High-resolution computed tomography in idiopathic pulmonary fibrosis: diagnosis and prognosis.
BACKGROUND
High-resolution computed tomography (HRCT) is an integral aspect of the evaluation of patients with suspected idiopathic pulmonary fibrosis (IPF). However, few studies have evaluated its use in a large cohort.


OBJECTIVE
To describe HRCT features in patients with mild to moderate IPF, compare diagnostic evaluations by a radiology core (three thoracic radiologists) with those by study-site radiologists, correlate baseline clinical and physiologic variables with HRCT findings, and evaluate their association with mortality.


METHODS
We assessed HRCT scans from patients with IPF (n = 315) enrolled in a randomized controlled study evaluating IFN-gamma1b.


RESULTS
There was concordance between study-site and core radiologists regarding the diagnosis of IPF in 86% of cases. Diffusing capacity of carbon monoxide (DLCO) was the physiologic characteristic most highly correlated with HRCT findings. Multivariate analysis identified three independent predictors of mortality: a higher extent of fibrosis score increased the risk of death (p < 0.0001), whereas a higher percent-predicted DLCO (p = 0.004) and treatment assignment to IFN-gamma1b rather than placebo (p = 0.04) reduced the risk of death.


CONCLUSIONS
A study-site diagnosis of IPF on HRCT was regularly confirmed by core radiologists. Extent of reticulation and honeycombing on HRCT is an important independent predictor of mortality in patients with IPF.
Lynch
David A
DA
Department of Radiology, and Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Box A030, Room 2233 Denver, CO 80262, USA. david.lynch@uchsc.edu
Godwin
J David
JD
Safrin
Sharon
S
Starko
Karen M
KM
Hormel
Phil
P
Brown
Kevin K
KK
Raghu
Ganesh
G
King
Talmadge E
TE
Bradford
Williamson Z
WZ
Schwartz
David A
DA
Richard Webb
W
W
D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000627:therapeutic use; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011653:Pulmonary Diffusing Capacity; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D011994:Recombinant Proteins; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
D011994:Recombinant Proteins; D007371:Interferon-gamma