Interstitial Lung Abnormalities at CT: Subtypes, Clinical                     Significance, and Associations with Lung Cancer

Hata, Akinori; Hino, Takuya; Yanagawa, Masahiro; Nishino, Mizuki; Hida, Tomoyuki; Hunninghake, Gary M.; Tomiyama, Noriyuki; Christiani, David C.; Hatabu, Hiroto

doi:10.1148/rg.220073

Cited by 14 publications

(7 citation statements)

References 72 publications

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“…The most clinically significant result about ILA is that patients with ILA have higher mortality than patients without ILA. Various research results in healthy subjects have been published on these results, and there is a very close consistency between studies [ 2 , 7 , 14 , 18 , 19 , 27 ], for example, in general population studies (the Framingham Heart Study [FHS] and the AGES-Reykjavik study) or among populations of smokers assessed for COPD or lung cancer screening (Danish Lung Cancer Screening Trial) [ 2 , 8 , 14 , 16 - 19 , 23 ]. The hazard ratios (HRs) of increased mortality range in subjects with ILA on low-dose chest CT from 1.3 to 2.7 compared with them without ILA.…”

Section: Body Partsmentioning

confidence: 74%

“…As already mentioned, ILAs are non-dependent abnormalities affecting more than 5% of any lung zone. Although it is retained to exclude minimal opacities and to conform to previous published literature, the threshold extent of 5% is acknowledged to be arbitrary and subjective [ 1 , 2 , 4 , 8 , 15 ]. For this reason, it is confusing for readers to determine whether the ILA is about 5% when it is found on chest CT.…”

Section: Body Partsmentioning

confidence: 99%

“…ILA is known to be found on chest CT in 4%–9% of smokers and 2%–7% of non-smokers [ 1 , 6 - 9 ]. When ILA is found on chest CT, if patients have symptoms of chronic cough or shortness of breath and pulmonary function tests (PFTs) show a decrease in total lung capacity or a decrease in excise capacity, additional examination or periodic follow-up tests are required because there is a high possibility of interstitial lung disease (ILD) [ 2 - 5 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Interstitial Lung Abnormality in Asian Population

Jin

2024

Tuberc Respir Dis

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Interstitial lung abnormalities (ILAs) are radiologic abnormalities found incidentally on chest computed tomography (CT) that can be show a wide range of diseases, from subclinical lung fibrosis to early pulmonary fibrosis including definitive usual interstitial pneumonia. To clear up confusion about ILA, the Fleischner society published a position paper on the definition, clinical symptoms, increased mortality, radiologic progression, and management of ILAs based on several Western cohorts and articles. Recently, studies on long-term outcome, risk factors, and quantification of ILA to address the confusion have been published in Asia. The incidence of ILA was 7% to 10% for Westerners, while the prevalence of ILA was about 4% for Asians. ILA is closely related to various respiratory symptoms or increased rate of treatment-related complication in lung cancer. There is little difference between Westerners and Asians regarding the clinical importance of ILA. Although the role of quantitative CT as a screening tool for ILA requires further validation and standardized imaging protocols, using a threshold of 5% in at least one zone demonstrated 67.6% sensitivity, 93.3% specificity, and 90.5% accuracy, and a 1.8% area threshold showed 100% sensitivity and 99% specificity in South Korea. Based on the position paper released by the Fleischner society, I would like to report how much ILA occurs in the Asian population, what the prognosis is, and review what management strategies should be pursued in the future.

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Section: Body Partsmentioning

confidence: 74%

Section: Body Partsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Interstitial Lung Abnormality in Asian Population

Jin

2024

Tuberc Respir Dis

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“…The adjudication of ILAs was reviewed by expert thoracic radiologists and an interstitial lung disease specialist (IM) reviewed chest HRCT and characterized the features of ILAs if present. Consistent with Fleischner Society definitions, we defined ILAs as the incidental finding of non‐dependent abnormalities that affected more than 5% of the cross‐sectional area of at least one of three lung zones on CT images 14,15 . ILAs were characterized as fibrotic when CT findings of architectural distortion, reticulation, traction bronchiectasis, and/or honeycombing are present (Figure 4).…”

Section: Methodsmentioning

confidence: 99%

Interstitial lung abnormalities after hospitalization for COVID‐19 in patients with cancer: A prospective cohort study

