Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Seoul Paik Hospital, Inje University, Seoul, South Korea.
Eur Radiol. 2021 Oct;31(10):7283-7294. doi: 10.1007/s00330-021-07868-z. Epub 2021 Mar 31.
To evaluate the clinico-radiological findings of acute fibrinous and organizing pneumonia (AFOP) in the literature according to whether a surgical or non-surgical biopsy was performed, as well as to identify prognostic predictors.
We searched the Embase and OVID-MEDLINE databases to identify studies that presented CT findings of AFOP and had extractable individual patient data. We compared the clinical and CT findings of the patients depending on whether a surgical or non-surgical biopsy was performed and identified survival predictors using a multivariate logistic regression analysis.
Eighty-one patients (surgical biopsy, n = 52; non-surgical biopsy, n = 29) from 63 studies were included. The surgical biopsy group frequently experienced an acute fulminant presentation (p = .011) and dyspnea (p = .001) and less frequently had a fever (p = .006) than the non-surgical biopsy group. The surgical biopsy group had a worse prognosis than the non-surgical biopsy group in terms of mechanical ventilation and mortality (both, p = .023). For survival analysis, the patients with the predominant CT finding of patchy or mass-like air-space consolidation survived more frequently (p < .001) than those with other CT findings. For prognostic predictors, subacute indolent presentation (p = .001) and patchy or mass-like air-space consolidation on CT images (p = .002) were independently associated with good survival.
Approximately one-third of alleged AFOP cases in the literature were diagnosed via non-surgical biopsy, but those cases had different symptomatic presentations and prognosis from surgically proven AFOP. Subacute indolent presentation and patchy or mass-like air-space consolidation at the presentation on CT images indicated a good prognosis in patients with AFOP.
• Acute fibrinous and organizing pneumonia (AFOP) cases diagnosed via non-surgical biopsy had different symptomatic presentations and prognosis from surgically proven AFOP. • Subacute indolent presentation and patchy or mass-like air-space consolidation on CT images indicated a good prognosis in patients with acute fibrinous and organizing pneumonia.
根据是否进行手术或非手术活检,评估文献中急性纤维蛋白性和机化性肺炎(AFOP)的临床-放射学表现,并确定预后预测因素。
我们检索了 Embase 和 OVID-MEDLINE 数据库,以确定提出 AFOP 的 CT 表现并有可提取的个体患者数据的研究。我们比较了进行手术和非手术活检的患者的临床和 CT 表现,并使用多变量逻辑回归分析确定了生存预测因素。
纳入了 63 项研究中的 81 名患者(手术活检组,n=52;非手术活检组,n=29)。手术活检组常表现为急性暴发性(p=0.011)和呼吸困难(p=0.001),而较少发热(p=0.006)。与非手术活检组相比,手术活检组在机械通气和死亡率方面预后较差(均,p=0.023)。对于生存分析,CT 表现为斑片状或块状气腔实变的患者比其他 CT 表现的患者存活更频繁(p<0.001)。对于预后预测因素,亚急性惰性表现(p=0.001)和 CT 图像上的斑片状或块状气腔实变(p=0.002)与良好的生存独立相关。
文献中约有三分之一的所谓 AFOP 病例是通过非手术活检诊断的,但这些病例的症状表现和预后与手术证实的 AFOP 不同。亚急性惰性表现和 CT 图像上的斑片状或块状气腔实变提示 AFOP 患者预后良好。
• 通过非手术活检诊断的急性纤维蛋白性和机化性肺炎(AFOP)病例的症状表现和预后与手术证实的 AFOP 不同。
• CT 图像上的亚急性惰性表现和斑片状或块状气腔实变提示急性纤维蛋白性和机化性肺炎患者预后良好。