Clinical use of densitometric analysis of lung pathology and digital data processing programs for determining surgical tactics in phthisiosurgical patients with HIV status
Authors: Kalabukha І.A. , Maietnyi E.M. , Vysotsky А.G. 
Published: June 2023

Objective — to determine the possibilities of using densitometric indicators of computed tomography (CT) and digital software processing of CT data in lung pathology for the formulation of personalized treatment tactics for phthisiosurgical patients with concomitant HIV pathology, and to justify the indications for surgical treatment.

Materials and methods. A retrospective analysis was conducted on the results of the examination and treatment of 11 patients with specific tuberculous lesions of the lungs. Specific therapy was initiated 2—3 months after the initial visit to the medical institution, and immunochromatographic tests for HIV and hepatitis, which were performed in advance, yielded doubtful (questionable) or negative results. Patients underwent a general clinical examination, echocardiogram, fibrobronchoscopy with examination of bronchoalveolar lavage for Mycobacterium tuberculosis, and molecular genetic tests of sputum or bronchoalveolar lavage. Express tests for HIV, hepatitis B, and hepatitis C, as well as routine blood and urine tests, were carried out. The Aquilion TSX-101A Toshiba (Japan) tomography was used as the main research tool. Densitometric analysis of lung parenchyma was performed using DICOM-VIEWER PHILIPS in the areas of interest. Digital analysis of images obtained from CT slices was conducted using the Dragonfly program.

Results and discussions. The clinical manifestation of patients’ «radiological findings» was asymptomatic in 81.8 % of cases and mostly perceived as a «post COVID-19 syndrome». The analysis of the laboratory data did not indicate specific signs of the disease in 72.7 % of cases. The study of the verified focal lesions without signs of destruction of the lung parenchyma during densitometric analysis of CT revealed densities that characterize exudative processes in the lung parenchyma (0—15 HU), which is a characteristic sign of a specific inflammatory process in the context of HIV infection. Histologically, high activity of a specific inflammatory process was detected in operated patients. During digital software processing, we observed a shift in densitometric indicators that are characteristic of the exudative phase of inflammation. Situations of HIV-associated infection and alteration-exudative reactions were noted, which were 100 % determined by densitometric analysis and digital software processing of the chest CT scan. Six patients underwent surgery on (2 lobectomies, 1 combined resection and 3 sublobar resections). Among the non-operated patients, 3 experienced a recurrence of a specific inflammatory process, and 1 patient still exhibits significant morphological changes in the parenchyma.

Conclusions. Densitometric analysis and digital software processing of CT scan allows you to objectify the patient's condition and reasonably prescribe personalized therapy. Identified patients with X-ray lesions of the lungs require a mandatory consultation with a thoracic surgeon and consideration of the issue of surgical treatment within 2—3 months after the start of specific therapy.