Dettmer Sabine, Ringshausen Felix C, Fuge Jan, Maske Hannah Louise, Welte Tobias, Wacker Frank, Rademacher Jessica
Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
J Clin Med. 2021 Jun 21;10(12):2736. doi: 10.3390/jcm10122736.
Among patients with bronchiectasis, nontuberculous mycobacterial pulmonary disease (NTM-PD) ranged between 1 and 6% and it is suspected that its prevalence is underestimated. Our aim was to evaluate differences in computed tomography (CT) features in patients with bronchiectasis, with and without NTM-PD, in order to facilitate earlier diagnosis in the future. In addition, we evaluated longitudinal changes after successful NTM-PD treatment. One hundred and twenty-eight CTs performed in adults with bronchiectasis were scored for the involvement, type, and lobar distribution of bronchiectasis, bronchial dilatation, and bronchial wall thickening according to Reiff. In addition, associated findings, such as mucus plugging, tree-in-bud, consolidations, ground-glass opacities, interlobular thickening, intralobular lines, cavities, and atelectasis, were registered. Patients with NTM-PD ( = 36), as defined by ATS/IDSA diagnostic criteria, were compared to bronchiectasis patients without NTM-PD ( = 92). In twelve patients with an available consecutive CT scan after microbiological cure of NTM-PD imaging findings were also scored according to Kim and compared in the course. In patients with NTM-PD, there was a higher prevalence of bronchiectasis in the middle lobes ( < 0.001), extended bronchiolitis ( = 0.032) and more small and large nodules ( < 0.001). Furthermore, cavities turned out to be larger ( = 0.038), and walls thickened ( = 0.019) and extended ( = 0.016). Patients without NTM more often showed peripheral ground-glass opacities (0.003) and interstitial changes ( = 0.001). CT findings decreased after successful NTM-PD treatment in the follow-up CT; however, without statistical significance for most features ( = 0.056), but bronchiolitis was the only significantly reduced score item ( = 0.043). CT patterns in patients with bronchiectasis and NTM-PD differ from those of patients with bronchiectasis without NTM-PD, although the findings are non-specific radiological features. Follow-up CT findings after microbiological cure differed interindividual regarding the decline in imaging features. Our findings may help practitioners to identify NTM-PD in patients with bronchiectasis. Further research is needed regarding the use of CT as a potential imaging biomarker for the evaluation of treatment response.
在支气管扩张症患者中，非结核分枝杆菌肺病（NTM-PD）的发病率在1%至6%之间，人们怀疑其实际患病率被低估了。我们的目的是评估合并和未合并NTM-PD的支气管扩张症患者在计算机断层扫描（CT）特征上的差异，以便在未来实现更早的诊断。此外，我们还评估了NTM-PD成功治疗后的纵向变化。对128例成年支气管扩张症患者的CT扫描结果，根据Reiff标准对支气管扩张的累及情况、类型、叶分布、支气管扩张及支气管壁增厚进行评分。此外，还记录了相关表现，如黏液嵌塞、树芽征、实变、磨玻璃影、小叶间隔增厚、小叶内线、空洞及肺不张。将符合美国胸科学会/美国感染病学会（ATS/IDSA）诊断标准的NTM-PD患者（n = 36）与未合并NTM-PD的支气管扩张症患者（n = 92）进行比较。在12例NTM-PD微生物学治愈后有连续CT扫描结果的患者中，还根据Kim标准对影像表现进行评分并比较病程变化。在NTM-PD患者中，中叶支气管扩张的患病率更高（P < 0.001），细支气管炎范围更广（P = 0.032），大小结节更多（P < 0.001）。此外，空洞更大（P = 0.038），洞壁增厚（P = 0.019）且范围扩大（P = 0.016）。未合并NTM的患者更常出现外周磨玻璃影（P = 0.003）和间质改变（P = 0.001）。在随访CT中，NTM-PD成功治疗后CT表现有所下降；然而，大多数特征无统计学意义（P = 0.056），但细支气管炎是唯一评分显著降低的项目（P = 0.043）。支气管扩张症合并NTM-PD患者的CT表现与未合并NTM-PD的支气管扩张症患者不同，尽管这些表现为非特异性放射学特征。微生物学治愈后的随访CT表现，在影像特征下降方面个体间存在差异。我们的研究结果可能有助于医生在支气管扩张症患者中识别NTM-PD。关于将CT用作评估治疗反应的潜在影像生物标志物，还需要进一步研究。
