Cendrine Godet1, François Laurent2, Anne Bergeron3, Pierre Ingrand4, Catherine Beigelman-Aubry5, Boubou Camara6, Vincent Cottin7, Patrick Germaud8, Bruno Philippe9, Christophe Pison10, Cécile Toper11, Marie France Carette12, Jean-Pierre Frat13, Guillaume Béraud14, France Roblot15, Jacques Cadranel16. 1. Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France. Electronic address: c.godet@chu-poitiers.fr. 2. Service d'Imagerie Médicale, Radiologie Diagnostique et Thérapeutique, Centre de Recherche Cardio-Thoracique, Université Bordeaux, Bordeaux, France; CHU 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. 3. Service de Pneumologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Diderot, Paris, France; Biostatistics 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. 4. Epidemiology and Biostatistics, INSERM Centre d'Investigation Clinique (CIC) 1402, Poitiers University Hospital, Poitiers, France. 5. Service de Radiodiagnostic et Radiologie Interventionnelle, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Lausanne, Switzerland. 6. Pôle Thorax et Vaisseaux, Clinique Universitaire de Pneumologie, CHU de Grenoble, Grenoble, France. 7. Service de Pneumologie, Centre National de Référence des Maladies Pulmonaires Rares, CHU de Lyon, Hôpital Louis Pradel, Lyon, France; UMR754, Université Claude Bernard Lyon 1, Lyon, France. 8. Service de Pneumologie, CHU de Nantes, Nantes, France. 9. Service de Pneumologie, Hôpital René Dubos, Centre Hospitalier Pontoise, Pontoise, France. 10. Pôle Thorax et Vaisseaux, Clinique Universitaire de Pneumologie, CHU de Grenoble, Grenoble, France; Université Grenoble Alpes, Saint-Martin-d'Hères, France; INSERM 1055, Grenoble, France. 11. Service de Pneumologie, Hôpital Tenon, AP-HP, Paris, France. 12. Service de Radiologie, Hôpital Tenon, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Université Paris 06, Sorbonne Université, Paris, France. 13. Service de Réanimation Médicale, CHU de Poitiers, Poitiers, France; INSERM, CIC 1402, Université de Poitiers, Poitiers, France. 14. Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France; EA2694, Université Droit et Santé Lille 2, Lille, France; Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium. 15. Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France; Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France; U1070 INSERM, Poitiers, France. 16. Service de Pneumologie, Hôpital Tenon, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Université Paris 06, Sorbonne Université, Paris, France.
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 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.
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.
Authors: Christian B Laursen; Jesper Rømhild Davidsen; Lander Van Acker; Helmut J F Salzer; Danila Seidel; Oliver A Cornely; Martin Hoenigl; Ana Alastruey-Izquierdo; Christophe Hennequin; Cendrine Godet; Aleksandra Barac; Holger Flick; Oxana Munteanu; Eva Van Braeckel Journal: J Fungi (Basel) Date: 2020-06-29