To quantify observer agreement and analyze causes of disagreement in identifying honeycombing at chest computed tomography (CT).
The institutional review board approved this multiinstitutional ...HIPAA-compliant retrospective study, and informed patient consent was not required. Five core study members scored 80 CT images with a five-point scale (5 = definitely yes to 1 = definitely no) to establish a reference standard for the identification of honeycombing. Forty-three observers from various subspecialties and geographic regions scored the CT images by using the same scoring system. Weighted κ values of honeycombing scores compared with the reference standard were analyzed to investigate intergroup differences. Images were divided into four groups to allow analysis of imaging features of cases in which there was disagreement: agreement on the presence of honeycombing, agreement on the absence of honeycombing, disagreement on the presence of honeycombing, and other (none of the preceding three groups applied).
Agreement of scores of honeycombing presence by 43 observers with the reference standard was moderate (Cohen weighted κ values: 0.40-0.58). There were no significant differences in κ values among groups defined by either subspecialty or geographic region (Tukey-Kramer test, P = .38 to >.99). In 29% of cases, there was disagreement on identification of honeycombing. These cases included honeycombing mixed with traction bronchiectasis, large cysts, and superimposed pulmonary emphysema.
Identification of honeycombing at CT is subjective, and disagreement is largely caused by conditions that mimic honeycombing.
To retrospectively assess the accuracy of thin-section computed tomography (CT) in distinguishing chronic hypersensitivity pneumonitis (HP) from idiopathic pulmonary fibrosis (IPF) and nonspecific ...interstitial pneumonia (NSIP), with histologic results as the reference standard.
This retrospective study was approved by the institutional research boards of the participating centers, and informed consent was waived. There was HIPAA compliance for all U.S. patients. The study included 66 patients (36 men, 30 women; mean age, 58.8 years +/- 10.9 standard deviation) with proved chronic HP (n = 18), IPF (n = 23), or NSIP (n = 25) who underwent CT. Two independent readers assessed the CT images, made a first-choice diagnosis, and noted the degree of confidence in the diagnosis. A general linear model was used to identify CT features that independently differentiated chronic HP from IPF and NSIP. Weighted kappa statistic was used to assess interobserver agreement.
The CT features that best differentiated chronic HP were lobular areas with decreased attenuation and vascularity, centrilobular nodules, and absence of lower zone predominance of abnormalities (P < or = .008). The features that best differentiated NSIP were relative subpleural sparing, absence of lobular areas with decreased attenuation, and lack of honeycombing (P < or = .002). The features that best differentiated IPF were basal predominance of honeycombing, absence of relative subpleural sparing, and absence centrilobular nodules (P < or = .004). A confident diagnosis was made in 70 (53%) of 132 readings. This diagnosis was correct in 66 (94%) of 70 readings. The accuracy for the entire cohort was 80%. Interobserver agreement for confident diagnosis was good to excellent (kappa = 0.77-0.96).
Characteristic CT features of chronic HP, IPF, and NSIP allow confident distinction between these entities in approximately 50% of patients.
The 2002 American Thoracic Society/European Respiratory Society classification of idiopathic interstitial pneumonias identified nonspecific interstitial pneumonia (NSIP) as a provisional diagnosis. ...Concern was expressed that NSIP was a "wastebasket" category, difficult to distinguish from other idiopathic interstitial pneumonias.
The following questions were addressed: (1) Is idiopathic NSIP a distinct entity? 2) If so, what are its clinical, radiologic and pathologic characteristics? (3) What is the role of radiology and pathology in establishing the diagnosis? (4) To make a diagnosis of idiopathic NSIP, what other disorders need to be excluded and how should this be done?
Investigators who had previously reported cases of idiopathic NSIP were invited to submit cases for review (n = 305). After initial review, cases with complete clinical, radiologic, and pathologic information (n = 193) were reviewed in a series of workshops.
