A comparison of idiopathic pulmonary fibrosis and chronic hypersensitivity pneumonia in terms of anterior mediastinal fat properties

Year 2022, Volume: 5 Issue: 1, 262 - 268, 17.01.2022

Sertan Bulut Deniz Çelik Hakan Ertürk Harun Karamanlı Mustafa Engin Şahin Özlem Sönmez Çiğdem Biber

https://doi.org/10.32322/jhsm.1017712

Cited By: 1

Abstract

Aim: The shape and physical properties of the anterior mediastinum can be easily affected by inflammatory lung diseases, tuberculosis, empyema, radiotherapy, chronic fibrotic lung diseases, previous surgery, and after steroid therapy. We planned to compare the properties of anterior mediastinal fat (AMF) in 3 different groups: patients with idiopathic pulmonary fibrosis (IPF), patients with chronic hypersensitivity pneumonia (cHP), and in the healthy control group. We investigate the AMF shape, dimensions, and AMF area properties on the images of high-resolution computed tomography (HRCT) and to find any difference between IPF and cHP patients in terms of AMF.
Material and Method: The study comprises a total of 80 cases in the three groups. The first group comprises 26 cases diagnosed as IPF. The second group comprises 19 cases diagnosed as cHP. The third group comprises 35 control patients. The clinical, demographical, and AMF characteristics on HRCT were retrospectively evaluated. The AMF shape and area characteristics were compared between the three groups.
Results: There was no statistical difference between the mean ages of cases, BMIs, and smoking status in IPF, cHP, and control groups. Gender distribution was found statistically significant between the 3 groups (p=0.001). A statistically significant difference was observed between the IPF and cHP groups in terms of FVC levels (2.67±0.59, 2.14±0.80, respectively; p=0.024). Also, a statistically significant difference was observed between the IPF and cHP groups in terms of DLCO levels (57.42±17.21; 77.31±35.21; respectively; p=0.016). In the evaluation of AMF shape properties between two groups (cHP and IPF), the concave figure was significantly more frequent in cHP group (p=0.014). The AMF area analyses revealed that the IPF group’s areas were significantly greater than the cHP and control group’s. The AP dimension of AMF analyses revealed that only the cHP group’s dimensions were significantly smaller than the control group’s (p=0.037). In the analysis of the transverse dimension of AMF, the IPF group’s dimensions were significantly greater than the cHP and control group’s (p<0.0001 and p=0.007; respectively) and also the cHP group’s dimensions were significantly greater than the control group’s (p<0.0001).
Conclusion: The transverse length, total AMF area, and shape characteristics of AMF can be evaluated as a radiological marker for differential diagnosis of IPF and cHP, whose differential diagnosis may be difficult. Both the transverse length and AMF area can take greater values in the IPF group than in the cHP group.

Keywords

idiopathic pulmonary fibrosis, chronic hypersensitivity pneumonia, anterior mediastinal fat

Project Number

yok

References

• Cabrera Cesar E, Lopez-Lopez L, Lara E, et al. Serum biomarkers in differential diagnosis of idiopathic pulmonary fibrosis and connective tissue disease-associated interstitial lung disease. J Clin Med 2021; 10: 3167.
• Caminati A, Madotto F, Conti S, Cesana G, Mantovani L, Harari S. The natural history of idiopathic pulmonary fibrosis in a large European population: the role of age, sex and comorbidities. Intern Emerg Med 2021; 16: 1793-802.
• Maher TM, Bendstrup E, Dron L, et al. Global incidence and prevalence of idiopathic pulmonary fibrosis. Respir Res 2021; 22: 197.
• Ley B, Collard HR, King TE Jr. Clinical course and prediction of survival in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2011; 183: 431-40.
• Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of idiopathic pulmonary fibrosis. an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med 2018; 198: e44-e68.
• Hobbs S, Chung JH, Leb J, Kaproth-Joslin K, Lynch DA. Practical imaging interpretation in patients suspected of having idiopathic pulmonary fibrosis: official recommendations from the Radiology Working Group of the Pulmonary Fibrosis Foundation. Radiol Cardiothorac Imaging 2021; 3: e200279.
• Koster MA, Thomson CC, Collins BF, Jenkins AR, Ruminjo JK, Raghu G. Diagnosis of hypersensitivity pneumonitis in adults, 2020 clinical practice guideline: summary for clinicians. Ann Am Thorac Soc 2021; 18: 559-66.
• Park Y, Ahn C, Kim TH. Occupational and environmental risk factors of idiopathic pulmonary fibrosis: a systematic review and meta-analyses. Sci Rep 2021; 11: 4318.
• W. K. (2008). Mediastinum. In Comprehensive Cytopathology (pp. 773-809). WB Saunders.
• Proto AV. Conventional chest radiographs: anatomic understanding of newer observations. Radiology 1992; 183: 593-603.
• Lee CH, Lee HJ, Son KR, et al. CT analysis of the anterior mediastinum in idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Korean J Radiol 2006; 7: 173-9.
• Teates CD. Steroid-induced mediastinal lipomatosis. Radiology. 1970; 96: 501-2.
• Toei H, Furuse M, Shinozaki T, Sohara Y. Nihon. Igaku Hoshasen Gakkai Zasshi 1997; 57: 493-498.
• Jalaber C, Lemerre-Poincloux J, Jouneau S, et al. Usefulness of body composition CT analysis in patients with idiopathic pulmonary fibrosis: a pilot study. Acad Radiol 2021; S1076-6332(21)00328-7.
• Hassan WA, Abo-Elhamd E. Anterior mediastinal fat changes in idiopathic pulmonary fibrosis: A preliminary study. Open J Respir Dis 2014.
• González, F. J., Alvarez, A., Cantador, et al. Relationship among radiological measurements of anterior mediastinal fat and outcomes of lung transplantation in fibrotic patients. Archivos de Bronconeumología 2020; 56: 710-7.
• Morisset J, Johannson KA, Jones KD, et al. Identification of diagnostic criteria for chronic hypersensitivity pneumonitis: an International Modified Delphi Survey. Am J Respir Crit Care Med 2018; 197: 1036-44.
• Rosito GA, Massaro JM, Hoffmann U, et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation 2008; 117: 605-13.
• Pereira CA, Gimenez A, Kuranishi L, Storrer K. Chronic hypersensitivity pneumonitis. J Asthma Allergy 2016; 9: 171-81.
• Morell F, Villar A, Montero MÁ, et al. Chronic hypersensitivity pneumonitis in patients diagnosed with idiopathic pulmonary fibrosis: a prospective case-cohort study. Lancet Respir Med 2013; 1: 685-94.