CT Imaging Assessment of Response to Treatment in Allergic Bronchopulmonary Aspergillosis in Adults With Bronchial Asthma - Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 Accéder directement au contenu
Article Dans Une Revue Chest Année : 2024

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

1 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
2 UPCité - Université Paris Cité
3 Hôpital Foch [Suresnes]
4 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
5 GETBO - Groupe d'Etude de la Thrombose de Bretagne Occidentale
6 CIC Brest
7 UB - Université de Bordeaux
8 CRCTB - Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux]
9 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
10 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
11 UT - Université de Tours
12 CEPR - Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100
13 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
14 CHU Angers - Centre Hospitalier Universitaire d'Angers
15 Centre médico chirurgical Magellan - Hôpital Haut-Lévêque - CHU de Bordeaux
16 PHERE (UMR_S_1152 / U1152) - Physiopathologie et Epidémiologie des Maladies Respiratoires
17 Centre Hospitalier René Dubos [Pontoise]
18 HUS - Les Hôpitaux Universitaires de Strasbourg
19 AGIR - Agents infectieux, résistance et chimiothérapie - UR UPJV 4294
20 CHU Amiens-Picardie
21 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
22 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
23 Service de Pneumologie et Immuno-Allergologie [CHU LIlle]
24 CIIL - Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204
25 CHU Rouen
26 CHIC - Centre Hospitalier Intercommunal de Créteil
27 Service Pneumologie-Allergologie [CHU Toulouse]
28 CRCM Toulouse - Centre de Ressources et de Compétences en Mucoviscidose [CHU Toulouse]
29 Hôpital Côte de Nacre [CHU Caen]
30 Université Paris-Saclay
31 USI Pneumologie - Service de pneumologie et de soins intensifs respiratoires [AP-HP, Hôpital Bicêtre] [Centre de Référence de l'hypertension pulmonaire sévère]
32 Pôle des Cardiopathies Congénitales du Nouveau-Né à L'adulte - Centre Constitutif Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint-Joseph, Hôpital Marie-Lannelongue, Inserm U999, Université Paris-Saclay
33 Hôpital Marie-Lannelongue
34 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
35 CIC Nantes - Centre d’Investigation Clinique de Nantes
36 ITX-lab - ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291
37 Centre Hospitalier Le Mans (CH Le Mans)
38 HUG - Hôpitaux universitaires de Genève = University Hospitals of Geneva
39 CHU Tenon [AP-HP]
40 SU - Sorbonne Université
Stéphane Dominique
Frédéric Rivière

Résumé

Background: One of the major challenges in managing allergic bronchopulmonary aspergillosis (ABPA) remains consistent and reproducible assessment of response to treatment.Research questionWhat are the most relevant changes in computed tomography (CT-scan) parameters over time for assessing response to treatment?
Study Design and 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: 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: 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.
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Dates et versions

hal-04473459 , version 1 (15-07-2024)

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Cendrine Godet, Anne-Laure Brun, Francis Couturaud, François Laurent, Jean-Pierre Frat, et al.. CT Imaging Assessment of Response to Treatment in Allergic Bronchopulmonary Aspergillosis in Adults With Bronchial Asthma. Chest, 2024, 165 (6), pp.1307-1318. ⟨10.1016/j.chest.2024.02.026⟩. ⟨hal-04473459⟩
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