Lee Han Na, Kim Mi Young, Koo Hyun Jung, Kim Sung-Soo, Yoon Dok Hyun, Lee Jae Cheol, Song Jin Woo
From the Department of Radiology and Research Institute of Radiology (HNL, MYK, HJK); Department of Healthcare Management, Cheongju University, Cheongju, South Korea (SSK); Oncology (DHY, JCL); and Pulmonary and Critical Care Medicine (JWS), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Medicine (Baltimore). 2016 Jan;95(2):e2460. doi: 10.1097/MD.0000000000002460.
To describe the computed tomography (CT) features of chemotherapy-induced interstitial pneumonitis (CIIP) with longitudinal follow-up.The study was approved by the local ethics committee. One hundred consecutive patients with CIIP between May 2005 and March 2015 were retrospectively enrolled. The initial CT was reviewed by 2 independent chest radiologists and categorized into 1 of 4 CT patterns in accordance with the 2013 guidelines for idiopathic interstitial pneumonia: nonspecific interstitial pneumonia (NSIP), organizing pneumonia (OP), hypersensitivity pneumonitis (HP) mimicking desquamative interstitial pneumonitis, and diffuse alveolar damage (DAD). We assessed semiquantitative analysis on a 5% scale to assess the extent of parenchymal abnormalities (emphysema, reticulation, ground-glass opacity, consolidation, honeycombing cyst) and their distribution on initial (n = 100), subsequent (n = 87), and second follow-up CT (n = 48). Interval changes in extent on follow-up CT were compared using paired t test. The clinic-radiologic factors were compared between Group 1 (NSIP and OP patterns) and Group 2 (HP and DAD patterns) using χ and independent t tests.The most common pattern of CIIP on the initial CT was HP (51%), followed by NSIP (23%), OP (20%), and DAD (6%). Diffuse ground-glass opacity was the most common pulmonary abnormality. The predominant distribution was bilateral (99%) and symmetric (82%), with no craniocaudal (60%) or axial (79%) dominance. Subsequent and second follow-up CTs showed decreased extent of total pulmonary abnormalities (P < 0.001, respectively). In comparison with Group 1 CIIP, Group 2 CIIP was more likely to be caused by molecularly targeted drugs (P = 0.030), appeared earlier (P = 0.034), and underwent more complete resolution (P < 0.001). Use of a CT pattern-recognition approach to CIIP is appropriate and practical in interpreting radiological findings.
通过长期随访描述化疗诱导的间质性肺炎（CIIP）的计算机断层扫描（CT）特征。本研究获当地伦理委员会批准。回顾性纳入2005年5月至2015年3月期间连续100例CIIP患者。由2名独立的胸部放射科医生对初始CT进行评估，并根据2013年特发性间质性肺炎指南将其分为4种CT模式之一：非特异性间质性肺炎（NSIP）、机化性肺炎（OP）、类似脱屑性间质性肺炎的过敏性肺炎（HP）和弥漫性肺泡损伤（DAD）。我们采用5%分级的半定量分析来评估实质异常（肺气肿、网状影、磨玻璃影、实变、蜂窝状囊肿）的范围及其在初始（n = 100）、后续（n = 87）和第二次随访CT（n = 48）上的分布。使用配对t检验比较随访CT上范围的间隔变化。使用χ检验和独立t检验比较第1组（NSIP和OP模式）和第2组（HP和DAD模式）之间的临床放射学因素。初始CT上CIIP最常见的模式是HP（51%），其次是NSIP（23%）、OP（20%）和DAD（6%）。弥漫性磨玻璃影是最常见的肺部异常。主要分布为双侧（99%）且对称（82%），无颅尾（60%）或轴向（79%）优势。后续和第二次随访CT显示全肺异常范围减小（P均<0.001）。与第1组CIIP相比，第2组CIIP更可能由分子靶向药物引起（P = 0.030），出现更早（P = 0.034），且完全缓解更多（P < 0.001）。采用CT模式识别方法诊断CIIP在解读影像学结果方面是合适且实用的。
