CT findings, radiologic-pathologic correlation, and imaging predictors of survival for patients with interstitial pneumonia with autoimmune features

Jonathan H. Chung, Steven M. Montner, Ayodeji Adegunsoye, Cathryn Lee, Justin Oldham, Aliya N. Husain, Heber MacMahon, Imre Noth, Rekha Vij, Mary E. Strek

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

OBJECTIVE. The objective of this study is to determine the CT findings and patterns of interstitial pneumonia with autoimmune features (IPAF) and to assess whether imaging can predict survival for patients with IPAF. MATERIALS AND METHODS. The study included 136 subjects who met the criteria for IPAF and had diagnostic-quality chest CT scans obtained from 2006 to 2015; a total of 74 of these subjects had pathologic samples available for review within 1 year of chest CT examination. CT findings and the presence of an usual interstitial pneumonitis (UIP) pattern of disease were assessed, as was the UIP pattern noted on pathologic analysis. Analysis of chest CT findings associated with survival was performed using standard univariate and multivariate Cox proportional hazards methods as well as the unadjusted log-rank test. Survival data were visually presented using the Kaplan-Meier survival curve estimator. RESULTS. Most subjects with IPAF (57.4%; 78/136) had a high-confidence diagnosis of a UIP pattern on CT. Substantially fewer subjects (28.7%; 39/136) had a pattern that was inconsistent with UIP noted on CT. The presence of a UIP pattern on CT was associated with smoking (p < 0.01), male sex (p < 0.01), and older age (p < 0.001). Approximately one-fourth of the subjects had a nonspecific interstitial pneumonitis pattern on C T. Of interest, nearly one-tenth of the subjects had a CT pattern that was most consistent with hypersensitivity pneumonitis rather than the customary CT patterns ascribed to lung disease resulting from connective tissue disease. Most subjects with a possible UIP pattern on CT (83.3%) had UIP diagnosed on the basis of pathologic findings. Focused multivariate analysis showed that honeycombing on CT (hazard ratio, 2.17; 95% CI, 1.05-4.47) and pulmonary artery enlargement on CT (hazard ratio, 2.08; 95% CI, 1.02-4.20) were independent predictors of survival. CONCLUSION. IPAF most often presents with a UIP pattern on CT and is associated with worse survival when concomitant honeycombing or pulmonary artery enlargement is present.

Original languageEnglish (US)
Pages (from-to)1229-1236
Number of pages8
JournalAmerican Journal of Roentgenology
Volume208
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Idiopathic Pulmonary Fibrosis
Interstitial Lung Diseases
Survival
Thorax
Pulmonary Artery
Extrinsic Allergic Alveolitis
Connective Tissue Diseases
Kaplan-Meier Estimate
Lung Diseases
Multivariate Analysis
Smoking

Keywords

  • C T
  • Connective tissue disease
  • Interstitial pneumonia with autoimmune features
  • Survival
  • Usual interstitial pneumonitis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

CT findings, radiologic-pathologic correlation, and imaging predictors of survival for patients with interstitial pneumonia with autoimmune features. / Chung, Jonathan H.; Montner, Steven M.; Adegunsoye, Ayodeji; Lee, Cathryn; Oldham, Justin; Husain, Aliya N.; MacMahon, Heber; Noth, Imre; Vij, Rekha; Strek, Mary E.

In: American Journal of Roentgenology, Vol. 208, No. 6, 01.06.2017, p. 1229-1236.

Research output: Contribution to journalReview article

Chung, Jonathan H. ; Montner, Steven M. ; Adegunsoye, Ayodeji ; Lee, Cathryn ; Oldham, Justin ; Husain, Aliya N. ; MacMahon, Heber ; Noth, Imre ; Vij, Rekha ; Strek, Mary E. / CT findings, radiologic-pathologic correlation, and imaging predictors of survival for patients with interstitial pneumonia with autoimmune features. In: American Journal of Roentgenology. 2017 ; Vol. 208, No. 6. pp. 1229-1236.
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abstract = "OBJECTIVE. The objective of this study is to determine the CT findings and patterns of interstitial pneumonia with autoimmune features (IPAF) and to assess whether imaging can predict survival for patients with IPAF. MATERIALS AND METHODS. The study included 136 subjects who met the criteria for IPAF and had diagnostic-quality chest CT scans obtained from 2006 to 2015; a total of 74 of these subjects had pathologic samples available for review within 1 year of chest CT examination. CT findings and the presence of an usual interstitial pneumonitis (UIP) pattern of disease were assessed, as was the UIP pattern noted on pathologic analysis. Analysis of chest CT findings associated with survival was performed using standard univariate and multivariate Cox proportional hazards methods as well as the unadjusted log-rank test. Survival data were visually presented using the Kaplan-Meier survival curve estimator. RESULTS. Most subjects with IPAF (57.4{\%}; 78/136) had a high-confidence diagnosis of a UIP pattern on CT. Substantially fewer subjects (28.7{\%}; 39/136) had a pattern that was inconsistent with UIP noted on CT. The presence of a UIP pattern on CT was associated with smoking (p < 0.01), male sex (p < 0.01), and older age (p < 0.001). Approximately one-fourth of the subjects had a nonspecific interstitial pneumonitis pattern on C T. Of interest, nearly one-tenth of the subjects had a CT pattern that was most consistent with hypersensitivity pneumonitis rather than the customary CT patterns ascribed to lung disease resulting from connective tissue disease. Most subjects with a possible UIP pattern on CT (83.3{\%}) had UIP diagnosed on the basis of pathologic findings. Focused multivariate analysis showed that honeycombing on CT (hazard ratio, 2.17; 95{\%} CI, 1.05-4.47) and pulmonary artery enlargement on CT (hazard ratio, 2.08; 95{\%} CI, 1.02-4.20) were independent predictors of survival. CONCLUSION. IPAF most often presents with a UIP pattern on CT and is associated with worse survival when concomitant honeycombing or pulmonary artery enlargement is present.",
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author = "Chung, {Jonathan H.} and Montner, {Steven M.} and Ayodeji Adegunsoye and Cathryn Lee and Justin Oldham and Husain, {Aliya N.} and Heber MacMahon and Imre Noth and Rekha Vij and Strek, {Mary E.}",
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T1 - CT findings, radiologic-pathologic correlation, and imaging predictors of survival for patients with interstitial pneumonia with autoimmune features

