CT evaluation of hyperattenuating mucus to diagnose allergic bronchopulmonary aspergillosis in the special condition of cystic fibrosis

Refait, John; Macey, Julie; Bui, Stéphanie; Fayon, Michaël; Berger, Patrick; Delhaès, Laurence; Laurent, François; Dournes, Gaël

doi:10.1016/j.jcf.2019.02.002

Cited by 22 publications

(12 citation statements)

References 32 publications

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“…Importantly, IMIS was cleared after oral corticosteroid treatment. The high prevalence of mucus abnormalities in ABPA was also confirmed in another CT imaging study, 39 further indicating that the prevalence is higher in CF than in non-CF asthma. To date, Agarwal et al 53 have recently introduced IMIS as the MR counterpart of HAM to diagnose ABPA.…”

Section: Mri Of Airway Inflammationsupporting

confidence: 52%

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The Clinical Use of Lung MRI in Cystic Fibrosis

Dournes

Walkup

Benlala

et al. 2021

Chest

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To assess airway and lung parenchymal damage noninvasively in cystic fibrosis (CF), chest MRI has been historically out of the scope of routine clinical imaging because of technical difficulties such as low proton density and respiratory and cardiac motion. However, technological breakthroughs have emerged that dramatically improve lung MRI quality (including signal-to-noise ratio, resolution, speed, and contrast). At the same time, novel treatments have changed the landscape of CF clinical care. In this contemporary context, there is now consensus that lung MRI can be used clinically to assess CF in a radiation-free manner and to enable quantification of lung disease severity. MRI can now achieve three-dimensional, high-resolution morphologic imaging, and beyond this morphologic information, MRI may offer the ability to sensitively differentiate active inflammation vs scarring tissue. MRI could also characterize various forms of inflammation for early guidance of treatment. Moreover, functional information from MRI can be used to assess regional, small-airway disease with sensitivity to detect small changes even in patients with mild CF. Finally, automated quantification methods have emerged to support conventional visual analyses for more objective and reproducible assessment of disease severity. This article aims to review the most recent developments of lung MRI, with a focus on practical application and clinical value in CF, and the perspectives on how these modern techniques may converge and impact patient care soon.

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Section: Mri Of Airway Inflammationsupporting

confidence: 52%

“… 38 However, lung structural abnormalities are shared commonly across the various forms of inflammation requiring different treatments. 39 Besides, PFT results correlate poorly with the inflammatory status. 40 BAL is the standard of reference to assess airway inflammation, but it is invasive.…”

Section: Mri Of Airway Inflammationmentioning

confidence: 99%

The Clinical Use of Lung MRI in Cystic Fibrosis

Dournes

Walkup

Benlala

et al. 2021

Chest

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“…Airway plugging with hyperdense mucus which is associated with tree-in-bud shadowing are other characteristic features seen in highresolution CAT (HRCT) scans. [108][109][110] Exacerbations in AFAD are not especially common compared to the often adult onset, "hyper-eosinophilic" phenotype, although in a Singaporean cohort where only 12% of severe asthmatics were sensitised to A. fumigatus there was an association with severe exacerbations. 8,111,112 Where they occur, exacerbations are often driven by bacterial or fungal bronchitis rather than eosinophilic inflammation, especially in those patients with bronchiectasis.…”

Section: Asthmamentioning

confidence: 97%

New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease

Wardlaw¹,

Rick²,

Özyiğit³

et al. 2021

JAA

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Allergy to airway-colonising, thermotolerant, filamentous fungi represents a distinct eosinophilic endotype of often severe lung disease. This endotype, which particularly affects adult asthma, but also complicates other airway diseases and sometimes occurs de novo, has a heterogeneous presentation ranging from severe eosinophilic asthma to lobar collapse. Its hallmark is lung damage, characterised by fixed airflow obstruction (FAO), bronchiectasis and lung fibrosis. It has a number of monikers including severe asthma with fungal sensitisation (SAFS) and allergic bronchopulmonary aspergillosis/mycosis (ABPA/ M), but these exclusive terms constitute only sub-sets of the condition. In order to capture the full extent of the syndrome we prefer the inclusive term allergic fungal airway disease (AFAD), the criteria for which are IgE sensitisation to relevant fungi in association with airway disease. The primary fungus involved is Aspergillus fumigatus, but a number of other thermotolerant species from several genera have been implicated. The unifying mechanism involves germination of inhaled fungal spores in the lung in the context of IgE sensitisation, leading to a persistent and vigorous eosinophilic inflammatory response in association with release of fungal proteases. Most allergenic fungi, including Alternaria and Cladosporium species, are not thermotolerant and cannot germinate in the airways so only act as aeroallergens and do not cause AFAD. Studies of the airway mycobiome have shown that A. fumigatus colonises the normal as much as the asthmatic airway, suggesting it is the tendency to become IgE-sensitised that is the critical triggering factor for AFAD rather than colonisation per se. Treatment is aimed at preventing exacerbations with glucocorticoids and increasingly by the use of anti-T2 biological therapies. Anti-fungal therapy has a limited place in management, but is an effective treatment for fungal bronchitis which complicates AFAD in about 10% of cases.

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“…Another imaging sign of ABPA is mucous impaction in the central airways [99]. Furthermore, high attenuation regions on CT, with a mucus density higher than the para-spinal skeletal muscle (generally >70 Hounsfield units), are considered a specific feature for the radiological diagnosis of ABPA in CF [41,84,86,[121][122][123][124][125] (figure 5a, b). Nodule or granuloma formation can be detected in the periphery of the lungs [85], as well as large opacities, which tend to affect the upper and middle lobes [90,126].…”

Section: Allergic Pulmonary Aspergillosismentioning

confidence: 99%

Aspergillus-related lung disease in people with cystic fibrosis: can imaging help us to diagnose disease?

Elders

Warris

et al. 2021

Eur Respir Rev

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In people with cystic fibrosis (PwCF), viscous sputum and dysfunction of the mucociliary escalator leads to early and chronic infections. The prevalence of Aspergillus fumigatus in sputum is high in PwCF and the contribution of A. fumigatus to the progression of structural lung disease has been reported. However, overall, relatively little is known about the contribution of A. fumigatus to CF lung disease. More knowledge is needed to aid clinical decisions on whether to start antifungal treatment. In this review, we give an overview of A. fumigatus colonisation and infection in PwCF and the different types of pulmonary disease caused by it. Furthermore, we discuss the current evidence for structural lung damage associated with A. fumigatus in PwCF on chest computed tomography and magnetic resonance imaging. We conclude that radiological outcomes to identify disease caused by A. fumigatus can be important for clinical studies and management.

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CT evaluation of hyperattenuating mucus to diagnose allergic bronchopulmonary aspergillosis in the special condition of cystic fibrosis

Cited by 22 publications

References 32 publications

The Clinical Use of Lung MRI in Cystic Fibrosis

The Clinical Use of Lung MRI in Cystic Fibrosis

New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease

Aspergillus-related lung disease in people with cystic fibrosis: can imaging help us to diagnose disease?

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