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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.

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Abbreviations

AE:

Acute exacerbation

AUC:

Area under the receiver operating characteristic curve

BAL:

Bronchoalveolar lavage

CI:

Confidence interval

CT:

Computed tomography

DLCO :

Diffusing capacity for carbon monoxide

FEV1 :

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

GGO:

Ground-glass opacity

HP:

Hypersensitivity pneumonitis

IPF:

Idiopathic pulmonary fibrosis

ROC:

Receiver operating characteristic

UIP:

Usual interstitial pneumonia

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Acknowledgments

We express our gratitude to Seonok Kim and Hwa Jung Kim of the Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, for valuable advice regarding the statistical analysis.

Funding

The authors state that this work has not received any funding.

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Author notes

  1. Eun Jin Chae and Jin Woo Song equally contributed as corresponding authors

Authors and Affiliations

  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

    Jooae Choe, Eun Jin Chae & Kyung-Hyun Do

  2. Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, 138-736, Seoul, South Korea

    Yeon Joo Kim & Jin Woo Song

  3. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, 138-736, Seoul, South Korea

    Joon Seon Song

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  1. Jooae Choe
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Corresponding authors

Correspondence to Eun Jin Chae or Jin Woo Song.

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Guarantor

The scientific guarantor of this publication is Eun Jin Chae.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Seonok Kim of the Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, kindly provided statistical advice for this manuscript.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• retrospective

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• performed at one institution

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Choe, J., Chae, E.J., Kim, Y.J. et al. Serial changes of CT findings in patients with chronic hypersensitivity pneumonitis: imaging trajectories and predictors of fibrotic progression and acute exacerbation. Eur Radiol 31, 3993–4003 (2021). https://doi.org/10.1007/s00330-020-07469-2

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  • DOI: https://doi.org/10.1007/s00330-020-07469-2

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