Chronic hypersensitivity pneumonitis: identification of key prognostic determinants using automated CT analysis

摘要

Background Chronic hypersensitivity pneumonitis (CHP) has a variable disease course. Computer analysis of CT features was used to identify a subset of CHP patients with an outcome similar to patients with idiopathic pulmonary fibrosis (IPF). Methods Consecutive patients with a multi-disciplinary team diagnosis of CHP ( n =?116) had pulmonary function tests (FEV1, FVC, DLco, Kco, and a composite physiologic index [CPI]) and CT variables predictive of mortality evaluated by analysing visual and computer-based (CALIPER) parenchymal features: total interstitial lung disease (ILD) extent, honeycombing, reticular pattern, ground glass opacities, pulmonary vessel volume (PVV), emphysema, and traction bronchiectasis. Mean survival was compared between both CHP and IPF patients ( n =?185). Results In CHP, visual/CALIPER measures of reticular pattern, honeycombing, visual traction bronchiectasis, and CALIPER ILD extent were predictive of mortality ( p 6?·?5% of the lung had a mean survival (35?·?3?±?6?·?1?months; n =?20/116 [17%]) and rate of disease progression that closely matched IPF patients (38?·?4?±?2?·?2?months; n =?185). Conclusions Pulmonary vessel volume can identify CHP patients at risk of aggressive disease and a poor IPF-like prognosis.