High-resolution computed tomography as a non-invasive imaging biomarker for interstitial lung diseases: a tertiary center study

Abstract

Background: Interstitial lung diseases (ILD) are a heterogeneous group of non-neoplastic disorders resulting from damage to the lung parenchyma by varying patterns of inflammation and fibrosis. With high-resolution computed tomography (HRCT) the pattern of lung damage can be mapped accurately which may help to identify specific ILD.Methods: 65 diagnosed cases of ILD by HRCT who were admitted to a tertiary care chest hospital, formed the study group. All these patients also underwent histopathological confirmation as per hospital protocol. The study was done over a period from August 2016 to July 2019. Clinical details, chest x-ray, HRCT and histopathological data was collected and analysed using 2x2 table for detecting sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV).Results: For diagnosing ILD like acute interstitial pneumonia (AIP), LIP and RB ILD the HRCT fared equally well in diagnostic utility as compared to histopathological examination. But in certain conditions like non-specific interstitial pneumonia (NSIP) the HRCT performed poorly in terms of PPV as compared to gold standard histopathology. In Bronchiolitis obliterans organizing pneumonia (BOOP) and usual interstitial pneumonia (UIP) again the HRCT performed fairly well as compared to gold standard.Conclusions: HRCT shows good correlation with histopathological diagnosis in identifying a various subtype of ILD and may thus serve a useful non-invasive, imaging biomarker not only for diagnosing a particular ILD but for prognostication and response to treatment.

Diagnostic Accuracy of Chest Radiograph in Interstitial Lung Disease as Confirmed by High-Resolution Computed Tomography (Hrct) Chest

“…This finding is in correlation with the well-known fact that ILD affects men more commonly. 11 CXR made a positive diagnosis of ILD in66.7% while HRCT was positive in 91.70% of our study subjects. A study conducted in Pakistan also reported that CXR was positive for ILD in 58.39% of their study participants.…”

“…20 Senger et al assessed the HRCT of 60 patients in India for the different interstitial lung diseases and compared the results with histopathology reports and reported a good correlation between the HRCT diagnosis of the different subtype of ILD and it histopathology diagnosis. 11 We stratified the diagnostic accuracy of CXR as compared to the HRCT for age and gender. We found no significant difference in the ability of CXR to diagnose ILD in either sex or at older age.…”

“…9 A number of studies have reported HRCT to be superior to Chest Radiograph (CXR) for the diagnosis of ILD. 10,11 HRCT is regarded superior to other modalities in characterization of different lung parenchymal pathologies and the extent of involvement. 12,13 It detects changes related to ILD well before they appear on CXR and therefore, can help in estimating prognosis, disease severity and response to treatment.…”