Computed tomography assessment of response to treatment in chronic pulmonary aspergillosis

Rational: Chronic pulmonary aspergillosis (CPA) is a debilitating syndrome characterized by slowly progressive lung cavitation in patients with pre-existing structural lung diseases. Long-term antifungal therapy is usually the only treatment option, which comprises substantial limitations. However, the response rates are difficult to compare between studies because the reported clinical, mycological or radiological criteria are not standardized. Objective parameters are therefore needed. Objectives: To determine the most relevant computed tomography (CT) criteria for assessing response to treatment in patients with CPA treated with antifungal therapy. Method: This is a retrospective analysis of clinical, biological and CT findings of 127 CPA from 8 academic centers. Thirty-six patients underwent follow-up CT at entry and 6 months later. The changes in CT parameters were assessed by systematic analysis of CT findings and definitions of patient improvement, stabilization or deterioration obtained with various scenario compared to those available in previous studies. Results: Radiological criteria significantly evolving in time were pleural and cavity wall thickening (P Conclusion: CT criteria can be applied for assessing treatment outcome in future cohort studies.