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Chest CT imaging features for prediction of treatment response in cryptogenic and connective tissue disease–related organizing pneumonia

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Abstract

Objectives

To investigate CT imaging features associated with poor clinical outcome after corticosteroid treatment in patients diagnosed with cryptogenic organizing pneumonia (COP) and connective tissue disease–related organizing pneumonia (CTD-OP) and to assess the difference in CT findings and treatment responses between COP and CTD-OP.

Methods

Chest CT images from 166 patients (COP, 131; CTD-OP, 35) with pathologically proven organizing pneumonia were reviewed by two thoracic radiologists. The type, distribution pattern, and extent of parenchymal abnormalities, along with other associated imaging features, were assessed for each patient. Logistic regression analyses were used to identify features associated with poor clinical outcomes such as residual disease (RD) and disease relapse. The differences between COP and CTD-OP were also analyzed.

Results

Consolidation involving more than 10% of parenchyma (hazard ratio [HR], 2.27), detectable bronchiectasis (HR, 3.59), and diagnosis of CTD-OP (HR, 4.31) were associated with a higher risk of RD after adjustments for patient age and sex. More than 10% consolidation involvement (HR, 2.54) and diagnosis of CTD-OP (HR, 6.42) were also associated with a higher risk of disease relapse. Compared with COP, CTD-OP demonstrated a greater extent of parenchymal abnormalities, especially consolidation, and was less likely to show a peribronchovascular distribution pattern.

Conclusion

Bronchiectasis and a greater extent of consolidation were associated with RD, with the latter also being associated with disease relapse. Compared with COP, CTD-OP was associated with worse treatment outcomes and demonstrated a greater extent of parenchymal abnormalities, which were also less likely to show a peribronchovascular pattern.

Key Points

• The presence of bronchiectasis and a high parenchymal involvement of consolidation on initial chest CT were associated with a worse response to corticosteroids in patients with organizing pneumonia.

• Connective tissue disease–related organizing pneumonia (CTD-OP) was associated with worse treatment outcomes than its idiopathic counterpart cryptogenic organizing pneumonia (COP).

• Compared with COP, CTD-OP generally demonstrated a greater extent of parenchymal abnormalities, especially consolidation, and was less likely to show a peribronchovascular distribution pattern.

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Abbreviations

COP:

Cryptogenic organizing pneumonia

CR:

Complete recovery

CTD:

Connective tissue disease

CTD-OP:

Connective tissue disease–related organizing pneumonia

DLCO:

Diffusion capacity for carbon monoxide

FVC:

Forced vital capacity

GGO:

Ground-glass opacity

HR:

Hazard ratio

HRCT:

High-resolution computed tomography

LN:

Lymph node

OP:

Organizing pneumonia

PFT:

Pulmonary function test

RD:

Residual disease

TLC:

Total lung capacity

References

  1. Cottin V, Cordier JF (2012) Cryptogenic organizing pneumonia. Semin Respir Crit Care Med 33:462–475

    Article  PubMed  Google Scholar 

  2. Cordier JF (2000) Organising pneumonia. Thorax 55:318–328

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Faria IM, Zanetti G, Barreto MM et al (2015) Organizing pneumonia: chest HRCT findings. J Bras Pneumol 41:231–237

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lee JW, Lee KS, Lee HY et al (2010) Cryptogenic organizing pneumonia: serial high-resolution CT findings in 22 patients. AJR Am J Roentgenol 195:916–922

    Article  PubMed  Google Scholar 

  5. Lee KS, Kullnig P, Hartman TE, Muller NL (1994) Cryptogenic organizing pneumonia: CT findings in 43 patients. AJR Am J Roentgenol 162:543–546

    Article  CAS  PubMed  Google Scholar 

  6. Oikonomou A, Hansell DM (2002) Organizing pneumonia: the many morphological faces. Eur Radiol 12:1486–1496

    Article  PubMed  Google Scholar 

  7. Johkoh T, Muller NL, Cartier Y et al (1999) Idiopathic interstitial pneumonias: diagnostic accuracy of thin-section CT in 129 patients. Radiology 211:555–560

    Article  CAS  PubMed  Google Scholar 

  8. Kim SJ, Lee KS, Ryu YH et al (2003) Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol 180:1251–1254

    Article  PubMed  Google Scholar 

  9. Torrealba JR, Fisher S, Kanne JP et al (2018) Pathology-radiology correlation of common and uncommon computed tomographic patterns of organizing pneumonia. Hum Pathol 71:30–40

    Article  PubMed  Google Scholar 

  10. Lazor R, Vandevenne A, Pelletier A, Leclerc P, Court-Fortune I, Cordier JF (2000) Cryptogenic organizing pneumonia. Characteristics of relapses in a series of 48 patients. The Groupe d'Etudes et de Recherche sur les Maladles “Orphelines” Pulmonaires (GERM"O"P). Am J Respir Crit Care Med 162:571–577

    Article  CAS  PubMed  Google Scholar 

  11. Nizami IY, Kissner DG, Visscher DW, Dubaybo BA (1995) Idiopathic bronchiolitis obliterans with organizing pneumonia. An acute and life-threatening syndrome. Chest 108:271–277

