Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper.

Even experienced radiologists may disagree on the identification of the presence of honeycombing, and this disagreement is caused mainly by the misinterpretation of conditions that may mimic honeycombing, such as traction bronchiectasis and emphysema

https://pubs.rsna.org/doi/pdf/10.1148/radiol.12112516?hits=20

Interobserver Variability in the CT Assessment of Honeycombing in the Lungs

Computed tomography (CT) has had a profound effect on the practice of medicine. Both the spectrum of clinical applications and the role that CT has played in enhancing the depth of our understanding of disease have been profound. Although almost 90 000 articles on CT have been published in peer-reviewed journals over the past 40 years, fewer than 5% of these have been published in Radiology. Nevertheless, these almost 4000 articles have provided a basis for many important medical advances. By enabling a deepened understanding of anatomy, physiology, and pathology, CT has facilitated key advances in the detection and management of disease. This article celebrates this breadth of scientific discovery and development by examining the impact that CT has had on the diagnosis, characterization, and management of a sampling of major health challenges, including stroke, vascular diseases, cancer, trauma, acute abdominal pain, and diffuse lung diseases, as related to key technical advances in CT and manifested in Radiology.

Computed Tomography: Revolutionizing the Practice of Medicine for 40 Years

Nonspecific interstitial pneumonia (NSIP) has variable clinical, pathologic, and radiologic manifestations Cellular and fibrotic NSIP are the two main histologic subtypes and differ from one another in the degree of inflammation and fibrosis It is important to differentiate NSIP from other diffuse lung diseases, especially usual interstitial pneumonia and hypersensitivity pneumonitis, owing to differences in prognosis and treatment At high-resolution computed tomography, the most common findings suggestive of NSIP are lower lobe peripherally predominant ground-glass opacity with reticular abnormality, traction bronchiectasis, and lower lobe volume loss Nodules, cysts, and areas of low attenuation are uncommon and should point one toward other diagnoses Because many cases of NSIP are associated with collagen vascular diseases, it is important to look for associated findings that may suggest an underlying collagen vascular disease Given the difficulty clinicians, pathologists, and radiologists experience in making the diagnosis of NSIP, a group approach in which these specialists work together to reach a consensus diagnosis has the highest likelihood of achieving the correct diagnosis

https://pubs.rsna.org/doi/pdf/10.1148/rg.291085096

Nonspecific interstitial pneumonia: radiologic, clinical, and pathologic considerations.

The study aims were to identify CT features that predict outcome of fibrotic idiopathic interstitial pneumonia (IIP) when information from lung biopsy data is unavailable. HRCTs of 146 consecutive patients presenting with fibrotic IIP were studied. Visual estimates were made of the extent of abnormal lung and proportional contribution of fine and coarse reticulation, microcystic (cysts ≤4 mm) and macrocystic honeycombing. A score for severity of traction bronchiectasis was also assigned. Using death as our primary outcome measure, variables were analysed using the Cox proportional hazards model. CT features predictive of a worse outcome were coarse reticulation, microcystic and macrocystic honeycombing, as well as overall extent of lung abnormality (p < 0.001). Importantly, increased severity of traction bronchiectasis, corrected for extent of parenchymal abnormality, was predictive of poor prognosis regardless of the background pattern of abnormal lung (HR = 1.04, CI = 1.03–1.06, p < 0.001). On bivariate Cox analysis microcystic honeycombing was a more powerful determinant of a poor prognosis than macrocystic honeycombing. In fibrotic IIPs we have shown that increasingly severe traction bronchiectasis is indicative of higher mortality irrespective of the HRCT pattern and extent of disease. Extent of microcystic honeycombing is a more powerful determinant of outcome than macrocystic honeycombing.

Fibrotic idiopathic interstitial pneumonias: HRCT findings that predict mortality

Purpose: To retrospectively analyze computed tomographic (CT) findings of chronic idiopathic interstitial pneumonia (IIP) and to determine which findings are most helpful for distinguishing IIP from usual interstitial pneumonia (UIP) with univariate and multivariate analyses Materials and Methods: Institutional review board approval and informed consent were not required for this retrospective review of patient records and images Two observers working independently and without knowledge of the diagnosis evaluated the extent and distribution of various thin-section CT findings (ground-glass opacity, consolidation, reticulation, and honeycombing) in 92 patients (51 men, 41 women; mean age, 56 years; age range, 29–81 years) with a histologic diagnosis of UIP (n = 20), cellular nonspecific interstitial pneumonia (NSIP) (n = 16), fibrotic NSIP (n = 16), respiratory bronchiolitis–associated interstitial lung disease (RB-ILD) (n = 11), desquamative interstitial pneumonia (DIP) (n = 15), or lymphoid interstitia

Usual Interstitial Pneumonia and Chronic Idiopathic Interstitial Pneumonia: Analysis of CT Appearance in 92 Patients

OBJECTIVE The aim of this study was to evaluate the image quality of high-resolution CT (HRCT) reconstructed from volumetric data with 16-channel multidetector-row CT (MDCT). SUBJECTS AND METHODS Eleven autopsy lungs that were diagnosed histopathologically were scanned by 16-channel MDCT with the step-and-shoot scan mode and three helical scan modes. Each helical mode had each size of focal spot, pitch, and time of gantry rotation. HRCT images were reconstructed from the volumetric data with each helical mode and axial sequence data. Two observers evaluated the image quality and noted the most appropriate diagnosis for each imaging. RESULTS Visualization of abnormal structures with one helical mode was equal to those with axial mode, whereas those with the other two helical modes were inferior to those with axial mode (Wilcoxon signed rank test; p<0.0001). There was no significant difference in diagnostic efficacy between modes. CONCLUSION The image quality of HRCT with appropriate helical mode is equal to that with axial mode and diagnostic efficacy is equal among all modes. These results may indicate that sufficient HRCT images can be obtained by only one helical scan without the addition of conventional axial scans.

Image quality of high-resolution CT with 16-channel multidetector-row CT: comparison between helical scan and conventional step-shoot scan.

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Usual Interstitial Pneumonia and Chronic Idiopathic Interstitial Pneumonia: Analysis of CT Appearance in 92 Patients

Image quality of high-resolution CT with 16-channel multidetector-row CT: comparison between helical scan and conventional step-shoot scan.