Nonspecific interstitial pneumonia and usual interstitial pneumonia: Comparative appearances at and diagnostic accuracy of thin-section CT

S. L S MacDonald, M. B. Rubens, D. M. Hansell, S. J. Copley, S. R. Desai, R. M. Du Bois, A. G. Nicholson, T. V. Colby, A. U. Wells

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Abstract

PURPOSE: To compare the morphologic abnormalities on thin-section computed tomographic (CT) images in a group of patients with histopathologically confirmed nonspecific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP) and a clinical presentation of idiopathic pulmonary fibrosis. MATERIALS AND METHODS: Thin-section CT imaging patterns and distribution of disease in 53 patients with histologic diagnoses of NSIP (n = 21) or UIP (n = 32) were quantified retrospectively and independently by four observers. The appearances of NSIP and UIP at CT were compared with univariate and multivariate techniques. RESULTS: The use of thin-section CT proved to have moderate sensitivity (70%), specificity (63%), and accuracy (66%) in the diagnosis of NSIP. An increased proportion of ground-glass attenuation was the cardinal feature of NSIP at CT (odds ratio: 1.04 for each 1% increase in the proportion of ground-glass attenuation). A histologic diagnosis of NSIP was most frequent (in 24 of 35 observations [69%]) when ground-glass attenuation predominated, and was more frequent with mixed (35 of 79 observations [44%]) than with predominantly reticular disease (25 of 98 [26%] observations, P < .005). Logistic regression analysis of the data indicated that misdiagnosis of UIP in patients with NSIP was associated with less ground-glass attenuation (P < .005) at CT and a subpleural disease distribution (P = .02), with the converse being true for UIP cases misdiagnosed as NSIP. CONCLUSION: In patients with a clinical presentation of idiopathic pulmonary fibrosis, the accuracy of thin-section CT in identifying NSIP is considerably higher than previously reported. At CT, NSIP is characterized by more ground-glass attenuation and a finer reticular pattern than is UIP. Nevertheless, considerable overlap in thin-section CT patterns exists between NSIP and UIP.

Original languageEnglish (US)
Pages (from-to)600-605
Number of pages6
JournalRadiology
Volume221
Issue number3
StatePublished - 2001
Externally publishedYes

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Idiopathic Pulmonary Fibrosis
Interstitial Lung Diseases
Glass
Diagnostic Errors
Logistic Models
Odds Ratio
Regression Analysis

Keywords

  • Computed tomography (CT), electron beam
  • Lung, CT
  • Pneumonia, nonspecific interstitial and fibrosis
  • Pneumonia, usual interstitial

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

MacDonald, S. L. S., Rubens, M. B., Hansell, D. M., Copley, S. J., Desai, S. R., Du Bois, R. M., ... Wells, A. U. (2001). Nonspecific interstitial pneumonia and usual interstitial pneumonia: Comparative appearances at and diagnostic accuracy of thin-section CT. Radiology, 221(3), 600-605.

Nonspecific interstitial pneumonia and usual interstitial pneumonia : Comparative appearances at and diagnostic accuracy of thin-section CT. / MacDonald, S. L S; Rubens, M. B.; Hansell, D. M.; Copley, S. J.; Desai, S. R.; Du Bois, R. M.; Nicholson, A. G.; Colby, T. V.; Wells, A. U.

In: Radiology, Vol. 221, No. 3, 2001, p. 600-605.

Research output: Contribution to journalArticle

MacDonald, SLS, Rubens, MB, Hansell, DM, Copley, SJ, Desai, SR, Du Bois, RM, Nicholson, AG, Colby, TV & Wells, AU 2001, 'Nonspecific interstitial pneumonia and usual interstitial pneumonia: Comparative appearances at and diagnostic accuracy of thin-section CT', Radiology, vol. 221, no. 3, pp. 600-605.
MacDonald SLS, Rubens MB, Hansell DM, Copley SJ, Desai SR, Du Bois RM et al. Nonspecific interstitial pneumonia and usual interstitial pneumonia: Comparative appearances at and diagnostic accuracy of thin-section CT. Radiology. 2001;221(3):600-605.
MacDonald, S. L S ; Rubens, M. B. ; Hansell, D. M. ; Copley, S. J. ; Desai, S. R. ; Du Bois, R. M. ; Nicholson, A. G. ; Colby, T. V. ; Wells, A. U. / Nonspecific interstitial pneumonia and usual interstitial pneumonia : Comparative appearances at and diagnostic accuracy of thin-section CT. In: Radiology. 2001 ; Vol. 221, No. 3. pp. 600-605.
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abstract = "PURPOSE: To compare the morphologic abnormalities on thin-section computed tomographic (CT) images in a group of patients with histopathologically confirmed nonspecific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP) and a clinical presentation of idiopathic pulmonary fibrosis. MATERIALS AND METHODS: Thin-section CT imaging patterns and distribution of disease in 53 patients with histologic diagnoses of NSIP (n = 21) or UIP (n = 32) were quantified retrospectively and independently by four observers. The appearances of NSIP and UIP at CT were compared with univariate and multivariate techniques. RESULTS: The use of thin-section CT proved to have moderate sensitivity (70{\%}), specificity (63{\%}), and accuracy (66{\%}) in the diagnosis of NSIP. An increased proportion of ground-glass attenuation was the cardinal feature of NSIP at CT (odds ratio: 1.04 for each 1{\%} increase in the proportion of ground-glass attenuation). A histologic diagnosis of NSIP was most frequent (in 24 of 35 observations [69{\%}]) when ground-glass attenuation predominated, and was more frequent with mixed (35 of 79 observations [44{\%}]) than with predominantly reticular disease (25 of 98 [26{\%}] observations, P < .005). Logistic regression analysis of the data indicated that misdiagnosis of UIP in patients with NSIP was associated with less ground-glass attenuation (P < .005) at CT and a subpleural disease distribution (P = .02), with the converse being true for UIP cases misdiagnosed as NSIP. CONCLUSION: In patients with a clinical presentation of idiopathic pulmonary fibrosis, the accuracy of thin-section CT in identifying NSIP is considerably higher than previously reported. At CT, NSIP is characterized by more ground-glass attenuation and a finer reticular pattern than is UIP. Nevertheless, considerable overlap in thin-section CT patterns exists between NSIP and UIP.",
keywords = "Computed tomography (CT), electron beam, Lung, CT, Pneumonia, nonspecific interstitial and fibrosis, Pneumonia, usual interstitial",
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TY - JOUR

