Characteristic chest CT findings for progressive cavities in Mycobacterium avium complex pulmonary disease: a retrospective cohort study

Abstract

Background: Although cavities are an important finding in Mycobacterium avium complex pulmonary disease (MAC-PD), there is little information regarding the types of cavities that indicate disease progression. This study was performed to identify cavity characteristics that were associated with disease progression in patients with MAC-PD.Methods: This retrospective cohort study included 97 patients presenting with MAC-PD with cavities between December 2006 and June 2016. We compared initial and final computed tomography (CT) findings, classified 52 and 45 patients in the progressive and non-progressive cavity groups, respectively, and examined the progressionrelated imaging features in initial CT images. A progressive cavity was defined by more than two-fold increase in internal diameter or emergence of a new cavity around the initial cavity.Results: Patients in the progressive group were older (p < 0.001), had a lower body mass index (p = 0.043), and showed higher diabetes complication rates (p = 0.005). The initial CT in the progressive group showed a longer maximum internal diameter of the cavity (p < 0.001) and higher rates of cavities close to the chest wall (p < 0.001), multiple cavities (p = 0.023), consolidation around the cavity (p < 0.001), atelectasis (p = 0.011), and pleural thickening (p < 0.001). Multivariable logistic regression analysis revealed that the maximum internal diameter of the cavity (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.02-1.21; p=0.012) and consolidation around the cavity (OR: 16.15, 95% CI: 4.05-64.46; p < 0.001) were significantly associated with progressive cavities. In cavities with a maximum internal diameter of ≥10 mm and simultaneous consolidation, the probability of progression was as high as 96.2%. The 10-year mortality rates in the progressive and non-progressive cavity groups were 46.7 and 9.8% (p < 0.001), respectively, while the 10-year respiratory failure rates were 28.1 and 0%, respectively (p < 0.001).Conclusions: Large cavity size and consolidation on CT showed strong relationships with disease progression, which led to respiratory failure and high mortality rate.

Clinical Implications of Size of Cavities in Patients With Nontuberculous Mycobacterial Pulmonary Disease: A Single-Center Cohort Study

“…Interestingly, in our study, a small cavity (< 2 cm) was not associated with poor prognosis. Large cavities were more prevalent in progressive cavitary NTM-PD [12]. Thus, the favourable outcomes of small cavities in patients with NTM-PD may be attributable to slow disease progression.…”

“…Additionally, the presence of a cavity increases the risk of all-cause mortality in patients with Mycobacterium avium complex pulmonary disease (MAC-PD) [20]. Moreover, large cavities are strongly associated with disease progression [12]. However, the impact of detailed differentiation based on radiographic ndings has not been reported.…”

“…Furthermore, more aggressive treatment, including parenteral agents, is also recommended for such patients [10,11]. The presence of cavities in itself has been considered an important prognostic factor; however, the clinical course may vary according to the radiographic features of such cavities [12]. Nevertheless, the impact on treatment outcomes and mortality of radiographic features such as size of cavities has rarely been reported.…”

Clinical Implications of Size of Cavities in Patients With Nontuberculous Mycobacterial Pulmonary Disease: A Single-Center Cohort Study

“…Additionally, the presence of a cavity increases the risk of all-cause mortality in patients with Mycobacterium avium complex pulmonary disease (MAC-PD) [ 20 ]. Moreover, large cavities are strongly associated with disease progression [ 12 ]. However, the impact of detailed differentiation based on radiographic findings has not been reported.…”

“…Furthermore, more aggressive treatment, including parenteral agents, is also recommended for such patients [ 10 , 11 ]. The presence of cavities in itself has been considered an important prognostic factor; however, the clinical course may vary according to the radiographic features of the cavities [ 12 ]. Nevertheless, the impact on treatment outcomes and mortality of radiographic features such as size of cavities has rarely been reported.…”