Have an account? Please log in.
Text size: Small font Default font Larger font
.
Radiology Daily
Radiology Daily PracticalReviews.com Radiology Daily

Nonspecific Interstitial Pneumonia Pattern Sometimes Progresses to Usual Interstitial Pneumonia Pattern on CT

April 5, 2008
Written by: , Filed in: Chest Radiology
  • Comments
.

The objective of a recent study was to evaluate NSIP and UIP findings on long-term follow-up CT.

The study has concluded that some patients with initial CT findings suggestive of nonspecific interstitial pneumonia (NSIP) developed CT findings suggestive of usual interstitial pneumonia (UIP) on >=3-year follow-up. In this study, there were no specific CT findings on the initial scans that predicted in which patients this would occur.

Participants
Twenty-three patients with histopathology-proven NSIP and 25 patients with histopathology-proven UIP were evaluated in this retrospective analysis. All patients had a CT at initial diagnosis and a follow-up CT at least three years later.

Methodology
All CTs were evaluated for the extent of and distribution of ground-glass opacity (GGO), reticular opacity (interlacing line shadows within secondary pulmonary lobules), traction bronchiectasis and bronchiolectasis, and honeycombing.

Following this evaluation, an assessment of whether the findings represented NSIP or UIP was made according to a scale of definite, probable, and indeterminate.

Two radiologists made this assessment independently. Definite radiologic criteria for NSIP were extensive GGO, no or minimal reticulation, no or minimal honeycombing, traction bronchiectasis, lung base predominance, and subpleural sparing.

Definite radiologic criteria for UIP were no or minimal GGO, reticulation, honeycombing, and peripheral and lung base predominance.

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists --

 

Body Imaging: Abdominal, Thoracic and Vascular University of California, San Francisco, Department of Radiology Course Director: Judy Yee, MD This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging and interventional techniques. Click here to read more or order: Body Imaging

Results of the Study
Initial CTs in patients with histopathology-proven NSIP were radiologically characterized as definite for NSIP in 16 of 23 patients, probable for NSIP in 2 of 23, indeterminate in 3 of 23, definite for UIP in 1 of 23, and probable for UIP in 1 of 23.

Initial CTs in patients with histopathology-proven UIP were radiologically characterized as definite for UIP in 6 of 25 patients, probable for UIP in 5 of 25, indeterminate in 5 of 25, definite for NSIP in 8 of 25, and probable for NSIP in 1 of 25.

Follow-up CT in patients with NSIP demonstrated great decrease in extent of GGO, increased reticular opacity, and greater probability of peripheral distribution (all P <0.05). In the 18 patients with initial CTs interpreted as definite or probable for NSIP, 5 (28%) had follow-up CTs interpreted as more suggestive of UIP. There were no findings on the initial CTs that predicted patients with NSIP that maintained an NSIP pattern of disease on follow-up and those that developed into a UIP pattern of disease. Conclusions
Over >=3 years of CT follow-up, 28% of patients with initial CT findings characterized as suggestive of NSIP developed CT features suggestive of UIP. There were no findings on the initial CTs that predicted in which patients this would occur.

Reviewer’s Comments
One of the limitations of this article was that in the patients whose CTs initially demonstrated an NSIP pattern of disease, and subsequently on follow-up developed a UIP pattern of disease, it is uncertain if there was also a histopathologic change.

Author: Vineet R. Jain, MD

Reference
Silva CI, Muller NL, et al. Nonspecific Interstitial Pneumonia and Idiopathic Pulmonary Fibrosis: Changes in Pattern and Distribution of Disease Over Time.
Radiology; 2008; 247 (April): 251-259:

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists --

 

Body Imaging: Abdominal, Thoracic and Vascular University of California, San Francisco, Department of Radiology Course Director: Judy Yee, MD This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging and interventional techniques. Click here to read more or order: Body Imaging
.
  • Comments
.

Would you like to keep current with radiological news and information?

Post Your Comments and Responses

Comments are closed.