This Article Full Text Full Text (PDF) All Versions of this Article: 200709-1365OCv1 178/4/372    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Akira, M. Articles by Sakatani, M. Search for Related Content PubMed PubMed Citation Articles by Akira, M. Articles by Sakatani, M.

Computed Tomography Findings in Acute Exacerbation of Idiopathic Pulmonary Fibrosis

Departments of ¹ Radiology, ² Pathology, and ³ Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Osaka, Japan

Correspondence and requests for reprints should be addressed to Masanori Akira, M.D., Department of Radiology, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai City, Osaka 591-8555, Japan. E-mail: Akira{at}kch.hosp.go.jp

Rationale: The serial computed tomography findings and prognosis of the acute exacerbation of idiopathic pulmonary fibrosis (IPF) are not yet well defined in a larger number of cases.

Objectives: To evaluate the parenchymal abnormalities and prognosis using high-resolution computed tomography (HRCT) in acute exacerbation of IPF.

Methods: The study consisted of clinical, laboratory, and HRCT data before and at the time of acute exacerbation in 64 episodes of 58 patients with IPF. A semiquantitative analysis of overall extent of parenchymal abnormalities, extent of alveolar opacity (ground-glass attenuation and consolidation), and extent of fibrotic opacity (reticulation and honeycombing) on CT was performed by two chest radiologists. The newly appeared parenchymal abnormalities were also classified into three patterns: peripheral, multifocal, and diffuse.

Measurements and Main Results: In all patients, HRCT scans taken at the exacerbation showed typical signs of IPF and newly developing alveolar opacity. They included 34 patients of peripheral pattern, 8 of multifocal pattern, and 16 of diffuse pattern. Twenty-five patients died and 33 survived after the initial exacerbation. Worse survival was associated with patients with diffuse type compared with patients with multifocal and peripheral type. The CT patterns and overall CT extent were associated with an increased hazard of death after adjusting for age, sex, smoking, baseline diffusion capacity for carbon monoxide, baseline FVC, and disease extent on CT. On multivariate analysis, the strongest correlations were observed between CT patterns (combined diffuse and multifocal versus peripheral) and survival (odds ratio, 4.629; 95% confidence interval, 1.900–11.278; P = 0.001).

Conclusions: HRCT extent and patterns are predictive of survival in acute exacerbation of IPF.

Key Words: lung disease, interstitial • computed tomography, high-resolution • idiopathic pulmonary fibrosis • acute exacerbation • acute lung injury

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject The computed tomography (CT) extent and patterns may give additional prognostic information to baseline features. Acute exacerbation may repeat in some patients with usual interstitial pneumonia. What This Study Adds to the Field High-resolution CT assessment is potentially helpful in predicting patient prognosis in acute exacerbation of idiopathic pulmonary fibrosis.

 

This article has been cited by other articles:

				K. Sakamoto, H. Taniguchi, Y. Kondoh, K. Ono, Y. Hasegawa, and M. Kitaichi Acute exacerbation of idiopathic pulmonary fibrosis as the initial presentation of the disease Eur. Respir. Rev., June 1, 2009; 18(112): 129 - 132. [Abstract] [Full Text] [PDF]

				J. Behr and V. J. Thannickal Update in Diffuse Parenchymal Lung Disease 2008 Am. J. Respir. Crit. Care Med., March 15, 2009; 179(6): 439 - 444. [Full Text] [PDF]