Quantitative CT imaging analysis to predict pathology features in patients with a congenital pulmonary airway malformation

Background: Risk for infection and potential malignant degeneration are the most common arguments for resecting asymptomatic Congenital Pulmonary Airway Malformations (CPAM). We aimed to investigate if CT-imaging characteristics can be used to predict histopathological features, by using an objective quantitative CT scoring method. Methods: Archival CPAM tissue samples were histologically re-assessed and patients who had a pre-operative volumetric CT-scan were included. Lung disease was quantified using the newly-developed congenital lung abnormality quantification(CLAQ) scoring method and obtained percentages were used to predict histopathological signs of inflammation and presence of mucinous proliferation (MP). Because MP is presumed a precursor for mucinous adenocarcinoma in situ (AIS) this method was also used to compare CT-scans of patients with AIS to those with only CPAM. Results: Thirty-three CPAM patients were included of which 13(39%) had histological signs of inflam-mation and 8(24%) had a MP. Patients with inflammation had a significantly smaller lesion (14% vs 38%) while those with MP had more extensive disease (54%vs17%). Patients with AIS had a significantly smaller lesion compared to CPAM patients (5%vs29%). Significant predictors for inflammation were smaller lesion size and percentage hypodensity within lesions while a larger lesion size and percentage parenchymal hyperdensity (solid lung tissue components) were predictors for MP as well as AIS. Conclusions: Smaller CPAM lesions may be more susceptible to inflammation while larger lesions may be associated with the presence of MP. Parenchymal hyperdensity is found as a predictor for MP as well as AIS and should therefore elicit more extensive gross sampling. (C) 2021 Published by Elsevier Inc.

Automated summary

This study aimed to predict histopathological features of congenital pulmonary airway malformations (CPAM) using CT imaging characteristics and a quantitative CT scoring method. The results showed that smaller CPAM lesions were more susceptible to inflammation, while larger lesions were associated with the presence of mucinous proliferation (MP). Parenchymal hyperdensity was found to be a predictor for MP and mucinous adenocarcinoma in situ (AIS).