Development and validation of a radiological diagnosis model for hypersensitivity pneumonitis

Margaret L. Salisbury, Barry H. Gross, Aamer Chughtai, Mohamed Sayyouh, Ella A. Kazerooni, Brian J. Bartholmai, Meng Xia, Susan Murray, Jeffrey L. Myers, Amir Lagstein, Kristine E. Konopka, Elizabeth A. Belloli, Jamie S. Sheth, Eric S. White, Colin Holtze, Fernando J. Martinez, Kevin R. Flaherty

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

High-resolution computed tomography (HRCT) may be useful for diagnosing hypersensitivity pneumonitis. Here, we develop and validate a radiological diagnosis model and modelbased 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 thinsection, 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 statusadjusted 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.

Original languageEnglish (US)
Article number1800443
JournalEuropean Respiratory Journal
Volume52
Issue number2
DOIs
StatePublished - 2018

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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