CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie pédiatrique, Service de Parasitologie-Mycologie, CIC 1401, F-33600 Pessac, France.
CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie pédiatrique, Service de Parasitologie-Mycologie, CIC 1401, F-33600 Pessac, France; Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, F-33000 Bordeaux, France; Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, F-33000 Bordeaux, France.
J Cyst Fibros. 2019 Jul;18(4):e31-e36. doi: 10.1016/j.jcf.2019.02.002. Epub 2019 Feb 12.
Mucus plugging (MP), central bronchiectasis (CB), and consolidation/atelectasia (CA) are conventional CT signs to diagnose allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF). Hyperattenuating mucus (HAM) has recently been described and may improve diagnostic accuracy. The goal of our study was to compare HAM versus conventional CT signs to diagnose ABPA in CF. Secondary objectives were to determine the optimal threshold of HAM quantitatively and to assess the diagnostic value of HAM using chest radiograph (CXR).
The study was retrospective and included 137 patients with CF, aged >6-year-old. The presence of HAM, CB, MP and CA were determined by two radiologists in consensus. HAM was quantified using an absolute mean density value (AMD) and a ratio between mucus and paraspinal muscle (DRM). Sensitivity (Se), Specificity (Sp) and Youden's J-index were calculated. The Cystic Fibrosis Conference Consensus criteria were chosen as Gold Standard.
23 out of 137 CF patients had ABPA. Using CT, the most sensitive structural alteration was MP (Se = 91%), followed by CB (Se = 87%) and CA (Se = 70%) whereas specificities were 28%, 19% and 58%, respectively. Conversely, HAM had the highest specificity (Sp = 100%) whereas Se was 69%. HAM had the highest Youden's J-index (p < 0.001) Quantitative optimal thresholds were AMD > 78 HU (Se/Sp = 71%/98%) and DRM > 1.3 (Se/Sp = 82%/97%). HAM was unseen using CXR (Se = 0%).
HAM is the most specific CT biomarker of ABPA in CF, with good sensitivity. Our study suggests that characterization of mucus density may improve the accuracy of imaging criteria to diagnose ABPA early.
黏液嵌塞（MP）、中央支气管扩张（CB）和实变/肺不张（CA）是诊断囊性纤维化（CF）中变应性支气管肺曲霉病（ABPA）的常规 CT 征象。最近描述了高衰减黏液（HAM），它可能提高诊断准确性。本研究的目的是比较 HAM 与常规 CT 征象来诊断 CF 中的 ABPA。次要目标是定量确定 HAM 的最佳阈值，并使用胸部 X 线摄影（CXR）评估 HAM 的诊断价值。
该研究为回顾性研究，纳入了 137 名年龄大于 6 岁的 CF 患者。由两位放射科医生通过共识来确定 HAM、CB、MP 和 CA 的存在。通过绝对平均密度值（AMD）和黏液与椎旁肌肉的比值（DRM）来定量 HAM。计算灵敏度（Se）、特异性（Sp）和约登指数。选择囊性纤维化会议共识标准作为金标准。
137 例 CF 患者中有 23 例患有 ABPA。使用 CT，最敏感的结构改变是 MP（Se=91%），其次是 CB（Se=87%）和 CA（Se=70%），而特异性分别为 28%、19%和 58%。相反，HAM 的特异性最高（Sp=100%），而 Se 为 69%。HAM 具有最高的约登指数（p<0.001），定量最佳阈值为 AMD>78 HU（Se/Sp=71%/98%）和 DRM>1.3（Se/Sp=82%/97%）。HAM 在 CXR 中不可见（Se=0%）。
HAM 是 CF 中 ABPA 的最特异 CT 生物标志物，具有良好的灵敏度。我们的研究表明，黏液密度特征分析可能会提高早期诊断 ABPA 的成像标准准确性。
