Computed tomography findings in pathological usual interstitial pneumonia: relationship to survival.
BACKGROUND
Patients with a clinicopathological diagnosis of idiopathic pulmonary fibrosis (IPF) may have typical findings of usual interstitial pneumonia (UIP) on computed tomography (CT) or nonspecific or atypical findings, including those often seen in nonspecific interstitial pneumonia.


OBJECTIVE
The aims of this study were to revisit the high-resolution CT findings of IPF and to clarify the correlation between the CT findings and mortality.


METHODS
The study included 98 patients with a histologic diagnosis of UIP and a clinical diagnosis of IPF. Two observers evaluated the CT findings independently and classified each case into one of the following three categories: (1) definite UIP, (2) consistent with UIP, or (3) suggestive of alternative diagnosis. The correlation between the CT categories and mortality was evaluated using the Kaplan-Meier method and the log-rank test, as well as Cox proportional hazards regression models.


RESULTS
Thirty-three of the 98 CT scans were classified as definite UIP, 36 as consistent with UIP, 29 as suggestive of an alternative diagnosis. The mean survival was 45.7, 57.9, and 76.9 months, respectively. There was no significant difference in survival among the three categories (all P > 0.05). Traction bronchiectasis and fibrosis scores were significant predictors of outcome (hazard ratios: 1.30 and 1.10, respectively; 95% confidence intervals: 1.18-14.2 and 1.03-1.19, respectively).


CONCLUSIONS
In patients with IPF and UIP pattern on the biopsy, the pattern of abnormality on thin-section CT, whether characteristic of UIP or suggestive of alternative diagnosis, does not influence prognosis. Prognosis is influenced by traction bronchiectasis and fibrosis scores.
Sumikawa
Hiromitsu
H
Department of Radiology, Osaka University Graduate School of Medical, 2-2 Yamadaoka, Suita, Osaka, 565-0825, Japan. h-sumikawa@radiol.med.osaka-u.ac.jp
Johkoh
Takeshi
T
Colby
Thomas V
TV
Ichikado
Kazuya
K
Suga
Moritaka
M
Taniguchi
Hiroyuki
H
Kondoh
Yasuhiro
Y
Ogura
Takashi
T
Arakawa
Hiroaki
H
Fujimoto
Kiminori
K
Inoue
Atsuo
A
Mihara
Naoki
N
Honda
Osamu
O
Tomiyama
Noriyuki
N
Nakamura
Hironobu
H
Müller
Nestor L
NL
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012153:Retention, Psychology; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*