Development and Validation of a Radiologic Diagnosis Model for Hypersensitivity Pneumonitis
- Margaret L. Salisbury1,
- Barry H. Gross2,
- Aamer Chughtai2,
- Mohamed Sayyouh2,
- Ella A. Kazerooni2,
- Brian B. Bartholmai3,
- Meng Xia4,
- Susan Murray4,
- Jeffrey L Myers5,
- Amir Lagstein5,
- Kristine E Konopka5,
- Elizabeth A. Belloli1,
- Jamie S. Sheth1,
- Eric S. White1,
- Colin Holtze1,
- Fernando J. Martinez6 and
- Kevin R. Flaherty1
- 1University of Michigan, Division of Pulmonary and Critical Care, Ann Arbor, MI
- 2University of Michigan, Department of Radiology, Ann Arbor, MI
- 3Mayo Clinic, Department of Radiology, Rochester, MN
- 4University of Michigan, Department of Biostatistics, Ann Arbor, MI
- 5University of Michigan, Department of Pathology, Ann Arbor, MI
- 6Cornell Medical College Division of Pulmonary and Critical Medicine, New York, NY, United States of America
- Margaret L. Salisbury. 1500 East Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109. E-mail: msalisbu{at}med.umich.edu
Abstract
Rationale: High resolution computed tomography may be useful for diagnosing hypersensitivity pneumonitis (HP). We develop and validate a radiologic diagnosis model and model-based points score.
Methods: Patients with interstitial lung disease seen at University of Michigan (derivation), or enrolling in the Lung Tissue Research Consortium (validation) were included. A thin-section, inspiratory CT was required. Thoracic radiologists documented radiologic features.
Results: The derivation cohort comprised 356 subjects (33.9% HP) and validation cohort 438 (15.2% HP) An age-, gender-, 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, CI 95% 3.53–10.90, p<0.0001) and diffuse axial disease distribution (OR 2.33, CI 95% 1.31–4.16, p=0.004) as HP predictors (AUC=0.814). A model-based score >2 (1 point for axial distribution, 2 for MA-AT>Reticulation) has specificity 90% and PPV 74% in the derivation 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%).
Conclusions: When radiologic MA or AT are more extensive than reticulation and disease has diffuse axial distribution, HP specificity is high and false diagnosis risk low (<10%), but PPV is diminished in a low-prevalence setting.
Abstract
When HRCT shows more mosaic attenuation than reticulation and diffuse axial ILD, false HP diagnosis risk is <10%
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Salisbury reports grants from NIH, during the conduct of the study;.
Conflict of interest: Dr. Gross has nothing to disclose.
Conflict of interest: Dr. Chughtai has nothing to disclose.
Conflict of interest: Dr. Sayyouh has nothing to disclose.
Conflict of interest: Dr. Kazerooni has nothing to disclose.
Conflict of interest: Dr. Bartholmai reports other support from the NIH/NHLBI for research related to the LTRC, previous to the conduct of the study.
Conflict of interest: Ms. Xia has nothing to disclose.
Conflict of interest: Dr. Murray reports grants from NIH, during the conduct of the study;.
Conflict of interest: Dr. Myers has nothing to disclose.
Conflict of interest: Dr. Lagstein has nothing to disclose.
Conflict of interest: Dr. Konopka has nothing to disclose.
Conflict of interest: Dr. Belloli has nothing to disclose.
Conflict of interest: Dr. Sheth has nothing to disclose.
Conflict of interest: Dr. White has nothing to disclose.
Conflict of interest: Dr. Holtze has nothing to disclose.
Conflict of interest: Dr. Martinez reports grants from National Institutes of Health, non-financial support from Bayer, non-financial support from Centocor, non-financial support from Gilead, non-financial support from Promedior, personal fees from Ikaria, personal fees from Genentech, personal fees from Nycomed/Takeda, personal fees from Pfizer, personal fees from Vertex, personal fees from American Thoracic Society, personal fees from Inova Health System, personal fees from MedScape, personal fees from Spectrum Health System, personal fees from University of Texas Southwestern, personal fees from Stromedix/Biogen, personal fees from Axon Communications, from Johnson & Johnson, from Genzyme, personal fees from National Association for Continuing Education, personal fees from Boehringer Ingelheim, personal fees from Veracyte, during the conduct of the study; personal fees from Forest, personal fees from Janssens, personal fees from GSK, personal fees from Nycomed/Takeda, personal fees from Actelion, personal fees from Amgen, personal fees from Astra Zeneca, personal fees from CSA Medical, personal fees from Ikaria/Bellerophon, personal fees from Forest, personal fees from Genentech, personal fees from GSK, personal fees from Janssens, personal fees from Merck, personal fees from Pearl, personal fees from Nycomed/Takeda, personal fees from Pfizer, personal fees from Roche, personal fees from Sudler & Hennessey, personal fees from American College of Chest Physicians, personal fees from CME Incite, personal fees from Center for Healthcare Education, personal fees from Inova Health System, personal fees from MedScape, personal fees from Miller Medical, personal fees from National Association for Continuing Education, personal fees from Paradigm, personal fees from Peer Voice, personal fees from Projects in Knowledge, personal fees from St. John's Hospital, personal fees from St. Mary's Hospital, personal fees from University of Illinois Chicago, personal fees from UpToDate, personal fees from Wayne State University, personal fees from GSK, personal fees from Boehringer Ingelheim, personal fees from GSK, personal fees from Ikaria, personal fees from Bayer, personal fees from Nycomed/Takeda, personal fees from Grey Healthcare, personal fees from Merion, personal fees from Informa, personal fees from Annenberg, personal fees from GSK , personal fees from Forest, outside the submitted work; .
Conflict of interest: Dr. Flaherty reports grants from NIH, during the conduct of the study; personal fees from Boehringer Ingelheim, personal fees from Fibrogen, personal fees from Genentech, personal fees from Gilead, personal fees from Ikaria, personal fees from ImmuneWorks, personal fees from MedImmune, personal fees from Novartis, personal fees from Takeda, personal fees from Vertex, personal fees from Veracyte, personal fees from Roche, personal fees from Pulmonary Fibrosis Foundation, grants from ImmuneWorks, grants and personal fees from Intermune, grants from Bristol-Myers Squibb, outside the submitted work; .
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