HRCT evaluation of patients with interstitial lung disease: comparison of the 2018 and 2011 diagnostic guidelines

Abstract

Background and aims: Chest high-resolution computed tomography (HRCT) is the central diagnostic tool in discerning idiopathic pulmonary fibrosis (IPF) from other interstitial lung disease (ILDs). In 2018, new guidelines were published and the nomenclature for HRCT interpretation was changed. We sought to evaluate how clinicians’ interpretation would change based on reading HRCTs under the framework of the old versus new categorization. Materials and methods: We collated HRCTs from 50 random cases evaluated in the Inova Fairfax ILD clinic. Six ILD experts were provided the deidentified HRCTs. They were all instructed to independently provide two reads of each HRCT, based on the old and the new guidelines. Results: The kappa statistic for concordance for HRCT reads under old guidelines was 0.5, while for the new guidelines it was 0.38. Under the framework of the old guidelines, there were 22 HRCTs with unanimous consensus reads, while only 15 with the new guidelines. There were 12 HRCTs read unanimously as usual interstitial pneumonia (UIP) pattern based on both the old and the new guidelines. Ten HRCTs were read as a possible UIP pattern based on the old guidelines and were classified in nine cases as probable UIP and one indeterminate based on the new guidelines. Of the 28 inconsistent UIP HRCTs (old guidelines), 25 were read as alternative diagnosis suggested, two were read as indeterminate and one as probable UIP. Conclusion: Implementation of the new guidelines to categorize HRCTs in ILD patients appears to be associated with greater inter-interpreter variability. How or whether new guidelines improve the care and management of ILD patients remains unclear. The reviews of this paper are available via the supplemental material section.

Intelligent Enhancement Algorithm-Based High Resolution CT Image in Evaluation of Expelling Wind and Relieving Cough and Asthma Prescription on Bronchial Asthma with High Immunoglobulin E Expression

“…In the classification process, the HRCT images are regarded as a complete knowledge system, the classification is performed according to the unique medical attribute and image pixel attribute "knowledge" of HRCT, the HRCT images are segmented into different regions, and the image enhancement processing is performed to highlight the local target region. The large amount of data information contained in the HRCT is reduced to obtain relatively small image data without affecting the quality of the target region in the image, assisting the physician to locate the region of interest until the accurate quantitative analysis, which can greatly improve the accuracy and accuracy of clinical diagnosis [14]. The approach involved in the algorithm is the conditional attribute S is defined according to Equation (1).…”

Interobserver agreement regarding the Fleischner Society diagnostic criteria for usual interstitial pneumonia patterns on computed tomography

“…However, their sample included normal examinations, which could have increased the level of agreement among the raters. In another study that analyzed interobserver agreement based on the most recent (2018) Fleischner Society criteria, the authors found only moderate agreement (κ = 0.50) among six ILD experts, although only one of them was a chest radiologist, the five other raters being pulmonologists ( 15 ) .…”

Multiform-based Baduanjin exercise prevention and treatment for idiopathic pulmonary fibrosis: study protocol for a randomized controlled trial

“…According to the 2018 New Evidence-based Guidelines for Diagnosis and Treatment of IPF [ 31 ], High-Resolution CT (HRCT) is the most important way to diagnose IPF at present [ 32 ]. The HRCT of the subjects before and after the trial is evaluated according to the “HRCT Efficacy Evaluation Table” and “HRCT Clinical Symptoms and Signs Efficacy Evaluation Table”.…”