TY - JOUR
T1 - Computed tomography findings in pathological usual interstitial pneumonia
T2 - Relationship to survival
AU - Sumikawa, Hiromitsu
AU - Johkoh, Takeshi
AU - Colby, Thomas V.
AU - Ichikado, Kazuya
AU - Suga, Moritaka
AU - Taniguchi, Hiroyuki
AU - Kondoh, Yasuhiro
AU - Ogura, Takashi
AU - Arakawa, Hiroaki
AU - Fujimoto, Kiminori
AU - Inoue, Atsuo
AU - Mihara, Naoki
AU - Honda, Osamu
AU - Tomiyama, Noriyuki
AU - Nakamura, Hironobu
AU - Müller, Nestor L.
PY - 2008/2/15
Y1 - 2008/2/15
N2 - Rationale: Patients with a clinicopathological diagnosis of idiopathic pulmonary fibrosis (IPF) may have typical findings of usual interstitial pneumonia (UIP) on computed tomography (CT) or nonspecific or atypical findings, including those often seen in nonspecific interstitial pneumonia. Objectives: The aims of this study were to revisit the high-resolution CT findings of IPF and to clarify the correlation between the CT findings and mortality. Methods: The study included 98 patients with a histologic diagnosis of UIP and a clinical diagnosis of IPF. Two observers evaluated the CT findings independently and classified each case into one of the following three categories: (1) definite UIP, (2) consistent with UIP, or (3) suggestive of alternative diagnosis. The correlation between the CT categories and mortality was evaluated using the Kaplan-Meier method and the log-rank test, as well as Cox proportional hazards regression models. Measurements and Main Results: Thirty-three of the 98 CT scans were classified as definite UIP, 36 as consistent with UIP, 29 as suggestive of an alternative diagnosis. The mean survival was 45.7, 57.9, and 76.9 months, respectively. There was no significant difference in survival among the three categories (all P > 0.05). Traction bronchiectasis and fibrosis scores were significant predictors of outcome (hazard ratios: 1.30 and 1.10, respectively; 95% confidence intervals: 1.18-14.2 and 1.03-1.19, respectively). Conclusions: In patients with IPF and UIP pattern on the biopsy, the pattern of abnormality on thin-section CT, whether characteristic of UIP or suggestive of alternative diagnosis, does not influence prognosis. Prognosis is influenced by traction bronchiectasis and fibrosis scores.
AB - Rationale: Patients with a clinicopathological diagnosis of idiopathic pulmonary fibrosis (IPF) may have typical findings of usual interstitial pneumonia (UIP) on computed tomography (CT) or nonspecific or atypical findings, including those often seen in nonspecific interstitial pneumonia. Objectives: The aims of this study were to revisit the high-resolution CT findings of IPF and to clarify the correlation between the CT findings and mortality. Methods: The study included 98 patients with a histologic diagnosis of UIP and a clinical diagnosis of IPF. Two observers evaluated the CT findings independently and classified each case into one of the following three categories: (1) definite UIP, (2) consistent with UIP, or (3) suggestive of alternative diagnosis. The correlation between the CT categories and mortality was evaluated using the Kaplan-Meier method and the log-rank test, as well as Cox proportional hazards regression models. Measurements and Main Results: Thirty-three of the 98 CT scans were classified as definite UIP, 36 as consistent with UIP, 29 as suggestive of an alternative diagnosis. The mean survival was 45.7, 57.9, and 76.9 months, respectively. There was no significant difference in survival among the three categories (all P > 0.05). Traction bronchiectasis and fibrosis scores were significant predictors of outcome (hazard ratios: 1.30 and 1.10, respectively; 95% confidence intervals: 1.18-14.2 and 1.03-1.19, respectively). Conclusions: In patients with IPF and UIP pattern on the biopsy, the pattern of abnormality on thin-section CT, whether characteristic of UIP or suggestive of alternative diagnosis, does not influence prognosis. Prognosis is influenced by traction bronchiectasis and fibrosis scores.
KW - High-resolution computed tomography
KW - Idiopathic pulmonary fibrosis
KW - Interstitial pneumonia
KW - Lung
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U2 - 10.1164/rccm.200611-1696OC
DO - 10.1164/rccm.200611-1696OC
M3 - Article
C2 - 17975197
AN - SCOPUS:39849111240
SN - 1073-449X
VL - 177
SP - 433
EP - 439
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 4
ER -