Potential role of CT-textural features for differentiation between viral interstitial pneumonias, pneumocystis jirovecii pneumonia and diffuse alveolar hemorrhage in early stages of disease: a proof of principle

BMC Medical Imaging

Jan Fritz¹  Marius Horger²  Wolfgang Maximilian Thaiss²  Michael Haap³  Robert Beck⁴  Meinrad Beer⁵  Christopher Kloth⁵ 

[1] 0000 0001 2171 9311, grid.21107.35, Russell H. Morgan, Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC, 3140A, 21287, Baltimore, MD, USA;0000 0001 2190 1447, grid.10392.39, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany;0000 0001 2190 1447, grid.10392.39, Department of Internal Medicine IV, Medical Intensive Care Unit, University of Tübingen, Otfried Müller Str. 10, 72076, Tübingen, Germany;0000 0001 2190 1447, grid.10392.39, Institute of Medical Virology, Eberhard-Karls-University, Elfriede-Aulhorn-Str. 6, 72076, Tübingen, Germany;grid.410712.1, Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany;

关键词: HRCT;    Pneumonia;    Texture analysis;    Pneumocystis jirovecii;   

DOI  :  10.1186/s12880-019-0338-0

来源: publisher

【 摘 要 】

BackgroundPulmonary involvement is common in several infectious and non-infectious diagnostic settings. Imaging findings consistently overlap and are therefore difficult to differentiate by chest-CT. The aim of this study was to evaluate the role of CT-textural features(CTTA) for discrimination between atypical viral (respiratory-syncitial-virus(RSV) and herpes-simplex-1-virus (HSV1)), fungal (pneumocystis-jirovecii-pneumonia(PJP)) interstitial pneumonias and alveolar hemorrhage.MethodsBy retrospective single-centre analysis we identified 46 consecutive patients (29 m) with RSV(n = 5), HSV1(n = 6), PJP(n = 21) and lung hemorrhage(n = 14) who underwent unenhanced chest CTs in early stages of the disease between 01/2016 and 02/2017. All cases were confirmed by microbiologic direct analysis of bronchial lavage. On chest-CT-scans, the presence of imaging features like ground-glass opacity(GGO), crazy-paving, air-space consolidation, reticulation, bronchial wall thickening and centrilobular nodules were described. A representative large area was chosen in both lungs and used for CTTA-parameters (included heterogeneity, intensity, average, deviation, skewness).ResultsDiscriminatory CTTA-features were found between alveolar hemorrhage and PJP consisting of differences in mean heterogeneity(p < 0.015) and uniformity of skewness(p < 0.006). There was no difference between CT-textural features of diffuse alveolar hemorrhage and viral pneumonia or PJP and viral pneumonia. Visual HRCT-assessment yielded great overlap of imaging findings with predominance of GGO for PJP and airspace consolidation for pneumonia/alveolar hemorrhage. Significant correlations between HRCT-based imaging findings and CT-textural features were found for all three disease groups.ConclusionCT-textural features showed significant differences in mean heterogeneity and uniformity of skewness. HRCT-based imaging findings correlated with certain CT-textural features showing that the latter have the potential to characterize structural properties of lung parenchyma and related abnormalities.

【 授权许可】

CC BY