HIV-infected patients with opportunistic pulmonary infections misdiagnosed as lung cancers: the clinicoradiologic features and initial application of CT radiomics

Weiya Shi, Lingxiao Zhou, Xueqing Peng, He Ren, Qinglei Wang, Fei Shan, Zhiyong Zhang, Lei Liu, Yuxin Shi


Background: To characterize clinicoradiologic and radiomic features for identifying opportunistic pulmonary infections (OPIs) misdiagnosed as lung cancers in patients with human immunodeficiency virus (HIV).
Methods: Twenty-four HIV-infected patients who were misdiagnosed with lung cancers on CT images and had OPIs confirmed by pathological examination or integration of clinical and laboratory findings and 49 HIV-infected patients with lung cancers confirmed pathologically were included. Semiautomated segmentation of the lesion was implemented with an in-house software. The lesion boundary was adjusted manually by radiologists. A total of 99 nonenhanced-CT-based radiomic features were then extracted with PyRadiomics. The clinicoradiologic and radiomic features were compared between the OPI and cancer groups.
Results: In the OPI group, 19 patients (79.2%) had tuberculosis (TB) infections, 2 (8.3%) had nontuberculosis mycobacterium (NTM) infections, 2 (8.3%) had cryptococcus infections and 1 (4.2%) had a mixed infection of TB and NTM. There were significant differences in age, proportion of smokers, smoking index, highly active antiretroviral therapy (HAART) duration, CD4+ counts and CD4+/CD8+ ratio between the two groups (P=0.000, 0.012, 0.007, 0.002, 0.000, and 0.000, respectively). In peripheral-type lesions, the presence of pleural indentation was less common, and the presence of satellite lesions was more common in the OPI group (P=0.016 and 0.020, respectively). Four radiomic parameters of central-type lesions were significantly different, including large dependence high gray level emphasis (LDHGLE), skewness, inverse difference normalized (IDN) and kurtosis (P=0.008, 0.017, 0.017, and 0.017, respectively). However, neither CT features of central-type lesions nor radiomic parameters of peripheral-type lesions were significantly different between the two groups.
Conclusions: Clinicoradiologic features together with radiomics may help identify OPIs mimicking lung cancers in HIV-infected patients.