Evaluation of HRCT for the Differential Diagnosis of Pneumonia-Like Consolidation Pattern of Pulmonary MALT Lymphoma from Lobar Pneumonia

Abstract

Wenli Qiu,1 Haibin Chen,2 Jian Zhang,3 Ren Shuai,1 Huifeng Zhang,1 Kai Guo,1 Li Zhu,1 Zhongqiu Wang1 1Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China; 2Science and Technology Department, Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine Prevention and Treatment of Tumor, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China; 3Department of Radiology, Liyang Traditional Chinese Medicine Hospital, Changzhou, Jiangsu, People’s Republic of ChinaCorrespondence: Zhongqiu WangDepartment of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Nanjing, 210029, Jiangsu Province, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: To assess the performance of high-resolution computed tomography (HRCT) in discriminating the consolidation pattern of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma from lobar pneumonia.Patients and Methods: This retrospective study comprised 26 patients with pathologically confirmed consolidation pattern of pulmonary MALT lymphoma (12 men and 14 women; mean age, 59.4± 12.1 years) and 36 patients with lobar pneumonia confirmed by body fluids or respiratory secretion culture (16 men and 20 women; mean age, 41.8± 26.3 years). Two radiologists independently evaluated the CT images. The effectiveness of these variables in distinguishing lobar pneumonia from MALT lymphoma was analyzed using logistic regression analysis.Results: The average age of lobar pneumonia patients was younger than that of MALT lymphoma patients (p=0.002). The respiratory symptom was more common in lobar pneumonia than MALT lymphoma (p=0.002). Signs of bronchiectasis within the consolidation and bulging of interlobar fissure occurred significantly more often in MALT lymphoma than pneumonia (69.2% vs 11.1%, p< 0.0001; 46.2% vs 19.4%, p=0.024). We used the predictors with p< 0.05 (age, respiratory symptoms, bronchiectasis, and bulging of interlobar fissure) to construct a logistic regression model. The area under curve (AUC), negative predictive value (NPV), positive predictive value (PPV), sensitivity, specificity, and accuracy were 0.891, 84.21%, 83.33%, 88.89%, 76.92%, and 83.87% for discriminating lobar pneumonia from MALT lymphoma.Conclusion: Middle-aged, presence of mild clinical symptoms, bronchiectasis and bulging of the interlobar fissure on chest CT images are potential markers to distinguish pulmonary MALT lymphoma from lobar pneumonia.Keywords: high-resolution computed tomography, pulmonary mucosa-associated lymphoid tissue lymphoma, lobar pneumonia, diagnosis

Keywords

• high-resolution computed tomography
• pulmonary mucosa-associated lymphoid tissue lymphoma
• lobar pneumonia
• diagnosis