T1 - Nonspecific interstitial pneumonia and usual interstitial pneumonia

T2 - Comparative appearances at and diagnostic accuracy of thin-section CT

AU - MacDonald, S. L S

AU - Rubens, M. B.

AU - Hansell, D. M.

AU - Copley, S. J.

AU - Desai, S. R.

AU - Du Bois, R. M.

AU - Nicholson, A. G.

AU - Colby, T. V.

AU - Wells, A. U.

PY - 2001

Y1 - 2001

N2 - PURPOSE: To compare the morphologic abnormalities on thin-section computed tomographic (CT) images in a group of patients with histopathologically confirmed nonspecific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP) and a clinical presentation of idiopathic pulmonary fibrosis. MATERIALS AND METHODS: Thin-section CT imaging patterns and distribution of disease in 53 patients with histologic diagnoses of NSIP (n = 21) or UIP (n = 32) were quantified retrospectively and independently by four observers. The appearances of NSIP and UIP at CT were compared with univariate and multivariate techniques. RESULTS: The use of thin-section CT proved to have moderate sensitivity (70%), specificity (63%), and accuracy (66%) in the diagnosis of NSIP. An increased proportion of ground-glass attenuation was the cardinal feature of NSIP at CT (odds ratio: 1.04 for each 1% increase in the proportion of ground-glass attenuation). A histologic diagnosis of NSIP was most frequent (in 24 of 35 observations [69%]) when ground-glass attenuation predominated, and was more frequent with mixed (35 of 79 observations [44%]) than with predominantly reticular disease (25 of 98 [26%] observations, P < .005). Logistic regression analysis of the data indicated that misdiagnosis of UIP in patients with NSIP was associated with less ground-glass attenuation (P < .005) at CT and a subpleural disease distribution (P = .02), with the converse being true for UIP cases misdiagnosed as NSIP. CONCLUSION: In patients with a clinical presentation of idiopathic pulmonary fibrosis, the accuracy of thin-section CT in identifying NSIP is considerably higher than previously reported. At CT, NSIP is characterized by more ground-glass attenuation and a finer reticular pattern than is UIP. Nevertheless, considerable overlap in thin-section CT patterns exists between NSIP and UIP.

AB - PURPOSE: To compare the morphologic abnormalities on thin-section computed tomographic (CT) images in a group of patients with histopathologically confirmed nonspecific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP) and a clinical presentation of idiopathic pulmonary fibrosis. MATERIALS AND METHODS: Thin-section CT imaging patterns and distribution of disease in 53 patients with histologic diagnoses of NSIP (n = 21) or UIP (n = 32) were quantified retrospectively and independently by four observers. The appearances of NSIP and UIP at CT were compared with univariate and multivariate techniques. RESULTS: The use of thin-section CT proved to have moderate sensitivity (70%), specificity (63%), and accuracy (66%) in the diagnosis of NSIP. An increased proportion of ground-glass attenuation was the cardinal feature of NSIP at CT (odds ratio: 1.04 for each 1% increase in the proportion of ground-glass attenuation). A histologic diagnosis of NSIP was most frequent (in 24 of 35 observations [69%]) when ground-glass attenuation predominated, and was more frequent with mixed (35 of 79 observations [44%]) than with predominantly reticular disease (25 of 98 [26%] observations, P < .005). Logistic regression analysis of the data indicated that misdiagnosis of UIP in patients with NSIP was associated with less ground-glass attenuation (P < .005) at CT and a subpleural disease distribution (P = .02), with the converse being true for UIP cases misdiagnosed as NSIP. CONCLUSION: In patients with a clinical presentation of idiopathic pulmonary fibrosis, the accuracy of thin-section CT in identifying NSIP is considerably higher than previously reported. At CT, NSIP is characterized by more ground-glass attenuation and a finer reticular pattern than is UIP. Nevertheless, considerable overlap in thin-section CT patterns exists between NSIP and UIP.

KW - Computed tomography (CT), electron beam

KW - Lung, CT

KW - Pneumonia, nonspecific interstitial and fibrosis

KW - Pneumonia, usual interstitial

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