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Eur Respir J. 2018 Aug 16;52(2). pii: 1800443. doi: 10.1183/13993003.00443-2018. Print 2018 Aug.

Development and validation of a radiological diagnosis model for hypersensitivity pneumonitis.

Author information

1
Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA.
2
Dept of Radiology, University of Michigan, Ann Arbor, MI, USA.
3
Dept of Radiology, Mayo Clinic, Rochester, MN, USA.
4
Dept of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
5
Dept of Pathology, University of Michigan, Ann Arbor, MI, USA.
6
Division of Pulmonary and Critical Medicine, Cornell Medical College, New York, NY, USA.

Abstract

High-resolution computed tomography (HRCT) may be useful for diagnosing hypersensitivity pneumonitis. Here, we develop and validate a radiological diagnosis model and model-based points score.Patients with interstitial lung disease seen at the University of Michigan Health System (derivation cohort) or enrolling in the Lung Tissue Research Consortium (validation cohort) were included. A thin-section, inspiratory HRCT scan was required. Thoracic radiologists documented radiological features.The derivation cohort comprised 356 subjects (33.9% hypersensitivity pneumonitis) and the validation cohort comprised 424 subjects (15.5% hypersensitivity pneumonitis). An age-, sex- and smoking status-adjusted logistic regression model identified extent of mosaic attenuation or air trapping greater than that of reticulation ("MA-AT>Reticulation"; OR 6.20, 95% CI 3.53-10.90; p<0.0001) and diffuse axial disease distribution (OR 2.33, 95% CI 1.31-4.16; p=0.004) as hypersensitivity pneumonitis predictors (area under the receiver operating characteristic curve 0.814). A model-based score >2 (1 point for axial distribution, 2 points for "MA-AT>Reticulation") has specificity 90% and positive predictive value (PPV) 74% in the derivation cohort and specificity 96% and PPV 44% in the validation cohort. Similar model performance is seen with population restriction to those reporting no exposure (score >2: specificity 91%).When radiological mosaic attenuation or air trapping are more extensive than reticulation and disease has diffuse axial distribution, hypersensitivity pneumonitis specificity is high and false diagnosis risk low (<10%), but PPV is diminished in a low-prevalence setting.

PMID:
29946001
PMCID:
PMC6181129
DOI:
10.1183/13993003.00443-2018
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Conflict of interest: M.L. Salisbury reports salary funding from a departmental National Institutes of Health (NIH) training grant. B.J. Bartholmai reports other support from the NIH/National Heart, Lung, and Blood Institute for research related to the Lung Tissue Research Consortium (LTRC), previous to the conduct of the study. S. Murray reports that NIH sponsored grants pay for statistical work carried out for the Pulmonary Division. F.J. Martinez has received grants for chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) studies from NIH, has participated in steering committees for IPF studies for Bayer, Centocor, Gilead and Promedior, has received personal fees (IPF advisory board) from Ikaria, Genentech, Nycomed/Takeda, Pfizer and Vertex, personal fees (IPF CME programmes) from the American Thoracic Society, MedScape and National Association for Continuing Education, personal fees (IPF grand rounds) from Inova Health System, Spectrum Health System and University of Texas Southwestern, personal fees (IPF study DSMB) from Stromedix/Biogen, personal fees (IPF teleconference consultation) from Axon Communications, Johnson & Johnson and Genzyme, personal fees (IPF advisory board) from Boehringer Ingelheim, and personal fees (IPF diagnostic advisor) from Veracyte, during the conduct of the study; and has received personal fees (steering committee COPD study) from Forest, Janssen, GSK and Nycomed/Takeda, personal fees (COPD PRO development) from Amgen, personal fees (COPD advisory board) from Actelion, AstraZeneca, CSA Medical, Ikaria/Bellerophon, Forest, Genentech, GSK, Janssen, Merck, Pearl, Nycomed/Takeda, Pfizer, Roche and Sudler & Hennessey, personal fees (COPD CME programmes) from the American College of Chest Physicians, CME Incite, Center for Healthcare Education, MedScape, Miller Medical, National Association for Continuing Education, Paradigm, Peer Voice, Projects in Knowledge, UpToDate, Wayne State University and Annenberg, personal fees (COPD grand rounds) from Inova Health System, St John's Hospital, St Mary's Hospital and University of Illinois Chicago, personal fees (COPD study DSMB) from GSK, personal fees (COPD FDA mock presentation) from Boehringer Ingelheim, GSK and Ikaria, personal fees (European Respiratory Society (ERS) bronchiectasis presentation) from Bayer, personal fees (ERS COPD presentation) from Nycomed/Takeda, personal fees (COPD consulting teleconference) from Grey Healthcare and Merion, personal fees (COPD book royalties) from Informa, and personal fees (speaking on COPD) from GSK and Forest, outside the submitted work. K.R. Flaherty reports grants from NIH, during the conduct of the study; and reports personal fees for consultancy on IPF from Boehringer Ingelheim, Fibrogen, Genentech, Ikaria, ImmuneWorks, MedImmune, Novartis, Takeda, Vertex, Veracyte, Roche and Biogen, personal fees for consultancy and DSMB on IPF from Gilead, personal fees for employment from Pulmonary Fibrosis Foundation, personal fees for consultancy and grants for clinical trials on IPF from Intermune, and grants for clinical trials on IPF from Bristol-Myers Squibb, outside the submitted work.

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