Sixty-seven cases were identified as NSIP. Mean age was 52 years, 67% were women, 69% were never-smokers, and 46% were from Asian countries. The most common symptoms were dyspnea (96%) and cough (87%); 69% had restriction. By high-resolution computed tomography, the lower lung zones were predominantly involved in 92% of cases; 46% had a peripheral distribution; 47% were diffuse. Most showed a reticular pattern (87%) with traction bronchiectasis (82%) and volume loss (77%). Lung biopsies showed uniform thickening of alveolar walls with a spectrum of cellular to fibrosing patterns. Five-year survival was 82.3%.
Idiopathic NSIP is a distinct clinical entity that occurs mostly in middle-aged women who are never-smokers. The prognosis of NSIP is very good.
The objective of our study was to review the chest radiographic and CT findings in patients with swine-origin influenza A (H1N1) virus (S-OIV) infection.
The most common radiographic and CT findings ...in seven patients with S-OIV infection are unilateral or bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. On MDCT, the ground-glass opacities and areas of consolidation had a predominant peribronchovascular and subpleural distribution, resembling organizing pneumonia.
Members of the Fleischner Society compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984 and 1996 for thoracic radiography and computed tomography (CT), ...respectively. The need to update the previous versions came from the recognition that new words have emerged, others have become obsolete, and the meaning of some terms has changed. Brief descriptions of some diseases are included, and pictorial examples (chest radiographs and CT scans) are provided for the majority of terms.
Patients with a clinicopathological diagnosis of idiopathic pulmonary fibrosis (IPF) may have typical findings of usual interstitial pneumonia (UIP) on computed tomography (CT) or nonspecific or ...atypical findings, including those often seen in nonspecific interstitial pneumonia.
The aims of this study were to revisit the high-resolution CT findings of IPF and to clarify the correlation between the CT findings and mortality.
The study included 98 patients with a histologic diagnosis of UIP and a clinical diagnosis of IPF. Two observers evaluated the CT findings independently and classified each case into one of the following three categories: (1) definite UIP, (2) consistent with UIP, or (3) suggestive of alternative diagnosis. The correlation between the CT categories and mortality was evaluated using the Kaplan-Meier method and the log-rank test, as well as Cox proportional hazards regression models.
Thirty-three of the 98 CT scans were classified as definite UIP, 36 as consistent with UIP, 29 as suggestive of an alternative diagnosis. The mean survival was 45.7, 57.9, and 76.9 months, respectively. There was no significant difference in survival among the three categories (all P > 0.05). Traction bronchiectasis and fibrosis scores were significant predictors of outcome (hazard ratios: 1.30 and 1.10, respectively; 95% confidence intervals: 1.18-14.2 and 1.03-1.19, respectively).
In patients with IPF and UIP pattern on the biopsy, the pattern of abnormality on thin-section CT, whether characteristic of UIP or suggestive of alternative diagnosis, does not influence prognosis. Prognosis is influenced by traction bronchiectasis and fibrosis scores.
Objectives
To determine high-resolution computed tomography (HRCT) findings helpful in predicting mortality in patients with acute exacerbation of idiopathic pulmonary fibrosis (AEx-IPF).
Methods
...Sixty patients with diagnosis of AEx-IPF were reviewed retrospectively. Two groups (two observers each) independently evaluated pattern, distribution, and extent of HRCT findings at presentation and calculated an HRCT score at AEx based on normal attenuation areas and extent of abnormalities, such as areas of ground-glass attenuation and/or consolidation with or without traction bronchiectasis or bronchiolectasis and areas of honeycombing. The correlation between the clinical data including the HRCT score and mortality (cause-specific survival) was evaluated using the univariate and multivariate Cox-regression analyses.
Results
Serum KL-6 level, PaCO
2
, and the HRCT score were statistically significant predictors on univariate analysis. Multivariate analysis revealed that the HRCT score was an independently significant predictor of outcome (hazard ratio, 1.13; 95% confidence interval, 1.06–1.19,
P
= 0.0002). The area under receiver operating characteristics curve for the HRCT score was statistically significant in the classification of survivors or nonsurvivors (0.944;
P
< 0.0001). Survival in patients with HRCT score ≥245 was worse than those with lower score (log-rank test,
P
< 0.0001).
Conclusion
The HRCT score at AEx is independently related to prognosis in patients with AEx-IPF.
Key Points
•
High-Resolution Computed Tomography (HRCT) helps clinicians to assess patients with interstitial fibrosis.
