Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Division of Internal Medicine, Ishikawa-ken Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, 920-0353, Japan.
Eur Radiol. 2020 Jun;30(6):3268-3276. doi: 10.1007/s00330-020-06664-5. Epub 2020 Feb 11.
This study was conducted in order to identify imaging features on three-dimensional computed tomography (CT) of unexplained chronic cough (UCC) patients with positive sputum cultures for filamentous Basidiomycetes (f-BM).
UCC outpatients who had been given various questionnaires for cough, pulmonary function tests, and fungal cultures of sputum were evaluated. Multidetector row CT (MDCT) was performed for three-dimensional CT analysis of the lungs. Retrospective analysis was carried out with three groups: f-BM culture-positive group, other fungal culture-positive group, and culture-negative group. The Kruskal-Wallis test, analysis of variance, Fischer exact test, χ test, Student's t test, Mann-Whitney U test, Spearman's correlation coefficient, and Dunn-Bonferroni post hoc method were used for statistical analysis.
Of the 50 patients, 3 were excluded and the remaining 47 were included in the analysis. There were no significant differences in respiratory function or clinical characteristics among the three groups. The common features on high-resolution CT (HRCT) included tree-in-bud (TIB) pattern, multiple centrilobular nodules, and bronchial wall thickening. Bronchiolar mucus plugs were detected in 7 (15%) of 47 cases. Bronchiole wall thickness and %FEV appeared to be slightly correlated (p = 0.033, r = 0.357). The bronchiole walls were significantly thicker when mucus plugs were found (p = 0.010). Bronchiolar walls were the thickest and the score of mucus plugs was the highest in patients with f-BM culture-positive sputum (p = 0.008).
Imaging findings for identifying f-BM culture-positive fungus-associated chronic cough (FACC) patients include high mucus plug scores and bronchiolar wall thickening on three-dimensional CT.
• Three-dimensional computed tomography helps clinicians assess patients with unexplained chronic cough and identify those with fungus-associated chronic cough. • A retrospective single-center study showed that computed tomography images in patients with filamentous Basidiomycetes cultured from sputum had mucus plugs and bronchiolar wall thickening. • UCC patients with sputum cultures positive for filamentous Basidiomycetes may have fine airway lesions that could not be detected without three-dimensional computed tomography.
本研究旨在识别三维计算机断层扫描（CT）在不明原因慢性咳嗽（UCC）患者中的影像学特征，这些患者的痰液丝状担子菌（f-BM）培养阳性。
对接受各种咳嗽问卷、肺功能检查和痰液真菌培养的 UCC 门诊患者进行评估。对患者进行多排 CT（MDCT）进行肺部三维 CT 分析。对 f-BM 培养阳性组、其他真菌培养阳性组和培养阴性组进行回顾性分析。采用 Kruskal-Wallis 检验、方差分析、Fisher 确切检验、卡方检验、学生 t 检验、Mann-Whitney U 检验、Spearman 相关系数和 Dunn-Bonferroni 事后检验方法进行统计学分析。
50 例患者中，有 3 例被排除，其余 47 例被纳入分析。三组间呼吸功能或临床特征无显著差异。高分辨率 CT（HRCT）的常见特征包括树芽征（TIB）、多发小叶中心结节和支气管壁增厚。47 例中发现支气管黏液栓 7 例（15%）。细支气管壁厚度和 %FEV 似乎略有相关（p=0.033，r=0.357）。当发现黏液栓时，细支气管壁明显增厚（p=0.010）。在 f-BM 培养阳性的痰液患者中，细支气管壁最厚，黏液栓评分最高（p=0.008）。
识别 f-BM 培养阳性真菌相关慢性咳嗽（FACC）患者的影像学发现包括三维 CT 上高黏液栓评分和细支气管壁增厚。
• 三维计算机断层扫描有助于临床医生评估不明原因慢性咳嗽患者，并识别真菌相关慢性咳嗽患者。• 一项回顾性单中心研究显示，丝状担子菌培养阳性的慢性咳嗽患者 CT 图像有黏液栓和细支气管壁增厚。• 未经三维 CT 检查，UCC 患者可能存在无法检测到的细支气管病变。
