Semin Respir Crit Care Med 2003; 24(4): 347-356
DOI: 10.1055/s-2003-42371
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

High-Resolution Computed Tomography in the Diagnosis of Diffuse Lung Disease: A Clinical Perspective

Athol U. Wells
  • Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
Further Information

Publication History

Publication Date:
18 October 2003 (online)

ABSTRACT

High-resolution computed tomography (HRCT) has a central role in the routine detection and diagnosis of individual diffuse lung diseases. The widespread use of HRCT has been stimulated by numerous published series, which have evaluated the accuracy of HRCT in cohorts of patients. However, these series have not simulated the integration of HRCT into clinical diagnosis, and this has led to difficulties in achieving the optimal diagnostic use of HRCT in routine practice. This article summarizes the problems facing the clinician in applying HRCT series to diagnosis in individual patients. The flaws in published series are discussed and the importance of integrating HRCT data with baseline clinical information and, in selected cases, histopathologic findings is highlighted.

REFERENCES

  • 1 Mathieson J R, Mayo J R, Staples C A, Muller N L. Chronic diffuse infiltrative lung disease: comparison of diagnostic accuracy of CT and chest radiography.  Radiology . 1989;  171 111-116
  • 2 Bergin C J, Coblentz C L, Chiles C, Bell D Y, Castellino R A. Chronic lung diseases: specific diagnosis by using CT.  Am J Roentgenol . 1989;  152 1183-1188
  • 3 Padley S PG, Hansell D M, Flower C DR, Jennings P. Comparative accuracy of high resolution computed tomography and chest radiography in the diagnosis of chronic diffuse infiltrative lung disease.  Clin Radiol . 1991;  44 222-226
  • 4 Grenier P, Valeyre D, Cluzel P, Brauner M W, Lenoir S, Chastang C. Chronic diffuse infiltrative lung disease: diagnostic value of chest radiography and high-resolution CT.  Radiology . 1991;  178 123-132
  • 5 Tung K T, Wells A U, Rubens M B, Kirk J ME, du Bois M R, Hansell D M. Accuracy of the typical computed tomographic appearances of fibrosing alveolitis.  Thorax . 1993;  48 334-338
  • 6 Nishimura K, Izumi T, Kitaichi M, Nagai S, Itoh H. The diagnostic accuracy of high-resolution computed tomography in diffuse infiltrative lung diseases.  Chest . 1993;  104 1149-1155
  • 7 Primack S L, Hartman T E, Hansell D M, Muller N L. End stage lung disease: findings in 61 patients.  Radiology . 1993;  189 681-686
  • 8 Grenier P, Chevret S, Beigelman C, Brauner M W, Chastang C, Valeyre D. Chronic diffuse infiltrative lung disease: determination of the diagnostic value of clinical data, chest radiography, and CT and bayesian analysis.  Radiology . 1994;  191 383-390
  • 9 Bonelli F S, Hartman T E, Swensen S J, Sherrick A. Accuracy of high-resolution HRCT in diagnosing lung diseases.  Am J Roentgenol . 1998;  170 1507-1512
  • 10 Johkoh T, Muller N L, Cartier Y. et al . Idiopathic interstitial pneumonias: diagnostic accuracy of thin-section HRCT in 129 patients.  Radiology . 1999;  211 555-560
  • 11 Raghu G, Mageto Y N, Lockhart D, Schmidt R A, Wood D E, Godwin J D. The accuracy of the clinical diagnosis of new-onset idiopathic pulmonary fibrosis and other interstitial lung disease.  Chest . 1999;  116 1168-1174
  • 12 Hartman T E, Swensen S J, Hansell D M. et al . Nonspecific interstitial pneumonia: variable appearance at high resolution chest CT.  Radiology . 2000;  217 701-705
  • 13 Hunninghake G W, Zimmerman M B, Schwartz D A. et al . Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med . 2001;  164 193-196
  • 14 MacDonald S LS, Rubens M B, Hansell D M. et al . Nonspecific interstitial pneumonia and usual interstitial pneumonia: comparative appearances at and diagnostic accuracy of thin-section CT.  Radiology . 2001;  221 600-605
  • 15 Flaherty K R, Thwaite E L, Kazerooni E A. et al . Radiological versus histological diagnosis in UIP and NSIP: survival implications.  Thorax . 2003;  58 143-148
  • 16 Wells A. Clinical usefulness of high resolution computed tomography in cryptogenic fibrosing alveolitis.  Thorax . 1998;  53 1080-1087
  • 17 American Thoracic Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement.  Am J Respir Crit Care Med . 2000;  161 646-664
  • 18 Wells A. High resolution computed tomography in sarcoidosis: a clinical perspective.  Sarcoidosis Vasc Diffuse Lung Dis . 1998;  15 140-146
  • 19 Hansell D M, Wells A U, Tung K T. Accuracy of CT appearances of fibrosing alveolitis (letter).  Thorax . 1994;  49 385-386
  • 20 The BTS guidelines on interstitial lung diseases: the diagnosis assessment and treatment of diffuse parenchymal lung disease in adults.  Thorax . 1999;  54 (suppl 1) S7-S9
  • 21 Hansell D M, Wells A U, Padley S PG, Muller N L. Hypersensitivity pneumonitis: correlation of individual HRCT patterns with functional abnormalities.  Radiology . 1996;  199 123-128
  • 22 Lynch D A, Newell J D, Logan P M, King Jr E T, Muller N L. Can CT distinguish hypersensitivity pneumonitis from idiopathic pulmonary fibrosis?.  Am J Roentgenol . 1995;  165 807-811
