{"title":"过敏性支气管肺霉菌病支气管中的高衰减粘液。","authors":"Shigeaki Hattori, Tsuyoshi Oguma, Takashi Ishiguro, Junko Suzuki, Koichi Fukunaga, Terufumi Shimoda, Hirokazu Kimura, Yasushi Obase, Naoki Okada, Jun Tanaka, Asako Kitahara, Katsuyoshi Tomomatsu, Yoshiki Shiraishi, Koichiro Asano","doi":"10.1111/myc.13705","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>High-attenuation mucus (HAM) is a specific manifestation of allergic bronchopulmonary mycosis (ABPM) on chest computed tomography (CT).</p><p><strong>Objectives: </strong>To compare the diagnostic accuracy of the two definitions of HAM and to clarify the clinical and radiographic characteristics of HAM-positive and HAM-negative ABPM.</p><p><strong>Methods: </strong>CT images at the diagnosis of ABPM using Asano's criteria were retrospectively analysed. In Study #1, radiographic data obtained using the same CT apparatus in a single institute were analysed to determine the agreement between the two definitions of HAM: a mucus plug that is visually denser than the paraspinal muscles or that with a radiodensity ≥70 Hounsfield units. In Study #2, HAM was diagnosed by comparison with the paraspinal muscles in patients with ABPM reporting to 14 medical institutes in Japan.</p><p><strong>Results: </strong>In Study #1, 93 mucus plugs from 26 patients were analysed. A substantial agreement for HAM diagnosis was observed between the two methods, with a κ coefficient of 0.72. In Study #2, 60 cases of ABPM were analysed; mucus plugs were present in all cases and HAM was diagnosed in 45 (75%) cases. The median A. fumigatus-specific IgE titre was significantly lower in HAM-positive patients than in HAM-negative patients (2.5 vs. 24.3 U<sub>A</sub> /mL, p = .004). Nodular shadows were observed more frequently in the airways distal to HAM than in those distal to non-HAM mucus plugs (59% vs. 32%, p < .001).</p><p><strong>Conclusion: </strong>In conclusion, agreement between the two methods to diagnose HAM was substantial. HAM was associated with some immunological and radiographic characteristics, including lower levels of sensitization to A. fumigatus and the presence of distal airway lesions.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 2","pages":"e13705"},"PeriodicalIF":4.1000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"High attenuation mucus in bronchi with allergic bronchopulmonary mycosis.\",\"authors\":\"Shigeaki Hattori, Tsuyoshi Oguma, Takashi Ishiguro, Junko Suzuki, Koichi Fukunaga, Terufumi Shimoda, Hirokazu Kimura, Yasushi Obase, Naoki Okada, Jun Tanaka, Asako Kitahara, Katsuyoshi Tomomatsu, Yoshiki Shiraishi, Koichiro Asano\",\"doi\":\"10.1111/myc.13705\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>High-attenuation mucus (HAM) is a specific manifestation of allergic bronchopulmonary mycosis (ABPM) on chest computed tomography (CT).</p><p><strong>Objectives: </strong>To compare the diagnostic accuracy of the two definitions of HAM and to clarify the clinical and radiographic characteristics of HAM-positive and HAM-negative ABPM.</p><p><strong>Methods: </strong>CT images at the diagnosis of ABPM using Asano's criteria were retrospectively analysed. In Study #1, radiographic data obtained using the same CT apparatus in a single institute were analysed to determine the agreement between the two definitions of HAM: a mucus plug that is visually denser than the paraspinal muscles or that with a radiodensity ≥70 Hounsfield units. In Study #2, HAM was diagnosed by comparison with the paraspinal muscles in patients with ABPM reporting to 14 medical institutes in Japan.