scholarly journals HRCT evaluation of patients with interstitial lung disease: comparison of the 2018 and 2011 diagnostic guidelines

2020 ◽  
Vol 14 ◽  
pp. 175346662096849
Author(s):  
Steven D. Nathan ◽  
Jean Pastre ◽  
Inga Ksovreli ◽  
Scott Barnett ◽  
Christopher King ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Interstitial Lung Disease ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lung Disease ◽  
Usual Interstitial Pneumonia ◽  
Kappa Statistic ◽  
High Resolution Computed Tomography ◽  
New Guidelines

Background and aims: Chest high-resolution computed tomography (HRCT) is the central diagnostic tool in discerning idiopathic pulmonary fibrosis (IPF) from other interstitial lung disease (ILDs). In 2018, new guidelines were published and the nomenclature for HRCT interpretation was changed. We sought to evaluate how clinicians’ interpretation would change based on reading HRCTs under the framework of the old versus new categorization. Materials and methods: We collated HRCTs from 50 random cases evaluated in the Inova Fairfax ILD clinic. Six ILD experts were provided the deidentified HRCTs. They were all instructed to independently provide two reads of each HRCT, based on the old and the new guidelines. Results: The kappa statistic for concordance for HRCT reads under old guidelines was 0.5, while for the new guidelines it was 0.38. Under the framework of the old guidelines, there were 22 HRCTs with unanimous consensus reads, while only 15 with the new guidelines. There were 12 HRCTs read unanimously as usual interstitial pneumonia (UIP) pattern based on both the old and the new guidelines. Ten HRCTs were read as a possible UIP pattern based on the old guidelines and were classified in nine cases as probable UIP and one indeterminate based on the new guidelines. Of the 28 inconsistent UIP HRCTs (old guidelines), 25 were read as alternative diagnosis suggested, two were read as indeterminate and one as probable UIP. Conclusion: Implementation of the new guidelines to categorize HRCTs in ILD patients appears to be associated with greater inter-interpreter variability. How or whether new guidelines improve the care and management of ILD patients remains unclear. The reviews of this paper are available via the supplemental material section.

scholarly journals Evaluation of Correlations between Genetic Variants and High-Resolution Computed Tomography Patterns in Idiopathic Pulmonary Fibrosis

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 762
Author(s):  
Elisa Baratella ◽  
Barbara Ruaro ◽  
Fabiola Giudici ◽  
Barbara Wade ◽  
Mario Santagiuliana ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Genetic Variants ◽  
Genetic Factors ◽  
Usual Interstitial Pneumonia ◽  
High Resolution Computed Tomography ◽  
Significant Difference ◽  
Genetic Evaluations

Background. Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease (ILD). This prospective observational study aimed at the evaluation of any correlation between genetic variants associated with IPF susceptibility and high-resolution computed tomography (HRCT) patterns. It also aimed at evidencing any differences in the HRTC pattern between the familial and sporadic form at diagnosis and after two years. Methods. A total of 65 IPF patients (mean age at diagnosis 65 ± 10) were enrolled after having given written informed consent. HRCT and genetic evaluations were performed. Results. A total of 19 familial (mean age 62 ± 15) and 46 sporadic (mean age 70 ± 9) IPF patients were enrolled. A statistically significant difference was evidenced in the HRTC pattern at diagnosis between the two groups. Sporadic IPF patients had a predominantly usual interstitial pneumonia (UIP) pattern compared with those patients with familial IPF (60.0% vs. 21.1%, respectively). Moreover, familial IPF patients had more alternative diagnoses than those with sporadic IPF (31.6% vs. 2.2%, respectively). Furthermore, there was a slight increase in the typical UIP pattern in the familial IPF group at two years from diagnosis. Conclusions. Genetic factors play a pivotal role in the risk of developing IPF. However, further studies are required to clarify how these genetic factors may guide clinical treatment decisions.

scholarly journals A Cross-Sectional Study of Radiological Profile of Interstitial Lung Disease Using High Resolution Computed Tomography of Patients Attending Medical College at Ahmedabad

2021 ◽  
Vol 8 (17) ◽  
pp. 1127-1132
Author(s):  
Nikunj C. Desai ◽  
Nilesh P. Parkar ◽  
Asutosh N. Dave
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Interstitial Pneumonia ◽  
Usual Interstitial Pneumonia ◽  
Cross Sectional Study ◽  
High Resolution Computed Tomography ◽  
Cross Sectional ◽  
Acute Interstitial Pneumonia

