CT Features of the Usual Interstitial Pneumonia Pattern: Differentiating Connective Tissue Disease–Associated Interstitial Lung Disease From Idiopathic Pulmonary Fibrosis

Chung, Jonathan H.; Cox, Christian W.; Montner, Steven M.; Adegunsoye, Ayodeji; Oldham, Justin M.; Husain, Aliya N.; Vij, Rekha; Noth, Imre; Lynch, David A.; Strek, Mary E.

doi:10.2214/ajr.17.18384

Cited by 119 publications

(87 citation statements)

References 34 publications

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“…As compared with UIP in an idiopathic context (defining IPF), a pattern of UIP at imaging in patients with CTD may be more frequently associated with subtle signs such as the "straightedge" sign (isolation of fibrosis to the lung bases with sharp demarcation in the craniocaudal plane without substantial extension along the lateral margins of the lungs on coronal images); the "exuberant honeycombing" (exuberant honeycomb-like cyst formation within the lungs constituting more than 70% of fibrotic portions of lung sign); and the "anterior upper lobe" sign (concentration of fibrosis within the anterior aspect of the upper lobes with relative sparing of the other aspects of the upper lobes and concomitant lower lobe involvement). 69 Whether these signs are clinically useful and provide additional diagnostic or prognostic information in the specific context of IIM remains to be determined.…”

Section: Computed Tomographymentioning

confidence: 99%

Lung Diseases in Inflammatory Myopathies

Barba

Mainbourg

Nasser

et al. 2019

Semin Respir Crit Care Med

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Lung involvement is the leading cause of mortality in inflammatory myopathy. A careful assessment of clinical and serologic manifestations especially myositis-associated autoantibodies allows precise classification of the different phenotypes of inflammatory myopathy and stratification of the risk of lung involvement. About three out of four patients with inflammatory myopathy develop interstitial lung disease (ILD), which represents the main cause of morbidity and mortality. In patients with a confirmed diagnosis of inflammatory myopathy, the approach to the diagnosis of ILD includes assessment of clinical and functional severity, evaluation of the high-resolution computed tomography pattern of disease, which often suggests nonspecific interstitial pneumonia or organizing pneumonia. Bronchoalveolar lavage to rule out infection is often performed; however, video-assisted thoracoscopic lung biopsy is now generally discouraged, unless malignancy is suspected. The so-called antisynthetase syndrome characterized by the combination of mechanics' hands, Raynaud' phenomenon, myositis often mild or absent, and presence of one of the anti-tRNA synthetase antibodies is associated with a 70% risk of ILD, especially in subjects with antibodies other than anti-Jo1 antibodies (i.e., anti-PL7 or -PL12 antibodies). Treatment depends on both severity and progression of ILD, often including a combination of corticosteroids and immunosuppressive therapy. Rituximab-based regimen has showed promising results in retrospective studies for the management of refractory or rapidly progressive forms of ILD. Clinical trials are ongoing to evaluate the actual efficacy of this strategy on mortality related to lung disease. Secondary pulmonary complications of inflammatory myopathy include opportunistic infections, aspiration pneumonia, pneumomediastinum, ventilatory failure due to diaphragmatic muscular weakness, drug-induced pneumonitis, and rarely pulmonary hypertension.

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Section: Computed Tomographymentioning

confidence: 99%

Lung Diseases in Inflammatory Myopathies

Barba

Mainbourg

Nasser

et al. 2019

Semin Respir Crit Care Med

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“…The pattern of UIP is nonspecific, as the UIP or UIP-like pattern is seen in patients with cHP, connective tissue disease (CTD) (especially in rheumatoid arthritis and polymyositis) and drug-induced lung disease, as well as in IPF [48][49][50][51][52]. There is increasing interest in determining features on HRCT of the chest that may distinguish non-IPF causes of UIP (such as CTD-ILD) from IPF, although validation is needed [53]. Rheumatoid arthritis (RA) is of particular interest, as UIP is the most common pattern of ILD among patients with RA-ILD, in contrast to nonspecific interstitial pneumonia (NSIP) in the other CTD-ILDs [54,55].…”

