Department of Diagnostic Radiology, Carmel Medical Center, Haifa, Israel.
B. Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.
Lung. 2020 Aug;198(4):715-722. doi: 10.1007/s00408-020-00371-0. Epub 2020 Jun 26.
Non-tuberculous mycobacteria pulmonary disease (NTM-pd) commonly complicates bronchiectasis. However, clinical and radiological features of NTM-pd and bronchiectasis are very similar. We aimed to develop a radiologic prediction tool for bronchiectasis to identify NTM-pd.
We reviewed clinical, laboratory and radiological data in patients with bronchiectasis. Radiologic features on CT scans and the individual components of the Bhalla scoring system were compared between people with and without NTM-pd. Logistic regression and receiver-operating curve (ROC) analysis were performed to predict NTM-pd.
People with NTM-pd had more pulmonary segments with bronchiectasis (13 ± 5 vs. 11 ± 5, p = 0.03), presence of mucus plugging (47% vs. 19%, p < 0.0001) and tree in bud infiltrates (53% vs. 28%, p = 0.004). The total modified- Bhalla score was worse among people with NTM-pd (median [IQR] 11[9,13] vs. 9[8,12], p = 0.03). Logistic regression identified the number of pulmonary segments involved, presence of bullae, consolidations, and a total score of 10 or more to be independently associated with presence of NTM-pd. ROC analysis with radiographic variables only identified an AUC of 0.706 (95% CI 0.644-0.762). When people with chronic Pseudomonas infection were excluded from the ROC analysis, prediction for NTM was improved: AUC = 0.87 (95% CI 0.796-0.945).
Radiological features together with advanced age and female gender may predict NTM-pd among people with bronchiectasis. Infection with Pseudomonas aeruginosa may resemble NTM radiographically, and this prediction rule may better differentiate people with and without NTM-pd when Pseudomonas infection is not present.
非结核分枝杆菌肺病（NTM-pd）常并发支气管扩张症。然而，NTM-pd 和支气管扩张症的临床和影像学特征非常相似。我们旨在开发一种支气管扩张症的放射预测工具，以识别 NTM-pd。
我们回顾了支气管扩张症患者的临床、实验室和影像学数据。比较了有和无 NTM-pd 的患者 CT 扫描上的放射学特征和 Bhalla 评分系统的各个组成部分。进行逻辑回归和接受者操作特征曲线（ROC）分析以预测 NTM-pd。
患有 NTM-pd 的患者的支气管扩张症肺段数更多（13 ± 5 比 11 ± 5，p = 0.03），黏液嵌塞（47%比 19%，p < 0.0001）和树芽浸润（53%比 28%，p = 0.004）的存在更多。患有 NTM-pd 的患者的改良-Bhalla 总评分更差（中位数[IQR] 11[9,13]比 9[8,12]，p = 0.03）。逻辑回归确定受累肺段数、大疱、实变和总分 10 分或更高与 NTM-pd 的存在独立相关。仅使用放射学变量进行 ROC 分析，AUC 为 0.706（95%CI 0.644-0.762）。当从 ROC 分析中排除慢性铜绿假单胞菌感染的患者时，对 NTM 的预测得到改善：AUC = 0.87（95%CI 0.796-0.945）。
放射学特征以及年龄较大和女性可能预测支气管扩张症患者中的 NTM-pd。铜绿假单胞菌感染可能在影像学上与 NTM 相似，并且当不存在铜绿假单胞菌感染时，该预测规则可能更好地区分有和无 NTM-pd 的患者。