Noh,

Bertini,

Mira‐Avendano

et al. 2023

Cancer Medicine

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IntroductionSurvivors of SARS‐CoV‐2 pneumonia often develop persistent respiratory symptom and interstitial lung abnormalities (ILAs) after infection. Risk factors for ILA development and duration of ILA persistence after SARS‐CoV‐2 infection are not well described in immunocompromised hosts, such as cancer patients.MethodsWe conducted a prospective cohort study of 95 patients at a major cancer center and 45 patients at a tertiary referral center. We collected clinical and radiographic data during the index hospitalization for COVID‐19 pneumonia and measured pneumonia severity using a semi‐quantitative radiographic score, the Radiologic Severity Index (RSI). Patients were evaluated in post‐COVID‐19 clinics at 3 and 6 months after discharge and underwent comprehensive pulmonary evaluations (symptom assessment, chest computed tomography, pulmonary function tests, 6‐min walk test). The association of clinical and radiological factors with ILAs at 3 and 6 months post‐discharge was measured using univariable and multivariable logistic regression.ResultsSixty‐six (70%) patients of cancer cohort had ILAs at 3 months, of whom 39 had persistent respiratory symptoms. Twenty‐four (26%) patients had persistent ILA at 6 months after hospital discharge. In adjusted models, higher peak RSI at admission was associated with ILAs at 3 (OR 1.5 per 5‐point increase, 95% CI 1.1–1.9) and 6 months (OR 1.3 per 5‐point increase, 95% CI 1.1–1.6) post‐discharge. Fibrotic ILAs (reticulation, traction bronchiectasis, and architectural distortion) were more common at 6 months post‐discharge.ConclusionsPost‐COVID‐19 ILAs are common in cancer patients 3 months after hospital discharge, and peak RSI and older age are strong predictors of persistent ILAs.

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“…[10][11][12] The ILDs are related to the increased risk of lung cancer and complications related to lung cancer treatment, which can be predicted by CT-based radiomics signatures. [13][14][15] Therefore, it is vital to distinguish "healthy aging" from diseases. The establishment of the "normal" lung appearance especially ILAs in the nonsmoking asymptomatic elderly cohort may avoid misdiagnosis and over-treatment of pulmonary diseases.…”

Section: Introductionmentioning

confidence: 99%

Peripheral interstitial lung abnormalities on LDCT in an asymptomatic, nonsmoking Chinese urban cohort

Gao

et al. 2023

Medicine

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To retrospectively investigate the imaging features and the related influencing factors of peripheral interstitial lung abnormalities (PILA) that caused “normal aging” by low-dose computed tomography (LDCT) in an nonsmoking, asymptomatic Chinese urban cohort. The clinical data of 733 subjects who underwent chest LDCT were retrospectively collected. The computed tomography (CT) signs of PILA (interlobular septal thickening [ILST], intralobular interstitial thickening [ILIT], ground-glass opacity [GGO], reticular shadow [RS], subpleural line [SL]) were evaluated at 6 levels and statistically analyzed. The effects of age, sex, body mass index (BMI), blood pressure (BP), and blood biochemistry parameters on ILST, ILIT, and RS were analyzed by Binary Logistic regression analysis. Significant age differences in PILA were found. None of the 5 PILA CT signs (GGO, ILST, ILIT, RS, and SL) was observed in subjects under 40 years old, while in subjects over 40 years old, the incidence of PILA increased with age. All 5 CT signs of PILA were significantly different among the subjects aged 18 to 49, 50 to 69, and 70 to 79 ( P < .05). There was no significant sex difference in PILA. Among age, sex, BMI, BP, and laboratory biochemistry parameters, only age had a significant effect on ILST, ILIT, and RS. LDCT can be used as a noninvasive method to evaluate the PILA. PILA were mainly affected by age, while sex, BMI, BP, and laboratory biochemistry parameters had little effect on PILA. PILA observed before the age of 40 years should be considered an abnormal finding, whereas it is common in individuals over 70.

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Interstitial Lung Abnormalities at CT: Subtypes, Clinical Significance, and Associations with Lung Cancer

Cited by 14 publications

References 72 publications

Interstitial Lung Abnormality in Asian Population

Interstitial Lung Abnormality in Asian Population

Interstitial lung abnormalities after hospitalization for COVID‐19 in patients with cancer: A prospective cohort study

Peripheral interstitial lung abnormalities on LDCT in an asymptomatic, nonsmoking Chinese urban cohort

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