Section: Rationale For Antifibrotic Medications In Non-ipf-pfmentioning

confidence: 99%

Antifibrotic therapy for fibrotic lung disease beyond idiopathic pulmonary fibrosis

2019

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Two antifibrotic medications (nintedanib and pirfenidone) were recommended (conditionally) for the treatment of patients with idiopathic pulmonary fibrosis (IPF) in the 2015 IPF evidence-based guidelines. These medications have been shown to reduce the rate of decline in forced vital capacity among patients with IPF over time and are the only two disease-modulating pharmacological agents approved by regulatory agencies and available for clinical use worldwide. With the evolved standard of care for interstitial lung disease evaluation including routine use of high-resolution computed tomography, fibrotic lung diseases other than IPF are increasingly recognised. In addition, it is becoming evident that genetic and pathophysiological mechanisms as well as disease behaviour in patients manifesting other “non-IPF progressive fibrotic interstitial lung diseases” (non-IPF-PF) may be similar to those in patients with IPF. Thus, it is biologically plausible that pharmacological agents with antifibrotic properties may be efficacious in non-IPF-PF. Indeed, studies are underway or planned to assess the safety and efficacy of nintedanib or pirfenidone among patients with several non-IPF fibrotic lung diseases. In this review, we briefly summarise the use of pirfenidone and nintedanib in IPF as well as the rationale and potential for use of these medications in non-IPF-PF that are being investigated in ongoing and upcoming clinical trials.

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“…The inflammatory reaction of interstitial and alveolar edema in Non-focus lung tissue during the early lung injury of COVID-19 pneumonia, which is difficult to be distinguished by eyes on CT images 4 , 9 , 10 . As an extension of computer-aided diagnosis, Lambin proposed the Radiomics method in 2012 11 .…”

Section: Introductionmentioning

confidence: 99%

The study of automatic machine learning base on radiomics of non-focus area in the first chest CT of different clinical types of COVID-19 pneumonia

Tan

Xiong

Jiang

et al. 2020

Sci Rep

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To explore the possibility of predicting the clinical types of Corona-Virus-Disease-2019 (COVID-19) pneumonia by analyzing the non-focus area of the lung in the first chest CT image of patients with COVID-19 by using automatic machine learning (Auto-ML). 136 moderate and 83 severe patients were selected from the patients with COVID-19 pneumonia. The clinical and laboratory data were collected for statistical analysis. The texture features of the Non-focus area of the first chest CT of patients with COVID-19 pneumonia were extracted, and then the classification model of the first chest CT of COVID-19 pneumonia was constructed by using these texture features based on the Auto-ML method of radiomics, The area under curve(AUC), true positive rate(TPR), true negative rate (TNR), positive predictive value(PPV) and negative predictive value (NPV) of the operating characteristic curve (ROC) were used to evaluate the accuracy of the first chest CT image classification model in patients with COVID-19 pneumonia. The TPR, TNR, PPV, NPV and AUC of the training cohort and test cohort of the moderate group and the control group, the severe group and the control group, the moderate group and the severe group were all greater than 95% and 0.95 respectively. The non-focus area of the first CT image of COVID-19 pneumonia has obvious difference in different clinical types. The AUTO-ML classification model of Radiomics based on this difference can be used to predict the clinical types of COVID-19 pneumonia.

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CT Features of the Usual Interstitial Pneumonia Pattern: Differentiating Connective Tissue Disease–Associated Interstitial Lung Disease From Idiopathic Pulmonary Fibrosis

Abstract: Although UIP is usually associated with IPF, the index of suspicion for CTD-ILD should be raised in the care of patients with any of the three CT signs. A thorough workup for CTD-ILD should be pursued, including referral to the rheumatology department.

Cited by 119 publications

References 34 publications

Lung Diseases in Inflammatory Myopathies

Lung Diseases in Inflammatory Myopathies

Antifibrotic therapy for fibrotic lung disease beyond idiopathic pulmonary fibrosis

The study of automatic machine learning base on radiomics of non-focus area in the first chest CT of different clinical types of COVID-19 pneumonia

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