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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/22551

Title: CT Imaging Assessment of Response to Treatment in Chronic Pulmonary Aspergillosis
Authors: Godet, Cendrine
Laurent, Francois
Bergeron, Anne
Ingrand, Pierre
Beigelman-Aubry, Catherine
Camara, Boubou
Cottin, Vincent
Germaud, Patrick
Philippe, Bruno
Pison, Christophe
Toper, Cécile
Carette, Marie France
Frat, Jean-Pierre
Béraud, Guillaume
Roblot, France
Cadranel, Jacques
Issue Date: 2016
Citation: CHEST, 150(1), p. 139-147
Abstract: BACKGROUND: Long-term antifungal therapy is usually the only treatment option for chronic pulmonary aspergillosis. However, response rates are difficult to compare because the reported clinical, mycologic, or radiologic criteria are not standardized. Objective parameters are therefore needed. To define the most relevant CT imaging variables in assessment of response to treatment, we investigated changes over time in CT imaging variables. METHODS: Changes in CT imaging variables were assessed by systematic analysis of the CT scan findings of 36 patients at diagnosis and 6 months after initiation of treatment. The relevant radiologic variables were determined by selecting those showing significant changes over time. Two experienced thoracic radiologists, blinded for clinical and serologic response, independently performed CT scan analyses. Interreader agreement and concordance between radiologic and clinical response were evaluated. RESULTS: Of the 36 patients, seven experienced clinical deterioration while undergoing therapy. Significantly evolving radiologic variables included cavity and pleural wall thickening (P < .05), which were associated with clinical improvement. There was a strong association between fungus ball disappearance and cavity/pleural wall thickening reduction and clinical improvement (P = .04). There was poor agreement between size changes of cavities or nodules, and clinical evolution (Cohen's k, -0.13 to -0.24). CONCLUSIONS: Variations in cavity and pleural wall thickness may be the most relevant CT imaging variables for assessing response to treatment. Loss of fungus ball is strongly associated with clinical and radiologic improvement, but cavity size changes are unrelated to chronic pulmonary aspergillosis evolution. All these CT imaging variables may be applied in future clinical trials to assess treatment outcome.
Notes: [Beraud, Guillaume; Roblot, France] Ctr Hosp Univ CHU Poitiers, Serv Malad Infectieuses & Tropicales, Poitiers, France. [Laurent, Francois] CHU Bordeaux, Serv Imagerie Med Radiol Diagnost & Therapeut, Bordeaux, France. [Laurent, Francois] Univ Bordeaux, Ctr Rech Cardio Thorac, Serv Imagerie Med Radiol Diagnost & Therapeut, Bordeaux, France. [Laurent, Francois] Univ Bordeaux, Ctr Rech Cardio Thorac, INSERM, U1045, Bordeaux, France. [Bergeron, Anne] Univ Paris Diderot, Serv Pneumol, Hop St Louis, AP HP, Paris, France. [Bergeron, Anne] Univ Paris Diderot, Biostat & Clin Epidemiol Res Team, UMR 1153, Ctr Rech Epidemiol & Stat Sorbonne Paris Cite CRE, Paris, France. [Ingrand, Pierre] Univ Poitiers Hosp, Epidemiol & Biostat, INSERM, CIC 1402, Poitiers, France. [Beigelman-Aubry, Catherine] CHU Vaudois, Serv Radiodiagnost & Radiol Intervent, Lausanne, Switzerland. [Camara, Boubou; Pison, Christophe] CHU Grenoble, Clin Univ Pneumol, Pole Thorax & Vaisseaux, Grenoble, France. [Cottin, Vincent] CHU Lyon, Hop Louis Pradel, Ctr Natl Reference Malad Pulmonaires Rares, Serv Pneumol, Lyon, France. [Cottin, Vincent] Univ Lyon 1, UMR754, Lyon, France. [Germaud, Patrick] CHU Nantes, Serv Pneumol, Nantes, France. [Philippe, Bruno] Ctr Hosp Pontoise, Hop Rene Dubos, Serv Pneumol, Pontoise, France. [Pison, Christophe] Univ Grenoble Alpes, St Martin Dheres, France. [Pison, Christophe] INSERM 1055, Grenoble, France. [Toper, Cecile; Cadranel, Jacques] Hop Tenon, AP HP, Serv Pneumol, Paris, France. [Carette, Marie France] Hop Tenon, AP HP, Serv Radiol, Paris, France. [Carette, Marie France; Cadranel, Jacques] Univ Paris 06, Univ Paris 04, Paris, France. [Frat, Jean-Pierre] CHU Poitiers, Serv Reanimat Med, Poitiers, France. [Frat, Jean-Pierre] Univ Poitiers, INSERM, CIC 1402, Poitiers, France. [Beraud, Guillaume] Univ Lille 2, EA2694, Lille, France. [Beraud, Guillaume] Hasselt Univ, Interuniv Inst Biostat & Stat Bioinformat, Hasselt, Belgium. [Roblot, France] Univ Poitiers, Fac Med & Pharm, Poitiers, France. [Roblot, France] INSERM, U1070, Poitiers, France.
URI: http://hdl.handle.net/1942/22551
DOI: 10.1016/j.chest.2016.02.640
ISI #: 000379220000027
ISSN: 0012-3692
Category: A1
Type: Journal Contribution
Validation: ecoom, 2017
Appears in Collections: Research publications

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