American Journal of Roentgenology, Vol 165, 807-811, Copyright © 1995 by American Roentgen Ray Society

ARTICLES

Can CT distinguish hypersensitivity pneumonitis from idiopathic pulmonary fibrosis?

DA Lynch, JD Newell, PM Logan, TE King Jr and NL Muller
Department of Radiology, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO, USA.

OBJECTIVE. The clinical management of patients with idiopathic pulmonary fibrosis differs markedly from that of patients with hypersensitivity pneumonitis. However, the two diseases often cannot be differentiated on clinical grounds. The purpose of this study was to establish whether CT can be used to make the distinction. MATERIALS AND METHODS. Thirty-six patients with idiopathic pulmonary fibrosis and 27 patients with hypersensitivity pneumonitis were studied. All diagnoses were confirmed or supported by open lung biopsy. Three of the patients with idiopathic pulmonary fibrosis had desquamative interstitial pneumonia, and the remainder had usual interstitial pneumonia. In 19 of the 27 patients with hypersensitivity pneumonitis, the disease was chronic (symptoms lasting more than 1 year), while eight had acute or subacute symptoms. Two radiologists, who had not previously seen any of the cases and were blinded to the diagnosis, reviewed the CT images by consensus. The extent and distribution of CT features (including ground- glass attenuation, honeycombing, and micronodules) were recorded. In each case, a CT diagnosis was made, and the level of diagnostic confidence was recorded. RESULTS. A CT diagnosis was made with a high level of confidence in 39 (62%) of 63 patients. In these patients, the CT diagnosis was correct in 35 cases (90%): 23 of 26 patients with a CT diagnosis of idiopathic pulmonary fibrosis and 12 of 13 patients with a CT diagnosis of hypersensitivity pneumonitis. In the three patients with desquamative interstitial pneumonia, the CT diagnoses were probable hypersensitivity pneumonitis in two cases and definite hypersensitivity pneumonitis in one case. Of the 19 patients with chronic hypersensitivity pneumonitis, only seven had a definite diagnosis of hypersensitivity pneumonitis based on CT findings; three had a definite diagnosis of idiopathic pulmonary fibrosis. The patients with idiopathic pulmonary fibrosis and usual interstitial pneumonia were more likely to have honeycombing and peripheral or lower lung zone predominance of disease, and less likely to have micronodules, than were patients with chronic hypersensitivity pneumonitis. The patients with idiopathic pulmonary fibrosis and desquamative interstitial pneumonia had widespread ground-glass opacity indistinguishable from some cases of acute or subacute hypersensitivity pneumonitis. CONCLUSION. Our results show that CT can be used to distinguish idiopathic pulmonary fibrosis from hypersensitivity pneumonitis in most but not all cases. Desquamative interstitial pneumonia cannot reliably be distinguished from acute or subacute hypersensitivity pneumonitis. Chronic hypersensitivity pneumonitis may have findings identical to those of usual interstitial pneumonia. Lung biopsy should still be considered the gold standard for diagnosis of interstitial lung disease.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				J. V. Hirschmann, S. N. J. Pipavath, and J. D. Godwin Hypersensitivity Pneumonitis: A Historical, Clinical, and Radiologic Review RadioGraphics, November 1, 2009; 29(7): 1921 - 1938. [Abstract] [Full Text] [PDF]

				T. Akashi, T. Takemura, N. Ando, Y. Eishi, M. Kitagawa, T. Takizawa, M. Koike, Y. Ohtani, Y. Miyazaki, N. Inase, et al. Histopathologic Analysis of Sixteen Autopsy Cases of Chronic Hypersensitivity Pneumonitis and Comparison With Idiopathic Pulmonary Fibrosis/Usual Interstitial Pneumonia Am J Clin Pathol, March 1, 2009; 131(3): 405 - 415. [Abstract] [Full Text] [PDF]

				V. Hanak, J. M. Golbin, T. E. Hartman, and J. H. Ryu High-Resolution CT Findings of Parenchymal Fibrosis Correlate With Prognosis in Hypersensitivity Pneumonitis Chest, July 1, 2008; 134(1): 133 - 138. [Abstract] [Full Text] [PDF]

