High-resolution Computed Tomography in Idiopathic Pulmonary Fibrosis: Diagnosis and Prognosis

Am J Respir Crit Care Med. 2005 Aug 15;172(4):488-93. doi: 10.1164/rccm.200412-1756OC. Epub 2005 May 13.

Abstract

Rationale: 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.

Objectives: 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.

Measurements and main 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.

Publication types

  • Clinical Trial
  • Clinical Trial, Phase III
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Humans
  • Interferon-gamma / therapeutic use
  • Lung / diagnostic imaging
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Pulmonary Diffusing Capacity
  • Pulmonary Fibrosis / diagnostic imaging*
  • Pulmonary Fibrosis / drug therapy
  • Pulmonary Fibrosis / mortality
  • Recombinant Proteins
  • Risk Factors
  • Tomography, X-Ray Computed / methods*

Substances

  • Recombinant Proteins
  • Interferon-gamma