Differentiation of pulmonary complications with extensive ground-glass attenuation on high-resolution CT in immunocompromised patients

Yoshie Kunihiro,Katsuyoshi Ito,Nobuyuki Tanaka,Reo Kawano,Toshikazu Gondo,Tsuneo Matsumoto,Toshiaki Yujiri,Taiga Kobayashi,Makoto Kubo

doi:10.1007/s11604-021-01122-8

Abstract

PurposeThe purpose of this study was to compare the high-resolution CT (HRCT) findings of pulmonary infectious and noninfectious complications with extensive ground-glass attenuation (GGA) in immunocompromised patients.Materials and methodsOne hundred fifty-two immunocompromised patients with pulmonary complications that showed extensive GGA (> 50% of the whole lung on HRCT) were included in this study. The diagnoses of the 152 patients were as follows: pneumocystis pneumonia (PCP), n = 82; drug-induced pneumonia, n = 38; bacterial pneumonia, n = 9; cytomegalovirus pneumonia, n = 6; idiopathic pneumonia syndrome, n = 6; diffuse alveolar hemorrhage (DAH), n = 4; fungal infection, n = 3; tuberculosis, n = 2 and pulmonary edema, n = 2. Two chest radiologists retrospectively evaluated the CT criteria, which consisted of 12 findings.ResultsThe nodule (p = 0.015), the bronchovascular bundle (BVB) thickening (p = 0.001), and the interlobular septum (ILS) thickening (p = 0.002) were significantly infrequent in PCP. The ILS thickening was significantly frequent in drug-induced pneumonia (p < 0.001) though it was also frequent in other noninfectious and infectious diseases. The BVB thickening was significantly frequent in bacterial pneumonia (p = 0.005). The nodule was significantly frequent in DAH (p = 0.049).ConclusionNodules, BVB thickening, and ILS thickening could be useful HRCT findings for the differential diagnosis of pulmonary complications in immunocompromised patients with extensive GGA.

Highlights

Ground-glass attenuation (GGA) or ground-glass opacity (GGO) is defined as increased attenuation of the lung parenchyma without obscuration of the pulmonary vessels on high-resolution CT (HRCT) and is caused by a wide variety of interstitial and alveolar diseases [1, 2]
PPV positive predictive value, NPV negative predictive value, PCP pneumocystis pneumonia, BVB bronchovascular bundle, ILS interlobular septum, DAH diffuse alveolar hemorrhage, AUCarea under the curve (p = 0.005; OR, 10.059; 95% CI, 1.013–99.863; sensitivity, 66.7%; specificity, 79.7%) was identified as an indicator of bacterial pneumonia (Tables 3 and 4)
Our study suggested that differentiation between pulmonary complications with acute or subacute extensive GGA in immunocompromised patients might be possible by evaluating various HRCT findings

Summary

Introduction

Ground-glass attenuation (GGA) or ground-glass opacity (GGO) is defined as increased attenuation of the lung parenchyma without obscuration of the pulmonary vessels on high-resolution CT (HRCT) and is caused by a wide variety of interstitial and alveolar diseases [1, 2]. Pulmonary complications, especially those which show extensive GGA on HRCT, could be major causes of morbidity and mortality in immunocompromised patients. Japanese Journal of Radiology (2021) 39:868–876 pneumonia (PCP), cytomegalovirus pneumonia (CMV-P), and noninfectious diseases, including drug-induced pneumonia, pulmonary edema, diffuse alveolar hemorrhage (DAH), and acute respiratory distress syndrome (ARDS) [3]. The underlying causes of ARDS could include sepsis, pneumonia, and other infectious or noninfectious conditions. In patients treated with hematopoietic stem cell transplantation (HSCT), idiopathic pneumonia syndrome (IPS) could occur as diffuse lung injury [4, 5]. It is important to distinguish between these diseases because the therapeutic strategies are different; it is challenging due to the similarities of the clinical and HRCT findings

Objectives

Methods

Results

Conclusion