The use of pretest probability increases the value of high-resolution CT in diagnosing usual interstitial pneumonia

Brownell, Robert; Moua, Teng; Henry, Travis S.; Elicker, Brett M.; White, Darin; Vittinghoff, Eric; Jones, Kirk D.; Urisman, Anatoly; Aravena, Carlos; Johannson, Kerri A.; Golden, Jeffrey A.; King, Talmadge E.; Wolters, Paul J.; Collard, Harold R.; Ley, Brett

doi:10.1136/thoraxjnl-2016-209671

Cited by 115 publications

(86 citation statements)

References 20 publications

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“…Previous studies have shown that patients with histologically proven IPF can present without the typical CT findings of UIP. 30 With the availability of new antifibrotic drugs such as pirfenidone and nintendanib 31,32 that slow down disease progression, treatment response needs to be measured. However, the most commonly used FIGURE 4.…”

Section: Discussionmentioning

confidence: 99%

Increased Expiratory Computed Tomography Density Reveals Possible Abnormalities in Radiologically Preserved Lung Parenchyma in Idiopathic Pulmonary Fibrosis

Petroulia¹,

Funke²,

Zumstein³

et al. 2018

Invest Radiol

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Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive lethal chronic lung disease with unclear pathogenesis. Radiological hallmark is the pattern of usual interstitial pneumonia accentuated in peripheral and basal areas with otherwise preserved lung structure. One hypothesis is that alveolar collapse and consequent induration lead to fibrotic transformation of lung tissue. The aim of the study was to investigate normal-appearing tissue during expiration for signs of collapsibility and differences from other diseases or controls. Materials and Methods: We retrospectively assessed a total of 43 patients (15 IPFs, 13 chronic obstructive pulmonary diseases, and 15 controls) with nonenhanced computed tomography (CT) in inspiration and expiration, performed for routine clinical workup. Densitometry of visually unaffected lung tissue was conducted in all lung lobes with a region of interest of 15-mm in diameter on soft tissue kernel reconstruction (slice thickness, 1 mm) during inspiration and expiration. Results: One-factor analysis of variance analysis yielded significant difference in attenuation changes between inspiration and expiration of unaffected lung parenchyma among all subject groups in all lung lobes. For IPF patients, the highest differences in densities were observed in the lower lobes, which is the predominantly affected site of usual interstitial pneumonia. In the chronic obstructive pulmonary disease group, the density remained rather equal in the entire lung. Conclusions: High CT attenuation changes between inspiration and expiration in IPF patients might suggest altered lung parenchyma in normal-appearing tissue on CT. Density changes during the respiratory cycle might be explained by alveolar collapse of radiologically unaffected lung tissue possibly preceding fibrosis. These results support the concept of alveolar collapse preceding lung fibrosis in IPF.

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Section: Discussionmentioning

confidence: 99%

Increased Expiratory Computed Tomography Density Reveals Possible Abnormalities in Radiologically Preserved Lung Parenchyma in Idiopathic Pulmonary Fibrosis

Petroulia¹,

Funke²,

Zumstein³

et al. 2018

Invest Radiol

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“…Analyses of patient populations meeting the "probable UIP" criteria in high-resolution computed tomography (HRCT) indicate that lack of honeycombing should not exclude IPF diagnosis if all remaining radiographic features of the UIP pattern are present (especially predominantly subpleural and basal distribution of changes as well as the presence of bronchiectasis) [30,[88][89][90][91][92][93][94][95][96][97][98]. The extent of reticular changes is of great importance.…”

Section: Introductionmentioning

confidence: 99%

“…A recently published meta-analysis demonstrated that IPF diagnosis can be made in as many as 94% (87-99%) of patients with a radiographic pattern corresponding to "probable UIP" [100]. The probability of IPF diagnosis increases in an appropriate clinical context, comprising the following: age above 60 years, a positive history of tobacco smoking (currently or in the past) and lack of other identifiable causes that could lead to interstitial fibrosis (especially lack of significant environmental exposure, chronic use of potentially pneumotoxic drugs or signs of CTD) [31,97,99,101,102]. In the group of patients with "probable UIP" (who had not undergone lung biopsy), an annual FVC decline was observed as well as a response to antifibrotic treatment (with nintedanib) reducing the rate of this decline, comparable with outcomes observed in the "definite UIP" group (based on radiographic or pathomorphological presentation) [103].…”