				M. Thomeer, M. Demedts, J. Behr, R. Buhl, U. Costabel, C. D. R. Flower, J. Verschakelen, F. Laurent, A. G. Nicholson, E. K. Verbeken, et al. Multidisciplinary interobserver agreement in the diagnosis of idiopathic pulmonary fibrosis Eur. Respir. J., March 1, 2008; 31(3): 585 - 591. [Abstract] [Full Text] [PDF]

				J L Myers and H D Tazelaar Challenges in pulmonary fibrosis: 6 {middle dot} Problematic granulomatous lung disease Thorax, January 1, 2008; 63(1): 78 - 84. [Abstract] [Full Text] [PDF]

				C. I. S. Silva, N. L. Muller, D. A. Lynch, D. Curran-Everett, K. K. Brown, K. S. Lee, M. P. Chung, and A. Churg Chronic Hypersensitivity Pneumonitis: Differentiation from Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia by Using Thin-Section CT Radiology, January 1, 2008; 246(1): 288 - 297. [Abstract] [Full Text] [PDF]

				H. Sahin, K. K. Brown, D. Curran-Everett, V. Hale, C. D. Cool, J. S. Vourlekis, and D. A. Lynch Chronic Hypersensitivity Pneumonitis: CT Features Comparison with Pathologic Evidence of Fibrosis and Survival Radiology, August 1, 2007; 244(2): 591 - 598. [Abstract] [Full Text] [PDF]

				J.-F. Cordier Challenges in pulmonary fibrosis {middle dot} 2 : Bronchiolocentric fibrosis Thorax, July 1, 2007; 62(7): 638 - 649. [Abstract] [Full Text] [PDF]

				S. Misumi and D. A. Lynch Idiopathic pulmonary fibrosis/usual interstitial pneumonia: imaging diagnosis, spectrum of abnormalities, and temporal progression. Proceedings of the ATS, January 1, 2006; 3(4): 307 - 314. [Abstract] [Full Text] [PDF]

				D. A. Lynch, W. D. Travis, N. L. Muller, J. R. Galvin, D. M. Hansell, P. A. Grenier, and T. E. King Jr Idiopathic Interstitial Pneumonias: CT Features Radiology, July 1, 2005; 236(1): 10 - 21. [Abstract] [Full Text] [PDF]

				J. N. Fink, H. G. Ortega, H. Y. Reynolds, Y. F. Cormier, L. L. Fan, T. J. Franks, K. Kreiss, S. Kunkel, D. Lynch, S. Quirce, et al. Needs and Opportunities for Research in Hypersensitivity Pneumonitis Am. J. Respir. Crit. Care Med., April 1, 2005; 171(7): 792 - 798. [Abstract] [Full Text] [PDF]

				T Fischer, J H Reynolds, and S E Trotter The idiopathic interstitial pneumonias: a beginner's guide Imaging, October 1, 2004; 16(1): 37 - 49. [Abstract] [Full Text] [PDF]

				E Kupeli, D Karnak, O Kayacan, and S Beder Clues for the differential diagnosis of hypersensitivity pneumonitis as an expectant variant of diffuse parenchymal lung disease Postgrad. Med. J., June 1, 2004; 80(944): 339 - 345. [Abstract] [Full Text] [PDF]

				D. G. Morris Gold, Silver, and Bronze: Metals, Medals, and Standards in Hypersensitivity Pneumonitis Am. J. Respir. Crit. Care Med., October 15, 2003; 168(8): 909 - 910. [Full Text] [PDF]

				F. Morell, A. Roger, M.-J. Cruz, X. Munoz, and M.-J. Rodrigo Suberosis: Clinical Study and New Etiologic Agents in a Series of Eight Patients Chest, September 1, 2003; 124(3): 1145 - 1152. [Abstract] [Full Text] [PDF]

				N. Kaminski, J. A. Belperio, P. B. Bitterman, L. Chen, S. W. Chensue, A. M.K. Choi, S. Dacic, J. H. Dauber, R. M. du Bois, J. J. Enghild, et al. Idiopathic Pulmonary Fibrosis Am. J. Respir. Cell Mol. Biol., September 1, 2003; 29(3): S1 - 105. [Full Text] [PDF]