BACKGROUND Interstitial lung disease (ILD) is an unpredictable diffuse parenchymal lung disease, which involves interstitium of lung (tissue around the alveoli of the lungs). High resolution computed tomography (HRCT) is one of the confirmatory, easily accessible methodology for the conclusion and follow up assessment of interstitial lung disease. We wanted to study the normal HRCT patterns found with interstitial lung disease and contrastingly different HRCT designs and clinical information in differential determination of pulmonary fibrosis. We also wanted to study the different patterns of interstitial lung disease on high resolution computed tomography and thereby provide accurate diagnosis and management to the patients. METHODS The study was a hospital based prospective, cross sectional study. In the present study, total fifty patients referred from Department of Medicine and Department of Pulmonary Medicine of GCS Medical College having suspicion of interstitial lung disease were studied from April 2019 to September 2019. All patients underwent HRCT thorax on 16 slice Siemens computerised tomography (CT) scan machine in recumbent position utilising usual HRCT protocol. Lung abnormalities were noticed and classified for explicit diagnosis of interstitial lung pathologies. RESULTS Most of the patients (N = 25) were found to be in the age group of 50 - 80 years (17 female & 8 male). Progressive dyspnoea (N = 47; 94 %) was the most common chief complaint. The most common form of interstitial lung disease was usual interstitial pneumonia (UIN) (N = 18; 36 %) in our study. Acute interstitial pneumonia (AIP) (N = 7; 14 %) and non-specific interstitial pneumonia, NSIP (N = 7; 14 %) were the next common interstitial lung diseases. CONCLUSIONS The most well-known interstitial lung disease seen in our examination was usual interstitial pneumonia. Cases of interstitial lung disease are on the rise. Interstitial lung disease should be ruled out in all patients with progressive dyspnoea, particularly when there are no obvious or known causes of dyspnoea. Clinical and laboratory findings, pulmonary function tests, history of exposure along with HRCT workup is indispensable for the identification or exclusion of interstitial lung disease. HRCT is also useful for the follow-up study. KEYWORDS Acute Interstitial Pneumonia (AIP), High Resolution Computed Tomography (HRCT), Interstitial Lung Disease (ILD), Nonspecific Interstitial Pneumonia (NSIP), Usual Interstitial Pneumonia (UIP)

scholarly journals Clinical diagnosis of patients subjected to surgical lung biopsy with a probable usual interstitial pneumonia pattern on high-resolution computed tomography

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Regina Celia Carlos Tibana ◽  
Maria Raquel Soares ◽  
Karin Mueller Storrer ◽  
Gustavo de Souza Portes Meirelles ◽  
Katia Hidemi Nishiyama ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lung Disease ◽  
Interstitial Pneumonia ◽  
Clinical Diagnosis ◽  
Lung Biopsy ◽  
Usual Interstitial Pneumonia ◽  
High Resolution Computed Tomography ◽  
Surgical Lung Biopsy

Abstract Background Usual interstitial pneumonia can present with a probable pattern on high-resolution computed tomography (HRCT), but the probability of identifying usual interstitial pneumonia by surgical lung biopsy in such cases remains controversial. We aimed to determine the final clinical diagnosis in patients with a probable usual interstitial pneumonia pattern on HRCT who were subjected to surgical lung biopsy. Methods HRCT images were assessed and categorized by three radiologists, and tissue slides were evaluated by two pathologists, all of whom were blinded to the clinical findings. The final clinical diagnosis was accomplished via a multidisciplinary discussion. Patients with a single layer of honeycombing located outside of the lower lobes on HRCT were not excluded. Results A total of 50 patients were evaluated. The most common final clinical diagnosis was fibrotic hypersensitivity pneumonitis (38.0%) followed by idiopathic pulmonary fibrosis (24.0%), interstitial lung disease ascribed to gastroesophageal reflux disease (12.0%) and familial interstitial lung disease (10.0%). In the group without environmental exposure (n = 22), 10 patients had a final clinical diagnosis of idiopathic pulmonary fibrosis (45.5%). Irrespective of the final clinical diagnosis, by multivariate Cox analysis, patients with honeycombing, dyspnoea and fibroblastic foci on surgical lung biopsy had a high risk of death. Conclusions The most common disease associated with a probable usual interstitial pneumonia pattern on HRCT is fibrotic hypersensitivity pneumonitis followed by idiopathic pulmonary fibrosis and interstitial lung disease ascribed to gastroesophageal reflux disease. In patients without environmental exposure, the frequencies of usual interstitial pneumonia and a final clinical diagnosis of idiopathic pulmonary fibrosis are not sufficiently high to obviate the indications for surgical lung biopsy.

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