Clinical course and changes in high-resolution computed tomography findings in patients with idiopathic pulmonary fibrosis without honeycombing

Abstract

Some patients with idiopathic pulmonary fibrosis (IPF) do not have honeycombing on highresolution computed tomography (HRCT) at their initial evaluation. The clinical course and sequential changes in HRCT findings in these patients are not fully understood. We reviewed the cases of 43 patients with IPF without honeycombing on initial HRCT from institutions throughout Japan. All patients were diagnosed with IPF based on a surgical lung biopsy. Multidisciplinary discussions were held five times between 2011 and 2014, to exclude alternative etiologies. We evaluated the sequential changes in HRCT findings in 30 patients with IPF. We classified these 30 patients into three groups based on their HRCT patterns and clarified the clinical characteristics and prognosis among the groups. The patterns of all 30 patients on initial HRCT corresponded to a possible usual interstitial pneumonia (UIP) pattern which was described in the 2011 International Statement. On long-term follow-up (71.0±38.7 standard deviation [SD] months), honeycombing was seen in 16 patients (53%, the HoneyCo group); traction bronchiectasis or cysts without honeycombing was observed in 12 patients (40%, the NoHoneyCo group), and two patients showed no interval change (7%, the NoChange group) on HRCT. The mean survival periods of the HoneyCo and NoHoneyCo groups were 67.1 and 61.2 months, respectively (p = 0.76). There are some patients with IPF whose conditions chronically progress without PLOS ONE |

What are the best indicators to assess malnutrition in idiopathic pulmonary fibrosis patients? A cross-sectional study in a referral center

“…As expected, those patients with decreased FFMI were relatively old. The fact that patients diagnosed by surgical lung biopsy were less likely to have a low FFMI could be explained by their early diagnosis as they did not have to wait for there to be honeycombing on the chest CT-scan (27,28), indicating more severe disease at the time of nutritional screening. We have no clear explanation why women and non-smokers are so likely to lose FFMI.…”

Several specific high-resolution computed tomography patterns correlate with survival in patients with idiopathic pulmonary fibrosis

“…Controversially, in a Japanese study, 43 IPF patients did not have honeycombing in HRCT at baseline and the emergence of honeycombing in the three years' follow-up did not affect patient survival. The small cohort size and relatively young mean age (64.5 years) of subjects examined in that study could partly explain the contradictory result (31).…”

Predicting Outcome in Idiopathic Pulmonary Fibrosis: Addition of Fibrotic Score at Thin-Section CT of the Chest to Gender, Age, and Physiology Score Improves the Prediction Model

“…A study (25) evaluating the role of serial CT to monitor disease progression concluded that the extent of fibrosis at the baseline scan was the only predictor of mortality. Also, development of honeycombing at serial CT monitoring for disease progression has not been shown to affect prognosis (26). In one of the early attempts at quantitative assessment of fibrosis, semiquantitative visual extent of fibrosis was the single best predictor of mortality and correlated much better than did quantitative measures such as skewness and kurtosis (27).…”