Chest
Volume 104, Issue 4, October 1993, Pages 1149-1155
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Clinical Investigations: Diffuse Lung Disease
The Diagnostic Accuracy of High-Resolution Computed Tomography in Diffuse Infiltrative Lung Diseases

https://doi.org/10.1378/chest.104.4.1149Get rights and content

The purpose of this study was to evaluate the role of high-resolution computed tomography (HRCT) in the clinical diagnosis of diffuse infiltrative lung disease (DILD). Diagnostic accuracy was compared using both chest radiography and HRCT. One hundred thirty-four cases of DILD, representing 21 different diseases, were selected for study, and the disease state was confirmed either histologically or microbiologically. The HRCT images and chest radiographs, available in all cases, were reviewed separately and in random order by 20 physicians who were provided only with information on each patient's age and sex. Overall, a correct first-choice diagnosis was made in 38 percent using radiographs and in 46 percent using HRCT images (p<0.01). The correct diagnosis was among the top three choices in 49 percent when chest radiographs were used, and in 59 percent when HRCT images were viewed (p<0.01). The correct first-choice diagnosis increased remarkably when the HRCT was used in usual interstitial pneumonia, sarcoidosis, alveolar proteinosis, bronchiolitis obliterans organizing pneumonia, hypersensitivity pneumonitis, and pulmonary lymphangiomyomatosis. High-resolution computed tomography was confirmed to be superior to conventional radiography in the accurate diagnosis of DILD in clinical practice.

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Patients

A total of 134 patients with DILD were examined. The study encompassed 21 different pulmonary diseases, and included 82 male and 52 female patients with a mean age of 49.1 years (range, 19 to 84 years). A specific diagnosis for each patient was confirmed histologically or microbiologically. Both chest radiographs and HRCT were obtained between 1982 and 1990 at the Chest Disease Research Institute, Kyoto University. The mean time interval between chest radiography and CT scanning was 12.1 days.

Results

Overall, a correct first-choice diagnosis was made in 38 percent using chest radiography and in 46 percent using HRCT (p<0.01). The correct diagnosis was among the top three choices in 49 percent using chest radiographs and in 59 percent using HRCT images (p<0.01). Therefore, for the diagnosis of DILD, HRCT is significantly superior to chest radiography.

The percentages for correct first diagnoses for each disease are listed in Table 2. Compared with chest radiography, the use of HRCT increased

Discussion

The present study confirmed the usefulness of HRCT in clinical practice. When the diagnosis is not known at the time the patient is referred for a CT scan, the study showed that HRCT can enhance the diagnostic accuracy for DILD, because the overall correct first-choice diagnosis, correct diagnosis among the top three choices, and the positive predictive values of first-choice diagnoses were significantly improved by HRCT compared with chest radiography.

Some biases and problems were inherent in

Acknowledgments

The authors are grateful to the following for participating in the conference: Yasuyuki Kurihara, M.D. (Department of Radiology, St. Mariannu University of Medical Science); Humikazu Sakai, M.D. (Department of Radiology, Sinsyu University Medical School); Giro Todo, M.D. (Nagahama Red Cross Hospital); Kiyoshi Murata, M.D. (Department of Radiology, Shiga University of Medical Science); Masayuki Hatakeyama, M.D. (Mimuro Hospital); Shizuo Morimoto, M.D., and Tuyoshi Jiyoukou, M.D. (Department of

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