  • 23 Lynch D A, Rose C S, Way D, King Jr E T. Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study.  Am J Roentgenol . 1992;  159 469-472
  • 24 American Thoracic Society/European Respiratory Society. 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
  • 25 Katzenstein A A, Myers J L. Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification.  Am J Respir Crit Care Med . 1998;  157 1301-1315
  • 26 Bjoraker J A, Ryu J H, Edwin M K. et al . Prognostic significance of histopathological subsets in idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med . 1998;  157 199-203
  • 27 Nagai S, Kitaichi M, Itoh H, Nishimura K, Izumi T, Colby T V. Idiopathic nonspecific interstitial pneumonia/fibrosis: comparison with idiopathic pulmonary fibrosis and BOOP.  Eur Resp J . 1998;  12 1010-1019
  • 28 Travis W D, Matsui K, Moss J, Ferrans V J. Idiopathic nonspecific interstitial pneumonia: prognostic significance of cellular and fibrosing patterns: survival comparison with usual interstitial pneumonia and desquamative interstitial pneumonia.  Am J Surg Pathol . 2000;  24 19-33
  • 29 Nicholson A G, Colby T V, du Bois M R, Hansell D M, Wells A U. The prognostic significance of the histologic pattern of interstitial pneumonia in patients presenting with the clinical entity of cryptogenic fibrosing alveolitis.  Am J Respir Crit Care Med . 2000;  162 2213-2217
  • 30 Park J S, Lee K S, Kim J S. et al . Nonspecific interstitial pneumonia with fibrosis: radiographic and CT findings in seven patients.  Radiology . 1995;  195 645-648
  • 31 Kim T S, Lee K S, Chung M P. et al . Nonspecific interstitial pneumonia with fibrosis: high resolution CT and pathologic findings.  Am J Roentgenol . 1998;  171 1645-1650
  • 32 Nishiyama O, Kondoh Y, Taniguchi H, Yamaki K, Suzuki R, Yokoi T. Serial high resolution CT findings in nonspecific interstitial pneumonia/fibrosis.  J Comput Assist Tomogr . 2000;  24 41-46
  • 33 Cottin V, Donsbeck A V, Revel D, Loire R, Cordier J F. Nonspecific interstitial pneumonia: individualization of a clinicopathologic entity in a series of 12 patients.  Am J Respir Crit Care Med . 1998;  158 1286-1293
  • 34 Black W C. How to review the radiology literature (review).  Am J Roentgenol . 1990;  154 17-22
  • 35 Epler G R, McLoud T C, Gaensler E A, Mikus J P, Carrington C B. Normal chest radiographs in chronic diffuse infiltrative lung disease.  N Engl J Med . 1978;  298 934-939
  • 36 Muller N L, Kullnig P, Miller R R. The CT findings of pulmonary sarcoidosis: analysis of 25 patients.  Am J Roentgenol . 1989;  152 1179-1182
  • 37 Lenoir S, Grenier P, Brauner M W. et al . Pulmonary lymphangiomyomatosis and tuberous sclerosis: comparison of radiographic and thin-section CT findings.  Radiology . 1990;  175 329-334
  • 38 Stein M C, Mayo J, Muller N L, Aberle D R, Webb W R, Gamsu G. Pulmonary lymphangitic spread of carcinoma: appearance on CT scans.  Radiology . 1987;  162 371-375
  • 39 Aberle D, Gamsu G, Ray C S, Feuerstein I M. Asbestos-related pleural and parenchymal fibrosis: detection with high resolution CT.  Radiology . 1988;  166 729-734
  • 40 Friedman A C, Fiel S B, Fisher M S, Radecki P D, Lev-Toaff A S, Caroline D F. Asbestos-related pleural disease and asbestosis: a comparison of CT and chest radiography.  Am J Roentgenol . 1988;  150 269-275
  • 41 Orens J B, Kazerooni E A, Martinez F J. et al . The sensitivity of high-resolution CT in detecting idiopathic pulmonary fibrosis proved by open lung biopsy.  Chest . 1995;  108 109-115
  • 42 Hyland R H, Gordon D A, Broder I. et al . A systematic controlled study of pulmonary abnormalities in rheumatoid arthritis.  J Rheumatol . 1983;  10 395-405
  • 43 Jurik A G, Davidsen D, Graudal H. Prevalence of pulmonary involvement in rheumatoid arthritis and its relationship to some characteristics of the patients: a radiological and clinical study.  Scand J Rheumatol . 1982;  11 217-224
  • 44 Gabbay E, Tarala R, Will R. et al . Interstitial lung disease in recent onset rheumatoid arthritis.  Am J Respir Crit Care Med . 1997;  156 528-535
  • 45 Remy-Jardin M, Remy J, Cortet B. et al . Lung changes in rheumatoid arthritis: CT findings.  Radiology . 1994;  193 375-382
  • 46 Dawson J K, Fewins H E, Desmond J, Lynch M P, Graham D R. Fibrosing alveolitis in patients with rheumatoid arthritis as assessed by high resolution computed tomography, chest radiography, and pulmonary function tests.  Thorax . 2001;  56 622-627
  • 47 Schurawitzki H, Stiglbauer R, Graninger W. et al . Interstitial lung disease in progressive systemic sclerosis: high resolution CT versus radiography.  Radiology . 1990;  176 755-759
  • 48 Franquet T, Gimenez A, Monill J M. et al . Primary Sjögren's syndrome and associated lung disease: CT findings in 50 patients.  Am J Roentgenol . 1997;  169 655-658
  • 49 Fenlon H M, Doran M, Sant S M. et al . High-resolution chest CT in systemic lupus erythematosus.  Am J Roentgenol . 1996;  166 301-307
  • 50 Flaherty K R, Travis W D, Colby T V. et al . Histopathologic variability in usual and nonspecific interstitial pneumonias.  Am J Respir Crit Care Med . 2001;  164 1722-1727
    >