The role of high-resolution computed tomography in the follow-up of diffuse lung disease

High-resolution computed tomography (HRCT) of the lung is a key component of the multidisciplinary approach to diagnosis in diffuse lung disease (DLD). HRCT also plays an important role in the follow-up of patients with established DLD. In this respect, serial HRCT examinations may provide valuable information that cannot be determined from clinical history and other diagnostic tests, such as pulmonary function tests. Important roles of HRCT in this context include assisting in determining prognosis, monitoring for the efficacy of treatment, detecting progression of disease or complications, and evaluating patients with worsening or acute symptoms. Both clinicians and radiologists should be aware of the expected evolution of HRCT changes in a variety of DLDs. The goals of this paper are to discuss: 1) the expected evolution of HRCT findings over time in common DLDs; 2) the role of serial HRCT examinations in formulating an initial diagnosis; and 3) the role of HRCT in the follow-up of patients with known DLD.

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High Resolution Computed Tomography of Diffuse Lung Disease

Investigative Radiology ◽

10.1097/00004424-198910000-00015 ◽

1989 ◽

Vol 24 (10) ◽

pp. 805-812 ◽

Cited By ~ 25

Author(s):

JEFFREY KLEIN ◽

GORDON GAMSU

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Lung Disease ◽

High Resolution Computed Tomography ◽

Diffuse Lung Disease ◽

Diffuse Lung

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Reader accuracy and confidence in diagnosing diffuse lung disease on high-resolution computed tomography of the lungs: impact of sampling frequency

Acta Radiologica ◽

10.1080/02841850802227147 ◽

2008 ◽

Vol 49 (8) ◽

pp. 870-875 ◽

Cited By ~ 4

Author(s):

B. Sundaram ◽

B. H. Gross ◽

E. Oh ◽

N. Müller ◽

J. D. Myles ◽

...

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Lung Disease ◽

Sampling Frequency ◽

High Resolution Computed Tomography ◽

Diffuse Lung Disease ◽

First Choice ◽

The Mean ◽

The Impact ◽

Diffuse Lung

Background: The accuracy of the number of high-resolution computed tomography (HRCT) images necessary to diagnose diffuse lung disease (DLD) is not well established. Purpose: To evaluate the impact of HRCT sampling frequency on reader confidence and accuracy for diagnosing DLD. Material and Methods: HRCT images of 100 consecutive patients with proven DLD were reviewed. They were: 48 usual interstitial pneumonia, 22 sarcoidosis, six hypersensitivity pneumonitis, five each of desquamative interstitial pneumonitis, eosinophilic granulomatosis, and lymphangioleiomyomatosis, and nine others. Inspiratory images at 1-cm increments throughout the lungs and three specified levels formed complete and limited examinations. In random order, three experts (readers 1, 2, and 3) ranked their top three diagnoses and rated confidence for their top diagnosis, independently and blinded to clinical information. Results: Using the complete versus limited examinations for correct first-choice diagnosis, accuracy for reader 1 (R1) was 81% versus 80%, respectively, for reader 2 (R2) 70% versus 70%, and for reader 3 (R3) 64% versus 59%. Reader accuracy within their top three choices for complete versus limited examinations was: R1 91% versus 91% of cases, respectively, R2 84% versus 83%, and R3 79% versus 72% of cases. No statistically significant differences were found between the diagnosis methods ( P=0.28 for first diagnosis and P=0.17 for top three choices). The confidence intervals for individual raters showed considerable overlap, and the point estimates are almost identical. The mean interreader agreement for complete versus limited HRCT for both top and top three diagnoses were the same (moderate and fair, respectively). The mean intrareader agreement between complete and limited HRCT for top and top three diagnoses were substantial and moderate, respectively. Conclusion: Overall reader accuracy and confidence in diagnosis did not significantly differ when fewer or more HRCT images were used.

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