Biopsy-proved idiopathic pulmonary fibrosis: spectrum of nondiagnostic thin-section CT diagnoses.
OBJECTIVE
To document the spectrum of misleading thin-section computed tomographic (CT) diagnoses in patients with biopsy-proved idiopathic pulmonary fibrosis (IPF).


METHODS
This study had institutional review board approval, and patient consent was not required. Three observers, blinded to any clinical information and the purpose of the study, recorded thin-section CT differential diagnoses and assigned a percentage likelihood to each for a group of 123 patients (79 men, 44 women; age range, 27-82 years) with various chronic interstitial lung diseases, including a core group of 55 biopsy-proved cases of IPF. Patients with IPF in the core group, in whom IPF was diagnosed as low-grade probability (<30%) by at least two observers, were considered to have atypical IPF cases, and the alternative diagnoses were analyzed further.


RESULTS
Thirty-four (62%) of 55 biopsy-proved IPF cases were regarded as alternative diagnoses. In these atypical IPF cases, the first-choice diagnoses, expressed with high degree of probability, were nonspecific interstitial pneumonia (NSIP; 18 [53%] of 34), chronic hypersensitivity pneumonitis (HP; four [12%] of 34), sarcoidosis (three [9%] of 34), and organizing pneumonia (one [3%] of 34); in eight (23%) of 34 cases, no single diagnosis was favored by more than one observer. Frequent differential diagnoses, although not always the first-choice diagnosis, were NSIP (n = 29), chronic HP (n = 23), and sarcoidosis (n = 9).


CONCLUSIONS
In the correct clinical setting, a diagnosis of IPF is not excluded by thin-section CT appearances more suggestive of NSIP, chronic HP, or sarcoidosis. (c) RSNA, 2010.
Sverzellati
Nicola
N
Department of Clinical Sciences, Section of Diagnostic Imaging, University of Parma Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100 Parma, Italy. nicolasve@tiscali.it
Wells
Athol U
AU
Tomassetti
Sara
S
Desai
Sujal R
SR
Copley
Susan J
SJ
Aziz
Zelena A
ZA
Zompatori
Maurizio
M
Chilosi
Marco
M
Nicholson
Andrew G
AG
Poletti
Venerino
V
Hansell
David M
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000542:Alveolitis, Extrinsic Allergic / Q000000981:diagnostic imaging; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D017565:Sarcoidosis, Pulmonary / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*