Comparative accuracy of high resolution computed tomography and chest radiography in the diagnosis of chronic diffuse infiltrative lung disease

doi:10.1016/S0009-9260(05)80183-7

Clinical Radiology

Volume 44, Issue 4, October 1991, Pages 222-226

https://doi.org/10.1016/S0009-9260(05)80183-7 Get rights and content

One hundred individuals who had undergone both high resolution computed tomography (HRCT) and chest radiography were studied to determine the accuracy of each technique in establishing the diagnosis of diffuse lung disease. The group consisted of 86 patients with a diagnosis of a chronic diffuse infiltrative lung disease and 14 normal subjects. Two independent observers assessed the HRCT examinations and chest radiographs and recorded the three most likely diagnoses. Overall a confident diagnosis was reached more often with HRCT (49%) than with chest radiography (41%). The diagnoses were correct in 82% of HRCT examinations and 69% of chest radiographs. Diagnoses made on HRCT, irrespective of the degree of certainty, were accurate more often than diagnoses made on chest radiography (56% and 47% respectively). Of the patients thought to have a normal chest radiograph, 42% had diffuse infiltrative lung disease (DILD). Of the patients thought to be normal on HRCT, 18% had DILD. Conversely, normal subjects were correctly identified as such in 82% of chest radiographs and in 96% of HRCT examinations. This study emphasizes the important role of CT in helping to confirm or refute the presence of abnormality when the chest radiograph is normal or questionably abnormal, and underlines the superior diagnostic accuracy of HRCT compared with conventional chest radiography in DILD.

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De las 2.729 personas con AR de nuestra área, 47 presentaban EPID sintomática, estimándose una prevalencia de EPID sintomática en AR del 1,72% (intervalo de confianza del 95%: 1,26-2,29) con una edad al diagnóstico de AR de 57,3 ± 13,3 años. Fue más frecuente en hombres, el 60,6% tenía antecedente de tabaquismo y el 84,3 y el 84,7% factor reumatoide y anticuerpos antipéptidos cíclicos citrulinados, respectivamente. El patrón más frecuente fue neumonía intersticial usual (NIU) en 28 (31,1%), la neumonía intersticial no específica (NINE) fue más frecuente en mujeres y el síndrome combinado enfisema-fibrosis (SCEF) exclusivamente en hombres.
En este estudio hemos analizado la prevalencia de AR-EPID sintomática en nuestra área, la cual está por debajo de lo esperado, probablemente en relación con las definiciones utilizadas. Así mismo, hemos descrito que el patrón NIU es el más frecuente en la AR, seguido del NINE y analizado por primera vez la prevalencia de SCEF en la AR, que alcanza el 13%.
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Of the 2,729 people with RA in our area, 47 had symptomatic ILD, estimating a prevalence of symptomatic ILD in RA of 1.72% (95% CI 1.26 - 2.29) with an age at diagnosis of RA of 57.3 ± 13.3 years. It was more frequent in men, 60.6% had a history of smoking, and 84.3% and 84.7% had rheumatoid factor (RF) and anti-cyclic citrullinated peptide (Anti-CCP) antibodies, respectively. The most frequent pattern was usual interstitial pneumonitis (UIP), appearing in 28 (31.1%). Nonspecific interstitial pneumonia (NSIP) was more frequent in women, while the combined pulmonary fibrosis-emphysema (CPFE) syndrome presented exclusively in men.
We have analysed the prevalence of symptomatic RA-ILD in our area, which is lower than expected, probably in relation to the definitions used. We have also described that the UIP pattern is the most frequent in RA in our environment, followed by the NSIP. Lastly, we have analysed the prevalence of CPFE in RA, which reaches 13%, for the first time.
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Citation Excerpt :
The chest radiograph is the most commonly performed respiratory imaging investigation worldwide, providing a single image overview of the entire thorax. In both children and adults, the sensitivity of chest radiography to ILD is lower than that of CT, with normal radiographic appearances of ChILD at initial presentation variably reported in 10% to 42% of children with later proven ILD.15,16 However, it is often the radiographic appearance that leads to further more sensitive and specific cross-sectional imaging evaluation of ChILD.15,16
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Several DLDs demonstrate temporal evolution of their imaging findings on HRCT, which allows for a more specific diagnosis on follow-up imaging than on initial imaging [9,27,59-64,67,68,72,73,76,142,145,147,150,153,154]. Numerous studies support the increased sensitivity and specificity of CT over chest radiography for lung parenchymal changes related to DLD [38-51]. There is no research to support the use of CT with IV contrast for follow-up imaging of DLD; however, IV contrast may be of use in evaluation of alternative diagnosis with overlapping clinical features or conditions that also involve the pleura, mediastinum, and pulmonary vessels (see the ACR Appropriateness Criteria topics on “Chronic Dyspnea-Noncardiovascular Origin” [6], “Noninvasive Clinical Staging of Primary Lung Cancer” [5], and “Suspected Pulmonary Embolism” [84]).
Diffuse lung disease, frequently referred to as interstitial lung disease, encompasses numerous disorders affecting the lung parenchyma. The potential etiologies of diffuse lung disease are broad with several hundred established clinical syndromes and pathologies currently identified. Imaging plays a critical role in diagnosis and follow-up of many of these diseases, although multidisciplinary discussion is the current standard for diagnosis of several DLDs. This document aims to establish guidelines for evaluation of diffuse lung diseases for 1) initial imaging of suspected diffuse lung disease, 2) initial imaging of suspected acute exacerbation or acute deterioration in cases of confirmed diffuse lung disease, and 3) clinically indicated routine follow-up of confirmed diffuse lung disease without acute deterioration.
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High resolution computed tomography (HRCT) plays a central role in the diagnostic process of interstitial lung disease (ILD). Although the HRCT findings usually correspond to recognizable chest radiography abnormalities, they are much more clearly identifiable on HRCT. In this chapter the role of chest radiography and HRCT in the diagnostic process of ILD are discussed. Main HRCT findings in ILD are described with a focus on specific situations where HRCT has a particular diagnostic importance and on the prognostic utility of specific CT patterns. The role of magnetic resonance imaging (MRI) and positron emission tomography (PET) in ILD patients is also discussed.
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The concordance between chest X-ray and thoracic CT was moderate for the detection of masses or nodules, mediocre for the detection of emphysema and alveolar opacities, and poor for the detection of interstitial syndrome. Similar results were observed by Padley et al. in the diagnosis of chronic diffuse infiltrative lung disease in 86 patients [13]. Of the patients with normal findings on chest X-ray, 42% exhibited diffuse infiltrative lung disease on CT.
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Original PaperComparative accuracy of high resolution computed tomography and chest radiography in the diagnosis of chronic diffuse infiltrative lung disease

Annals of Thoracic Surgery

Asbestos-related pleural and parenchymal fibrosis: detection with high resolution CT

Radiology

Chronic lung diseases: specific diagnosis by using CT

American Journal of Roentgenology

Normal chest roentgenogram in chronic diffuse infiltrative lung disease

New England Journal of Medicine

Application of ILO classification to a population without industrial exposure: findings to be differentiated from pneumoconiosis

American Journal of Roentgenology

A new look at pattern recognition of diffuse pulmonary disease

American Journal of Roentgenology

The role of high resolution computed tomography in the diagnosis of interstitial lung disease

Thorax

Original Paper
Comparative accuracy of high resolution computed tomography and chest radiography in the diagnosis of chronic diffuse infiltrative lung disease