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Development and validation of a radiological diagnosis model for hypersensitivity pneumonitis
- Source :
- European Respiratory Journal. 52:1800443
- Publication Year :
- 2018
- Publisher :
- European Respiratory Society (ERS), 2018.
-
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-ATReticulation"; OR 6.20, 95% CI 3.53-10.90; p0.0001) 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 score2 (1 point for axial distribution, 2 points for "MA-ATReticulation") 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 (score2: 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.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Population
Air trapping
Logistic regression
Sensitivity and Specificity
Severity of Illness Index
03 medical and health sciences
0302 clinical medicine
Severity of illness
medicine
Humans
030212 general & internal medicine
education
Lung
Aged
Retrospective Studies
education.field_of_study
business.industry
Interstitial lung disease
Retrospective cohort study
Middle Aged
medicine.disease
Logistic Models
030228 respiratory system
Radiological weapon
Female
Radiology
medicine.symptom
Tomography, X-Ray Computed
business
Hypersensitivity pneumonitis
Alveolitis, Extrinsic Allergic
Subjects
Details
- ISSN :
- 13993003 and 09031936
- Volume :
- 52
- Database :
- OpenAIRE
- Journal :
- European Respiratory Journal
- Accession number :
- edsair.doi.dedup.....efec0093cd2a936b24481a8653c1a332