CT Imaging Assessment of Response to Treatment in Allergic Bronchopulmonary Aspergillosis in Adults With Bronchial Asthma.

ABPA Allergic Bronchopulmonary Aspergillosis CT computed tomography radiological response treatment outcomes

Journal

Chest

ISSN: 1931-3543

Titre abrégé: Chest

Pays: United States

ID NLM: 0231335

Informations de publication

Date de publication:
20 Feb 2024

Historique:

received: 18 11 2023

revised: 10 02 2024

accepted: 17 02 2024

medline: 23 2 2024

pubmed: 23 2 2024

entrez: 22 2 2024

Statut: aheadofprint

Résumé

One of the major challenges in managing allergic bronchopulmonary aspergillosis (ABPA) remains consistent and reproducible assessment of response to treatment. What are the most relevant changes in computed tomography (CT-scan) parameters over time for assessing response to treatment? In this ancillary study of a randomized clinical trial (NEBULAMB), asthmatic patients with available CT-scan and without exacerbation during a 4-month ABPA exacerbation treatment period (corticosteroids and itraconazole) were included. Changed CT-scan parameters were assessed by systematic analyses of CT-scan findings at initiation (M0) and end of treatment (M4). CT-scans were assessed by two radiologists blinded to the clinical data. Radiological parameters were determined by selecting those showing significant changes over time. Improvement of at least one, without worsening of the others, defined the radiological response. Agreement between radiological changes, clinical and immunologic responses was likewise investigated. Among the 139 originally randomized patients, 132 were included. We identified 5 CT-scan parameters showing significant changes at M4: mucoid impaction extent, mucoid impaction density, centrilobular micronodules, consolidation/ground-glass opacities and bronchial wall thickening (P<0.05). These changes were only weakly associated with one another, except for mucoid impaction extent and density. No agreement was observed between clinical or immunologic and radiological responses, assessed as an overall response, or considering each of the parameters (Cohen's κ, -0.01 to 0.24). Changes in extent and density of mucoid impactions, centrilobular micronodules, consolidation/ground-glass opacities and thickening of the bronchial walls were found to be the most relevant CT-scan parameters to assess radiological response to treatment. A clinical, immunologic and radiological multidimensional approach should be adopted to assess outcomes, probably with a composite definition of response to treatment.

Sections du résumé

BACKGROUND BACKGROUND

One of the major challenges in managing allergic bronchopulmonary aspergillosis (ABPA) remains consistent and reproducible assessment of response to treatment.

RESEARCH QUESTION OBJECTIVE

What are the most relevant changes in computed tomography (CT-scan) parameters over time for assessing response to treatment?

STUDY DESIGN AND METHODS METHODS

In this ancillary study of a randomized clinical trial (NEBULAMB), asthmatic patients with available CT-scan and without exacerbation during a 4-month ABPA exacerbation treatment period (corticosteroids and itraconazole) were included. Changed CT-scan parameters were assessed by systematic analyses of CT-scan findings at initiation (M0) and end of treatment (M4). CT-scans were assessed by two radiologists blinded to the clinical data. Radiological parameters were determined by selecting those showing significant changes over time. Improvement of at least one, without worsening of the others, defined the radiological response. Agreement between radiological changes, clinical and immunologic responses was likewise investigated.

RESULTS RESULTS

Among the 139 originally randomized patients, 132 were included. We identified 5 CT-scan parameters showing significant changes at M4: mucoid impaction extent, mucoid impaction density, centrilobular micronodules, consolidation/ground-glass opacities and bronchial wall thickening (P<0.05). These changes were only weakly associated with one another, except for mucoid impaction extent and density. No agreement was observed between clinical or immunologic and radiological responses, assessed as an overall response, or considering each of the parameters (Cohen's κ, -0.01 to 0.24).

INTERPRETATION CONCLUSIONS

Changes in extent and density of mucoid impactions, centrilobular micronodules, consolidation/ground-glass opacities and thickening of the bronchial walls were found to be the most relevant CT-scan parameters to assess radiological response to treatment. A clinical, immunologic and radiological multidimensional approach should be adopted to assess outcomes, probably with a composite definition of response to treatment.

Identifiants

DOI: 10.1016/j.chest.2024.02.026 PMID: 38387646

pubmed: 38387646

pii: S0012-3692(24)00261-7

doi: 10.1016/j.chest.2024.02.026

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Investigateurs

Hervé Mal (H)

Pierre Le Guen (P)

Clairelyne Dupin (C)

Jean Claude Meurice (JC)

Marion Verdaguer (M)

Joe de Keizer (J)

Céline Delétage-Métreau (C)

Raphael Le Mao (R)

Cécile Tromer (C)

Gaëlle Fajole (G)

Mélanie Rayez (M)

Christel Saint Raymond (CS)

Hubert Gheerbrant (H)

Anne Badatcheff (A)

Christine Person (C)

Julie Macey (J)

Xavier Dermant (X)

Jean-François Boitiaux (JF)

Marine Gosset-Woimant (M)

Carine Metz-Favre (C)

Tristan Degot (T)

Claire Poulet (C)

Elisabeth Popin (E)

Anne Sophie Gamez (AS)

Clément Boissin (C)

Anne Prevotat (A)

Gilles Mangiapan (G)

Danielle Brouquières (D)

Hervé Le Floch (H)

Hélène Morisse-Pradier (H)

Caroline Sattler (C)

Daniela Muti (D)

Patrick Germaud (P)

Stéphanie Dirou (S)

Audrey Paris (A)

Boris Melloni (B)

Julia Ballouhey (J)

Louise Bondeelle (L)

Lucie Laurent (L)

Chantal Belleguic (C)

Mallorie Kerjouan (M)

Gaëtan Deslée (G)

Sandra Dury (S)

Emmanuel Bergot (E)

Romain Magnier (R)

Hugues Morel (H)

Bertrand Lemaire (B)

Cécile Tumino (C)

Agathe Sénéchal (A)

Pascaline Choinier (P)

Antoine Parrot (A)