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Computed Tomography Findings in Pathological Usual Interstitial Pneumonia

Relationship to Survival

Departments of ¹ Radiology and ² Medical Physics, Osaka University Graduate School of Medicine, Osaka, Japan; ³ Department of Pathology, Mayo Clinic, Scottsdale, Arizona; ⁴ Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan; ⁵ Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan; ⁶ Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan; ⁷ Department of Radiology, Dokkyo University School of Medicine, Tochigi, Japan; ⁸ Department of Radiology, Kurume University School of Medicine, Kurume, Japan; and ⁹ Department of Radiology, University of British Columbia and Vancouver General Hospital, Vancouver, Canada

Correspondence and requests for reprints should be addressed to Hiromitsu Sumikawa, M.D., Department of Radiology, Osaka University Graduate School of Medical, 2-2 Yamadaoka, Suita, Osaka, 565-0825, Japan. E-mail: h-sumikawa{at}radiol.med.osaka-u.ac.jp

Rationale: 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.

Objectives: 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.

Methods: 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.

Measurements and Main Results: 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).

Conclusions: 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.

Key Words: interstitial pneumonia • idiopathic pulmonary fibrosis • high-resolution computed tomography • lung

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Few previous reports have described the CT findings of UIP diagnosed according to the current histopathological criteria and the frequency of patients with IPF who have atypical CT findings. In addition, it is still unclear which CT findings influence the prognosis. What This Study Adds to the Field 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.

 

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