• Trond Mogens Aaløkken, Anne Naalsund, Georg Mynarek, Audun Elnaes Berstad, Steinar Solberg, Erik H Strøm, Helge Scott, Alf Kolbenstvedt, and Vidar Søyseth.
• Department of Radiology, Oslo University Hospital Rikshospitalet, Norway. trond.mogens.aalokken@rikshospitalet.no
• Acta Radiol. 2012 Apr 1;53(3):296-302.

BackgroundThe relative clinical benefit of histopathology and computed tomography (CT) in patients with idiopathic interstitial pneumonia (IIP) is under debate.PurposeTo analyze thin-section CT features and histopathologic findings in patients with usual interstitial pneumonia (UIP) in the clinical context of idiopathic pulmonary fibrosis (IPF), and to evaluate and compare diagnostic accuracy of the two methods among patients with an appropriate spectrum of IIP.Material And MethodsThe study included 91 patients (49 men; mean age 53.2 years; median follow-up 7.2 years) with clinically suspected interstitial lung disease. All underwent surgical lung biopsy and thin-section CT. Two independent readers retrospectively assessed the CT images for the extent and pattern of abnormality and made a first-choice diagnosis. Two pathologists retrospectively assessed the histopathologic slides. In 64 patients with IIP, a retrospective composite reference standard identified 41 patients with UIP. CT characteristics of UIP and IIPs other than UIP were compared with univariate and multivariate analyses.ResultsThere was good agreement between the readers for the correct first-choice CT diagnosis of UIP (κ = 0.79). The sensitivity, specificity, and positive predictive value of the CT diagnosis of UIP were 63%, 96%, and 96%, respectively. The sensitivity, specificity, and positive predictive value of the histological diagnosis of UIP were 73%, 74%, and 83%, respectively. The CT feature that best differentiated UIP from IIPs other than UIP was the extent of reticular pattern (odds ratio, 5.1).ConclusionSurgical lung biopsy may not be warranted in patients with thin-section CT diagnosis of UIP.

25 keywords...

hide…