{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:06:55Z","timestamp":1784549215097,"version":"3.55.0"},"reference-count":23,"publisher":"European Respiratory Society (ERS)","issue":"4","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2026,2,18]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      We developed a chest radiography (CXR) scoring system using a deep neural network to quantify the severity of\n                      <jats:italic>Mycobacterium<\/jats:italic>\n                      \u2005\n                      <jats:italic>avium<\/jats:italic>\n                      complex pulmonary disease (MAC-PD). This study aimed to stratify disease extent using CXR scores and propose treatment strategy accordingly.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed chest radiographs obtained at treatment initiation in patients who began therapy for MAC-PD at Seoul National University Hospital between 1 January 2011, and 31 August 2024. Patients were classified into mild or extensive disease groups based on a CXR score cut-off of 4.0. The impact of macrolide\/ethambutol-based initial treatment regimens, alternative intensified regimens (including inhaled amikacin or clofazimine), and intensified regimens (including intravenous amikacin) on culture conversion was assessed using Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study comprised 541 patients (299 and 242 with mild and extensive disease types, respectively). Alternative intensified regimens were used in 103 patients (19.0%), and intensified regimens were used in 25 patients (4.6%). Culture conversion was achieved in 450 patients (83.2%), with no significant differences between the mild (81.6%) and extensive (85.1%) groups (p=0.277). In mild disease, neither alternative intensified regimens (adjusted hazard ratio (aHR) 0.84, 95% confidence interval (CI) 0.60\u20131.19) nor intensified regimens (aHR 0.99, 95% CI 0.53\u20131.89) were associated with improved culture conversion. In contrast, in extensive disease, use of intensified regimens (aHR 1.90, 95% CI 1.12\u20133.22) was associated with a higher likelihood of culture conversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CXR score-based disease stratification may guide individualised treatment strategy in patients with MAC-PD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/23120541.01355-2025","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T13:15:12Z","timestamp":1773321312000},"page":"01355-2025","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiographic severity and treatment optimisation in\n                    <i>Mycobacterium avium<\/i>\n                    complex pulmonary disease"],"prefix":"10.1183","volume":"12","author":[{"given":"Youngchan","family":"Cho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiin","family":"Bae","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joong-Yub","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Joon","family":"Yim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soon Ho","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1897-946X","authenticated-orcid":false,"given":"Nakwon","family":"Kwak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"2026072004300703000_12.4.01355-2025.1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa241"},{"key":"2026072004300703000_12.4.01355-2025.2","doi-asserted-by":"crossref","unstructured":"Kim J-Y , Kwak N , Yim J-J . The rise in prevalence and related costs of nontuberculous mycobacterial diseases in South Korea, 2010\u20132021. Open Forum Infect Dis 2022; 9: ofac649. doi:10.1093\/ofid\/ofac649","DOI":"10.1093\/ofid\/ofac649"},{"key":"2026072004300703000_12.4.01355-2025.3","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.jiph.2023.11.028","article-title":"Trend of nontuberculous mycobacteria species and minimal inhibitory concentration in a referral laboratory in Korea from 2013 to 2019","volume":"17","author":"Kim","year":"2024","journal-title":"J Infect Public Health"},{"key":"2026072004300703000_12.4.01355-2025.4","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix517"},{"key":"2026072004300703000_12.4.01355-2025.5","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-209729"},{"key":"2026072004300703000_12.4.01355-2025.6","first-page":"ofab087","volume-title":"Open Forum Infect Dis","volume":"8","author":"Kang","year":"2021"},{"key":"2026072004300703000_12.4.01355-2025.7","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.chest.2022.06.018","article-title":"Deep learning-based prediction model using radiography in nontuberculous mycobacterial pulmonary disease","volume":"162","author":"Lee","year":"2022","journal-title":"Chest"},{"key":"2026072004300703000_12.4.01355-2025.8","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202305-407OC"},{"key":"2026072004300703000_12.4.01355-2025.9","doi-asserted-by":"crossref","unstructured":"Van Ingen J , Aksamit T , Andrejak C , et al. Treatment outcome definitions in nontuberculous mycobacterial pulmonary disease: an NTM-NET consensus statement. Eur Respir J 2018; 51: 1800170. doi:10.1183\/13993003.00170-2018","DOI":"10.1183\/13993003.00170-2018"},{"key":"2026072004300703000_12.4.01355-2025.10","first-page":"ofaf138","volume-title":"Open Forum Infect Dis","volume":"12","author":"Kim","year":"2025"},{"key":"2026072004300703000_12.4.01355-2025.11","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad682"},{"key":"2026072004300703000_12.4.01355-2025.12","doi-asserted-by":"crossref","first-page":"202","DOI":"10.4046\/trd.2023.0120","article-title":"Real-world outcomes of amikacin liposome inhalation suspension for refractory Mycobacterium avium complex pulmonary disease","volume":"87","author":"Kim","year":"2024","journal-title":"Tuberc Respir Dis (Seoul)"},{"key":"2026072004300703000_12.4.01355-2025.13","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s13244-023-01395-9","article-title":"A deep learning model using chest X-ray for identifying TB and NTM-LD patients: a cross-sectional 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