				D. A. Weiland, D. A. Lynch, S. P. Jensen, J. D. Newell, D. E. Miller, R. S. Crausman, C. Kuhn III, and D. G. Kern Thin-Section CT Findings in Flock Worker's Lung, a Work-related Interstitial Lung Disease Radiology, April 1, 2003; 227(1): 222 - 231. [Abstract] [Full Text] [PDF]

				H. R. Collard and T. E. King Jr Demystifying Idiopathic Interstitial Pneumonia Arch Intern Med, January 13, 2003; 163(1): 17 - 29. [Abstract] [Full Text] [PDF]

				American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias . This Joint Statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS Board of Directors, June 2001 and by The ERS Executive Committee, June 2001 Am. J. Respir. Crit. Care Med., January 15, 2002; 165(2): 277 - 304. [Full Text] [PDF]

				K.-I. Kim, C. W. Kim, M. K. Lee, K. S. Lee, C.-K. Park, S. J. Choi, and J. G. Kim Imaging of Occupational Lung Disease RadioGraphics, November 1, 2001; 21(6): 1371 - 1391. [Abstract] [Full Text] [PDF]

				W. Merrill Hypersensitivity Pneumonitis : Just Think of It! Chest, October 1, 2001; 120(4): 1055 - 1057. [Full Text] [PDF]

				G. W. HUNNINGHAKE, M. B. ZIMMERMAN, D. A. SCHWARTZ, T. E. KING JR., J. LYNCH, R. HEGELE, J. WALDRON, T. COLBY, N. MULLER, D. LYNCH, et al. Utility of a Lung Biopsy for the Diagnosis of Idiopathic Pulmonary Fibrosis Am. J. Respir. Crit. Care Med., July 15, 2001; 164(2): 193 - 196. [Abstract] [Full Text] [PDF]

				J.P. Utz, J.H. Ryu, W.W. Douglas, T.E. Hartman, H.D. Tazelaar, J.L. Myers, M.S. Allen, and D.R. Schroeder High short-term mortality following lung biopsy for usual interstitial pneumonia Eur. Respir. J., February 1, 2001; 17(2): 175 - 179. [Abstract] [Full Text] [PDF]

				J.H. Ryu, T.V. Colby, T.E. Hartman, and R. Vassallo Smoking-related interstitial lung diseases: a concise review Eur. Respir. J., January 1, 2001; 17(1): 122 - 132. [Abstract] [Full Text] [PDF]

				J. E. Michaelson, S. M. Aguayo, and J. Roman Idiopathic Pulmonary Fibrosis : A Practical Approach for Diagnosis and Management Chest, September 1, 2000; 118(3): 788 - 794. [Full Text] [PDF]

				R. M. Schwartzstein and E. J. Mark Case 27-2000- A 61-Year-Old Man with Rapidly Progressive Dyspnea N. Engl. J. Med., August 31, 2000; 343(9): 642 - 649. [Full Text] [PDF]

				L. D. Matar, H. P. McAdams, and T. A. Sporn Hypersensitivity Pneumonitis Am. J. Roentgenol., April 1, 2000; 174(4): 1061 - 1066. [Full Text] [PDF]

				T. King Idiopathic Pulmonary Fibrosis: Diagnosis and Treatment . International Consensus Statement Am. J. Respir. Crit. Care Med., February 1, 2000; 161(2): 646 - 664. [Full Text]

				A. Wells Clinical usefulness of high resolution computed tomography in cryptogenic fibrosing alveolitis Thorax, December 1, 1998; 53(12): 1080 - 1087. [Full Text]

				W. W. DOUGLAS, J. H. RYU, S. J. SWENSEN, K. P. OFFORD, D. R. SCHROEDER, G. M. CARON, R. A. DEREMEE, and Members of the Lung Study Group Colchicine versus Prednisone in the Treatment of Idiopathic Pulmonary Fibrosis . A Randomized Prospective Study Am. J. Respir. Crit. Care Med., July 1, 1998; 158(1): 220 - 225. [Abstract] [Full Text] [PDF]