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High-Resolution Computed Tomography in Idiopathic Pulmonary Fibrosis

Diagnosis and Prognosis

Department of Radiology, and Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center; National Jewish Medical and Research Center, Denver, Colorado; Department of Radiology, and Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, Washington; Clinical Science and Biometrics Departments, InterMune, Inc., Brisbane; Department of Medicine, San Francisco General Hospital, and Department of Radiology, University of California–San Francisco, San Francisco, California; and Department of Medicine, Duke University Medical Center, Durham, North Carolina

Correspondence and requests for reprints should be addressed to David A. Lynch, M.D., University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Box A030, Room 2233 Denver, CO 80262. E-mail: david.lynch{at}uchsc.edu

Rationale: High-resolution computed tomography (HRCT) is an integral aspect of the evaluation of patients with suspected idiopathic pulmonary fibrosis (IPF). However, few studies have evaluated its use in a large cohort. Objectives: To describe HRCT features in patients with mild to moderate IPF, compare diagnostic evaluations by a radiology core (three thoracic radiologists) with those by study-site radiologists, correlate baseline clinical and physiologic variables with HRCT findings, and evaluate their association with mortality. Methods: We assessed HRCT scans from patients with IPF (n = 315) enrolled in a randomized controlled study evaluating IFN-1b. Measurements and Main Results: There was concordance between study-site and core radiologists regarding the diagnosis of IPF in 86% of cases. Diffusing capacity of carbon monoxide (DL_CO) was the physiologic characteristic most highly correlated with HRCT findings. Multivariate analysis identified three independent predictors of mortality: a higher extent of fibrosis score increased the risk of death (p < 0.0001), whereas a higher percent-predicted DL_CO (p = 0.004) and treatment assignment to IFN-1b rather than placebo (p = 0.04) reduced the risk of death. Conclusions: A study-site diagnosis of IPF on HRCT was regularly confirmed by core radiologists. Extent of reticulation and honeycombing on HRCT is an important independent predictor of mortality in patients with IPF.

Key Words: high-resolution computed tomography • idiopathic pulmonary fibrosis • mortality • prognosis

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