High Resolution CT Findings of Nontuberculous Mycobacterial Pulmonary Disease: Comparison between the First Treatment and the Re-Treatment Group

비결핵 항산균 폐질환의 고해상도 전산화단층촬영 소견: 초치료군과 재치료군의 비교

Purpose: To analyze and compare the thin section CT findings of first and re-treatment nontuberculous mycobacterial (NTM) pulmonary disease. Materials and Methods: Between January 2005 and April 2010, 121 patients with positive sputum culture for NTM were recruited. We included only 32 patients underwent high resolution chest CT and were confirmed by American Thoracic Society criteria NTM pulmonary infection (first treatment 15, re-treatment 17 patients). CT images of 32 patients were reviewed retrospectively. We evaluated the frequency and laterality of the followings; nodule, increased density, bronchial change, parenchymal change. Results: The significantly frequent CT findings of the re-treatment NTM group were well defined nodules (retreatment-82.4%, first treatment-33.3%, p = 0.00), consolidations (retreatment-88.2%, first treatment-53.3%, p = 0.03), bronchial changes (bronchiectasis; retreatment-100%, first treatment-66.6%, p = 0.01, bronchial narrowing; retreatment-23.5%, first treatment-0%, p = 0.04 and mucoid impaction; retreatment-58.8%, first treatment-20.0%, p = 0.03) and atelectasis with bronchiectasis (retreatment-88.2%, first treatment-26.7%, p = 0.00). However, most of the evaluated thin-section CT findings, such as centrilobular and ill-defined nodules, lobular, segmental and subpleural consolidations, ground glass attenuation, bronchial wall thickening, cavities, pleural lesions, fibrotic band, emphysema and laterality of lesions, have not shown significant differences between first treatment and the re-treatment group. Conclusion: Thin section CT findings of well defined nodules, consolidations, bronchial changes (bronchiectasis, bronchial narrowing and mucoid impaction) and atelectasis with bronchiectasis are highly suggestive of re-treatment NTM pulmonary disease.

목적: 비결핵성 항산균 폐질환 환자의 초치료군과 재치료군에서 고해상도 CT 소견을 분석, 비교하고자 하였다. 대상과 방법: 2005년 1월부터 2010년 4월까지 객담배양검사에서 비결핵 항산균 양성결과를 보인 121명의 환자 중 흉부CT를 시행하고 미국흉부학회 비결핵 항산균 폐질환 진단기준을 충족하여 확진된 32명(초치료군 15명, 재치료군 17명)을 대상으로 하였다. 환자들의 CT 영상은 후향적으로 평가하였으며, 결절, 음영증가, 공동, 기관변화, 폐실질변화, 흉막변화 등의 소견의 빈도와 분포를 분석하였다. 결과: 재치료군에서 유의하게 자주 관찰되는 소견은 경계명확 결절(재치료군-82.4%, 초치료군-33.3%, p = 0.00), 기강경화(재치료군-88.2%, 초치료군-53.3%, p = 0.03), 기관지변화(기관지확장; 재치료군-100%, 초치료군-66.6%, p = 0.01, 기관지내강협착; 재치료군-23.5%, 초치료군-0%, p = 0.04, 점액 매복; 재치료군-58.8%, 초치료군-20.0%, p = 0.03)와 기관지확장을 동반한 무기폐(재치료군-88.2%, 초치료군-26.7%, p = 0.00) 등이었다. 그러나 대부분의 CT 소견(소엽중심성과 경계불명확 결절, 분절성과 흉막하 기강경화, 기관벽비후, 공동, 섬유성대, 폐기종, 흉막 변화 그리고 양측성)은 초치료군과 재치료군 사이에 유의한 차이를 보이지 않았다. 결론: 재치료 비결핵 항산균 폐질환을 시사하는 고해상도 CT 소견은 경계명확 결절, 기강경화, 기관변화(기관지확장, 기관지내강협착, 점액매복), 기관지확장을 동반한 무기폐 등이었다.