title: Thin-Section CT Features of Idiopathic Pulmonary Fibrosis Correlated with Micro-CT and Histologic Analysis.
abstract: Purpose To elucidate the underlying lung changes responsible for the computed tomographic (CT) features of idiopathic pulmonary fibrosis (IPF) and to gain insight into the way IPF proceeds through the lungs and progresses over time. Materials and Methods Micro-CT studies of tissue cores obtained from explant lungs were examined and were correlated 1:1 with a CT study obtained immediately before transplantation. Samples for histologic analysis were obtained from selected cores. Results In areas with no or minimal abnormalities on CT images, small areas of increased attenuation located in or near the interlobular septa can be seen on micro-CT studies. In more involved lung areas, the number of opacities increases and opacities enlarge and approach each other along the interlobular septa, causing a fine reticular pattern on CT images. Simultaneously, air-containing structures in and around these opacities arise, corresponding with small cysts on CT images. Honeycombing is caused by a progressive increase in the number and size of these cystic structures and tissue opacities that gradually extend toward the centrilobular region and finally replace the entire lobule. At histologic analysis, the small islands of increased attenuation very likely correspond with fibroblastic foci. Near these fibroblastic foci, an abnormal adjacency of alveolar walls was seen, suggesting alveolar collapse. In later stages, normal lung tissue is replaced by a large amount of young collagen, as seen in patients with advanced fibrosis. Conclusion Fibrosis and cyst formation in patients with IPF seem to start at the periphery of the pulmonary lobule and progressively extend toward the core of this anatomic lung unit. Evidence was found that alveolar collapse might already be present in an early stage when there is only little pulmonary fibrosis.©RSNA, 2016.
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Cindy
authors.initials: C
authors.lastname: Mai
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Stijn E
authors.initials: SE
authors.lastname: Verleden
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: John E
authors.initials: JE
authors.lastname: McDonough
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Stijn
authors.initials: S
authors.lastname: Willems
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Walter
authors.initials: W
authors.lastname: De Wever
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Johan
authors.initials: J
authors.lastname: Coolen
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Adriana
authors.initials: A
authors.lastname: Dubbeldam
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Van Raemdonck
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Eric K
authors.initials: EK
authors.lastname: Verbeken
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: James C
authors.initials: JC
authors.lastname: Hogg
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Bart M
authors.initials: BM
authors.lastname: Vanaudenaerde
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Wim A
authors.initials: WA
authors.lastname: Wuyts
authors.affiliation: From the Department of Radiology (C.M., W.D.W., J.C., A.D., J.A.V.), Leuven Lung Transplant Unit (S.E.V., J.E.M., S.W., D.E.V.R., G.M.V., B.M.V., W.A.W.), and Department of Pathology (E.K.V.), UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; and University of British Columbia James Hogg Research Centre, St Paul's Hospital, Vancouver, British Columbia, Canada (J.E.M., J.C.H.).
authors.forename: Johny A
authors.initials: JA
authors.lastname: Verschakelen
mesh_terms: D006652:Histological Techniques; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging*; D008168:Lung / Q000000981:diagnostic imaging / Q000648:ultrastructure; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055114:X-Ray Microtomography / Q000379:methods