Abstract
OBJECTIVE. A substantial proportion of cases of usual interstitial pneumonia (UIP) are due to connective tissue disease (CTD)-associated interstitial lung disease (ILD). The purpose of this study was to determine whether specifc CT fndings can help differentiate a UIP pattern of CTD-ILD from a UIP pattern of idiopathic pulmonary fbrosis (IPF) and whether these signs are associated with survival. MATERIALS AND METHODS. Adults visiting an ILD clinic from 2006 to 2015 enrolled in a research registry with a multidisciplinary diagnosis of CTD-ILD or IPF and a UIP pattern at high-resolution CT were included in the study. In these subjects with CT fndings of UIP due to either IPF or CTD-ILD, three CT fndings anecdotally associated with CTD-ILD were assessed for diagnostic accuracy: the "straight-edge" sign, the "exuberant honeycombing" sign, and the "anterior upper lobe" sign. Survival assessments were performed with univariate and multivariable techniques. RESULTS. The subjects included 63 patients who had CTD-ILD and 133 patients who had IPF with a UIP pattern at CT. All three CT signs were signifcantly more common in subjects with CTD-ILD than those with IPF (prevalence, 22.2-25.4% for CTD-ILD, 6.0-12.8% for IPF; p = 0.028 to < 0.001). The highest specifcity (94.0%) and sensitivity (25.4%) were seen for the straight-edge sign. No CT sign was associated with survival in multivariable analysis. CONCLUSION. Although UIP is usually associated with IPF, the index of suspicion for CTD-ILD should be raised in the care of patients with any of the three CT signs. A thorough workup for CTD-ILD should be pursued, including referral to the rheumatology department.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 307-313 |
| Number of pages | 7 |
| Journal | American Journal of Roentgenology |
| Volume | 210 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2018 |
| Externally published | Yes |
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Keywords
- Connective tissue disease
- Idiopathic pulmonary fbrosis
- Survival
- Usual interstitial pneumonia
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
Cite this
CT features of the usual interstitial pneumonia pattern : Differentiating connective tissue disease-associated interstitial lung disease from idiopathic pulmonary fibrosis. / Chung, Jonathan H.; Cox, Christian W.; Montner, Steven M.; Adegunsoye, Ayodeji; Oldham, Justin; Husain, Aliya N.; Vij, Rekha; Noth, Imre; Lynch, David A.; Strek, Mary E.
In: American Journal of Roentgenology, Vol. 210, No. 2, 01.02.2018, p. 307-313.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - CT features of the usual interstitial pneumonia pattern
T2 - Differentiating connective tissue disease-associated interstitial lung disease from idiopathic pulmonary fibrosis
AU - Chung, Jonathan H.
AU - Cox, Christian W.
AU - Montner, Steven M.
AU - Adegunsoye, Ayodeji
AU - Oldham, Justin
AU - Husain, Aliya N.
AU - Vij, Rekha
AU - Noth, Imre
AU - Lynch, David A.
AU - Strek, Mary E.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - OBJECTIVE. A substantial proportion of cases of usual interstitial pneumonia (UIP) are due to connective tissue disease (CTD)-associated interstitial lung disease (ILD). The purpose of this study was to determine whether specifc CT fndings can help differentiate a UIP pattern of CTD-ILD from a UIP pattern of idiopathic pulmonary fbrosis (IPF) and whether these signs are associated with survival. MATERIALS AND METHODS. Adults visiting an ILD clinic from 2006 to 2015 enrolled in a research registry with a multidisciplinary diagnosis of CTD-ILD or IPF and a UIP pattern at high-resolution CT were included in the study. In these subjects with CT fndings of UIP due to either IPF or CTD-ILD, three CT fndings anecdotally associated with CTD-ILD were assessed for diagnostic accuracy: the "straight-edge" sign, the "exuberant honeycombing" sign, and the "anterior upper lobe" sign. Survival assessments were performed with univariate and multivariable techniques. RESULTS. The subjects included 63 patients who had CTD-ILD and 133 patients who had IPF with a UIP pattern at CT. All three CT signs were signifcantly more common in subjects with CTD-ILD than those with IPF (prevalence, 22.2-25.4% for CTD-ILD, 6.0-12.8% for IPF; p = 0.028 to < 0.001). The highest specifcity (94.0%) and sensitivity (25.4%) were seen for the straight-edge sign. No CT sign was associated with survival in multivariable analysis. CONCLUSION. Although UIP is usually associated with IPF, the index of suspicion for CTD-ILD should be raised in the care of patients with any of the three CT signs. A thorough workup for CTD-ILD should be pursued, including referral to the rheumatology department.
AB - OBJECTIVE. A substantial proportion of cases of usual interstitial pneumonia (UIP) are due to connective tissue disease (CTD)-associated interstitial lung disease (ILD). The purpose of this study was to determine whether specifc CT fndings can help differentiate a UIP pattern of CTD-ILD from a UIP pattern of idiopathic pulmonary fbrosis (IPF) and whether these signs are associated with survival. MATERIALS AND METHODS. Adults visiting an ILD clinic from 2006 to 2015 enrolled in a research registry with a multidisciplinary diagnosis of CTD-ILD or IPF and a UIP pattern at high-resolution CT were included in the study. In these subjects with CT fndings of UIP due to either IPF or CTD-ILD, three CT fndings anecdotally associated with CTD-ILD were assessed for diagnostic accuracy: the "straight-edge" sign, the "exuberant honeycombing" sign, and the "anterior upper lobe" sign. Survival assessments were performed with univariate and multivariable techniques. RESULTS. The subjects included 63 patients who had CTD-ILD and 133 patients who had IPF with a UIP pattern at CT. All three CT signs were signifcantly more common in subjects with CTD-ILD than those with IPF (prevalence, 22.2-25.4% for CTD-ILD, 6.0-12.8% for IPF; p = 0.028 to < 0.001). The highest specifcity (94.0%) and sensitivity (25.4%) were seen for the straight-edge sign. No CT sign was associated with survival in multivariable analysis. CONCLUSION. Although UIP is usually associated with IPF, the index of suspicion for CTD-ILD should be raised in the care of patients with any of the three CT signs. A thorough workup for CTD-ILD should be pursued, including referral to the rheumatology department.
KW - Connective tissue disease
KW - Idiopathic pulmonary fbrosis
KW - Survival
KW - Usual interstitial pneumonia
UR - http://www.scopus.com/inward/record.url?scp=85041322072&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85041322072&partnerID=8YFLogxK
U2 - 10.2214/AJR.17.18384
DO - 10.2214/AJR.17.18384
M3 - Article
C2 - 29140119
AN - SCOPUS:85041322072
VL - 210
SP - 307
EP - 313
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
SN - 0361-803X
IS - 2
ER -