in%20patients%20with%20chronic%20hypersensitivity%20pneumonitis:%20imaging%20trajectories%20and%20predictors%20of%20fibrotic%20progression%20and%20acute%20exacerbation&amp;offset=0&amp;pcAvailability=true
Publisher
EUROPEAN RADIOLOGY
Location
영국
Language
영어
ISSN
0938-7994
Citation Volume
31
Citation Number
6
Citation Start Page
3993
Citation End Page
4003
Appears in Collections:
Medicine > Medicine
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