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European Radiology

, Volume 27, Issue 12, pp 5127–5135 | Cite as

CT findings associated with survival in chronic hypersensitivity pneumonitis

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

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.

Keywords

Chronic hypersensitivity pneumonitis CT Survival Usual interstitial pneumonitis Pulmonary hypertension 

Notes

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Jonathan H. Chung, MD.

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.

Funding

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

Statistics and biometry

Two of the authors have significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Jonathan H. Chung
    • 1
  • Steven M. Montner
    • 1
  • Ayodeji Adegunsoye
    • 2
  • Justin M. Oldham
    • 3
  • Aliya N. Husain
    • 4
  • Rekha Vij
    • 2
  • Imre Noth
    • 2
  • Mary E. Strek
    • 2
  1. 1.Department of RadiologyThe University of Chicago Medical CenterChicagoUSA
  2. 2.Section of Pulmonary/Critical Care; Department of MedicineThe University of Chicago Medical CenterChicagoUSA
  3. 3.Section of Pulmonary/Critical Care; Department of MedicineThe University of California at DavisSacramentoUSA
  4. 4.Department of PathologyThe University of Chicago Medical CenterChicagoUSA

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