Rheumatoid arthritis-associated interstitial lung disease

Radiologic identification of usual interstitial pneumonia pattern

Deborah Assayag, Brett M. Elicker, Thomas H. Urbania, Thomas V. Colby, Bo Hyoung Kang, Jay H Ryu, Talmadge E. King, Harold R. Collard, Dong Soon Kim, Joyce S. Lee

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine the accuracy of computed tomography (CT) in identifying the histopathologic usual interstitial pneumonia (UIP) pattern in rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Materials and All patients were enrolled into institutional review board-Methods: approved longitudinal cohorts at their respective institution, and informed consent was obtained at the time of enrollment. Images of patients with surgical lung biopsyproved RA-ILD (n = 69) were collected from three tertiary care centers. Two experienced thoracic radiologists independently reviewed the CT scans. The CT pattern was categorized as definite UIP, possible UIP, or inconsistent with UIP in accordance with published criteria. Findings of biopsies were reviewed by an experienced lung pathologist. The sensitivity and specificity of definite CT UIP pattern to histopathologic UIP pattern were determined. The agreement between radiologists was assessed by calculating a k score. Results: The histopathologic UIP pattern was present in 42 of 69 (61%) patients. Men were more likely than women to have a histopathologic UIP pattern (P =.02). Twenty patients (29%, 20 of 69) had a definite UIP pattern on CT scans. The specificity of CT UIP pattern was 96% (26 of 27; 95% confidence interval [Cl]: 81%, 100%), with a negative predictive value of 53% (26 of 49). The sensitivity of CT UIP pattern was 45% (19 of 42; 95% Cl: 30%, 61%), with a positive predictive value of 95% (19 of 20). The agreement between radiologists for definite UIP pattern versus not was 87% (k = 0.67, P <.0001). Conclusion: Definite UIP pattern on a CT scan in RA-ILD is highly specific and moderately sensitive for histopathologic UIP pattern. CT can therefore help accurately identify the UIP pattern in RA-ILD.

Original languageEnglish (US)
Pages (from-to)583-588
Number of pages6
JournalRadiology
Volume270
Issue number2
DOIs
StatePublished - Feb 2014

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Idiopathic Pulmonary Fibrosis
Interstitial Lung Diseases
Rheumatoid Arthritis
Tomography
Lung
Research Ethics Committees
Informed Consent
Tertiary Care Centers

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Rheumatoid arthritis-associated interstitial lung disease : Radiologic identification of usual interstitial pneumonia pattern. / Assayag, Deborah; Elicker, Brett M.; Urbania, Thomas H.; Colby, Thomas V.; Kang, Bo Hyoung; Ryu, Jay H; King, Talmadge E.; Collard, Harold R.; Kim, Dong Soon; Lee, Joyce S.

In: Radiology, Vol. 270, No. 2, 02.2014, p. 583-588.

Research output: Contribution to journalArticle

Assayag, D, Elicker, BM, Urbania, TH, Colby, TV, Kang, BH, Ryu, JH, King, TE, Collard, HR, Kim, DS & Lee, JS 2014, 'Rheumatoid arthritis-associated interstitial lung disease: Radiologic identification of usual interstitial pneumonia pattern', Radiology, vol. 270, no. 2, pp. 583-588. https://doi.org/10.1148/radiol.13130187
Assayag, Deborah ; Elicker, Brett M. ; Urbania, Thomas H. ; Colby, Thomas V. ; Kang, Bo Hyoung ; Ryu, Jay H ; King, Talmadge E. ; Collard, Harold R. ; Kim, Dong Soon ; Lee, Joyce S. / Rheumatoid arthritis-associated interstitial lung disease : Radiologic identification of usual interstitial pneumonia pattern. In: Radiology. 2014 ; Vol. 270, No. 2. pp. 583-588.
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abstract = "Purpose: To determine the accuracy of computed tomography (CT) in identifying the histopathologic usual interstitial pneumonia (UIP) pattern in rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Materials and All patients were enrolled into institutional review board-Methods: approved longitudinal cohorts at their respective institution, and informed consent was obtained at the time of enrollment. Images of patients with surgical lung biopsyproved RA-ILD (n = 69) were collected from three tertiary care centers. Two experienced thoracic radiologists independently reviewed the CT scans. The CT pattern was categorized as definite UIP, possible UIP, or inconsistent with UIP in accordance with published criteria. Findings of biopsies were reviewed by an experienced lung pathologist. The sensitivity and specificity of definite CT UIP pattern to histopathologic UIP pattern were determined. The agreement between radiologists was assessed by calculating a k score. Results: The histopathologic UIP pattern was present in 42 of 69 (61{\%}) patients. Men were more likely than women to have a histopathologic UIP pattern (P =.02). Twenty patients (29{\%}, 20 of 69) had a definite UIP pattern on CT scans. The specificity of CT UIP pattern was 96{\%} (26 of 27; 95{\%} confidence interval [Cl]: 81{\%}, 100{\%}), with a negative predictive value of 53{\%} (26 of 49). The sensitivity of CT UIP pattern was 45{\%} (19 of 42; 95{\%} Cl: 30{\%}, 61{\%}), with a positive predictive value of 95{\%} (19 of 20). The agreement between radiologists for definite UIP pattern versus not was 87{\%} (k = 0.67, P <.0001). Conclusion: Definite UIP pattern on a CT scan in RA-ILD is highly specific and moderately sensitive for histopathologic UIP pattern. CT can therefore help accurately identify the UIP pattern in RA-ILD.",
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T2 - Radiologic identification of usual interstitial pneumonia pattern