    Article  CAS  PubMed  Google Scholar 

  12. Yoo JW, Song JW, Jang SJ et al (2011) Comparison between cryptogenic organizing pneumonia and connective tissue disease-related organizing pneumonia. Rheumatology (Oxford) 50:932–938

    Article  Google Scholar 

  13. Chung MP, Nam BD, Lee KS et al (2018) Serial chest CT in cryptogenic organizing pneumonia: evolutional changes and prognostic determinants. Respirology 23:325–330

    Article  PubMed  Google Scholar 

  14. Onishi Y, Kawamura T, Nakahara Y et al (2017) Factors associated with the relapse of cryptogenic and secondary organizing pneumonia. Respir Investig 55:10–15

    Article  PubMed  Google Scholar 

  15. Yoshinouchi T, Ohtsuki Y, Kubo K, Shikata Y (1995) Clinicopathological study on two types of cryptogenic organizing pneumonitis. Respir Med 89:271–278

    Article  CAS  PubMed  Google Scholar 

  16. Tabaj GC, Fernandez CF, Sabbagh E, Leslie KO (2015) Histopathology of the idiopathic interstitial pneumonias (IIP): a review. Respirology 20:873–883

    Article  PubMed  Google Scholar 

  17. Douglas WW, Tazelaar HD, Hartman TE et al (2001) Polymyositis-dermatomyositis-associated interstitial lung disease. Am J Respir Crit Care Med 164:1182–1185

    Article  CAS  PubMed  Google Scholar 

  18. Epler GR, Colby TV, McLoud TC, Carrington CB, Gaensler EA (1985) Bronchiolitis obliterans organizing pneumonia. N Engl J Med 312:152–158

    Article  CAS  PubMed  Google Scholar 

  19. Kaushik P, Cooper ES, Banda VR, Vatsavai SR, Kaushik R (2005) Bronchiolitis obliterans with organizing pneumonia in rheumatoid arthritis--a fatal case and short review of literature. Rheumatol Int 25:391–393

    Article  PubMed  Google Scholar 

  20. Kim EA, Lee KS, Johkoh T et al (2002) Interstitial lung diseases associated with collagen vascular diseases: radiologic and histopathologic findings. Radiographics 22 Spec No:S151–S165

    Article  PubMed  Google Scholar 

  21. Taylor JG, Bolster MB (2003) Bronchiolitis obliterans with organizing pneumonia associated with scleroderma and scleroderma spectrum diseases. J Clin Rheumatol 9:239–245

    Article  PubMed  Google Scholar 

  22. Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M et al (2011) Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis. Chest 139:893–900

    Article  PubMed  Google Scholar 

  23. Vasu TS, Cavallazzi R, Hirani A, Sharma D, Weibel SB, Kane GC (2009) Clinical and radiologic distinctions between secondary bronchiolitis obliterans organizing pneumonia and cryptogenic organizing pneumonia. Respir Care 54:1028–1032

    PubMed  Google Scholar 

  24. (2000) American Thoracic Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement. American Thoracic Society (ATS), and the European Respiratory Society (ERS). Am J Respir Crit Care Med 161:646–664

  25. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722

    Article  PubMed  Google Scholar 

  26. Zare Mehrjardi M, Kahkouee S, Pourabdollah M (2017) Radio-pathological correlation of organizing pneumonia (OP): a pictorial review. Br J Radiol 90:20160723

    Article  PubMed Central  PubMed  Google Scholar 

  27. Lee JS, Lynch DA, Sharma S, Brown KK, Muller NL (2003) Organizing pneumonia: prognostic implication of high-resolution computed tomography features. J Comput Assist Tomogr 27:260–265

    Article  PubMed  Google Scholar 

  28. Elicker B, Pereira CA, Webb R, Leslie KO (2008) High-resolution computed tomography patterns of diffuse interstitial lung disease with clinical and pathological correlation. J Bras Pneumol 34:715–744

    Article  PubMed  Google Scholar 

  29. Lee SM, Seo JB, Yun J et al (2019) Deep learning applications in chest radiography and computed tomography: current state of the art. J Thorac Imaging 34:75–85

    Article  PubMed  Google Scholar 

  30. Gillies RJ, Kinahan PE, Hricak H (2016) Radiomics: images are more than pictures, they are data. Radiology 278:563–577

    Article  PubMed  Google Scholar 

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Funding

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

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Authors and Affiliations

  1. Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea

    Young Hoon Cho

  2. Department of Thoracic Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Eun Jin Chae & Kyung-Hyun Do

  3. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Jin Woo Song

  4. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Se Jin Jang

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  1. Young Hoon Cho
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Correspondence to Eun Jin Chae.

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The scientific guarantor of this publication is Eun Jin Chae.

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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.

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Cho, Y.H., Chae, E.J., Song, J.W. et al. Chest CT imaging features for prediction of treatment response in cryptogenic and connective tissue disease–related organizing pneumonia. Eur Radiol 30, 2722–2730 (2020). https://doi.org/10.1007/s00330-019-06651-5

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  • DOI: https://doi.org/10.1007/s00330-019-06651-5

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