Published ahead of print on November 1, 2007, doi:10.1164/rccm.200611-1696OC Am. J. Respir. Crit. Care Med., Volume 177, Number 4, February 2008, 433-439 A more recent version of this article appeared on February 15, 2008
Submitted on November 23, 2006 Computed Tomography Findings in Pathological Usual Interstitial Pneumonia: Relationship to SurvivalHiromitsu Sumikawa1*,1 Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan, 2 Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Medical Physics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan, 3 Department of Pathology, Mayo Clinic, Scottsdale, AR, USA, 4 Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Tikami, Kumamoto, Japan, 5 Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto City, Aichi, Japan, 6 Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohamashi, Kanagawa, Japan, 7 Department of Radiology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan, 8 Department of Radiology, Kurume University School of Medicine, Asahi-machi, Kurume, Japan, 9 Department of Radiology, University of British Columbia and Vancouver General Hospital, Vancouver, Canada * To whom correspondence should be addressed. 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 CT or nonspecific or atypical findings, including those often seen in non-specific interstitial pneumonia (NSIP). 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 histological diagnosis of UIP and a clinical diagnosis of IPF. Two observers evaluated the CT findings independently and classified each case into 1 of the following 3 categories: a. Definite UIP; b. Consistent with UIP; c. 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 alternative diagnosis. The mean survival was 45.7, 57.9 and 76.9 months, respectively. There was no significant difference in survival among the 3 categories (all p > 0.05). Traction bronchiectasis and fibrosis scores were significant predictors of outcome (hazard ratios: 1.30, 1.10, respectively; 95% Confidence Interval: 1.18-14.2, 1.03-1.19, respectively). Conclusion: In patients who have biopsy proven IPF with 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 CT, lung
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