AU - Assayag, Deborah

AU - Elicker, Brett M.

AU - Urbania, Thomas H.

AU - Colby, Thomas V.

AU - Kang, Bo Hyoung

AU - Ryu, Jay H

AU - King, Talmadge E.

AU - Collard, Harold R.

AU - Kim, Dong Soon

AU - Lee, Joyce S.

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N2 - Purpose: To determine the accuracy of computed tomography (CT) in identifying the histopathologic usual interstitial pneumonia (UIP) pattern in rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Materials and All patients were enrolled into institutional review board-Methods: approved longitudinal cohorts at their respective institution, and informed consent was obtained at the time of enrollment. Images of patients with surgical lung biopsyproved RA-ILD (n = 69) were collected from three tertiary care centers. Two experienced thoracic radiologists independently reviewed the CT scans. The CT pattern was categorized as definite UIP, possible UIP, or inconsistent with UIP in accordance with published criteria. Findings of biopsies were reviewed by an experienced lung pathologist. The sensitivity and specificity of definite CT UIP pattern to histopathologic UIP pattern were determined. The agreement between radiologists was assessed by calculating a k score. Results: The histopathologic UIP pattern was present in 42 of 69 (61%) patients. Men were more likely than women to have a histopathologic UIP pattern (P =.02). Twenty patients (29%, 20 of 69) had a definite UIP pattern on CT scans. The specificity of CT UIP pattern was 96% (26 of 27; 95% confidence interval [Cl]: 81%, 100%), with a negative predictive value of 53% (26 of 49). The sensitivity of CT UIP pattern was 45% (19 of 42; 95% Cl: 30%, 61%), with a positive predictive value of 95% (19 of 20). The agreement between radiologists for definite UIP pattern versus not was 87% (k = 0.67, P <.0001). Conclusion: Definite UIP pattern on a CT scan in RA-ILD is highly specific and moderately sensitive for histopathologic UIP pattern. CT can therefore help accurately identify the UIP pattern in RA-ILD.

AB - Purpose: To determine the accuracy of computed tomography (CT) in identifying the histopathologic usual interstitial pneumonia (UIP) pattern in rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Materials and All patients were enrolled into institutional review board-Methods: approved longitudinal cohorts at their respective institution, and informed consent was obtained at the time of enrollment. Images of patients with surgical lung biopsyproved RA-ILD (n = 69) were collected from three tertiary care centers. Two experienced thoracic radiologists independently reviewed the CT scans. The CT pattern was categorized as definite UIP, possible UIP, or inconsistent with UIP in accordance with published criteria. Findings of biopsies were reviewed by an experienced lung pathologist. The sensitivity and specificity of definite CT UIP pattern to histopathologic UIP pattern were determined. The agreement between radiologists was assessed by calculating a k score. Results: The histopathologic UIP pattern was present in 42 of 69 (61%) patients. Men were more likely than women to have a histopathologic UIP pattern (P =.02). Twenty patients (29%, 20 of 69) had a definite UIP pattern on CT scans. The specificity of CT UIP pattern was 96% (26 of 27; 95% confidence interval [Cl]: 81%, 100%), with a negative predictive value of 53% (26 of 49). The sensitivity of CT UIP pattern was 45% (19 of 42; 95% Cl: 30%, 61%), with a positive predictive value of 95% (19 of 20). The agreement between radiologists for definite UIP pattern versus not was 87% (k = 0.67, P <.0001). Conclusion: Definite UIP pattern on a CT scan in RA-ILD is highly specific and moderately sensitive for histopathologic UIP pattern. CT can therefore help accurately identify the UIP pattern in RA-ILD.

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