Shalmon Tamar, Freund Ophir, Wand Ori, Schneer Sonia, Hershko Tzlil, Hadad Yitzhak, Aviram Galit, Bar-Shai Amir, Adir Yochai, Shitrit David, Unterman Avraham
Department of Radiology, Tel Aviv Medical Center, Tel Aviv University, Israel.
Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Israel; Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Israel.
Respir Med. 2025 Jan;236:107901. doi: 10.1016/j.rmed.2024.107901. Epub 2024 Dec 3.
The radiologic criteria of hypersensitivity pneumonitis (HP) guidelines focus on four HP compatible features (HPCF) in high-resolution computed tomography (HRCT): ground glass opacities, mosaic attenuation, air-trapping, and centrilobular nodules. However, evidence to support these criteria are limited.
Consecutive interstitial lung disease (ILD) patients who underwent HRCT between 2016 and 2021 in three medical centers were included. We assessed the prevalence of HPCF in each ILD and their association with HP diagnosis. We evaluated the impact of HPCF amount for HP diagnosis and the performance of the radiologic criteria by the ATS/JRS/ALAT and CHEST HP guidelines.
436 patients with ILD were included (mean age 66, 48 % females), of them, 56 (13 %) with HP. All four HPCF were more prevalent in HP than in non-HP ILD (p < 0.001 for all). In multivariate analysis, air-trapping was the strongest independent predictor (AOR 4.1, 95 % CI 2-8.4, p < 0.001). Centrilobular nodules were present almost exclusively in HP and smoking-related ILD. The amount of HPCF in HRCT had an excellent predictive ability for HP diagnosis (receiver operating characteristic AUC 0.85, 95 % CI 0.80-0.90). The radiologic criteria of both guidelines had high specificity for "typical HP" and high sensitivity for "compatible with HP", although with low positive predictive values. Our findings remained robust even when including only patients that had a diagnostic biopsy.
The presence and amount of HPCF in HRCT predicted HP diagnosis in real-life settings. While current HP radiologic criteria demonstrated good diagnostic performance, our findings highlight areas for future improvement.
过敏性肺炎（HP）指南的放射学标准聚焦于高分辨率计算机断层扫描（HRCT）中的四个HP兼容特征（HPCF）：磨玻璃影、马赛克衰减、空气潴留和小叶中心结节。然而，支持这些标准的证据有限。
纳入2016年至2021年在三个医疗中心接受HRCT检查的连续性间质性肺疾病（ILD）患者。我们评估了每种ILD中HPCF的患病率及其与HP诊断的关联。我们评估了HPCF数量对HP诊断的影响以及美国胸科学会/日本呼吸学会/拉丁美洲胸科协会（ATS/JRS/ALAT）和美国胸科医师学会（CHEST）HP指南的放射学标准的性能。
纳入436例ILD患者（平均年龄66岁，48%为女性），其中56例（13%）患有HP。所有四个HPCF在HP中比在非HP的ILD中更常见（所有p均<0.001）。在多变量分析中，空气潴留是最强的独立预测因素（优势比4.1，95%置信区间2 - 8.4，p<0.001）。小叶中心结节几乎仅见于HP和与吸烟相关的ILD。HRCT中HPCF的数量对HP诊断具有出色的预测能力（受试者操作特征曲线下面积0.85，95%置信区间0.80 - 0.90）。两个指南的放射学标准对“典型HP”具有高特异性，对“与HP兼容”具有高敏感性，尽管阳性预测值较低。即使仅纳入进行了诊断性活检的患者，我们的发现仍然可靠。
HRCT中HPCF的存在和数量可预测现实环境中的HP诊断。虽然当前HP的放射学标准显示出良好的诊断性能，但我们的发现突出了未来改进的领域。
