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Comparison of CT Findings of Non-Tuberculous Mycobacterial Pulmonary Infection: Disease Stable versus Progressed Group비결핵 항산균 폐 질환의 전산화단층촬영 소견: 질환 안정군과 질환 진행군의 비교
Go Eun Yang, MD1, Heon Han, MD1*, Ji Young Hong, MD2, Taek Geun Ohk, MD3
Departments of 1Radiology, 3Emergency Medicine, Kangwon National University Hospital, Chuncheon, Korea2Department of Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
Purpose: To compare initial CT findings of non-tuberculous mycobacteria (NTM) pulmonary infection between stable and progressed groups and determine whether they could be used to predict disease prognosis and treatment response. Materials and Methods: From July 2006 to October 2013, 71 patients with NTM infection were retrospectively reviewed. Lung lesion pattern of CT finding, specific species, disease duration, and follow-up period were analyzed. These patients were classified into NTM stable (n = 46) and progressed (n = 25) groups. Results: The most common CT findings of NTM infection were small nodules (n = 71, 100%) and bronchiectasis (n = 67, 94%). Large consolidation (> 2 cm, n = 34, 48%) and involvement of more than four lobes (n = 49, 69%) were also commonly observed. According to disease prognosis, large consolidation (n = 18, 72%, p = 0.003), cavitary lesion (n = 17, p = 0.002), and involvement of four or more lobes (n = 21, p = 0.044) on CT were significantly more frequent in disease progressed group than that in the stable group. Conclusion: Among common CT findings of NTM disease, some CT findings such as large consolidation, cavitary lesion, and disease extent are good predictors of re-sponse to treatment in NTM pulmonary disease.
Index termsLungNontuberculous MycobacteriaComputed Tomography, X-ray
Received August 7, 2017Revised November 1, 2017Accepted November 7, 2017*Corresponding author: Heon Han, MDDepartment of Radiology, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon 24289, Korea.Tel. 82-33-258-2329 Fax. 82-33-258-2221E-mail: [email protected]
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distri-bution, and reproduction in any medium, provided the original work is properly cited.
pISSN 1738-2637 / eISSN 2288-2928J Korean Soc Radiol 2018;79(2):57-62https://doi.org/10.3348/jksr.2018.79.2.57
Fig. 1. A 76-year-old man with non-tuberculous mycobacteria disease, classified as progressed group. A, B. Axial CT scan shows cavitary lesion (arrow) in left upper lobe (A), and bronchiectasis with peribronchial nodules in both upper lobes (A, B). C, D. Axial CT scan with lung setting image (C) and mediastinal setting image (D) show large consolidation (arrowheads) in left lower lobe.
C D
A B
비결핵 항산균 폐 질환의 전산화단층촬영 소견
60 jksronline.org대한영상의학회지 2018;79(2):57-62
verted group)에서 객담 음전군에 비하여 더 흔하게 나타나 치
료 반응에 대한 질환의 예후를 예측하는 좋은 인자라고 하였다.
본 연구에서는 MAC 이외에도 다양한 비결핵 항산균 균종들
의 영상을 분석하였고, 이전 MAC에 관한 연구와 유사하게 몇
가지 CT 소견이 비결핵 항산균 질환 치료 예후·예측의 인자가
될 수 있다고 볼 수 있다. 또한, 결핵의 과거력이 있는 환자가 유
의하게 진행군에서 높게 나타나, 이 또한 예후·예측에 도움을
줄 수 있을 것으로 보인다. 그러나 치료 과거력과 염증 수치인
ESR/CRP는 연관이 없는 것으로 나타났다.
본 연구에서는 몇 가지 제한점이 있는데, 비결핵 항산균의 종
에 따라 전산화단층촬영 소견을 평가하지 않았다는 점이 있고
이에 대하여는 이전 연구에서 언급된 바가 있어서 분석에 포함
하지 않았다. 또한, 전산화단층촬영 소견 중 기관지 확장은 그
범위에 관계없이 여부만을 판별하여 기관지 확장의 범위에 따
른 예후·예측을 하지는 않았다는 점이 있다. Kuroishi 등(11)에
따르면 이러한 요인도 치료 경과에 유의한 차이가 있는 것으로
보고되어 향후 추가적인 연구가 필요할 것으로 사료된다.
결론적으로, NTM 폐 질환에 있어 몇 가지 흔하게 발견되는
초기 고해상도 CT 소견 중에서 큰 기강 경화와 공동성 병변, 4
폐엽 이상의 넓은 부위의 침범은 질환이 진행되는 환자에서 더
자주 보이는 소견으로 비결핵 항산균 치료에 있어 불량한 예후
를 예측할 수 있는 인자라고 할 수 있으며, 결핵의 과거력도 예
후 예측에 도움을 줄 수 있다고 볼 수 있다.
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Fig. 2. A 68-year-old man with non-tuberculous mycobacteria disease, classified as stable group.A. Normal both upper lobes.B. Mild bronchiectasis in right middle lobe (arrow) and small peribronchial nodules in right middle lobe and left lingular division. C. Small peribronchial nodules in right middle lobe and right lower lobe. D. Mild bronchiectasis in left lingular division (arrow) and peribronchial nodules in both basal lung.
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