Visual and quantitative assessment of HRCT pulmonary changes in idiopathic interstitial pneumonia with PFT correlation

Abstract

Abstract Background Our study was designed to correlate the degree of parenchymal affection in idiopathic interstitial pneumonia using visual and semi-quantitative HRCT assessment with pulmonary function test results. The study involved 50 patients diagnosed as idiopathic interstitial pneumonia. They were referred from a chest outpatient clinic to the Radiology Department in the Faculty of Medicine, Cairo University for HRCT assessment in the period from January 2017 to March 2019. Variable lung parenchymal affection was studied using HRCT and variable post acquisition processing (multi-planar reconstruction, volumetric assessment, 3D color-coded images). Results Usual interstitial pneumonia was the most common type of IP, found in approximately 40 patients (80% of cases) followed by nonspecific interstitial pneumonia found in 5 patients (10% of cases) and lymphocytic interstitial pneumonia found in 3 patients (6% of cases), and desquamative interstitial pneumonia was the least common type of IP, found only in 2 patients (4% of cases). Honeycombing was significantly correlated with FVC%, FEV1%, and FEV1/FVC% (p = 0.013, p = <0.001, p = 0.002 respectively). Also, reticular was significantly correlated with FVC% (p = 0.041). Conclusion Semi-quantitative image analysis, including the use of machine learning, provides a great deal of promise in the ILD field; such methods may be used together with visual analysis to obtain the most accurate diagnostic and prognostic information. Summary/keywords HRCT is most sensitive in the detection of ILD than chest radiography or conventional chest computed tomography (CT). Advances in HRCT scanning and interpretation have facilitated and improved accuracy for use in diagnosing idiopathic pulmonary fibrosis (IPF), eliminating the need for a surgical biopsy in many patients. Consequently, HRCT scans became sufficient to allow a confident IPF diagnosis It is important to note that there are potential differences in interpretation of HRCT patterns between thoracic radiologists. However, these differences seem to be in general within a clinically acceptable range of observer variation and can be partially mitigated by review of difficult cases at ILD referral centers. Semi-quantitative CT assessment is increasingly being used in ILD to identify pulmonary abnormalities and diagnose specific ILDs; recent studies showed that outcomes of computer-assisted imaging can be correlated with lung function tests and degree of dyspnea and functional disability This study was designed to correlate the degree of parenchymal affection in IP using visual and semi-quantitative HRCT assessment with PFT results. Semi-quantitative imaging, including color-coded images (HU related), is a new and promising approach in the field of ILD diagnosis and prognosis.