Serial Evaluation of High-Resolution Computed Tomography Findings in Patients with Idiopathic Pulmonary Fibrosis in Usual Interstitial Pneumonia

Abstract

Background: The development of well-matured fibrosis in usual interstitial pneumonia (UIP) is strongly associated with an unfavorable outcome of patients with idiopathic pulmonary fibrosis (IPF). However, differences in the rates of development are likely to result in variable clinical courses in IPF patients. Objective: We tried to evaluate the progression of honeycombing and ground-glass opacity on CT using a scoring system, and to examine those serial changes in the clinical course of disease. Methods: A hospital-based, retrospective cohort study. Twenty-three patients with IPF diagnosed as UIP by surgical lung biopsy were analyzed during the initial examination by scoring the presence of honeycombing (HC: range, 0–24) and ground-glass opacity (GG: range, 0–24) on CT scan. We also compared the serial changes observed in the CT scores (interval: 2–42 months, 2–6 examinations). Results: (1) The serial change in the HC score in treated patients (n = 10) was similar to that in untreated patients (n = 16); (2) the HC score at the time of the initial examination and the rate of HC progression were both higher in the non-surviving patients (HC 12.3 ± 3.7, mean ± SD; ΔHC 4.2 ± 1.3 per year) than in the surviving patients (HC 5.8 ± 2.7; ΔHC 1.2 ± 0.7 per year) (p < 0.05); (3) the GG score did not correlate with the HC score at any of the examinations; (4) the HC score was higher in the lower lung field than in the upper and middle lung fields. Conclusions: Scoring of the honeycombing and its serial changes using the high-resolution computed tomography scoring method was useful for predicting the prognosis in patients with IPF/UIP. Corticosteroid treatment did not prevent the progression of HC.

CT Scan Findings of Probable Usual Interstitial Pneumonitis Have a High Predictive Value for Histologic Usual Interstitial Pneumonitis

“…30,33 Th e extent of honeycombing and of pulmonary fi brosis on CT scan has adverse prognostic ramifi cations. [33][34][35][36][37] Th ough we hoped to see a relationship between CT scan honeycombing and microscopic honeycombing, there was no such association in our study suggesting that honeycombing on CT scan and histology are dissimilar. It has been shown that CT scan honeycombing is associated with a poor prognosis but this is not the case for microscopic honeycombing; microscopic honeycombing also is not necessarily specifi c for a UIP diagnosis as opposed to CT scan honeycombing which is highly specifi c for UIP.…”

Idiopathic Pulmonary Fibrosis: Evaluation with Positron Emission Tomography

“…There remains considerable error using combined clinical diagnostic criteria or even high-resolution CT scans with the accuracy of these methods hovering in the 70% range [11, 12]. Some have advocated the use of serial high-resolution CT scans in monitoring these patients, being able to better document increasing honeycomb changes or fibrosis in those with progressive disease [13]. However, the utility of this information in those with clinically progressive disease remains to be defined.…”

Do High-Resolution CT Findings of Usual Interstitial Pneumonitis Obviate Lung Biopsy?

“…Other investigations have confirmed the concordance of HRCT images with physiologic, pathologic, and clinical manifestations of UIP [34]. Indeed, scoring of the honeycombing and tracking serial changes by HRCT has been shown to be useful for predicting the prognosis in patients with UIP [35]. To our knowledge, the current findings reveal how this evolving body of evidence is synthesized by chest clinicians and applied to their care of patients.…”