title: CT Imaging Assessment of Response to Treatment in Chronic Pulmonary Aspergillosis.
abstract: Long-term antifungal therapy is usually the only treatment option for chronic pulmonary aspergillosis. However, response rates are difficult to compare because the reported clinical, mycologic, or radiologic criteria are not standardized. Objective parameters are therefore needed. To define the most relevant CT imaging variables in assessment of response to treatment, we investigated changes over time in CT imaging variables.
  
  
  
  Changes in CT imaging variables were assessed by systematic analysis of the CT scan findings of 36 patients at diagnosis and 6 months after initiation of treatment. The relevant radiologic variables were determined by selecting those showing significant changes over time. Two experienced thoracic radiologists, blinded for clinical and serologic response, independently performed CT scan analyses. Interreader agreement and concordance between radiologic and clinical response were evaluated.
  
  
  
  Of the 36 patients, seven experienced clinical deterioration while undergoing therapy. Significantly evolving radiologic variables included cavity and pleural wall thickening (P < .05), which were associated with clinical improvement. There was a strong association between fungus ball disappearance and cavity/pleural wall thickening reduction and clinical improvement (P = .04). There was poor agreement between size changes of cavities or nodules, and clinical evolution (Cohen's κ, -0.13 to -0.24).
  
  
  
  Variations in cavity and pleural wall thickness may be the most relevant CT imaging variables for assessing response to treatment. Loss of fungus ball is strongly associated with clinical and radiologic improvement, but cavity size changes are unrelated to chronic pulmonary aspergillosis evolution. All these CT imaging variables may be applied in future clinical trials to assess treatment outcome.
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France. Electronic address: c.godet@chu-poitiers.fr.
authors.forename: Cendrine
authors.initials: C
authors.lastname: Godet
authors.affiliation: Service d'Imagerie Médicale, Radiologie Diagnostique et Thérapeutique, Centre de Recherche Cardio-Thoracique, Université Bordeaux, Bordeaux, France; CHU de Bordeaux, Service d'Imagerie Médicale, Radiologie Diagnostique et Thérapeutique, and Institut National de la Santé et de la Recherche Médicale (INSERM) U1045, Centre de Recherche Cardio-Thoracique, Université Bordeaux, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Laurent
authors.affiliation: Service de Pneumologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Diderot, Paris, France; Biostatistics and Clinical Epidemiology Research Team, Unité Mixte de Recherche (UMR) 1153, Centre de Recherche en Epidémiologie et Statistique de Sorbonne Paris Cité (CRESS), Université Paris Diderot, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bergeron
authors.affiliation: Epidemiology and Biostatistics, INSERM Centre d'Investigation Clinique (CIC) 1402, Poitiers University Hospital, Poitiers, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ingrand
authors.affiliation: Service de Radiodiagnostic et Radiologie Interventionnelle, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Lausanne, Switzerland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Beigelman-Aubry
authors.affiliation: Pôle Thorax et Vaisseaux, Clinique Universitaire de Pneumologie, CHU de Grenoble, Grenoble, France.
authors.forename: Boubou
authors.initials: B
authors.lastname: Camara
authors.affiliation: Service de Pneumologie, Centre National de Référence des Maladies Pulmonaires Rares, CHU de Lyon, Hôpital Louis Pradel, Lyon, France; UMR754, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Cottin
authors.affiliation: Service de Pneumologie, CHU de Nantes, Nantes, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Germaud
authors.affiliation: Service de Pneumologie, Hôpital René Dubos, Centre Hospitalier Pontoise, Pontoise, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Philippe
authors.affiliation: Pôle Thorax et Vaisseaux, Clinique Universitaire de Pneumologie, CHU de Grenoble, Grenoble, France; Université Grenoble Alpes, Saint-Martin-d'Hères, France; INSERM 1055, Grenoble, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Pison
authors.affiliation: Service de Pneumologie, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Toper
authors.affiliation: Service de Radiologie, Hôpital Tenon, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Université Paris 06, Sorbonne Université, Paris, France.
authors.forename: Marie France
authors.initials: MF
authors.lastname: Carette
authors.affiliation: Service de Réanimation Médicale, CHU de Poitiers, Poitiers, France; INSERM, CIC 1402, Université de Poitiers, Poitiers, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Frat
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France; EA2694, Université Droit et Santé Lille 2, Lille, France; Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Béraud
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France; Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France; U1070 INSERM, Poitiers, France.
authors.forename: France
authors.initials: F
authors.lastname: Roblot
authors.affiliation: Service de Pneumologie, Hôpital Tenon, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Université Paris 06, Sorbonne Université, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cadranel
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000175:diagnosis / Q000188:drug therapy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012698:Serologic Tests / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: CT; chronic pulmonary aspergillosis; radiologic response; treatment outcome