Section: Introductionmentioning

confidence: 99%

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

Piotrowski

Bestry²,

Białas

et al. 2020

Advances in Respiratory Medicine

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“…HRCT may be used to identify sites for bronchoalveolar lavage and lung biopsy, guide treatment strategies, and predict treatment outcomes [6].…”

Section: Introductionmentioning

confidence: 99%

Visual and quantitative assessment of HRCT pulmonary changes in idiopathic interstitial pneumonia with PFT correlation

Kolta

Goneimy

2020

Egypt J Radiol Nucl Med

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Background: Our study was designed to correlate the degree of parenchymal affection in idiopathic interstitial pneumonia using visual and semi-quantitative HRCT assessment with pulmonary function test results. The study involved 50 patients diagnosed as idiopathic interstitial pneumonia. They were referred from a chest outpatient clinic to the Radiology Department in the Faculty of Medicine, Cairo University for HRCT assessment in the period from January 2017 to March 2019. Variable lung parenchymal affection was studied using HRCT and variable post acquisition processing (multi-planar reconstruction, volumetric assessment, 3D color-coded images). Results: Usual interstitial pneumonia was the most common type of IP, found in approximately 40 patients (80% of cases) followed by nonspecific interstitial pneumonia found in 5 patients (10% of cases) and lymphocytic interstitial pneumonia found in 3 patients (6% of cases), and desquamative interstitial pneumonia was the least common type of IP, found only in 2 patients (4% of cases).Honeycombing was significantly correlated with FVC%, FEV1%, and FEV1/FVC% (p = 0.013, p = <0.001, p = 0.002 respectively). Also, reticular was significantly correlated with FVC% (p = 0.041). Conclusion: Semi-quantitative image analysis, including the use of machine learning, provides a great deal of promise in the ILD field; such methods may be used together with visual analysis to obtain the most accurate diagnostic and prognostic information. Summary/keywords: HRCT is most sensitive in the detection of ILD than chest radiography or conventional chest computed tomography (CT). Advances in HRCT scanning and interpretation have facilitated and improved accuracy for use in diagnosing idiopathic pulmonary fibrosis (IPF), eliminating the need for a surgical biopsy in many patients. Consequently, HRCT scans became sufficient to allow a confident IPF diagnosis It is important to note that there are potential differences in interpretation of HRCT patterns between thoracic radiologists. However, these differences seem to be in general within a clinically acceptable range of observer variation and can be partially mitigated by review of difficult cases at ILD referral centers. Semi-quantitative CT assessment is increasingly being used in ILD to identify pulmonary abnormalities and diagnose specific ILDs; recent studies showed that outcomes of computer-assisted imaging can be correlated with lung function tests and degree of dyspnea and functional disability This study was designed to correlate the degree of parenchymal affection in IP using visual and semi-quantitative HRCT assessment with PFT results. Semi-quantitative imaging, including color-coded images (HU related), is a new and promising approach in the field of ILD diagnosis and prognosis.

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The use of pretest probability increases the value of high-resolution CT in diagnosing usual interstitial pneumonia

Cited by 115 publications

References 20 publications

Increased Expiratory Computed Tomography Density Reveals Possible Abnormalities in Radiologically Preserved Lung Parenchyma in Idiopathic Pulmonary Fibrosis

Increased Expiratory Computed Tomography Density Reveals Possible Abnormalities in Radiologically Preserved Lung Parenchyma in Idiopathic Pulmonary Fibrosis

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

Visual and quantitative assessment of HRCT pulmonary changes in idiopathic interstitial pneumonia with PFT correlation

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