AU - Chung, Jonathan H.

AU - Montner, Steven M.

AU - Adegunsoye, Ayodeji

AU - Lee, Cathryn

AU - Oldham, Justin

AU - Husain, Aliya N.

AU - MacMahon, Heber

AU - Noth, Imre

AU - Vij, Rekha

AU - Strek, Mary E.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - OBJECTIVE. The objective of this study is to determine the CT findings and patterns of interstitial pneumonia with autoimmune features (IPAF) and to assess whether imaging can predict survival for patients with IPAF. MATERIALS AND METHODS. The study included 136 subjects who met the criteria for IPAF and had diagnostic-quality chest CT scans obtained from 2006 to 2015; a total of 74 of these subjects had pathologic samples available for review within 1 year of chest CT examination. CT findings and the presence of an usual interstitial pneumonitis (UIP) pattern of disease were assessed, as was the UIP pattern noted on pathologic analysis. Analysis of chest CT findings associated with survival was performed using standard univariate and multivariate Cox proportional hazards methods as well as the unadjusted log-rank test. Survival data were visually presented using the Kaplan-Meier survival curve estimator. RESULTS. Most subjects with IPAF (57.4%; 78/136) had a high-confidence diagnosis of a UIP pattern on CT. Substantially fewer subjects (28.7%; 39/136) had a pattern that was inconsistent with UIP noted on CT. The presence of a UIP pattern on CT was associated with smoking (p < 0.01), male sex (p < 0.01), and older age (p < 0.001). Approximately one-fourth of the subjects had a nonspecific interstitial pneumonitis pattern on C T. Of interest, nearly one-tenth of the subjects had a CT pattern that was most consistent with hypersensitivity pneumonitis rather than the customary CT patterns ascribed to lung disease resulting from connective tissue disease. Most subjects with a possible UIP pattern on CT (83.3%) had UIP diagnosed on the basis of pathologic findings. Focused multivariate analysis showed that honeycombing on CT (hazard ratio, 2.17; 95% CI, 1.05-4.47) and pulmonary artery enlargement on CT (hazard ratio, 2.08; 95% CI, 1.02-4.20) were independent predictors of survival. CONCLUSION. IPAF most often presents with a UIP pattern on CT and is associated with worse survival when concomitant honeycombing or pulmonary artery enlargement is present.

AB - OBJECTIVE. The objective of this study is to determine the CT findings and patterns of interstitial pneumonia with autoimmune features (IPAF) and to assess whether imaging can predict survival for patients with IPAF. MATERIALS AND METHODS. The study included 136 subjects who met the criteria for IPAF and had diagnostic-quality chest CT scans obtained from 2006 to 2015; a total of 74 of these subjects had pathologic samples available for review within 1 year of chest CT examination. CT findings and the presence of an usual interstitial pneumonitis (UIP) pattern of disease were assessed, as was the UIP pattern noted on pathologic analysis. Analysis of chest CT findings associated with survival was performed using standard univariate and multivariate Cox proportional hazards methods as well as the unadjusted log-rank test. Survival data were visually presented using the Kaplan-Meier survival curve estimator. RESULTS. Most subjects with IPAF (57.4%; 78/136) had a high-confidence diagnosis of a UIP pattern on CT. Substantially fewer subjects (28.7%; 39/136) had a pattern that was inconsistent with UIP noted on CT. The presence of a UIP pattern on CT was associated with smoking (p < 0.01), male sex (p < 0.01), and older age (p < 0.001). Approximately one-fourth of the subjects had a nonspecific interstitial pneumonitis pattern on C T. Of interest, nearly one-tenth of the subjects had a CT pattern that was most consistent with hypersensitivity pneumonitis rather than the customary CT patterns ascribed to lung disease resulting from connective tissue disease. Most subjects with a possible UIP pattern on CT (83.3%) had UIP diagnosed on the basis of pathologic findings. Focused multivariate analysis showed that honeycombing on CT (hazard ratio, 2.17; 95% CI, 1.05-4.47) and pulmonary artery enlargement on CT (hazard ratio, 2.08; 95% CI, 1.02-4.20) were independent predictors of survival. CONCLUSION. IPAF most often presents with a UIP pattern on CT and is associated with worse survival when concomitant honeycombing or pulmonary artery enlargement is present.

KW - C T

KW - Connective tissue disease

KW - Interstitial pneumonia with autoimmune features

KW - Survival

KW - Usual interstitial pneumonitis

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