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Original Research: Chest Infections |

CT Imaging Assessment of Response to Treatment in Chronic Pulmonary Aspergillosis

Cendrine Godet, MD; François Laurent, MD, PhD; Anne Bergeron, MD, PhD; Pierre Ingrand, MD, PhD; Catherine Beigelman-Aubry, MD; Boubou Camara, MD; Vincent Cottin, MD, PhD; Patrick Germaud, MD; Bruno Philippe, MD; Christophe Pison, MD, PhD; Cécile Toper, MD; Marie France Carette, MD; Jean-Pierre Frat, MD; Guillaume Béraud, MD, PhD; France Roblot, MD; Jacques Cadranel, MD, PhD
Author and Funding Information

FUNDING/SUPPORT: This study was funded by grants from Pfizer (Paris, France), ASTELLAS Pharma SAS (France), SOS Oxygène (Nice, France), ISIS Médical (France), and AADAIRC (Poitou-Charentes, France). The funders of this study provided access to the research database, which included collection and management of data. The funders of this study had no role in study design, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data and has final responsibility for the decision to submit for publication.

aService de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France

bService d’Imagerie Médicale, Radiologie Diagnostique et Thérapeutique, Centre de Recherche Cardio-Thoracique, Université Bordeaux, Bordeaux, France

cCHU de Bordeaux, Service d’Imagerie Médicale, Radiologie Diagnostique et Thérapeutique, and Institut National de la Santé et de la Recherche Médicale (INSERM) U1045, Centre de Recherche Cardio-Thoracique, Université Bordeaux, Bordeaux, France

dService de Pneumologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Diderot, Paris, France

eBiostatistics and Clinical Epidemiology Research Team, Unité Mixte de Recherche (UMR) 1153, Centre de Recherche en Epidémiologie et Statistique de Sorbonne Paris Cité (CRESS), Université Paris Diderot, Paris, France

fEpidemiology and Biostatistics, INSERM Centre d’Investigation Clinique (CIC) 1402, Poitiers University Hospital, Poitiers, France

gService de Radiodiagnostic et Radiologie Interventionnelle, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Lausanne, Switzerland

hPôle Thorax et Vaisseaux, Clinique Universitaire de Pneumologie, CHU de Grenoble, Grenoble, France

iService de Pneumologie, Centre National de Référence des Maladies Pulmonaires Rares, CHU de Lyon, Hôpital Louis Pradel, Lyon, France

jUMR754, Université Claude Bernard Lyon 1, Lyon, France

kService de Pneumologie, CHU de Nantes, Nantes, France

lService de Pneumologie, Hôpital René Dubos, Centre Hospitalier Pontoise, Pontoise, France

mUniversité Grenoble Alpes, Saint-Martin-d’Hères, France

nINSERM 1055, Grenoble, France

oService de Pneumologie, Hôpital Tenon, AP-HP, Paris, France

pService de Radiologie, Hôpital Tenon, AP-HP, Paris, France

qUniversité Pierre et Marie Curie (UPMC), Université Paris 06, Sorbonne Université, Paris, France

rService de Réanimation Médicale, CHU de Poitiers, Poitiers, France

sINSERM, CIC 1402, Université de Poitiers, Poitiers, France

tEA2694, Université Droit et Santé Lille 2, Lille, France

uInteruniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium

vFaculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France

wU1070 INSERM, Poitiers, France

CORRESPONDENCE TO: Cendrine Godet, MD, CHU de Poitiers, Service des Maladies Infectieuses et Tropicales, 2 rue de la Milétrie, 86021 Poitiers cedex, France


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(1):139-147. doi:10.1016/j.chest.2016.02.640
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Published online

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 κ, –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.

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