HRCT imaging of pulmonary fibrosis
HRCT is the non-invasive, gold-standard diagnostic tool for fibrotic ILDs1,2
High-resolution computed tomography (HRCT) is essential for reaching accurate diagnoses of pulmonary fibrosis in ILDs, as well as assessing lesions, monitoring changes, screening for complications, and assessing prognosis.3
The heterogeneity and unpredictability of ILDs can make pulmonary fibrosis a challenge to detect, often leading to a delayed diagnosis.4–7
HRCT IMAGES HELP YOU RECOGNIZE FIBROTIC ILDs
Clustered cystic airspaces with well defined walls, measuring 2–10 mm in diameter, sometimes reaching 25 mm, usually in subpleural regions
Associated signs with honeycombing
Traction bronchiectasis and bronchiolectasis
Loss of lobar volume
Subpleural honeycombing forming several layers of cysts in a 73-year-old man with UIP.
TRACTION BRONCHIECTASIS / BRONCHIOLECTASIS
Abnormal and irregular dilation of the bronchi/bronchioles due to respiratory tract inflammation (sometimes reversible) or pulmonary fibrosis
On a HRCT scan, it appears as an increase in the calibre of the distal respiratory tract (no reduction in the diameter peripherally, visibility in the subpleural lung at least 20 mm from the pleura)
On the scan, they present as tubular or cyctic air spaces depending on the orientation of the bronchi in the cross-section
Differentiating between traction bronchiectasis and honeycomb is sometimes difficult on axial cross-sections. Sagittal or coronal cross-sections and the minIP are usual
Traction bronchiectasis is associated with signs of fibrosis
72-year-old man with UIP. HRCT shows diffuse reticulations, and traction bronchiectasis and bronchiolectasis.
IPF – UIP PATTERN
ATS/ERS/JRS/ALAT guidelines recommend that IPF can be confidently diagnosed if the clinical evaluation of the patient points to IPF and the HRCT shows a definite or probable pattern of UIP (conditional biopsy recommended)2
Why is early screening and diagnosis of IPF with HRCT important?
Subpleural reticular thickening, air trapping and traction bronchiectasis
SARCOIDOSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE
How does sarcoidosis-associated interstitial lung disease impact patients?
iNSIP – NSIP PATTERN
Ground-glass opacity, subpleural sparing and traction bronchiectasis
Accurate HRCT interpretation is key to help support patients with fibrotic ILDs
Initial evaluation for ILDs
Diagnosis of ILDs
ILD patient cases for evaluation and diagnosis
- ALAT, Latin American Thoracic Society; ATS, American Thoracic Society; ERS, European Respiratory Society; HRCT, high-resolution computed tomography; ILD, interstitial lung disease; iNSIP, idiopathic non-specific interstitial pneumonia; IPF, idiopathic pulmonary fibrosis; JRS, Japanese Respiratory Society; UIP, usual interstitial pneumonia.
Chowaniec M, Skoczyńska M, Sokolik R, Wiland P. Interstitial lung disease in systemic sclerosis: challenges in early diagnosis and management. Reumatologia. 2018;56(4):249–254.
Raghu G, Remy-Jardin M, Myers JL, et al; on behalf of the ATS/ERS/JRS/ALAT. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2018;198(5):e44–e68.
- Brauner M, et al. Imagerie des pneumopathies infiltrantes diffuses. Press Med. 2010;39:73–84.
- Wells AU, Brown KK, Flaherty KR, et al. What’s in a name? That which we call IPF, by any other name would act the same. Eur Respir J. 2018;51(5):1800692.
- Wijsenbeek MS, Kreuter M, Olson A, et al. Progressive fibrosing interstitial lung diseases: current practice in diagnosis and management. Curr Med Res Opin. 2019:1–10.
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- Chaudhuri N, Spencer L, Greaves M, et al. A Review of the Multidisciplinary Diagnosis of Interstitial Lung Diseases: A Retrospective Analysis in a Single UK Specialist Centre. J Clin Med. 2016;5(66):1–9.
- Cottin V, Hirani N, Hotchkin D, et al. Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases. Eur Respir Rev. 2018;27(150):180076.
- Cottin V, Brown KK. Interstitial lung disease associated with systemic sclerosis (SSc–ILD). Respir Res. 2019a;20(1):13.
- Wong AW, Ryerson C, Guler S. Progression of fibrosing interstitial lung disease. Respir Res. 2020:29;21(1):32.
- Flaherty KR, Brown KK, Wells AU, et al. Design of the PF-ILD trial: A double-blind, randomised, placebo-controlled phase III trial of nintedanib in patients with progressive fibrosing interstitial lung disease. BMJ Open Resp Res. 2017;4(1):e000212.
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- Hoffmann-Vold AM, Fretheim H, Halse AK, et al. Tracking impact of interstitial lung disease in systemic sclerosis in a complete nationwide cohort. Am J Respir Crit Care Med. 2019;200:1258–1266.
- Hoffmann-Vold AM, Maher TM, Philpot EE, et al. The identification and management of interstitial lung disease in systemic sclerosis: evidence-based European consensus statements. The Lancet Rheumatology. 2020b;2: e71–e83.
- Asano Y, Jinnin M, Kawaguchi Y, et al. Diagnostic criteria, severity classification and guidelines of systemic sclerosis: Guideline of SSc. J Dermatol. 2018;45, 633–691.