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High-resolution computed tomography features of nonspecific interstitial pneumonia and usual interstitial pneumonia.
J Comput Assist Tomogr. 2005 May-Jun; 29(3):339-45.JC

Abstract

OBJECTIVE

To assess the accuracy of high-resolution computed tomography (HRCT) in the diagnosis of nonspecific interstitial pneumonia (NSIP). We hypothesized that the computed tomography (CT) features of NSIP could be distinguished from those of usual interstitial pneumonia (UIP).

METHODS

The HRCT images of 47 patients with surgical lung biopsy-proven NSIP (n = 25) and UIP (n = 22) were independently reviewed by 2 thoracic radiologists. Predominant imaging patterns, most likely diagnosis, and diagnostic level of confidence were recorded. A confident HRCT diagnosis of NSIP was based on the presence of spatially uniform, bilateral, basal-predominant ground-glass and/or reticular opacities with little if any honeycombing, whereas UIP was confidently diagnosed if a spatially inhomogeneous, bilateral, peripheral, basal-predominant pattern of reticular opacities and honeycombing with little if any ground-glass attenuation was identified.

RESULTS

A predominant pattern of ground-glass and/or reticular opacity with minimal to no honeycombing was demonstrated in 48 (96%) of 50 readings in patients with NSIP. Conversely, the presence of honeycombing as a predominant feature had a predictive value of 90% for UIP (P < 0.001). Usual interstitial pneumonia was more likely than NSIP to be subpleural and patchy (P < 0.001). A confident CT diagnosis of NSIP and UIP was correct in 73% and 88% of cases, respectively. The correctness of a CT diagnosis made at intermediate or high confidence was 68% and 88%, respectively. The kappa value for distinction of NSIP from UIP was 0.72.

CONCLUSION

In contrast to previous reports, NSIP can be separated from UIP in most cases. The presence of honeycombing as a predominant imaging finding is highly specific for UIP and can be used to differentiate it from NSIP, particularly when the distribution is patchy and subpleural predominant. The presence of predominant ground-glass and reticular opacity is highly characteristic of NSIP, but there is a subset of patients with UIP who have this pattern and may require biopsy for differentiation from NSIP.

Authors+Show Affiliations

Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15891504

Citation

Elliot, Tracy L., et al. "High-resolution Computed Tomography Features of Nonspecific Interstitial Pneumonia and Usual Interstitial Pneumonia." Journal of Computer Assisted Tomography, vol. 29, no. 3, 2005, pp. 339-45.
Elliot TL, Lynch DA, Newell JD, et al. High-resolution computed tomography features of nonspecific interstitial pneumonia and usual interstitial pneumonia. J Comput Assist Tomogr. 2005;29(3):339-45.
Elliot, T. L., Lynch, D. A., Newell, J. D., Cool, C., Tuder, R., Markopoulou, K., Veve, R., & Brown, K. K. (2005). High-resolution computed tomography features of nonspecific interstitial pneumonia and usual interstitial pneumonia. Journal of Computer Assisted Tomography, 29(3), 339-45.
Elliot TL, et al. High-resolution Computed Tomography Features of Nonspecific Interstitial Pneumonia and Usual Interstitial Pneumonia. J Comput Assist Tomogr. 2005 May-Jun;29(3):339-45. PubMed PMID: 15891504.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-resolution computed tomography features of nonspecific interstitial pneumonia and usual interstitial pneumonia. AU - Elliot,Tracy L, AU - Lynch,David A, AU - Newell,John D,Jr AU - Cool,Carlyne, AU - Tuder,Rubin, AU - Markopoulou,Katerina, AU - Veve,Robert, AU - Brown,Kevin K, PY - 2005/5/14/pubmed PY - 2005/6/29/medline PY - 2005/5/14/entrez SP - 339 EP - 45 JF - Journal of computer assisted tomography JO - J Comput Assist Tomogr VL - 29 IS - 3 N2 - OBJECTIVE: To assess the accuracy of high-resolution computed tomography (HRCT) in the diagnosis of nonspecific interstitial pneumonia (NSIP). We hypothesized that the computed tomography (CT) features of NSIP could be distinguished from those of usual interstitial pneumonia (UIP). METHODS: The HRCT images of 47 patients with surgical lung biopsy-proven NSIP (n = 25) and UIP (n = 22) were independently reviewed by 2 thoracic radiologists. Predominant imaging patterns, most likely diagnosis, and diagnostic level of confidence were recorded. A confident HRCT diagnosis of NSIP was based on the presence of spatially uniform, bilateral, basal-predominant ground-glass and/or reticular opacities with little if any honeycombing, whereas UIP was confidently diagnosed if a spatially inhomogeneous, bilateral, peripheral, basal-predominant pattern of reticular opacities and honeycombing with little if any ground-glass attenuation was identified. RESULTS: A predominant pattern of ground-glass and/or reticular opacity with minimal to no honeycombing was demonstrated in 48 (96%) of 50 readings in patients with NSIP. Conversely, the presence of honeycombing as a predominant feature had a predictive value of 90% for UIP (P < 0.001). Usual interstitial pneumonia was more likely than NSIP to be subpleural and patchy (P < 0.001). A confident CT diagnosis of NSIP and UIP was correct in 73% and 88% of cases, respectively. The correctness of a CT diagnosis made at intermediate or high confidence was 68% and 88%, respectively. The kappa value for distinction of NSIP from UIP was 0.72. CONCLUSION: In contrast to previous reports, NSIP can be separated from UIP in most cases. The presence of honeycombing as a predominant imaging finding is highly specific for UIP and can be used to differentiate it from NSIP, particularly when the distribution is patchy and subpleural predominant. The presence of predominant ground-glass and reticular opacity is highly characteristic of NSIP, but there is a subset of patients with UIP who have this pattern and may require biopsy for differentiation from NSIP. SN - 0363-8715 UR - https://www.unboundmedicine.com/medline/citation/15891504/High_resolution_computed_tomography_features_of_nonspecific_interstitial_pneumonia_and_usual_interstitial_pneumonia_ DB - PRIME DP - Unbound Medicine ER -