•
The main abnormalities of acute exacerbation are ground-glass opacification and consolidation.
•
Extent of abnormalities on HRCT correlates with poor prognosis.
To retrospectively assess the change in disease pattern of nonspecific interstitial pneumonia (NSIP) and idiopathic pulmonary fibrosis (IPF) findings seen at thin-section computed tomography (CT) at ...long-term follow-up and to compare the same with initial findings at CT.
The study included 48 patients (28 men, 20 women; mean age, 57.5 years) with biopsy-proved NSIP (n = 23) or IPF (n = 25) who underwent CT at initial diagnosis and at follow-up 34-155 months later. The CT scans were randomized and reviewed by two independent thoracic radiologists for pattern and distribution of ground-glass opacity (GGO), reticulation, traction bronchiectasis and bronchiolectasis, and honeycombing. Statistical analysis was performed by using nonparametric methods and univariate logistic regression.
Follow-up CT in patients with NSIP showed marked decrease in the extent of GGO, increase in reticulation, and a greater likelihood of peripheral distribution (all P < .05). At presentation, the CT findings were interpreted as suggestive of NSIP in 18 of 23 patients with NSIP and indeterminate or suggestive of IPF in five. In five (28%) of 18 patients with initial findings suggestive of NSIP, the follow-up CT scans were interpreted as more suggestive of IPF. No CT features seen at presentation allowed distinction between patients with NSIP that maintained an NSIP pattern at follow-up and those that progressed to an IPF pattern.
At follow-up CT, 28% of patients with initial CT findings suggestive of NSIP progressed to findings suggestive of IPF. Similar initial CT findings for NSIP may have different imaging outcomes.
Recent clinical practice guidelines have addressed the diagnosis of idiopathic pulmonary fibrosis (IPF) and fibrotic hypersensitivity pneumonitis (fHP). These disease-specific guidelines were ...developed independently, without clear direction on how to apply their respective recommendations concurrently within a single patient, where discrimination between these two fibrotic interstitial lung diseases represents a frequent diagnostic challenge. The objective of this review, created by an international group of experts, was to suggest a pragmatic approach on how to apply existing guidelines to distinguish IPF and fHP. Key clinical, radiologic, and pathologic features described in previous guidelines are integrated in a set of diagnostic algorithms, which then are placed in the broader context of multidisciplinary discussion to guide the generation of a consensus diagnosis. Although these algorithms necessarily reflect some uncertainty wherever strong evidence is lacking, they provide insight into the current approach favored by experts in the field based on currently available knowledge. The authors further identify priorities for future research to clarify ongoing uncertainties in the diagnosis of fibrotic interstitial lung diseases.
Emphysema is a key contributor to airflow limitation in chronic obstructive pulmonary disease (COPD) and can be quantified using CT scanning. We investigated the change in CT lung density in a ...longitudinal, international cohort of patients with COPD. We also explored the potential relation between emphysema and patient characteristics, and investigated if certain circulating biomarkers were associated with decline in CT lung density.
We used a random coefficient model to assess predictors of both CT lung density and its longitudinal change over 3 years in 1928 patients with COPD enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. Lung density was measured for every voxel in the CT scan and after correcting for lung volume was expressed as the density at lowest 15th percentile point of the distribution. This study is registered with ClinicalTrials.gov, number NCT00292552.
Lung density at baseline was influenced by age, sex, body-mass index, current smoking status and smoking history, and severity of airflow limitation. The observed decline in lung density was variable (mean decline -1·13 g/L SE 0·06 per year). The annual decline in lung density was more rapid in women (additional -0·41 SE 0·14 g/L per year, p=0·003) than men and in current smokers (additional -0·29 SE 0·14 g/L per year, p=0·047) than in former smokers. Circulating levels of the biomarkers surfactant protein D (SP-D) and soluble receptor for advanced glycation endproduct (sRAGE) were significantly associated with both baseline lung density and its decline over time.
This study shows that decline in lung density in COPD can be measured, that it is variable, and related to smoking and gender. We identified potential biochemical predictors of the presence and progression of emphysema.
GlaxoSmithKline.
PDF
