High-resolution computed tomography as a non-invasive imaging biomarker for interstitial lung diseases: a tertiary center study
Keywords:HRCT, BOOP, NSIP, UIP, AIP, ILD
Background: Interstitial lung diseases (ILD) are a heterogeneous group of non-neoplastic disorders resulting from damage to the lung parenchyma by varying patterns of inflammation and fibrosis. With high-resolution computed tomography (HRCT) the pattern of lung damage can be mapped accurately which may help to identify specific ILD.
Methods: 65 diagnosed cases of ILD by HRCT who were admitted to a tertiary care chest hospital, formed the study group. All these patients also underwent histopathological confirmation as per hospital protocol. The study was done over a period from August 2016 to July 2019. Clinical details, chest x-ray, HRCT and histopathological data was collected and analysed using 2x2 table for detecting sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV).
Results: For diagnosing ILD like acute interstitial pneumonia (AIP), LIP and RB ILD the HRCT fared equally well in diagnostic utility as compared to histopathological examination. But in certain conditions like non-specific interstitial pneumonia (NSIP) the HRCT performed poorly in terms of PPV as compared to gold standard histopathology. In Bronchiolitis obliterans organizing pneumonia (BOOP) and usual interstitial pneumonia (UIP) again the HRCT performed fairly well as compared to gold standard.
Conclusions: HRCT shows good correlation with histopathological diagnosis in identifying a various subtype of ILD and may thus serve a useful non-invasive, imaging biomarker not only for diagnosing a particular ILD but for prognostication and response to treatment.
Seaton A. Pulmonary Fibrosis. In: Seaton D, Leitch AG editors. Crofton and Douglas’s Respiratory Diseases. 5th ed. London: Blackwell Science Limited. 2007;888-90.
Wells AU, Hirani N. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax. 2008;63(5):v1-58.
Flaherty KR, King TE, Raghu G, Lynch JP III, Colby TV, Travis WD. Idiopathic Interstitial Pneumonia; what is the effect of a multidisciplinary approach to diagnosis. Am Jr Resp Critical Care Med. 2004;170(8):904-10.
Corrin B, Nicholson AJ, Diffuse Parenchymal Lung Disease: Pathology of the Lungs, 2nd edition; Churchill Livingstone. 2011;263-5.
American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med. 2002;165:277-304.
British Thoracic Society and Standards of Care Committee: The Diagnosis, Assessment and Treatment of Diffuse Parenchymal Lung Disease in Adults. Thorax. 1999;54;S1-28.
Osler W. The Principles and Practice of Medicine. 1st edition: New York, Appleton. 1892.
Hamman L, Rich AR. Acute Diffuse interstitial fibrosis of the lungs. Bull John Hopkins Hosp. 1944;74:177-212.
Coultas DB, Zumwalt RE, Black WC. The epidemiology of interstitial lung diseases. Am J Respir Crit Care Med. 1994;150:967-72.
Roelandt M, Demedts M, Callebaut W. Epidemiology of interstitial lung disease in Flanders: registration by pneumologists in 1992-1994. Acta Clin Belg. 1995;50:260-8.
Keogh BA, Crystal RG. Pulmonary function testing in IPD. What does it tell us? Chest. 1980;78:856-65.
Genereux GP. Radiologic assessment of diffuse lung disease. In: Radiology, Diagnosis, Imaging, Intervention, Taveras and Ferrucci, (Eds), JP Lippincott, Philadelphia. 1992;53(1):1-18.
Mathieson JR, Mayo JR, Staples CA, Müller NL. Chronic diffuse infiltrative lung disease: comparison of diagnostic accuracy of CT and chest radiography. Radiol. 1989;171(1):111-6.
Colby TV, Swensen SJ. Anatomic distribution and histopathologic patterns in diffuse lung disease: correlation with HRCT. J Thorac Imaging. 1996;11:1-26.