</p><p><strong>Results: </strong>In Study #1, 93 mucus plugs from 26 patients were analysed. A substantial agreement for HAM diagnosis was observed between the two methods, with a κ coefficient of 0.72. In Study #2, 60 cases of ABPM were analysed; mucus plugs were present in all cases and HAM was diagnosed in 45 (75%) cases. The median A. fumigatus-specific IgE titre was significantly lower in HAM-positive patients than in HAM-negative patients (2.5 vs. 24.3 U<sub>A</sub> /mL, p = .004). Nodular shadows were observed more frequently in the airways distal to HAM than in those distal to non-HAM mucus plugs (59% vs. 32%, p < .001).</p><p><strong>Conclusion: </strong>In conclusion, agreement between the two methods to diagnose HAM was substantial. HAM was associated with some immunological and radiographic characteristics, including lower levels of sensitization to A. fumigatus and the presence of distal airway lesions.</p>\",\"PeriodicalId\":18797,\"journal\":{\"name\":\"Mycoses\",\"volume\":\"67 2\",\"pages\":\"e13705\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2024-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Mycoses\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/myc.13705\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"DERMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Mycoses","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/myc.13705","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:高亮度粘液(HAM)是胸部计算机断层扫描(CT)中过敏性支气管肺霉菌病(ABPM)的一种特殊表现:比较两种HAM定义的诊断准确性,明确HAM阳性和HAM阴性ABPM的临床和影像学特征:采用浅野标准对诊断 ABPM 的 CT 图像进行回顾性分析。在研究 1 中,分析了在一家研究所使用同一台 CT 仪器获得的影像学数据,以确定两种 HAM 定义之间的一致性:视觉密度高于脊柱旁肌肉的粘液栓塞或放射密度≥70 Hounsfield 单位的粘液栓塞。在第 2 项研究中,HAM 是通过与向日本 14 家医疗机构报告的 ABPM 患者的脊柱旁肌肉进行比较来诊断的:在 1 号研究中,对 26 名患者的 93 个粘液栓进行了分析。两种方法的 HAM 诊断结果基本一致,κ系数为 0.72。研究 2 分析了 60 例 ABPM 病例;所有病例均有粘液栓,其中 45 例(75%)确诊为 HAM。HAM 阳性患者的烟曲霉特异性 IgE 滴度中位数明显低于 HAM 阴性患者(2.5 vs. 24.3 UA /mL,p = .004)。与非 HAM 粘液栓远端相比,在 HAM 远端气道中更常观察到结节状阴影(59% 对 32%,P 结论:HAM 阳性患者的结节状阴影比非 HAM 阴性患者的结节状阴影更多:总之,两种诊断 HAM 的方法之间存在很大的一致性。HAM 与一些免疫学和放射学特征有关,包括对烟曲霉菌的致敏程度较低和存在远端气道病变。
High attenuation mucus in bronchi with allergic bronchopulmonary mycosis.
Background: High-attenuation mucus (HAM) is a specific manifestation of allergic bronchopulmonary mycosis (ABPM) on chest computed tomography (CT).
Objectives: To compare the diagnostic accuracy of the two definitions of HAM and to clarify the clinical and radiographic characteristics of HAM-positive and HAM-negative ABPM.
Methods: CT images at the diagnosis of ABPM using Asano's criteria were retrospectively analysed. In Study #1, radiographic data obtained using the same CT apparatus in a single institute were analysed to determine the agreement between the two definitions of HAM: a mucus plug that is visually denser than the paraspinal muscles or that with a radiodensity ≥70 Hounsfield units. In Study #2, HAM was diagnosed by comparison with the paraspinal muscles in patients with ABPM reporting to 14 medical institutes in Japan.
Results: In Study #1, 93 mucus plugs from 26 patients were analysed. A substantial agreement for HAM diagnosis was observed between the two methods, with a κ coefficient of 0.72. In Study #2, 60 cases of ABPM were analysed; mucus plugs were present in all cases and HAM was diagnosed in 45 (75%) cases. The median A. fumigatus-specific IgE titre was significantly lower in HAM-positive patients than in HAM-negative patients (2.5 vs. 24.3 UA /mL, p = .004). Nodular shadows were observed more frequently in the airways distal to HAM than in those distal to non-HAM mucus plugs (59% vs. 32%, p < .001).
Conclusion: In conclusion, agreement between the two methods to diagnose HAM was substantial. HAM was associated with some immunological and radiographic characteristics, including lower levels of sensitization to A. fumigatus and the presence of distal airway lesions.
期刊介绍:
The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi.
Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.