Lam Diana L, Kapnadak Siddhartha G, Godwin J David, Kicska Gregory A, Aitken Moira L, Pipavath Sudhakar N
Department of Radiology, University of Washington School of Medicine, Seattle, WA, 98195, USA.
Department of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA.
Clin Respir J. 2018 Feb;12(2):459-466. doi: 10.1111/crj.12536. Epub 2016 Aug 22.
Mycobacterium abscessus infection in cystic fibrosis (CF) patients can lead to poor outcomes. Early diagnosis is important, but there are no studies outlining specific imaging features of M. abscessus in CF.
To describe the computed tomography (CT) findings of early M. abscessus infection in our CF population.
Thirteen CF patients with sputum cultures positive for M. abscessus from 2006 to 2013 were identified at our institution. Clinical characteristics including culture dates and lung function were reviewed. Positive cultures were classified as "disease" versus "colonization" based on published criteria. Chest CT scans were reviewed at times closest to initial infection, and features including bronchiectasis, mucous plugging, consolidation, ground glass opacities, nodules, and cavitation were evaluated. Brody scores were calculated to evaluate extent of CF lung disease.
All patients had bronchiectasis and mucous plugging, with 10 of 13 (76.9%) in an upper lobe distribution. Consolidation was seen in 12 of 13 (92.3%) patients, 8 (61.5%) patients had nodules, and 5 (38.5%) with cavitation. The average Brody score was 59.5, which was no different than previously described CF cohorts without M. abscessus. There were no significant differences between subjects with disease versus colonization.
The most common CT features of early M. abscessus in our CF population include bronchiectasis, mucus plugging, and consolidation, but the findings did not reveal a unique radiologic signature. CT at this initial time point may not distinguish early M. abscessus infection from background lung disease or mycobacterial colonization in CF patients.
囊性纤维化（CF）患者发生脓肿分枝杆菌感染可导致不良预后。早期诊断很重要，但尚无研究概述CF患者中脓肿分枝杆菌的特定影像学特征。
描述我们CF患者群体中早期脓肿分枝杆菌感染的计算机断层扫描（CT）表现。
在我们机构中确定了2006年至2013年间13例痰培养脓肿分枝杆菌呈阳性的CF患者。回顾了包括培养日期和肺功能在内的临床特征。根据已发表的标准，将阳性培养物分为“疾病”与“定植”。在最接近初始感染的时间点回顾胸部CT扫描，并评估包括支气管扩张、黏液嵌塞、实变、磨玻璃影、结节和空洞等特征。计算布罗迪评分以评估CF肺部疾病的程度。
所有患者均有支气管扩张和黏液嵌塞，13例中有10例（76.9%）分布于上叶。13例患者中有12例（92.3%）出现实变，8例（61.5%）患者有结节，5例（38.5%）有空洞。平均布罗迪评分为59.5，与先前描述的无脓肿分枝杆菌的CF队列无异。疾病组与定植组之间无显著差异。
我们CF患者群体中早期脓肿分枝杆菌感染最常见的CT特征包括支气管扩张、黏液嵌塞和实变，但这些表现未显示出独特的放射学特征。在这个初始时间点的CT可能无法将CF患者的早期脓肿分枝杆菌感染与背景肺部疾病或分枝杆菌定植区分开来。
